New Grad’s New Role

[AlwaysMythtaken]

Hey, I need some help.

I passed my boards in late August and immediately took a position at a SNF, figuring I’d get my year experience in before I started applying to hospital and before I entered a BSN program. 
After two weeks of training, I was given my own shift of 3-11 as the RN supervisor, managing the care of over 60 patients, two LVNs, and several CNAs. At first, I was excited for the challenge, and felt supported by the existing staff, who were always available to answer any questions. After about a month, however, I started to feel the weight of the role. Since taking the position, I’ve lost ten pounds, sleeping is a thing of the past, I can’t eat, and I have never left less than three hours after my shift has ended. It was never going to be any easy position, but the demands of the role make me feel like I’ve been set up to fail. 
I only have time for quick rounds at the start of my shift, and can only pop in on our patients when an issue arises for each individually. 3-11 in a SNF is peak Sundowner’s time, peak admission, peak visitor phone call or visit. (And I am by no means saying the other shifts don’t have challenges. We’re all fried.) We’ve recently been admitting several patients with severe mental health issues (schizophrenia), which would be fine, but our facility, per policy, does not give medications that could help patients with psychosis.

I want to look for another position, but I’m thinking, this might just be Nursing, Love it or Leave It. If that’s the case I’m willing to accept that and stick it out, because why leave one position and go to another, and am only asking for coping tips.  But if this is unusual, please let me know. If you’ve worked SNF, tell me how you handled the role. 
 

Sorry for the long post. Thank you.

[JKL33]

I do not have experience with the RN role in LTC, but have a couple of comments that seem true regardless:

1. If they are accepting patients to the facility without the ability and/or intention to deliver proper treatment for the diagnosed conditions, that is a problem. I would find out more about this, pronto and personally I would make a decision about working somewhere based on what the truth of the situation is. If they're just throwing up their hands saying they can't do this and they can't do that, inappropriately applying regulations, etc., then I would be out.

2. As evidenced by your weight loss and other signs of significant stress, you need a change right away. I know the big question is "what kind of change" (counseling, a different job, etc), but we cannot know that. I do think a little introspection might help you get some direction. As follows:

- Why are you staying so late, and are the tasks you are accomplishing really imperative--or are you simply feeling either like a failure or that the place is going to fall apart if you don't take the weight of the world on your shoulders?

- Why unable to sleep and eat properly? Granted some of that (minor alterations in sleep and nutrition) might fall within the range of normal for new nurses experiencing normal stress during role transition. But given your situation you do need to take a hard look at what aspects of this are making you so stressed. I suspect you are already in that trap of thinking that 1) you should be able to do everything 2) the reason you can't is because you are a new grad or some other personal attribute or failure 3) you need to try harder because you are failing

It may help you to understand that LTC has been this way as long as probably any of us can ever recall. However it was yesterday is generally the same as it was last year and 5 years ago. You are not failing, LTC is simply a place with a lot of harsh realities. The fundamental things that would need to change to provide excellent care to residents without nurses and CNAs risking and sacrificing and working themselves to the bone are not going to happen today or tomorrow or next week.

It can be really hard to grasp what one has walked into as a new nurse. It makes you feel things and learn something about life/the world. Not all hearts and rainbows.

Take some time to put things into a healthy perspective about what your realistic role and duty is. Nothing is going to fall apart any more than it already is if you don't sacrifice yourself. You are not a superhero or a perfect angelic being or anyone with any kind of supernatural powers do accomplish everything all by yourself so that businesses don't have to hire more nurses. Please feel free to lay your head down and relax all your muscles and just get some sleep.