New Grad on Subacute floor at LTC... need advice :'(

Pepper The Cat, BSN, RN · Dec 7, 2015

My first thought is you need to grow a thicker skin. If hearing "she is slow at med pass" makes you cry, you will not survive.

Are you slow? If so, it's a legitament comment. Does you being slow cause extra work for others?

Now, what can you do to improve. Have you asked for help? Have you asked for hints/tips to improve?

Why are you afraid of losing your license? Have you made errors?

I see see what the LPN said as an off the cuff comment. Perhaps she is having to answer pts who are asking where their meds are.

It does take time to learn how to time manage etc, but quitting really won't help you. Your problems here will simply carry over to the new job. Give yourself time to learn. It will get better

nutella, MSN, RN · Dec 8, 2015

LTC can be rough as a new graduate nurse - for several reasons.

First you are learning and as a new graduate it takes time. While it is true that people get faster over time because they get more confident, know more about the medications, and so on it is a learning curve. I doubt that the other nurses were that fast in the beginning.

The other thing is that you are a RN and there are usually a lot of LPN in LTC facilities. Depending on the culture of that facility there can be some animosities towards RN. Sometimes other nurses simply already forgot how it was for them when they were new.

In any way, you have to ensure you are doing everything the right way. Not everything is a good fit for a LTC facility. You are probably overwhelmed, nightshifts can be hard for people who are not naturally night owls.

If you have a preceptor or mentor it would be good to reach out the get an honest feedback about where you are at in the orientation process.

If it is truly an unsafe place to work and you are truly endangering your license it is best to go.

If it is more your perception and a reality check with your preceptor/mentor reveals that you are struggling like most new grads you can plan. It is easier to find another job if you are employed.

When you interview do not blame the facility or the environment, just say that you would like to work in a more acute environment to increase your nursing skills. Make yourself more marketable by passing an ACLS class, get some continues education in a specialty you want to work in, be positive.

I know nurses who had to start in LTC because there is no nursing shortage in my area and that was the only job available. Some of them left after one to two years and went to an acute hospital - by that time they had good experience and were secure in basic nursing.

Good luck with whatever you decide to do.

TheCommuter, BSN, RN · Dec 8, 2015

The 'my license is at risk' mantra is overinflated. Statistically, nurses lose their licensure for issues involving addiction, impaired practice, theft, diversion of narcotics, and other drug-related charges. A nurse's license is typically not on the line for issues such as sloppy care or failing to administer a medication.

With that having been said, I've worked in subacute LTC before. The trick is to not spend more than 10 minutes with any particular resident during medication pass. You quickly assess them, change any dressings, medicate them, and move on to the next resident. They're not our friends or anything like that, so there's no reason to spend an inordinate amount of time on any particular person.

Good luck to you. I wouldn't return to subacute LTC unless I desperately needed the money to avoid becoming homeless.

quiltynurse56, LPN, LVN · Dec 8, 2015

It takes to time to get it up to speed. Though, maybe you could ask the LPNs if they have any suggestions that may help you. Or, you can look at how you are prioritizing your patients. You are in the learning phase of your job yet and sometimes we need to stop and evaluate how we are doing. This comment may just be what you need to evaluate how things are going for you.

jlautier · Dec 8, 2015

Keep the job, broaden your search. I was there too. We all take a tour. Be a model employee. Patients first. Outpatient dialysis is the way I got out. I worked my way into acutes, and now work at a hospital. Good luck keep the faith! Organize yourself there; use your census to remind yourself of any 12 pm or 2 pm meds. And finger sticks too. LTC is only a med pass, that's why LPNs work there. Trust me. It's hard because of the volume. The only thing that helps in ltc is popping the same pills for the same patient everyday. That's how it gets easier. Don't focus in on a hospital, keep searching for jobs. Use your networks, your friends, whose short ? Who needs a body? Good luck!!

Nursynursenurse, ADN, RN · Dec 8, 2015

LTC is only a med pass, that's why LPNs work there.

NO NO NO! Residents conditions are constantly changing and good assessment skills along with critical thinking are huge in LTC. We are the ones that catch a decline and know when to send them into acute care. I wish my job was "only a med pass".

Candogal · Dec 9, 2015

Ugh!! I worked as a brand new RN on the overnight shift at a sub-acute/ LTC for 13 long months. It was rough but I'm lucky that for the most part the night crew was a great bunch to work with. I hate to say this but there were occasions where I witnessed the long term LPNs give the newer grads a hard time. I don't know if it's because some might feel trapped at the place due to their degree (I even visited my old place today and talked to a few that are like help me get out!) and they know that you will basically get experience and move on (yes, that's what I did and it wasn't a day too soon-I feel like I aged a few years there) and leave them behind to train yet another higher degree RN or that they've been there for so long that they don't remember what it's like to be new. I get not wanting to risk your license, I felt the same way because of the stressful environment. Remember you are not alone I know of 3 RNs that cried or had a total breakdown during their first week but nursing will get easier. I love what I do now, no stress, Mon-Friday job I'm usually out by 4:30 and I get paid $10 more per hour than I did working LTC/subacute and that was only a year ago. Consider getting wound certified (WCC- approx. $3000)- I'm not (but defintely plan to go for my WOCN) because a wound center took a chance on me and trained me and now I work at 2 wound centers and I feel really blessed because I love what I do and can see myself sticking with it for many, many years.

new.grad.rn · Dec 9, 2015

She said it in a loud aggressive tone. And I was actually done with my med pass but standing at my cart to chart since all the nurses had a computer.

new.grad.rn · Dec 9, 2015

There's a difference between having a legitimate comment, and belittling and aggressively talking loud enough about me to another nurse so I can hear. Its really sad I see that there's this idea that it's okay to jump on new grads. Do nurses realize or remember that this is a whole new world for us?

new.grad.rn · Dec 9, 2015

To the the poster who said that people over use the saying lose my license. Well one of the LPNs (the best nurse there I might add) whom I was working with actually has a reprimand on her license and that she fail to properly document a wound and notified the doctor. If you search her first and last name on google it comes up with her license number. And honestly that was probably from just doing too much and she forgot to do it. It happens when you have SO many patients. Administration only cares about call lights being answered..

Another example, a patient had an ABT due at 6 p.m., the IV bag didn't have an amount of time for how long the bag was supposed to run. And one of the LPNs told me "oh just run it over 30 minutes. "...

Yeah okay and the state comes in and sees that, it will I show I administered an IV bag with no rate on it. That's total lack of care and good judgement.

Also I want to say thank you for all the positive feedback that I did receive! I realize that long term care (subacute or not) is not a place for me. Handling 16 patients at one time is not going to be my thing. & I honestly take my hat off to the nurses that can do that. I do plan to continue to work there until I find an acute position where I might have four to five patients with a higher acuity. I can deal with that. But 16 different diagnosis going on at once is way too much. And litearlly everyone usually has an issuse where I needed to call the doctor and get some type of STAT order like a KUB and CXR, one patient vomiting, one c/o SOB, plus pass a billion unorganized medication. Dont forget admmissions coming in! (One admission came in with 130 HR, O2sat @ 70%, 25RR and wheezing)

Im really glad the Nursing field is such a wide open arena. Again thanks everyone for taking the time to comment!

bluegeegoo2, LPN · Dec 9, 2015

NO NO NO! Residents conditions are constantly changing and good assessment skills along with critical thinking are huge in LTC. We are the ones that catch a decline and know when to send them into acute care. I wish my job was "only a med pass".

Agreed. I've obviously been doing it wrong. No wonder I'm exhausted after a shift! What with all of the extra work of doing assessments, calling doctors, implementing and evaluating the effectiveness of ordered treatment and whatnot. I'm looking forward to going to work and just passing meds. I wonder how long I'll stay employed?