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New LVN in desperate need of advice.

by 2014PN 2014PN (New) New

Hello everyone,

I am questioning whether if I should even go further into this career.

Brief history, I graduated nursing school beginning of 2014 & passed my boards later in 2015 and it took me a year to find a job. Here I am, 2 years from my last clinical experience... I just got hired at an Assisted Living/Memory care to find out I'll be the only nurse in the building along with 2 med techs and CNA's. My nerves are out of whack right now. I know I am behind on my skills, I don't even know how the paper work goes, we were never taught any of that in my nursing school. I fear speaking with Doctors and not knowing what they're talking about.

I don't want my preceptor to find me annoying for asking so many questions and having blank moments from doing what should be a simple task because I have to think about it first due to the fear of making a mistake.

As of now, I'm trying my best to refresh my mind with all the necessary things I know I'll be dealing with working in AL/memory care.

But any advice? What should I do? What if I need more days of training.. what if I come across a med that I don't know much of.. How to deal with emergencies? falls? Transcribing new orders, MAR, documentation/charting and if you have worked or currently working at an AL, how does your day go?

Thank you so much for taking the time to read this, any advice will be greatly appreciated :'-)

HouTx, BSN, MSN, EdD

Specializes in Critical Care, Education. Has 35 years experience.

Congratulations on your new job.

It's normal to be anxious when you're trying something new, no matter what it is. Based on your comments, you will be the only nurse available to deal with clinical issues, so it's going to be very important for you to follow your company's policies and procedures. Make sure you understand the P&P because they will describe the "rules" for dealing with emergencies, falls, etc. If you come across a situation for which there is no Policy, I suggest that you work with your supervisor to create one.

In an AL setting, the residents should be fairly self-sufficient so you shouldn't actually be responsible for administering medications - but if you need to obtain information on a medication, the organization should have a current reference available.

Another biggie - As an LPN, you have a "directed" scope of practice that requires supervision of an RN, or other provider. Make sure you contact your clinical supervisor whenever you encounter any situation that is beyond your scope of practice because this type of violation is one that is not tolerated by our BONs.

Thank you so much for taking the time to respond. I really appreciate it.

I just finished my online orientation and will be starting my training next week. Training will only be 32 hours :-/ I sure hope that is enough.

Hey 2014PN! I enjoyed the assisted living facilities that I did clinicals for in undergrad. They can be intimidating, particularly because of the volume of patients. However, that quickly subsides after you get used to it. HouTx is right, you typically do not administer medications in assisted living. If I remember correctly from my clinicals, we had a list of residents who had requested "reminders" for their meds, meaning we knocked on their door and we reminded them it was time to take their medication.

In addition to this, we helped people get up in the morning and encouraged them to participate in the daily activities. We ensured that everyone made it to meal times, we cut up food, we helped dress people, we packed some wounds, emptied some ostomy bags, etc. Pretty much your good, old-fashioned, classic caregiver type duties. You will become much more confident the more you do. The best part if that you will get to know your residents. That will also calm your nerves because you will have a lot of familiarity in your day to day work.

It would do you some good to review certain policies beforehand. I know there can be a lot, but definitely go over the policy for falls before you ever experience one. This may ease your mind, as you know that falls in assisted living are likely to happen. You can make yourself a little "cheat sheet" on an index card and keep it behind your name tag or in a bag just in case.

As far as the paperwork goes, you will learn it very quickly! I would definitely give this job a shot before giving up on it altogether. You seem like a very thoughtful person who is thinking ahead. Those are very good qualities to have. Your residents will be lucky to have you!

Thank you Kate_Peds. That sounds like a very beautiful place to work in :-)

I am on my last day of training. First day of training wasn't really training, she introduced herself and said "okay start pre pouring your meds, I'll give you 30 minutes to do that" while she does her paperworks and play with her phone, that is 100% truth and on my second day, she expected me to know all the meds and recognize all the residents and so I made my FIRST EVER MED ERROR, she left me on the floor by myself :( she said "I'm not going to baby you because you know why? You're not in school anymore, you are working".. I got yelled at by our supervisor, our ED and soon today, by the family member of the resident :(. I feel like quitting. This place pre pours their meds for 25 residents in memory care who doesn't have any name tags/bracelets. This place doesn't have a structure since they are new :( (MAR is not always updated, Med cart is a mess, they don't do charting to save your life, Alot of meds are unavailable & much more) so many room for med errors and I fear for my license. What should I do? My preceptor, all she has done is teach me shortcuts & even told me that if I make a med error, to not say anything and just monitor the resident. What kind of advice is that? Is that how things work in these kinds of setting...

Edited by 2014PN

2014PN, what you've just described is very concerning. I am concerned that your training seems sparse, but more importantly, it is worrying that your preceptor would tell you to knowingly conceal any mistakes that could harm a patient.

I do not typically tell people to up and leave a job. We all need money. However, if all of these things are true, it appears that you are placing yourself at risk in this type of facility. I am so sorry that you experienced a medication error. I know that is difficult. It happens to everyone at some point, but I know that it can feel extremely bad when it happens during your training. You should not be "babied" but at the same time you should be adequately prepared.

This does not sound like the appropriate environment for a newer nurse, nor does it sound like the appropriate environment for anyone.

If I were in that situation I would move on to something else. They have not invested a lot of money into training you, so there is little for either side to "lose" by you walking away. There is, however, a lot for you to lose if you stay and engage in the questionable practices that they are advocating for. Do you have the means to resign from this position and look for something else? I know that you are an LVN. Have you considered working in a clinic, a school, or another LTC facility?

I am not trying to discourage you, but I would be worried for even the most experienced nurse in the world to say those things about a LTC facility. Those standards are not up to par with what the residents require. No charting, a non-updated MAR, covering up of errors. It is not a good mix.

I wish you the best of luck and I hope that you reach out if you need any advice. The community here is very supportive. I am sorry about your training experience. Know that you deserve so much more than that!