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

[newrnltc]

jlynn I'm sorry you're going through this. I know what you mean by management doesn't give a damn. When I was new I was naive and tried offering suggestions but now I see why other nurses "don't bother". I tried to ask for a day off months in advance to attend a continuing education class and they denied it. The other nurses said they just don't want you to better yourself. The moral is low and I am starting to really dislike working 5 8's due to call outs I sometimes end up working 6-7 days in a row with only one day off and they make it so hard to get overtime.. supervisor has to give you a special form so you will be reimbursed wth? my reg assignent has 7 gts, 13 diabetics, plenty of q6 meds and since we are not electronic, like 20 residents to redundantly chart on daily.. counmadin tx. no sls bleed.. when there is already a flowsheet we have to fill out for that cmon now. I think if the facility is unwillinging to work with its staff then we should just do what we can and then go when its time.. prayers and hugs!

[arallenrn11]

Am I becoming a more skilled nurse? Nope. Am I learning new skills? Nope, I am losing skills that I learned in nursing school. We have no IVs on our floor. No GTs. I have done one foley (in 6 months!) It was my hope that after 6 months "experience" I could apply to hospitals and get a real nursing job. I've spent the last 3 weeks updating my resume and applying everywhere. If I hear back, it's a rejection. I am so discouraged. I feel the longer I stay here the less marketable I become. I no longer can apply for new grad programs because technically I am "experienced" but realistically, I have no more experience than a new grad.

Exactly! I'm not the only one.

[lilede15]

Exactly! I'm not the only one.

Im sorry you are having a bad experience w LTC. I have been an RN in geriatrics for 12 years. I start iv's often, deaw blood daily, assess daily, pull picc lines, give meds via picc or iv, g-tubes, etc. You name it we do it. I feel very much like a nurse with what I do daily. I have worked in PICCU also and what I do as a geriatric nurse is more rewarding. I feel more independent. I have to make a complete head to assessment before calling a doc and use my nursing judgement alot more than in hosp where a nurse has a doc at their fingertips. I hope you find a LTC facility that fits w you

[lumbarpain, ADN, RN]

So True, I charted heavy. Very narrative and in dept. Being precise, to the point and quick is essential in charting. I always felt I would miss something if I wasnt writing a FULL LETTER . My mind would just keep writing and writing at times, Then I would realize what I was doing when everyone else was writing short, accurate notes.

And my handwriting was the neatest. I loved penmanship in my grammar school days and it stuck with me. So, If a social worker, doctor or other person read the chart, Guess whos nursing notes they read!!!!! MINE!!! They couldnt understand anyone elses!!!! I think the other nurses did that on purpose. I hated that. I couldnt follow up when I was sitting there reading these heiroglyphics of another healthteam member.!!!!

And I totally agree, CNAS should be emptying foley caths, taking BPs and temps also. If you help them out, they will help you out, hopefully. One hand washed the other and both hands wash the face.

If a routine is established for each resident and the same CNAS are performing the job every day this truely makes a difference. The CNA KNOWS the resident and the Resident is comfortable with the CNA. Perfect together.

Getting the demanding patients out of the way first is also a biggee. Otherwise, If you arent there at precisely 9am to give someone their meds, they will only call attention to themselves with constant call bell ringing, yelling out and eventually you will have the Nurse Manager asking why they are so upset or even worse the Adminstrator strolling into a room to find out what the commotion is all about. So....this helps too.

[Anne36, LPN]

"These are great tips! The CNAs can take bps but that is always done last for them (30 min to end of shift) because at start they are busy with getting res OOB, washed up, fed and we have 1/2 hr monitoring flow sheets/dayroom monitoring etc, hydration pass, snack pass, then 1/2 the res want to go back to bed or family says they do.. there's only one lift in the whole place"

Sorry if this was already covered in the thread, but you should be assigning the CNAs and directing them to get Vital Signs very first thing. Arent you the charge nurse? They dont know enough to prioritize vitals over changing a brief. Have 1 CNA take each side of the hall and get all Vitals, drop it off at the med cart and then they can do AM care. If someone temperature is 102 or has a pulse ox of 80, is it going to matter if they are still in their nightgown?

[Tired nurse]

Only 30  residents? As a travel LPN I often see LPNs with this assignment and in LTC now they push the old people aside for the the younger post hospital skilled pts. They are younger want to be waited on and donnot understand what takes 1 LPN so long to pass meds to 30 to 60 people. Which causes nurses to burn out and leave also because of more skilled they give RNs the easiest assignments to try and retain them. And as usual the LPNs are *** on and now they cannot even get them to stay under such horrible conditions. They will never get enough RNs to care for skilled pts in LTC!

[Tired nurse]

Example the other day I had 40 residents that were mostly skilled but on a LTC floor med pass took 3 hrs and some people got mad because it is physically impossible to get all these meds out at the the same time. I am sick of this kind of impossible situation put on staff in LTC and all management says is work harder or when you are assaulted by a resident you are told it is what you signed up for! I didn't sign up for that! Screw nursing it sucks!

[ShayNeq65]

Finallydidit said:

First of all...... Take your breaks!! If you don't take care of you, you can't expect to take care of anyone else.. ...

The first thing I would do is get your med times changed... This will be a HUGE help, and it is as simple thing to do.

The first half of my hall is sched for 9am meds and the 2nd half is sched for 10am meds. this turns a 2 hour med pass into 3 hours. Also look at your Med passes and see if anything can be combined and sched it accordingly. It won't work for all of your Residents, but every little bit helps....

My first med pass includes all 30 of my Residents of course, but my 1&2pm passes, are down to less then 10 residents. allowing me time to chart and stock etc.

The Residents that need coaxing, put their meds in food, or a drink that you know that will finish.

Tell your CNAs that unless it is an emergency or high priority, to make notes and tell you the little things all at once and speaking of CNAs, why are they not doing your vital signs?

Staff assignments, they are adults, let them decide among themselves, if they are unable to do this, then tell them you will have to, then put them all where they don't want to be, and it won't take them long to work out their own system.

If you allow family members to run over you they will.... I have been known to put them in their place in a very in a very nice way. If this was your mothers medicine would you want me to ignore giving it to her, so I could discuss a non-emergent matter with another Residents family member? The answer is Always NO!......... Then I say give me about 15-20 minutes and I will be happy to speak with you, They get the hint and it also shows them that I have no favorites and all of my Residents are important to me.

These are just a few of the tidbits that come to mind....... From what I have seen in LTC it takes 4-6 months to find your groove and actually be able to clock out on time!...... hang in there

Great advice! ✌️?

[ShayNeq65]

Another good comment! I agree! Give yourself some time to get your groove. I am always in awe of really great LTC nurses...as a group we rock! Look at everything we must deal with...once trained and at our job for awhile in LTC there is almost nothing we can't handle!

love to my many nurse brothers & sisters!

[garciadiego]

Run!!!