New RN working Rehab/LTC Im overwhelmed. HELP!

SWiseRN · Aug 6, 2011

My first few days were very overwhelming as well, but I had great preceptors to shadow. I cried before work and after work because I was so overwhelmed, but it did start to get better. Take notes, make lists, and write out a tentative schedule for the day. Don't be afraid to ask questions. I never regret asking questions, but do regret when I don't ask enough questions. You aren't expected to be good at this yet, it takes time. The med passes will take forever and probably run into one another but TAKE YOUR TIME. Don't rush. At the end of your shift, just BREATHE and be thankful that you made it through another shift. You can do this!

vampiregirl, BSN, RN · Aug 6, 2011

I don't know any new nurse (and some not so new nurses) that were not completely, totally overwhelmed their first days, weeks or even a month in LTC:) Give yourself time.

Have a preceptor help you figure out a general routine. Prioritize and figure out a routine based on things that HAVE to be done at a specific time- things like who has blood sugars that must be checked before they eat, if you have to be in the dining room at a certain time etc. Just do the best you can, it takes time:)

SunshineAnytime · Aug 6, 2011

I'm in the same boat as you. Today was my 2nd full day "shadowing" as a new grad. My supervisor today made me do EVERYTHING... call doctors, and families about patients that I'm not even too familiar with yet. I'm not even 100% familiar with the hands on nursing care, let alone the extras like calling family and delegating to CNA's. Nursing school gradually exposed us to more responsibility, but I feel like I'm expected to know everything about a brand new facility from jump! I'm hoping it will get better for us!! I'm going to talk to my DON about reasonable expectations for me during orientation.

JenniferSews · Aug 6, 2011

You've gotten great advice. Sit down with your preceptor and ask her how she sets up the day. Take that schedule home, visualize it, and then get a good night's sleep. You won't be on schedule for the first 6 months or so most likely, but it helps anyway. And like someone else said don't be afraid to ask questions. Even of those nurses who huff and puff. Eventually you will earn their respect.

Also know that the degree you can keep a schedule depends on the mix of LTC to subacute. LTC residents tend to get into a schedule anyway and so you know Mrs X always wants her meds at a certain time. Sub acute patients aren't as predictable since they are short term stay and don't have that routine. They are also far sicker and require a higher level of care and more time from your day.

Good luck!

Jules25 · Aug 6, 2011

I started working LTC for the first time in my life in June. It was much more stressful than I could have imagined. I had previously worked for 15 yrs in ICU and PACU, then taken off 16 yrs to raise a family. I have found a love for my residents and have some suggestions that have helped me.

I made a list of all the common and/or unusual meds my residents were on, their uses etc. and kept it in my pocket. I could study it quickly at breakfast before I left home or pull it out as a reference at work.

I made a list of the residents and their room numbers and alphabetized it, so I could quickly locate a resident. This was helpful as I oriented on Skilled, but occasionally worked Assisted.

I asked tons of questions and most of the staff were very happy to see me suceed and answered questions.

I requested to work days in sucession instead of one off, one on etc. so I could learn residents names, treatments, special requests or oddities much quicker.

Never be hesitant to tell someone you are new if you cannot answer a question, they will understand.

Lastly, I prayed every day that I would give my residents my very best.

You can do this. Each nursing job has a learning curve and you will grow from it. I also had 1 1/2 weeks of orientation. Do not be afraid to ask to shadow more, if you are not ready. Good Luck.

Musical RN · Aug 6, 2011

I agree with the other comments. It will get better each day you show up and work a shift. Each day you will start getting to know the residents better and then one day you may find like I did that I was looking forward to seeing the residents. I had many years experience in acute care, neurology, oncology, med-surg and then took off 11 years to raise my family. I re-entered and did 6 years home health. I started LTC in February 2011 and I was totally overwhelmed taking care of 30 patients on a mix of LTC and rehab!

I have had many people tell me, and I now agree that once you work LTC, you can work anywhere. It's challenging for many reasons including that some of the patients cannot tell us what they are needing. I've seen former experienced acute care nurses only work a day or two before they quit. Going into acute care after LTC experience is an easy transition, while entering LTC is very hard, especially with rehab patients who are very ill.

Hang in there and I hope you post again with an update soon.

nola1202 · Aug 6, 2011

I've been a nurse for 25 plus yrs. I still felt overwhelmed, clumsy and stupid when I started in LTC. It's really hard! So many patient's, medications, treatments..and all the usual stuff that goes on. Just show up, one day at a time. Set a short term goal of the day that is realistic, then meet that goal!

I find it helps me to feel I am more in control and like I accomplished something. On my day off, I push myself to do something fun. Going back to work is easier then. You'll be fine, I just know it somehow!

pixie120 · Aug 6, 2011

I'm in the same boat as you. Today was my 2nd full day "shadowing" as a new grad. My supervisor today made me do EVERYTHING... call doctors, and families about patients that I'm not even too familiar with yet. I'm not even 100% familiar with the hands on nursing care, let alone the extras like calling family and delegating to CNA's. Nursing school gradually exposed us to more responsibility, but I feel like I'm expected to know everything about a brand new facility from jump! I'm hoping it will get better for us!! I'm going to talk to my DON about reasonable expectations for me during orientation.

I am not trying to mean here, and this is not directed at any particular nurse but after one graduates from an approved nursing program, with something like 1000 hours of clinical,how can a new grad realistically expect me, as a DNS, to believe that they are not 100% familiar with hands on nursing care? Calling families and MD's and supervising CNA's I can believe comes with time, but are you saying that you really do not yet have a bedside manner, and feel comfortable with what your nursing role is? Hands on nursing care is do the focused assessment, head to toe, and proceed. Don't try to outthink it or change it or reinvent it, just do it.

My nursing school exposed me to 100 Percent responsibility, are you saying that you did not do a preceptorship? Were you never taking care of your own patients prior to graduation?

I don't expect any nurse to know everything about a new facility but I expect her /himto know where the chart is, who the MD is , phone numbers for family, lab book, assignment book, and MAR/med cart, e-kit and the rest will come with time. One day of "paperwork" orientation should suffice for that, and 3-4 on the med cart of the unit that you will work on, and then..... be the nurse. Do the assessments just like in school and take care of the patient. (Will you be slow with the meds, absolutely, but if you are geniune and trying, we will support you, if you spend your time crying and complaining, we won't).THere isn't any special way to do this, the older, more experienced nurses just have more experience under their belt and build a repertoire of knowledge specific to what constitutes acuity vs chronic, that will take time, but KNOWING the patient is in respiratory distress, bowel distress, cardiac distress...that should already be in your knowledge bag. I appreciate your candor and this is helping me understand my nurses better, but my nurses are not new grads, and they have some of the same complaints? Am I missing something here?

SunshineAnytime · Aug 6, 2011

I cant speak for anyone else... but going from 2 patients in my ICU preceptorship to 30 in LTC is a big learning curve. I am comfortable doing all of the responsibilities of my role as a nurse. I was criticized yesterday (my 2nd day on the unit) for not knowing where the biohazard room was. The nurse I shadow splits the unit with me for med pass. Giving report and being expected to answer family member's questions about the patients I did not provide care to is unrealistic. My nurse asks me to check and recheck meds on the MARs before I give them but then tells me I am moving too slow. I'm trying my best to keep up though but not meeting expectations is frustrating

pixie120 · Aug 6, 2011

I cant speak for anyone else... but going from 2 patients in my ICU preceptorship to 30 in LTC is a big learning curve. I am comfortable doing all of the responsibilities of my role as a nurse. I was criticized yesterday (my 2nd day on the unit) for not knowing where the biohazard room was. The nurse I shadow splits the unit with me for med pass. Giving report and being expected to answer family member's questions about the patients I did not provide care to is unrealistic. My nurse asks me to check and recheck meds on the MARs before I give them but then tells me I am moving too slow. I'm trying my best to keep up though but not meeting expectations is frustrating

Make sure you get a good, thorough report from the off-going nurse, check the progress notes in the charts, and tell the family you will look into it. What types of questions? It is a very big learning curve, but any "big" questions they might have should be in the progress notes, the MD note, the PT/OT notes, or the labs and/or the patient himself/herself. Just ignore those that criticise you, it's a silly RN/LPN/CNA attitude that needs to be extinguished. Every person there knows you are new, should be helping/answeirng questions not pointing fingers. THere is no reason to check, and recheck meds. Look at MAR, confirm the 5 (6)rights of med administration, period. This explains why my nurses are struggling to get meds out timely, med needs to match MAR, end of story. Of course, double check insulin.

surfnbeagle · Aug 9, 2011

I think all of the posters have given you some great advice! It sounds to me that your expectations for yourself are high, as seen by wanting to learn. We have all been there at some time or another. Be easy on yourself, you are just starting! I have seen so many nurses try to transition from other specialty areas with unrealistic expectations. If you would like, you can private message me if I can help you in anyway. Good luck!