New-ish RN, 30 residents please help!

[newrnltc]

Hello fellow nurses!

I've been reading all nurses since I was a nursing student. I graduated in may last year. Started out in subacute rehab part-time - stayed for about 5 months, 20 residents/day. Managed well enough, felt like I was making a difference most days. I was recently hired full time elsewhere and just finished orientation @ an LTC. In my new place I have to do meds, tx, charting, fs, labs, md calls for 30 res and sometimes also charge duties including staff assigments, mds and whatever things come up and ppl are directed to "speak with the nurse".

It's been about a month and I am getting very discouraged. So many of the res are extensive assist, more GT's than PO.. the PO's need so much coaxing everyday just to take their meds. Others want to punch you in the face. So many of the res are lonely, I wish I had more time to talk with them and really take care of them but every day I hit the ground running, every meal time I have to stop and help feed, everyday there is a 30 min meeting about what we are doing wrong (cutting into medpass), every 10 min a cna is calling to "come quick" for some little thing, family members standing over my medcart glaring at me (even after I explain please let me finish with this res first, its dangerous to distract a nurse while she is drawing meds.. but w/the customer service focus nowadays I will probably get in trouble for saying that), needy res wanting the curtains moved/tv fixed/better pillow "RIGHT NOW!!!", call bells that have to be answered within a few secs or the supervisor comes charging down the hall...

Even with my "brain sheet".. whose on what feeds, who has early PT/OT, who is going out etc.. I'm still not finishing within the golden 2 hours.. its more like 4 hours and then the 2nd med pass begins...I don't even take a meal break and I wouldn't mind that if I could get out on time but after my shift ends.. after handover, count out narcs etc I still sit for hours charting because almost every one needs daily notes. Don't get me started on the faulty bp machines where the cuffs pop off and take forever, pulse ox doesn't work.. asked for new ones and still nothing.... What can I do to make this work? Quitting is not an option... I see other nurses finish on time. Many disgruntled co-workers.. I've also seen a few RNs quit in the short time I've been here... but I can't. I guess I just need some understanding and advice from the allnurses community. Please help me...

Thank you

[angie1368]

I love your positive attitude. Thanks for the tips!

[lumbarpain, ADN, RN]

You are very welcome. Being new at any job is so so stressful and the WANT of doing the right things all the time can get you crazy....If you take a deep breath during your most hectic moments, get your thoughts in line and take that NEEDED REST during work even if you go to sit on the pot in the ladies room for 10 minutes...DO IT....just regain your strength....You would have never gotten this far and became an RN if you give up so soon....get your experience behind you, if you dont like it after some time, seek a different specialty or career. I am done with LTC....but you are new....give your self that chance to really see if its for you before bowing out. I did....for 17 years.

[newrnltc]

Nurse 456 I feel your pain, so don't be sorry for venting! Sometimes when I get home I feel like quitting nursing forever. We have a crazy work load and the most unsupportive head nurse ever! Yesterday I was in the middle of a medpass and she goes "I just came from room @#$.. go suction her".. while I had two med cups and a syringe in my hand! She does the same thing to other nurses like when IVs are beeping, instead of just looking at it herself she walks around and finds you to go look and none of us are every sitting on our butts we are busy as hell~! Sadly she is besties with the supervisor and other nurses have warned me if I complain about her, her buddy will find a way to write me up. I can't believe it's come to this. We were all bright eyed new grads with hope of making a difference, having a rewarding career... sigh..

If it's any help, my floor lost two good RNs this month and they both found hospital jobs.. even if you don't get a hospital job perhaps there are better places. But do your research! I went from an okay place to hell on earth! Good luck!! btw did your bp cuff have to be facility approved? I am thinking of getting one, every saved min counts!

[newrnltc]

Lumbarpain thanks for your encouragement! I agree that good leadership is important! Nurses leave managers not organizations. Where did you go after LTC? I really care for my residents and most of the staff are pretty supportive but for lack of a better description, there are evil forces at work there! Lazy people hiding out and making other people do their work because they know the right people. People that will throw you to the wolves. I wish I had more experience to deal with this kind of thing.

I hope you like your new place of work alot better!

[TheCommuter, BSN, RN]

Am I learning new skills? Nope, I am losing skills that I learned in nursing school.

This is interesting. I work at a LTC with multiple PICC lines, central lines, peripheral IVs, IV pumps, TPN, G-tubes, trachs, continuous pulse oximetry, wound vacs, and so forth.

I sometimes wish that the skills and acuity were lower. However, it is only going to worsen as the facility seeks out the sickest short-term residents for the maximum reimbursement rate. Since Medicare is limiting their reimbursements, this is my facility's way of keeping the cash flow up.

[lumbarpain, ADN, RN]

I am still looking for a position that is just primarily paperwork or being on my own, (field) However, being the seasoned( another word for old timer) I feel discriminated against even though I have tremendous experience.

I dont like to disuade any new nurses from achieving the experience I acquired over the years...IF there is a place worse than HELL, I went through it. You must realize that even though the job sucks(scuse the term) you are a very needed part of the increasing need for geriatric nurses. Patience is a virtue on this job. Caring a priority and being very astute to the needs and wants of your patients DOES make a difference....Did you ever notice that when you are working, family or friends would say to you. "OMG, I am so happy you are here tonight!!! Because they know you will get the job done.....Its a great feeling to know that someone DOES care if you are there and doing your best. But, at this point of my life I felt that my own health and well being was more important otherwise I wouldnt be able to function at all on any job, so I gave it one more try in a small dilapitated nursing home which of course turned into a nightmare......But, I tried it again....and now I forge onward as I always have done. And contrary to what the higher ups may think after you havent worked on the floor for over 2 years...THE KNOWLEDGE NEVER LEAVES YOU......but obviously in our present world, nothing is ever good enough, sad to say.

[wearinwhite]

I feel like I am driving 180 miles/hr down the highway: just getting though the day,surely missing lots, and quiet unsafe. I am 2 months into my first RN job as charge nurse (only nurse on floor) on the dementia floor with 36 residents. I do have 4 cnas, thank god! THANK YOU for earlier posts.... i needed to feel not so alone. i am praying this will get better with time?

[CapeCodMermaid, RN]

The demand for excellent nurses with excellent clinical skills is going to be increasing in skilled facilities. With Medicare payments being cut to hospitals who have patients readmitted within 30 days of discharge, hospitals are going to be partnering with skilled facilities that have good staffing and great nurses. I think the days of one nurse for 25-40 skilled residents are going to be over. Facilities that don't staff to acuity or that don't have support staff in place will not be getting Medicare admissions.No offense to anyone, but if you just want to pass pills all day, don't be thinking of working in a nursing home. We need nurses with stellar assessment skills to spot the small changes in a resident so we can head off a major change and keep them in the facility instead of sending them to the hospital.

[joanna73, BSN, RN]

This is true re: assessment. The elderly can go downhill in a very short period of time. The days of LTC being "easy and unskilled" as many perceive it are long over. We also have 30 residents, and most often, they remain with us rather than being transferred to emergency when they get sick. Having come from med surg, I can attest to the fact that the skillset is virtually the same.

[lumbarpain, ADN, RN]

Most people think that elderly just sit and sleep in wheelchairs all day.....some do, but most times this isnt the case....its a very taxing job, very demanding in the physical realm as well as the mental realm. Especially with alzheimers residents where you are dealing with a person who is disorientated, confused and may harm others. I think LTC nurses are still looked down upon, but we will all be there (OLD) one day, and hopefully with Gods Help we have special people around us who will care for us in our last days on earth.

[lumbarpain, ADN, RN]

Newrnitc.....I am so so sorry for not responding to you much sooner, I go on All Nurses.com once in a while......I apologize for the long response.

I moved out of my homestate in late 2010. My last nursing home job let me go due to lack of work.....as they did with the whole staff , including kitchen and a social worker.....it was scarey but we all got our notices. LACK OF WORK??????HA!!!!!!! other nurses wanted to put it on TV that this nursing home was doing this to its staff......But..we had nothing to back us up like a union. Thats another bad thing about Nursing homes...aides have their unions but the nurses dont have a thing.

I am unemployed at present. I cannot return to my regular job due to numerous bad injuries I sustained on the job.....however , I can work, I am not disabled. Just unable to lift, pull push and stand for hours upon hours. Its not easy for even though I am a seasoned nurse, My prolonged Non working stretch is hurting me. So....I forge onward......If I have to leave it all behind I will. Or I will have to. I enjoyed my job in the very beginning but if you dont have good managers and CNA to work with you are like Moses in the desert, all alone, ready to collapse!!! I wish you much luck.....the elderly NEED good nurses, good patient caring nurses who can empathize and take just a few simple minutes every day to get close to them so they dont feel so alone. Lonliness/depression can kill a person. They die of a broken heart. Thank for the words of encouragement also, its great when nurses can help each other.....We all row the same boat!!!!! lumbarpain

[jlynn2303]

I graduated in Nov 10, passed my boards in Jan 11 and started working in ltc a year ago this month. What I wanted to do was hospice, however, and after the magic six months, I began applying for hospice jobs - and got one. I loved it. Census kept dropping, however, and I was the newest nurse, so I, along with other staff, was laid off. Since the company that owns the hospice also owns two ltc facilities in town, they transferred me, with the understanding that when the hospice census picks up, I will transfer back. It just keeps dropping, however. And this ltc facility just got a bad state review. I just thought it was all because I was new at the old place, the first ltc, that it was so insane. It wasn't. And this place is even worse. I feel like I put my license on the line every single day I walk into that place. I have five gtubes, an IV, seven diabetics, a trach and four people with regular breathing treatments. Plus bandage changes, creams, ungents, orders, supervision.... Plus aides are not ALLOWEd to do vitals, pass out ensures etc. Only nurses. I want to cry every time I have to go into that place. The state review happened while I was orienting, but I know they will be back. No matter what I do, I am out of compliance. From beginning to end of the shift, in one way or another, I am out of compliance, mainly on med pass. And management does not give a damn. I come into the first shift nurse in tears - and she's been there 13 years. One nurse, who had been there for 15 years just walked out in the middle of a shift yesterday. I don't mind being busy. I like being busy. I just don't like feeling like I risk my license every day I go to work. I don't think the hospice census will pick up. I don't want to look like I am job hopping. I wasn't going to leave the hospice job - it left me! The nurses that are still at hospice are on reduced hours. I don't know what to do. Prayers and advice appreciatted.