New nurse (RN) with doubts; advice needed soon!

[BonnieSc]

Since new grad jobs are scarce in my area, I was thrilled to get a regular part-time job at an LTC/SNF. But the thrilled-ness didn't last long: the administrator who hired me while the DON was on vacation was apparently fired (don't know why), and the DON hadn't intended to hire new nurses at all. She said the position I was theoretically hired for was no longer open, but she could offer me on-call. I had already done a day of preliminary orientation (mostly paperwork and policies). I was bewildered by this sudden change, and was talking to the DON on the telephone, and said yes, I wanted the on-call job. She asked me to come for my first day of on-floor orientation the next day (today).

I HATED it. Everyone was nice to me and everything, and the place seemed to run fairly smoothly from what I could tell, and the staff work hard. But I thought there would be more to LTC nursing than giving meds all day (the nurse who was orienting me said it usually doesn't take quite that long--obviously it's going to take longer when you're orienting someone, although I didn't actually do anything, just watched and asked questions--but still, it seemed like that was by far the majority of the duties). I thought there would be more assessments, more treatments, more guiding of the CNAs. And I think some of the things I didn't like may simply be part of the reality of LTC--saying sarcastic things about the patients more-or-less behind their backs, ignoring them when they cry, taking shortcuts while saying "but if the state was here, we wouldn't...", and not necessarily a reflection on the facility.

Fellow nurses, I am in agony. I don't know what to do. The job I was excited about was retracted; even with eight shifts of orientation (very generous, I know, for an on-call nurse), I have doubts about my ability to do well on-call, as a new nurse; I'm not sure whether this is a good, stable facility; and I just might hate SNF nursing on principle...

If I'm going to quit, I feel like I shouldn't waste any more of their time and money--and yet I also feel like I ought to give it more time.

HELP! I have another orientation shift tomorrow.

[Chico David, BSN, RN]

Here's my answer as a 27 year RN who has mentored a lot of nurses over the years:

Your first job will set the tone for your whole career. Go where you have to go and do what you have to do to get a decent job at a facility you can be proud of. We are still in a nursing shortage - even if the economic downturn may have abated it slightly - so even if you have to commute further or move, you should be able to find a decent job.

[MelodyRNurse]

I was in a similar position when I was a new LPN, except I was per diem. I don't know what your nurse to patient ratio is and I also don't know how many different units they will float you to, but these two things make a big difference. I am just going to tell you that as a prn nurse floating between 8 different units, it was pure hell for me. The hardest part of being in LTC as a new nurse (to me) was learning the patients and all the meds. It is also difficult to get help when you need it because the other nurses are so busy.

LTC is a lot more then just passing out meds, but unfortunately it will take up so much of your time the rest has to be squeezed in and there is just never enough time to get it all done.

If I had to do it over I would never ever have taken a position in LTC as my first job. For someone who has never been a nurse before it is way to much and the orientation is way to short, imo.

Also, if you don't have to direct your CNA's around, consider yourself very very lucky!

Don't do anything that makes you feel uncomfortable.

[rentalnurse, RN]

Once you get the hang of all the meds it will go quicker and you will have time to do the other things. I was a new RN working LTC previously med tech for 2 yrs there, the LPN was supposed to orient me and she just told me to go pass meds. I came in one mon and the DON handed me the keys and said its all yours. the only RN with 2 LPNs and 169 pateints, I was scared to death. I stayed a few months and took a job with less patients which was better.

Wonder why the admin hired you? usually its the Don job unless there is none..

[brick195969]

wendy,

nursing is the most disenchanting profession around if you judge it on what goes on around you. Sounds to me like you would be a welcome addition for the patients benefit, which is what all nurses are supposed to be there for(as an advocate). I am a nursing student and just finished my first semester of a 2 year program. I am an older student and have worked very hard in night school to get where I am. I am currently working at a nursing home during the break and have experienced exactly what your describe in regards to the staff. There is one nurse who is very consciencious and still does a good job and one who complains daily about how "disenchanted" she is with nursing. Do your best for your patients, never deride them or belittle them behind their back and remember that regardless of the reception you get from staff or even patients(who are usually very sick or lonely) that you do your best to be the best nurse you can be. Now some people will say , what does he know , he is some overly enthusiastic nursing student who hasn't got enough experience to know what he is saying. Let me just say this, I have been in the work force for a long time and my integrity is intact, I do the best job I can and I rarely disappoint my employers or myself. I enjoy caring for my patients and even when it is rough and tough , later in the day I remind myself that I have done the best I can. good luck tomorrow(i too am working on New Years Eve).

[rhondaa83]

wendy,

nursing is the most disenchanting profession around if you judge it on what goes on around you. Sounds to me like you would be a welcome addition for the patients benefit, which is what all nurses are supposed to be there for(as an advocate). I am a nursing student and just finished my first semester of a 2 year program. I am an older student and have worked very hard in night school to get where I am. I am currently working at a nursing home during the break and have experienced exactly what your describe in regards to the staff. There is one nurse who is very consciencious and still does a good job and one who complains daily about how "disenchanted" she is with nursing. Do your best for your patients, never deride them or belittle them behind their back and remember that regardless of the reception you get from staff or even patients(who are usually very sick or lonely) that you do your best to be the best nurse you can be. Now some people will say , what does he know , he is some overly enthusiastic nursing student who hasn't got enough experience to know what he is saying. Let me just say this, I have been in the work force for a long time and my integrity is intact, I do the best job I can and I rarely disappoint my employers or myself. I enjoy caring for my patients and even when it is rough and tough , later in the day I remind myself that I have done the best I can. good luck tomorrow(i too am working on New Years Eve).

I could not have said that better myself.

[Jo Dirt]

Medication passes are a big part of a LTC nurse's job. It certainly isn't glamorous, and you don't get to bask in the glory of being "the nurse" but it's what you make it to be. Maybe I'm spoiled, but the LTC facility where I work is an excellent facility. The CNAs rarely have to be directed, they know their job and do it. Once in awhile we get a bad apple but the other aides usually run them off pretty quick.

Those sarcastic remarks, no, it isn't "right" but it is a residual effect of the stress of the job. The patients (and their families) can be very needy, demanding and impossible to please, and most people can't avoid at least a little cynicism. Not that it's right but it's a reality of the nature of this type of work and it's usually what distinguishes those who stick with the job with those who become burned out and disillusioned and head for the hills. It's like a defense mechanism.

The nursing home is a lot of times a dumping ground for old, unwanted people who don't have any future except going from the nursing home to the funeral home. We (the workers) are the only family some of them have. I love the patients and I am sure most of the other workers love them, too, even when they may complain about how whiney or annoying they can be.

The nursing home is a whole different world.

[buggybum96]

I too, am a brand new nurse, who works both in a hospital and a LTC facility. I took a per diem LPN position at the LTC so I could "get my feet into both worlds." While I've always known since I started school in 2006 that what I really really want to do is work in a doctor's office, I needed the other experiences as well. Just to kinda confirm what I already knew.

After 3 months in the hospital I am finding my stride. Does it all make sense? Heck no! But it will. Is the LTC difficult. Yes and for the same reasons...Too many staff/resident ratio. I had 3 days orientation and mind you the days were spread out. Turned out on my own on a 7-3 shift. Needless to say by 10:30 that morning I had another nurse helping me and by 2:05 that afternoon, the ADON was helping. I begged them for a few more days but that didn't happen initially and after my disasterous 7-3 shift, I had one more 3-11 shift of orientation. The hardest part is getting to know the 64 faces and who gets what, when. Who goes to the 1st and 2nd dinner seating, who stays in their rooms, yada yada yada...... Thank heavens the people I work with are patient and kind and words of kindness and encouragement are always forthcoming.

Give it time. That is what I keep telling myself. I like the LTC but I still know that a physician's office is where I want to end up. All of this craziness will make me a better nurse. Chin up and keep going. You CAN do this!

:nurse:

[Whispera, MSN, RN]

How about making a list of the positives (even if they're potential) and the negatives and seeing if staying where you are makes sense logically? As a new grad, there are so many options open to you. If you're miserable and it doesn't make sense to push through the new-job chaos, go somewhere else to work!

[achot chavi]

My advice is unless you really need this job- RUN don't look back, you are too good a nurse with too good an attitude to be dragged down by politics like this, something smells with the whole thing ( usually DON's do the initial hiring, and its weird to be hired (did you have a contract?) and have the rug pulled under you like that,)

If you need the money and the job- then take it and go in, do your job quietly, try not to bump heads with the others and try to do a good job. Try to keep your high ethical standards.

DO NOT talk or laugh at patients behind their backs, DO NOT do things that you wouldn't do if the state were observing.

Always practice nursing as if G-d is leading the way and there is a lawyer and the state peering over your shoulder !!!

You sound like you care- I'm sure the patients will love you where ever you end up working.

[husker_rn, RN]

I agree with the previous posters. There is much more to LTC than passing meds; you will see multi-system failure over and over everyday. Many think it is easier than hospital nursing. It is not. It is just different. And it is worth every minute once you get to know the elders in your care. They can go from stable to critical in no time at all. And they deserve the same care and consideration that hospital patients get. I went back to the hospital setting to be closer to home but still work PRN at my old facility; I miss my residents a lot !! And since most of my patients are frail elderly, the LTC experience has helped me a lot.