levisandtees

Our ratio is 32-36 per nurse and 12-14 per aid on AM shift...I had 30 residents for two days due to low census and was astonished at how much of a difference that made as far as spending quality time with the residents/how smooth the day went...my case manager simply said "Ha don't get used to it". I agree that even complaints from family members don't seem to make a difference. I just do the best I can with what I have each day but I'm afraid of burnout under the stress of the circumstances.

I'm just getting back into it, too...I recommend the couch to 5K plan (c25k.com)--there is corresponding music on iTunes for each week of program...so you alternate walking/running and build up to running the 5K. I have trouble finding motivation at times, too, but feel great once the workout is over.

I have only worked at one facility that did this; actually utilized CNAs to assist with putting meds in the correct order per MAR (by patient with different sections for AM, NOON, PM, HS, NOC). At my current facility everyone dreads refill day because pharmacy stocks the drawers and they are never in order by name, time, etc. and med pass takes much longer (they inevitably forget a container and we're running to contingency throughout med pass, putting meds in order, calling pharmacy with corrections, trading meds between halls because even though a resident switched rooms a month ago they're still being stocked in the other cart, etc.). Maybe the dual nurse check is overkill for normal meds (not a bad idea for narcs) but I would definitely appreciate it if they were in some semblance of order at the start of shift.

The facility I work for expects one month notice ("professional courtesy") per P&P and "reserves the right to hold any accrued PTO and provide negative feedback with future job references if employees do not comply with policy". Of course now management is suspicious anytime we use a chunk of PTO...

That's awesome--I'll bet you will gain so much experience with this group. Best of luck!

Thanks for the advice. I think I will go ahead and take it on my own--the only bonus taking it at the facility was no out of pocket expense on my part plus my time was paid for...but in the long run my own peace of mind is worth more than that. Thanks again!

I am a new LPN and my CPR certification expired October 17, 2008...my facility sent me a notice in Sept to sign up for one of their in-house training sessions which I did...when I showed up, found out that the instructor had cancelled. I immediately went to the Nurse Manager (freaking out) and asked if I should go the Red Cross for recert and she advised me not to worry about it--that I could actually go 30 days over my expiration date and still be able to take the recertification as opposed to the entire eight hour training. I was scheduled for another class earlier this month and they called me the day before and advised that the class had been cancelled and they would let me know when the next class is available "but don't worry we'll get you in class soon". My question is this...they KNOW that I am not currently CPR certified and of course it's a requirement for all nursing staff so I do have some concerns about getting fired for being out of compliance but my real concern is whether I'm required by the BON to have current CPR cert? I am in Wisconsin and checked their website but didn't see reference to this. If anyone knows I would really appreciate your input!! Thanks!

Congratulations!!! It's great to hear the success stories!! I've been working now for two months and while I don't yet feel like "the nurse" I am getting more comfortable and look forward to going in and learning new things each day. Congrats again on your success and thanks for sharing.

Hi Blaze, My school also used that grading scale--80% was a B- and anything below that was failing...and we used Potter & Perry Fundamentals first semester...I would recommend using the NCLEX questions at the end of the chapters to ensure understanding of the material as well as the CD that comes with the text. I would also suggest getting in the habit now of knowing WHY and not just memorizing facts because the test questions are geared to the hows and whys vs. easy multiple choice (and second semester is more difficult with alterations, etc.). In Fundamentals and Skills I made up index cards with the "expected outcomes" for each chapter on index cards with the answer, diagram, etc. on the reverse side and kept them handy for studying. Meeting with the professor to help focus your studying might also help (I never used NCLEX guides until I was preparing for boards--because I too thought that was way too much information). Lastly (sorry this has been so long) I strongly recommend study groups--talking through anatomy, physiology, etc. helped things stick a little better than just reading text, powerpoints, etc. over and over. Best of luck as you work through your first semester--it's tough but it's so worth it!!

I worked full-time in an office while earning my LPN (one semester for generals and two semesters nursing core)...I didn't have a choice financially...31 with two teens and a husband that traveled the majority of the time...no vacation or time to myself for that matter because all flex time went toward missing work for clinicals and exams. If you do it, my advice is to resolve to not stress over perfection--there was no way possible to maintain a 4.0 and it took me awhile to come to terms with that. Best of luck with whatever route you choose!!

I'm a Vans and Converse All Stars girl myself, but I do not wear them to work--prefer something a little more substantial for the random fluid issues/spills and with more support for those long hours...I definitely understand financial limitations but these are your feet--and if you don't find something comfortable you will be absolutely miserable during your shift...for my clinicals I found all white leather Nikes in the boys department so they were a bit cheaper but once I started my first job I splurged on Asics running shoes and I LOVE them with a passion...12 hour shifts and feel like I'm walking (sometimes running) on the clouds. Best of luck as you start clinicals!

Also agree with OP...our clinicals were for six hours twice a week for six weeks and we had the same patient for the first three weeks and the same two patients for the last three weeks...I did CNA work which was fine because that's what got me interested in nursing in the first place but practically zero procedures--besides basic med pass got to give one insulin shot...I was totally upfront about this when I interviewed and with all of my trainers but sometimes they look at me with such disbelief or irritation to have to show me things. I don't know about anyone else, but it seemed to depend on the professor...some were known to go to the facility prior to clinical and communicate with the nursing staff about procedures that needed to be done so that students could practice skills where other professors had to be tracked down just so that meds could be administered let alone doing anything extra. I do agree with others, though--procedures are picked up quickly when you get to practice them daily on the job. When I have never done a procedure, I ask that another nurse come to the room and walk me through it--that way I don't have to keep saying "I'm sorry but I have never done that"--and they know that I WANT to/am willing to jump in and do it myself. It's also a nice confidence booster and sense of accomplishment--when I did my first catheter I was over the moon!!!

Sound, I, too, experience this...I started the same time as several others (all of us brand new LPNs) and they are completely at ease with the supervisors and other staff--laughing and joking with similar interests, etc. Because I haven't made these connections I think that it makes even asking work-related questions difficult. I've always been quiet but adjusted at previous jobs--I guess I've never felt at this much of a disadvantage/unsupported before. Sorry I don't have any suggestions...at this point I just try to smile at everyone and be polite (when I'm not totally engrossed in a situation in which case I've been told I look mad ). Good luck--I hope others have some ideas!!!

Thanks for everyone's responses--it's really easy to lose perspective and confidence--and it's wonderful to hear from others who have been through the same thing...thanks for the reassurance that things will get better!!

Hi Ready, Unfortunately no advice but just wanted to let you know that you're not alone (I could have written this post having myself just posted a msg about feeling like a sham and know nothing nurse at LTC). After reading others' posts I believe that maybe it will get better (or on the flip side I will realize that LTC is not for me) but I'm going to stick it out to find out. I just keep thinking that if I had 20 residents instead of 30 I would be fine you know? Best of luck and feel free to vent anytime!!

I graduated with my LPN in May and just finished my twelve day on-the- floor training at a 100-bed LTC. I feel like a complete sham--like I don't know how I made it through school and passed the boards...I feel like I know nothing--from different treatments that other nurses are talking about to abbreviations that they use to simple things that I SHOULD know regarding med interactions. I just feel so frustrated...I've rotated halls so I have worked with every resident (sort of) but I still don't recognize 1/2 of them and have to ask CNAs or nurses to verify before I give meds...my wound treatments look like they're done by a five year old playing doctor and I'm completely befuddled when it comes to charting about wounds and other things...part of me says "you're new--you'll get this" but part of me is thinking that I'm just not cut out for handling 35-ish patients at this point. I have started to go back through my skill books, drug book and read up on conditions that my residents have, but I'm wondering if there is more that I could do to help myself? On the bright side I have had a few small victories...I am now pretty comfortable with feeding tubes and straight cathing patients so I guess that I can be taught...the other thing is that I LOVED being a CNA in LTC--that led me to nursing...but I feel like all I do is run around all day and spend zero time with my patients...and the other nurses speed through med pass ASAP so they can sit behind the desk and talk (which is SO not my style--I'd rather be helping the aides or spending more time with patients)...does anyone have any advice? I've thought about asking one of the nurses if I could come in on my day off unpaid of course and shadow her but I don't know if that's allowed. Thanks for listening to my rant and for any insight or direction anyone has to offer.

I couldn't agree more...I too am a brand new LPN and just survived day three at LTC...my preceptor seemed very understanding that I had never done procedures (such as flushing G-tubes, drawing up insulin because everyone at the clinicals I attended had the pens, etc.) but when it came to me doing it, I apparently was taking too long because she either pulled the thing out of my hand (syringe that I was attempting to flush with) or sigh and say "here just let me do it" (in the case of the insulin)...as if I wasn't already stressed/frustrated enough!! One moment she would say that we needed to help CNAs answer call lights (which I readily do as a former CNA) and after I DID answer a light she berated me for doing so, saying that we didn't have time for that (and certainly don't have time for chit-chat with the residents as we're passing meds). My head was spinning by the end of the shift. Thank goodness my preceptor yesterday was the complete opposite--she was beyond wonderful...she made me feel comfortable and allowed me to perform the procedures at my own pace--and CORRECTLY for that matter (heavens--I feel indebted to her for this!!). I think that if I can "stick with" her for my last days of orientation I'll be so much better off...ratio is 40:1...just getting to know who is who and how they take their meds is such a learning curve...we "tag-teamed" meds and treatments yesterday so at this moment it hurts my head to think about doing it all on my own...I already feel, though, that coming in an hour early to get organized with a to-do list (for vitals, accuchecks, treatments, weights, who is leaving for the day, etc.) will put me ahead of the game somewhat...I understand that doing so won't guarantee I'll be out on time, but I think I will feel better prepared to start the day and deal with crises as they arise. Best of luck to all in this boat!!

Hi--congrats on deciding to get back into the program!! I think that all schools have their own rules...mine allows general credits (A&P, etc.) to be five years old but for core courses (Pharm, Fundamentals, Skills, etc.) they will go back two years at most. I'd say check with your counselor to avoid the speculation and worry. Best of luck!! :)

Thanks for all of the great advice!! Nat, I have the same fear as I too am starting at a LTC working every other weekend...thankfully this facility offers 14 days of orientation and if I still need additional training (I'm a new LPN grad) they'll provide another seven days. The negative is that I won't have the same preceptor during this period, but I did schedule my training pretty consecutive with six of the days on Sat and Sun...I'm hoping to soak up all that I can, take good notes and get "in the groove" during orientation so that I'll be more comfortable once I'm only in the facility four times a month. Best of luck to all in the new job boat and please keep the suggestions coming!!

I hope I'm just being overly nervous about this...I accepted a verbal job offer at LTC the morning of July 18 and was told that I would receive a job offer letter outlining pay, hours, etc. as well as orientation and drug test dates. I went in for the "physical assessment" on Monday, July 21 as directed and passed (though I wasn't on his appointment list) and was given a document outlining what I need to bring to orientation (and verified the orientation schedule). I turned in notice at my current employer (office job--I'm a new grad) but have still not received the job offer letter. I called the hiring manager earlier this week to "check in" and let her know that everything was in place (including that I had scheduled my drug test based on info given during "physical assessment") and verify if I would receive my offer letter in the mail or if I would receive on the first day of orientation and was told "you'll receive it in the mail--thanks goodbye". Um, ok. Does anyone know if this is typical? I had three job offers and chose this place but am now wondering if I made the right decision...my orientation begins next week. I don't want to stress this if it's no big deal but in my previous job I drafted job offer letters on behalf of my boss before she offered the position (so they could be emailed and sent snail mail as soon as she hung up the phone). Is my perspective skewed? Is the job offer letter not so important in the nursing arena? I know that it's not a guarantee of employment but I know I would feel more comfortable if I had it in hand (false sense of security I guess?!). Thanks for any insight!!

What type of info/direction were you given? I wrote several during clinicals based on patients that I cared for...things like anxiety r/t deficient knowledge as evidenced by xyz, how to bathe newborn, how to use the suction thingy (very technical right?!), breastfeeding, etc. I also invested in two great care plan books...Nursing Care Plans and All in One Care Plans...they made a huge difference in the time I spent on prep. Good luck!!

Congrats!! I too passed last month and had my first interviews last week (and wahoo...start my first LPN position in a few weeks)...I had questions ranging from "whose job is it to answer call lights?" to "what do you dislike most about nursing?" to (UGH) "one of your patients just fell, you're one CNA short, you have a patient passing, another patient with behavioral issues involving a CNA and a doctor on the phone waiting to speak to you...what do you do?" I definitely agree with the above poster who said breathe and think about your response--and feel free to ask for clarification if you aren't sure what the interviewer is asking. Best of luck and keep us posted!!

I liked Mosby's Illustrated Study Guide for the NCLEX-PN as well as Exam Cram-PN...I passed June 28 (wahoo). I went on the Pearson-Vue site and paid for early results (took on Saturday and knew I passed Monday morning) but it showed up on the state site within five days. Sounds like it's different from state to state...best of luck!!