Orientation-not enough

[dinkymouse]

I figure this is a frequent problem but I need to rant! When I accepted the job at my nursing home I told them I had not worked in 11 years and said I wanted a thourough orientation. "No problem you can have as long as you need." Well apparently 3 days was enough. I went in yesterday and found I was charge for the facility and was responsible for the large unit. It has the skilled patients and a chronic hall. Their are 78 patients here and the number of medications is astronomical. I had not passed all the meds to pts. yet and it took me almost 2 hours. Luckily all the aides had shown up and were helpful in finding the residents and knew how most took their meds. I had 3 med passes to do. Blood sugars and insulin, vitals and assessments on the 11 hot charts-those with immeadiate health issues and answering the phones. There are about 20 keys, with only 3 marked, and finding the right one took for ever. I had never given report and was told from the night shift that nothing was different except one patient went to the hospital. I work only weekends so I didn't have a clue as what had happened during the week. I also didn't know what was normal on patients so if there was something that concerned me I had to dig to find out if this was "normal" for this patient. I had treatments to do and the lpn at the other station is one who does her work, poorly, and didn't like having to help an rn with questions. :angryfire There isn't a sheet that has all the residents name and rm numbers on it so if I wanted to find them I had to search through the med books, there are 3.

I work on Tuesday and I am the rn charge again. Things are different during the week with labs, dr. visits and such. I am telling the don that I need help and more orientation. I have no idea why they think I should know everything after 3 days. At first I was panicking but told myself to slow down and prioritize. getting the right med to the right patient, etc. My legs and back were killing me from running back and forth between the halls. Thanks for letting me rant. :rotfl:

[dinkymouse]

:chuckle I went in this morning to find state had shown up so we had an lpn who passed the meds for the entire building. It was a day like I used to have in the hospital. Constantly busy. I sent 1 pt to the hospital for CHF, evaluated 8 for new c/o. Took orders, noted orders etc. The don was in a witchy mood but the administrator was very helpful. She showed me where the forms were, what to send to the hospital etc. Because state was there I also had to answer call lights that weren't answered within 1 sec :rotfl: I worked 10hours when sceduled for 8. The don told me that I did a really good job. I wanted to smack her. I don't feel I need a refresher course. I still have the ability to tell, before others, when a patient is in trouble. My assessment skills are as good as they were before. My problem is knowing the policy and proceedures there. If I knew the pts. better I would be able to tell what concerns I should f/u on. Finding the paper work and where to file it is also a problem. I will make it through but I did tell the don I didn't like working like this and I felt I didn't have enough knowledge of the place to be in charge. Of course she said I would learn it eventually. It seems that most of the other nurses are lpn's so when I am there I am charge.

[dinkymouse]

Check you state staffing requirements. 78 sounds like alot to me for a 3-11..even a 11-7 shift.

This is a first for many years. We hired a new nurse (not new to nursing, but she's been doing psych for many years)...our DON has her on orientation for 4 weeks!! She will be getting trained on each shift. Hopefully this one will stick.

Actually it was a 7-3 shift. 4 weeks of orientation would be nice. Luxury

[jsteine1]

There are a few on-line refresher courses, costing in the neighborhood of 500 Dollars. You complete the theory portions online and can use your current employers place of business to complete the clinical portions. The university of South Dakota has a good one that is recommended by a number of State Boards of Nursing. If your employer requires it,they should pay for it.

[dinkymouse]

:balloons: Thank you everyone for the sympathy and advice. I got called in yesterday and it was very busy. I made the other nurse show me exactly how it is done. Two admits within an hour, doctors orders from 2 days ago and a dnr patient going downhill was a little stressfull but I realize I can handle it. One thing that drives me nuts is that when fax orders come in who ever picks them up just throws them on the desk and then they get shoved around so you can't find them. Too many people tell me too many things at once so I am getting a little pda to list who and what needs done. I can then erase it as I go. I still have yet to get my own set of keys to the millions of doors and I also stated I need my own. I got tired of running around finding someone that had keys. I was worried that I wouldn't be able to handle the stress because I had problems dealing with it in the last 10 years but I haven't freaked yet so I don't think I will. Thank you for everything. I am glad I joined this site.

[Mandylpn]

Your story sounds very familiar to me. I have worked at two LTC facilities thus far and I am so glad I got out. I mean I loved the rez's but the managment #$%^&! Never would I imagine doing a med pass like you did, I don't know how you did it. Where I worked, I was told I could take as long as I needed for orientation, then all of a sudden my phone was ringing because they were short, could I cover a shift, etc, and I was still being trained in! The second week I showed up for my shift and I was on my own. I never got any help from anyone, they would all finish early and there was me still giving meds and treatments at 10 pm (2 to 10:30 shift). I was starting to be concerned about my license on the line! Don't tell me this is the real world, please, I have worked at places where co-workers are willing to pitch in and help you, this place was not normal! I now work in assisted living and cannot believe the difference in the work environment. good luck and stick up for yourself because there are lots of jobs out there!

[dinkymouse]

:flamesonb I wanted to run screaming from work today!!!!! Got called in early. When I pulled in an ambulance was pulling away. DO I REALLY WANT TO GO IN HERE? 11 1/2 hours later I got to leave after a night nurse had signed out the am meds but didn't give them, I have a dying patient that orders taken the day before hadn't been put on the MAR's (I will remember to check for new orders from now :wink2: on. I got called after I left cuz their narc count wasn't right. Wasn't me thank god!! The evening lpn is a witch and I was afraid I was going to scream at her when I said "you need to check ??'s mar cuz there are a lot of changes. "I never give meds without the MAR". Well neither do I but if they aren't on there you can't look. I am laughing at myself right now cuz I got everything done, even if it took me and extra hour and a half. MONEY MONEY I told my aides that work tomorrow if any one of them bothers me while I am doing meds I will fire them.

[mrsmoo2]

I just started a job at a ltc thursday (found out I passed boards wed)..I'm orientating on 2:30-10:30..I did my clinicals there, so I had a bit of an idea how it went, but at this place the charge nurses do everything...there's no way I can learn it all before they want to put me out on my own in the next 2 weeks....I've never done an admit, never reordered meds, never sent anyone out, never even taken an order from a dr....never even talked to a dr yet!! How will I ever be able to run a wing without doing some serious damage??? Will it all just "sink in" as they keep telling me? Everyone says, don't worry, it just takes time..but time's the one thing no one wants to give me!!! I really like this job, I'm just so afraid of screwing something up or hurting someone. I can request more orientation time...supposedly I can have as much as I want, but they're sefiantly pushing to cut it short & I'm afraid if I ask for more they'll think I can't handle the job, so I don't know what to do..from the sounds of some posts, I should be thankful for 2 weeks.

[CapeCodMermaid, RN]

Our corporate big wigs tell me we have a 74% turn over rate of licensed staff....I told them to look at the orientation process. If you spend a bit more time in the beginning, the nurses are less likely to become overwhelmed and leave....so we started having longer orientations. Trouble was we weren't getting any smarter nurses or better outcomes. One nurse had to be told the same thing at least 6 times...we're not talking brain surgery here...this was filling out the lab slip! Not every nurse is cut out for LTC. When my mom was in the ICU, her nurse found out that I was a nurse and worked subacute in a SNF. She tried to hire me for the unit because she said if you can work subacute in a SNF, the ICU wouldn't be hard. She had worked in a SNF for a month and said it was way harder....

[dinkymouse]

I sent a message to our don yesterday to say I needed at least 2 days orientation on weekdays. I didn't ask her if I could have it I told her I needed it. Proud of myself for that. I would like more time but I doubt I could get it. I discovered that the orientation process here is random depending on how many nurses they have. One girl had two days and it shows.

[dinkymouse]

I just started a job at a ltc thursday (found out I passed boards wed)..I'm orientating on 2:30-10:30..I did my clinicals there, so I had a bit of an idea how it went, but at this place the charge nurses do everything...there's no way I can learn it all before they want to put me out on my own in the next 2 weeks....I've never done an admit, never reordered meds, never sent anyone out, never even taken an order from a dr....never even talked to a dr yet!! How will I ever be able to run a wing without doing some serious damage??? Will it all just "sink in" as they keep telling me? Everyone says, don't worry, it just takes time..but time's the one thing no one wants to give me!!! I really like this job, I'm just so afraid of screwing something up or hurting someone. I can request more orientation time...supposedly I can have as much as I want, but they're sefiantly pushing to cut it short & I'm afraid if I ask for more they'll think I can't handle the job, so I don't know what to do..from the sounds of some posts, I should be thankful for 2 weeks.

It will come to you but if you need more orientation don't let them get you to work alone. I think my doing it the first time without complaint is what made them think I didn't need it. Take notes on everything you are taught and those things you observe, take them home and put it into your computer and print it out in small font. Laminate it and keep it with you when at work. I have also made a cheat sheet telling me what time things have to be done, like when the meds have to be given. If you have any vitals to do during your shift put the b/p cuff, thermometer and anything else you need in your med cart. Take them during meds if you have the time. Get any forms you will need during the day and keep them on a clipboard and fill them out as you go. I rarely have talked to the doctor, usually his nurse. If you have questions ask them of her, she may act like a witch but at least you'll have covered your butt. Don't let things distract you from what you are doing at that point in time unless it is an emergency. Delegate, delegate, delegate. Hang in there, the fact that you asked here for help tells me you will be a good nurse.:icon_hug:

[rosiegirl212]

I know how that is. I just quit my new job today after only like 3 weeks of being there. Tuesday was my last day of orientation and as a new grad fresh from school I didn't feel it was safe to let me off on my own. I asked for more time and they said 2 more weeks which is like 7 days on my schedule and they couldn't guarentee more time after that so I chose the best thing for me which was quitting. Better to lose a job than to lose my license you know.

[N.U.R.S.E.]

Ltc is a joke I have found things that are deplorable nothing is ever done how you are suppose to residents who get meds at 4 6 and 8 all given together and the administration looks the other way other duties that **** away ur time but u better make it out at the end of ur shift