New Lvn nurse left Ltc advice

[clvn23]

So I'm still a new grad technically still under a year I have 6 months working in school with I loved but the year ended so I start working in a snf I worked there for a month and a half so I don't even put them on my resume which sucks cause I learned so much there I just don't want a bad reference the nurses who workered there said I wouldn't put them on there resume cause the don is crazy she will turn her back on you real quick I quickly realized anyway I have a few questions about working in a snf just so I know for my next job this place ,any advice what do you do for patients that pocket meds I would crush and mix with applesauce and give with spoon and they will pocket any tricks that are legal lol?Also when we would do the narc count I would get so stressed out cause the other nurses would forget to sign off when we would count they would call the number I would be checking the pills to see if it was accurate do you check the signatures to I mean that would take forever how do you Ltc nurses go about narc count could someone be calling out the wrong amount of pills if they possibly took one?also i had about 25 patients when I worked which is average I was just slow but they weren't giving me time to get better it was a few days I was always staying over 2 hours the don was so mad she said it's unacceptable that she's not signing anymore overtime so felt she was gonna fire me if I didn't quit how I felt ,and then I went in on my day off to talk to them how I felt with the administrator totally different person the don tried to be all nice they knew I was struggling and they have me a evening shift which I didn't know was the worst shift 3-11 as its hard you have 48 patients it's like no one cared that l was struggling I was done after that and they wants me to come in at 7am the next day cause I was a treatment nurse to I didn't get home till 1am I texted them I quit the next day morning I didn't mean to be unprofessional but no one from management or high up is there on the weekend to talk to after that night i felt my license was in jeopardy I'm a new grad I couldn't handle that many pts ,that's , all the don told me to see what the other nurses were doing to be quicker which they were doing illegal shortcuts to be quicker.well thanks for reading my rant I'm still in search of a Lvn job now but glad I'm out of there I was miserable but loved my pts!too bad I can't put the experience on my resume :/

[mtjoanna]

First is an observation--this is not an easy post to read or get through as it is written almost as a string-of-consciousness rather than as a paragraph with punctuation and easily seen points and questions.

As far as crushing meds, you do need to make sure that they are appropriate meds for crushing, of course. Legally, without an order, medications cannot be "hidden" from residents/patients. I do crush many medications, but am always careful to verbally state that these are medications, not just "a bite of pudding or applesauce." I have one resident who will hold medications in the mouth for up to 30 minutes and then spit them out. I've found that adding a packet of Splenda to the crushed meds and pudding/applesauce has made a tremendous difference (think Mary Poppins for diabetics).

For counting narcs, I don't check every signature for every medication that we count; yes that would take forever. What you can do is, at some point during your shift, you go through page by page and double check the numbers. I will usually do this near the end of my shift to make sure I have not missed any. When I am counting with another nurse, and it is my shift that is ending, I hold the book and the other nurse is looking at the medication. She says the medication card number (we use bubble packs) and I read and state how many there should be and she verifies or corrects me. If it's off one, we figure out why. When I'm coming on shift, I look at the bubble pack and the other nurse handles the book.

As far as being overwhelmed, that is difficult. You can ask for more orientation. I personally won't go to another shift without at least a day's orientation to that shift. I know the residents, but I don't know their daytime schedules, meds or many of the procedures that occur during the day. If they are unwilling to provide training, you are better off going to a different facility.