bigmamabear

Ok, so wooohoo! passed my NCLEX-PN in December (right before Christmas), and landed my first nursing job 2 weeks later at a very nice nursing home. I started on the 3rd of January this year, did a few days in a classroom style orientation and then 2 weeks of shadowing a nurse on the floor, which I felt was pretty generous of the company. I started on my own last weekend, they put me on one of their easiest med pass halls two days in a row and I managed to stay afloat and stay 'in the green.' The last two nights however, I was moved to two of the heavier med pass halls with a few more acutely ill residents and I drowned. The ratio was initially indicated in orientation to be 1 LPN: 3 CNAs: 20 residents max, however it's been more like 1:2:20, which is still fine-as long as everyone is doing their jobs. I have done clinical rotations in nursing homes with 1 LPN: 2 CNAs: 30 residents, so this seemed a whole lot better. A little background-I never worked as a CNA before nursing school, I did a year and a half as a patient care tech (PCT) about 15 years ago in a mental health facility, but I'm finding out that is nothing like being a CNA in a nursing home. Nursing school was mainly working 5-7hr stints at the hospital 3 days a week, max of 3 patients. We essentially did the half-role of CNA and assisted with brief and bed changes, bed baths, toileting, and just checking up on the residents; we were not allowed to pass meds, change bandages, give showers, or anything of that nature without our instructor or a staff member present. As far as time management goes, as long as you could give a bed bath if needed and change linens for 3 people in 5hrs, you were good to go. Most of us walked the units in circles just so we weren't sitting around. Don't get me wrong, I didn't come out of nursing school a young pup with no idea about how the world worked, or with that glassy smile on as I pinned the ID on my NON-SCHOOL scrubs with my name followed by "LPN". I knew that this would be hard work. I knew I had a lot to learn and what I learned in nursing school would not prepare me for everything in the real world. I have a lot of questions about what my responsibilities are as far as being an LPN, one of them being patient care. I have been told by a few of the nurses at the facility that were so gracious to pause their own med passes and help me when I was drowning in my own (and fighting back tears after being yelled at by two residents for med pass timing tbh) that the CNAs know I'm a new grad nurse and I don't know the roles yet, so they are taking advantage of me. I'm getting used to the scheduling, but the supervisor changes the CNAs on the unit around without letting the nurses know, I don't know where the CNAs are at half the time, and by the end of my shift last night, I had one resident still in a dirty brief, a room that wasn't picked up (washcloths, trash out), VS were not all done as asked, one resident who didn't get oral care, not to mention one pissed off oncoming CNA. I could not find my CNA to rectify the situation, and once I did, I was informed that he got in an argument with the oncoming CNA and clocked out/left for the night. The supervisor was notified, but I was also informed that they rarely do anything disciplinary-wise, I'm believing this to be because of the high CNA turnover. I'm only 4 days in to being on my own and I can tell you I'm so irritated with the lack of communication I'm coming close to going off-which is not like me, I'm usually a cool cucumber. I will make it a point to better communicate with my supervisor to know who my CNAs are on my next shift, and I'm pretty good about asking what to do in situations I've never been in (TORB, calling physicians, charting for different issues:unsure:). I'm trying to find out what roles the CNAs are supposed to fulfill and how I could stay on top of that along with trying to learn/do the things I'm supposed to be doing for the shift. I have thought about having a pre-shift meeting with myself and the assigned CNAs on my hall to discuss expectations and lay out my needs, I already put out a highlighted VS sheet with a bright orange note that I need them by a certain time (which is *consistently* ignored, btw). I also know I don't want to seem pushy and overbearing, there's a fine line between being firm with expectations and just plain being a witch. Someone with more experience please guide me!