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New RN in LTC, feeling overwhelmed.

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by kohlbesc kohlbesc (New) New

I'm a new RN in a PM position at a long term care facility. I had 7 days of orientation now I've been on my own for 3 weeks. I'm feeling incredibly overwhelmed with having so many residents (25-30). I do have a med tec who helps with my med passes which is wonderful. I'm more insecure about my assessment skills and when to contact a physician. I'm learning so much as I go but I'm afraid that I'm going to miss a key sign/symptom on a resident. Everyday I'm leaving feeling like I should have done more but I'm running around like crazy during my entire shift. Any advice on how to survive in LTC and key areas to focus on is appreciated.

From what I gather many LTC nurses - esp. those who are new to this type of nursing - feel this way. Hopefully some of them can offer you advice - all I can say is continue to do the best you can, ask for help when you need it and keep plugging.

Aww don't worry and this to shall pass .Your new maybe what we should do for you is chug on over to mambi pambi land and get you some Self Confidence you new RN. Tissue? ( I had to sorry) No really all jokes a side your new to this and it will take time just slow down. The key is to slow down so you can move faster and not so scattered your fighting your body right now and this in natural. ( Trying to Impress)

If you need to make notes on a note pad then do it. Start reaching out to your aids even your Med Tech they are your eyes and ears on the floor and start Prioritizing Tasks. Roam wasn't built in a day and neither were you trying to become a Nurse. These are my thoughts i hoped they helped. If not there's always Mambi Pambi Land LOL

RNGrammie

Has 3 years experience.

I've been in LTC for almost 3 yrs now and some days I still feel overwhelmed. I am currently in a Supervisor position but I pick up time as a charge nurse on one of the units. We have about 40 residents on each floor w/ 2 charge nurses...1 for each "side" and 4-5 CNA's. Having a med tech would be like heaven for me. I'd be able to do more w/ and for the residents. Everything does seem rushed at times.

You will develop a routine and it may take longer than 3 weeks. Be patient and always learn something new each day. You will have many "aahhaaa" moments and it will all eventually click!!

Stick with it!! :nurse:

You have my sympathy, respect, and prayers. My first job as an LPN while I completed my RN and for several years after was in a prison. I loved it--I really did. But where I worked primarily was in the maximum and super high maximum security. Most days and every night there were only 2 nurses, sometimes only one or neither of us were RN's (until I finished school of course) and there were 900 inmates between the 2 of us--600 in max, 300 in super max. The patients were of course chronic care--we sent our sicker patients to the infirmary, where we sometimes all worked, and did more hands on med surg work, or to the hospital when they were very sick. But every one of the 900 inmates was a potential patient, and we were always overwhelmed and overworked. We would go out onto the tiers (12 flights of stairs every med pass, and that's if you didn't forget anything :D) to pass meds--no MAR once we had poured the meds and labeled the cup--so if we got to a patient with a cup of 17 different medications and the patient wasn't familiar to us and was saying they only got 1 or the meds were wrong--well, just imagine. While we were trying to focus on making sure the patients took their meds, other inmates on the tiers were calling through the doors, hey nurse, i don't feel good. or i put in a sick call slip and haven't been seen. or so many others, sometimes really serious stuff. many times we encountered unconscious insulin dependent diabetics which we had to run for glucagon for--stopping for long enough to get a doctor's order (not an easy thing inside the walls of a prison, believe me). anyway, you do the absolute best you can do, and you pray, and you listen and you stay aware. you stay highly attuned to your patients norms and you trust your gut. and you LISTEN LISTEN LISTEN because many will complain and you will learn how to triage them with out even seeming to think about it, but to live with yourself if you make a mistake and it causes pain, suffering or death--well, I believe most of us are nurses to alleviate suffering, and the pain we cause ourselves when we aren't able to is worse than what anyone else can do to us.

I did finally leave the prison--I missed it for a while, but now I am at home in the operating room and love it. when I walk away from a patient, my part is finished--I am not worrying about or making notes about things I forgot to do that I need to try to follow up on the next day etc.

I'm praying for you. You will do fine. Just hang on.

nurse2033, MSN, RN

Specializes in ER, ICU.

I would say the biggest thing to watch for, in regard to contacting the doctor, is any sudden change in condition. Once you see something that concerns you, take any appropriate action, and reassess in a few minutes. If there is still a problem, or it is worse, time to call. Have your report ready, I like the SBAR format (situation, background, assessment, request). Doctors don't really like to to be just "notified" of a change if there is nothing to do about it. Sometimes just putting it in the SBAR format helps you make the decision to call. Hang in there, good luck.

bubblymom373

Specializes in LTC.

This feeling will pass, hang in there. I find that learning to prioritize and delegate are important in getting the work done and allowing you to not feel so rushed during the shift.

Where I work we have parameters for blood sugars, temps, and BPs for when to call the MD. We also call for falls that are requiring neuro checks. As one post stated we also call for any sudden change in condition. If you are unsure about calling is there another nurse there that you can bounce the situation off ? I find that just talking to another nurse regarding the situation can help to decide what I should do if I am unsure. With calling the MD I try to err on the side of caution.

In my facility most of the situations I face are chest pain, CHF, pneumonia, stroke, and hip fractures. I have a mental check list for each of what needs to be assessed to ensure that nothing is missed and I have the info the MD will need when called. Maybe you could do something like that for where you work. Your assessment skills will come with time and practice.

Best of luck. You sound like you will be a great nurse.:)

I feel for you, it is overwhelming, and it doesn't sound like you had a lot of orienatation. We have a new RN who was initially given 3 weeks orientation and now they are giving him an additional SIX weeks of orientation so seven days seems like not a lot to me.

elprup, BSN, RN

Has 2 years experience.

I'm a new RN in a PM position at a long term care facility. I had 7 days of orientation now I've been on my own for 3 weeks. I'm feeling incredibly overwhelmed with having so many residents (25-30). I do have a med tec who helps with my med passes which is wonderful. I'm more insecure about my assessment skills and when to contact a physician. I'm learning so much as I go but I'm afraid that I'm going to miss a key sign/symptom on a resident. Everyday I'm leaving feeling like I should have done more but I'm running around like crazy during my entire shift. Any advice on how to survive in LTC and key areas to focus on is appreciated.

Exactly why I did not stay...and I did not have a med tech. Everybody kept saying it will get better, but nope, it was just not for me. Good luck to you!!!!