ChickenJoyRN,BSN

I am a new-grad and just started a position at a SNF in the Bay Area. I was wondering what the nurse to patient ratio, according to state guidelines, is in California. I have been working in this facility for about 2-3 weeks or so and I have to say that I am starting to regret it. I was oriented for only 2 days on the unit and they put me by myself for a PM shift. I figured I would have more time for orientation, right? Our current census is 68 patients and there are only 2 charge nurses for 3 stations. That's a 1:34 ratio!!!! I have concerns about being overwhelmed with 34 patients with only 2 days of orientation. I still do not know how to do anything in the nurses station and all my meds are being given 2 hours late. I am worried that I may make a mistake that may jeopardize my license or even worse jeopardize a residents life!!! I'm not confident the management would have my back if something goes wrong, meaning I am placing my RN license, that I worked so hard for, at risk as I working here. I continue to ask for more days of orientation to my DON, but she insist I will do fine and start to get the hang of it soon. I feel more on time after I have cared for about 20-25 residents. But then I think about the other 15 I have to attend to and it just get pushes back all my responsibilities. I have spoken to some of the nurses that have worked there for a long time and they said they used to have 3 nurses for each station (1:22 ratio). But not anymore:uhoh3: since the facility underwent new management. I guess I'm looking for advice on what to do as well. I go to work scared, full of anxiety and uncertain. Now, as a new grad, I don't think that is a healthy way to begin a career. I don't want to loose my license. I originally wanted to work in a hospital, but none were taking new grads. I would be devastated if I lose my RN license over a job I didn't want in the first place. If this is the way SNF's operate, then I may have to consider looking for another one or just not consider SNF's at all. Thanks for reading. Any advice or insight will help a lot.

Okay, I need to vent. So during the middle of my 2nd day of orientation my DSD comes up to me and ask if I can come in tomorrow for a 3-11 and work on my own because someone called in sick. I said I am available, but do not feel comfortable being by myself yet. She said I will do fine and that I can go to the other nurse on the other wing if I have any questions. She even said she lives 5 minutes away and to call her if I need help and she would come over. I would be responsible for 34 residents. I did not feel right about this at all, but my DSD said I would be okay. So I decided to give it a shot since there will be another nurse on the other side. So as all would expect I was swamped and overwhelmed. I was a turtle during my med pass and residents were complaining they were not getting the right amount of meds. I was not doing my FSBS before dinner and I was basically about 2 hours behind everything I needed to do. But in the middle of my shift, the other nurse comes to me and ask if I can either work the AM shift tomorrow or the Noc right after my shift. I was like ***???? Is that a joke? Please tell me you're joking. Unfortunately, he was not. Our DSD called him to ask me that question. When I asked the other nurse where is she, he said not in the area. I was like WOW?!?!?!? I've never been more set-up in my life. I was really put in a difficult position. So I took the NOC shift and was going to be working 16hours straight. I figured that was the best choice since I was behind in my charting and everything else, I would be able to catch up during dead time. The moment I thought I was caught up, it was time for the 600 meds. Now I had pre-poured meds and still ended up swamped and behind. When the Day shift came they all felt sorry for me. I looked drained and stressed. They said it doesn't make sense to put a new grad with 2 days orientation by himself for a straight 16 hour shift. I totally agreed. So these are my thoughts. -Are all my days/shifts going to be like this in this LTC facility? That is a lose, lose situation. The nurses are stressed and the residents don't get the proper care. -Most of the nurses say that they all went through that, but with about 1-2 weeks orientation/training, NOT 2 days orientation. I feel like was set up. -I don't know what they expect from me, a new grad with no experience. Is my DSD to blame? Her whole deal just seem a little fishy. She said to call if I need help, but she was about 2 hours away during my shift. -I am strongly considering to leave unless someone tells me this is the norm in a LTC facility and this is how new grads get introduced to the environment. -I'm so stressed out and drained and just the thought of going back to work leave a nasty feeling in my stomach. Any advice, comments, response, tips would help a lot. I was really looking forward to working here, but this experience has left a nasty taste in my mouth. Thanks for reading.

Thank you to all responders. I just finished my second day of orientation today and it was my first day on the floor shadowing an LVN. I have to say that I was overwhelmed....even though I was shadowing an LVN. I had the 7-3 shift. I asked a ton of questions during the morning med pass. I can see how easy it is to be distracted my residents and co workers. There are a lot of medications to know(generic names too). Some are similar but there are a wide variety. I took some of the advice and wrote down some of the residents' likes and dislikes. I wanted to be aggressive, so I requested to do the 1300 med pass. My trainer agreed and said she is going to let me do it all by myself while she charts MD orders in the nurses station. I was shocked because I was expecting her to shadow me. But I decided to go for it, but always kept in mind to slow down when flustered and always ask when in doubt. I've never block out simultaneously so much in my life. Its like I knew what had to be done but for some reason could not do it. She told me that it okay, I'm just starting and started shadowing me. At the end of our shift we stayed till 400-415 charting. I wanted to stay so that I can get the whole charting experience regardless if they where gonna pay me or not. So at the end of the day, my biggest concern is knowing all the residents' face, name, room number, diagnosis, MD, and family. I feel that would be a big part in my development. I also learned that I need to have a system for med pass and brush up on drug names and purpose. Thanks again for all the advice and responses. Any others would still help a lot. Thanks all and wish me luck!!!

WOW. I just responded to your message. I was gonna apply at that place but got hired at a Castro Valley location. Let me know how its going.

Thanks. And your're right, I didn't mean it in that manner. I understand we all work as a team and I will do my best to act in an authoritative and respectful manner. Such a new grad(rookie) move!!! My apologies. Thanks again

My situation: -New grad RN, BSN in December 2008, 27 y/o male -No hospital (CNA,LVN) experience -Got a job in a LTC in California $30/hr -DON expects "aggressiveness" out of me and said my ratio is 1:30 with CNA's and LVN's assistance. -Don't know my shift yet, I start some time next week. -I have been a server/bartender for about 5 years. My Questions: -I know I'm going to struggle for the first 2-3 months or so. I've been told everyone usually does. What are the top 3-5 tips/advice you can give based on my situation? -What is the worst thing I can do? For example, "Don't ever, ever do....." And I know the obvious, don't kill anyone, any other scenarios will help. What is the best thing I can do? For example, " You should always, always do this........" -How can I gain respect of CNA's, LVN's, peers, and staff? Some of the people here look older than me and have been there a long time. How does a young, new grad come in and give them orders while gaining respect? -What does a normal, routine day consist of for an new grad RN? What does a catastrophic day consist of for a new grad RN? -I loved being a server/bartender for 5 years. In the back of my mind I'm thinking 1:30 ratio may bring me back to my serving days. I understand that there is a lot more risk involved and more critical thinking required, but do you think my serving/bartending experience will help me care for my patients? -What are the top 3-5 tips/advice while being oriented? What are the top 3-5 things that should consistently replay in my head as my shift goes on? Thanks in advance for all the responses, tips, advice, and experience shared. I really appreciate it!!! I really want to develop into a great nurse. The beginning is very important. I finally get an opportunity to begin my career. I believe that putting in time/work off the floor will help you be better when your're on the floor. That's why I'm trying to get as much information now. Thanks again. -J

I was just offered a job at a SNF and they offered me $30/hr as a new grad. I do live in the Bay Area California though. But when they offered me the position, I didn't even bother asking for a rate. I was just too excited they offered me the position!!!! As a new-grad in this economy, "We" are in no position to negotiate pay. You can try, but success is very slim. They may even look at you differently after. Take what you can to get your feet wet and get experience!!! As a new-grad, experience is far more valuable than any pay rate.

thank you very much!!!!that was very informative. sounds like there are a lot of opportunities to build leadership skills. so if i wanted to become an officer it is required that i commit to 8 years of service (3 years active, 5 reserve) during my 3 years active, will i continually be moved to different locations based on their need? do they take care of my housing? during my 5 years of reserve, am i required to live in the same location?

My situation: -New grad RN with a BSN degree -No medical/nurse experience -27 years old male, not married (but in a relationship), no kids -No military experience, background or knowledge -Wants to begin nursing career ASAP Questions: -How well will I fit in the military(Nurse Corps)? -Will I be accepted in the Nurse Corps? Are there requirements like physical/written exams? Is it common for a guy with my situation to join the Nurse Corps? -Will I be stationed in locations/cities that I have no say in? Will the military have me under contract for a certain amount of years? What is Active vs Reserve? -What are the professional benefits? Financial benefits? Personal benefits? Long and short term benefits? -What are the "cons" of joining the military? Will I be in combat? What kind of preliminary training is involved? -What can I expect 1 year into it? 2 years into it? 5 years into it? 10-20 years into it? I know what you are probably asking yourself, "Why won't this guy just talk to a recruiter?" A buddy of mine met with one before and decided that the military was not for him, but the recruiter continued to pursue him for a long time. The recruiter continually emailed him, called him and left a lot of messages. I'm not looking for that. I had another friend who actually followed through and joined the military because the recruiter told to pick three city's he would like to be stationed and my friend did not get stationed in any of them. Basically the recruiter painted a very pretty picture for my friend and he bought it. I just want facts and no gimmicks. I feel a lot more comfortable getting information in here than speaking to a recruiter. I think there is a good blend of recruiters and individuals with personal experience in here. Any information on what it is like would help a lot. Thanks!!! Oh!!! Try not to use a lot of military jargon. I noticed from the posts that you guys use a lot of acronyms. Believe me, I'm not going to understand it, unless you explain in simple terms. Thanks again.

If you plan to work in a far location, how does the interview process go? Since I'm in the Bay Area and I wanted to work in SoCal, would I have to take a trip down there just for an interview even though its not a guarantee I'll get the position?

Are nursing homes examples of SNF's?

Here is my situation: -Graduated December 2008 -Active California Registered Nurse License -No experience, except from clinical rotations from the nursing program -I stay in the Northern California (Bay Area) -Want to work in the hospital setting. Prefer ED, ICU but is willing to get my foot in the door through MedSurg. -BUT NO NEW GRAD PROGRAMS IN SITE!!!!! I have heard some in the Bay Area starting in the summer, but I anticipate it is going to be about 300 applicants applying for about 5-7 positions. -All hospitals turned me down because I have no experience or they are not accepting new grads at the time. That's basically my situation in a nutshell. Now I've spoken to a few recruiters, friends that are RNs who already work in the hospital, and family and they all recommend I start looking at "skilled nursing facilities" to get experience for about 6 months to a year. Now my question is... -Are nursing homes the only skilled nursing facility? (Is a skilled nursing facility basically a nursing home or are there other types?) -Is it common for new grads to begin their career in a skilled nursing facility? Will skilled nursing facilities accept new grads? -Given my situation, is a skilled nursing facility my only best shot to begin my nursing career? -Is 6 months to a year at a skilled nursing facility adequate experience if you are considering to work in an acute care setting (ED, ICU) if they ask for experienced nurses? -Pros and Cons on working at a skilled nursing facility? Thank you in advance for your input.

You never know with this type of exam. I am not really sure if Math questions are considered "easy" questions. I think I read it somewhere on this site. Try not to assume you did not pass. I was certain I got my math question wrong and I still passed. Good luck to you.

Yup. This was probably the most unusual exam I have ever taken in my life. That just proves that you can never tell with this exam.

Well folks, you can add another testimony to this "Pearsonvue Trick" I took my NCLEX-RN exam last Friday. I've been attempting to re-register everyday since and it did not let me continue to the payment window. I found out I passed this morning. Good luck to everyone waiting for results!!!

I found out this morning that I passed the NCLEX-RN. I have been reading this forum for the past year and have read so many success stories. I am happy to finally share a success story of my own. :typing History: The first time I took the exam was on December 23. My prep was mainly focused with Kaplan. I used qbank and question trainers. I studied M-F at the library for about 6-7 hours in a span of 2.5 months. My activity and diet was horrible. I did not exercise and my diet consist mostly of fast foods. When my exam date as getting closer, I told all my family and friends when I was taking the exam. I took the exam at 8AM dispite the fact that I am NOT a morning person. I took the exam with high anxiety all through 265 questions. A few weeks later found out I failed. After going throught the five stages of grief I was ready to begin studying again. Pre-NCLEX-RN: I decided switch up my gameplan for studying. I threw out Kaplan because it didn't work for me. I decided to use Saunders Comprehensive review 4th Edition and Lacharity's Prioritization book. I did about 100 questions a day. After getting advice from others in this forum, I decided to cut my study time from 6-7 hours a day to 2-3 hours a day. I found more time to exercise and eat healthy after cutting down on my studying time. I was able to go to the gym and fix healthy meals for myself. I also snacked on a lot of brain food like peanuts and blueberries while studying in the library. My theme this time was, "A healthy body equals a healthy/strong mind." NCLEX-RN: This time I didn't tell anybody I was taking the exam, not even my girlfriend. I have to admit, I was not as nervous this time. I took my time with each question and did not want to rush myself for the first 90 questions. I utilized my breaks everytime I felt frustrated, off track or out of my zone. There were moments when I knew I got the question wrong, but I kept telling myself, "Just get the next one, just get the next one." I think there was a guy typing an essay for his exam in the booth next to me. He mad a lot of noise and it distracted me so I asked for some headphones. I highly recommend using these. It zones everyone out and you can concentrate 10x better. I used my whiteboard all the time. Sometimes writing about the content triggers your brain to recall more. It worked for me. After 1 math, 5-6 SATA's, and a myriad of meds, prioritizations and delegations, the screen went gray after 76 questions. I hit myself on the head because I felt like I needed more questions to prove my competency. The exam proctor told me to relax and not worry because she saw that I was discouraged. Left the building not knowing how to feel. Post-NCLEX-RN: I know your not suppose to be thinking about the exam during this time but that is impossible. I was on this website 6-8 times a day. I even got hooked on the "Pearsonvue Trick." It was Easter Sunday and my whole family was asking me when I was going take the exam again. I just kept telling them, "Ummmm, pretty soon I hope." They continued to show their support and told me I would do fine. Today, Tuesday morning I looked in the CA BRN website and found my name with a liscense number next to it. I immediately got down to my knees and thanked God for this moment. My take/advice: It may sound a little wierd but, I'm happy I failed the first time. One cannot know success without experiencing failure. It pushed me to work harder. It was like the NCLEX-RN said, "C'mon I know you can do better than that. Come back next time giving you full potential." And I did. So if you are discouraged from failing once, twice or even three times, just know that everytime you get back on that saddle you're getting stronger and stronger than before. As far as studying, WHAT you use to study is not as important as HOW you study. The first time I was basically beating my brain up for no reason for about 6-7 hours a day. I was not absorbing/retaining anything I learned. Try 2-3 hours and try to limit yourself to 100 questions a day with a lot of focus on the rationals. Now if you know for sure you are solid in the content departement, I would recommend Kaplan. But if you are not that confident, then try Saunders 4th edition. It's a great book!!! I cannot emphasize that enough. I found some of the quesitons on the exam vaguely familiar. Well that's basically my NCLEX-RN journey in a nut-shell. I wanted to say a lot more but felt it was more important to share the juicy stuff. Feel free to ask any questions if you want more details about my experience. I'd be happy to share more if it will help reach your pursuit of RN status. Good luck to you all. It's time for me to celebrate RN style, but first let me start by getting something I haven't had in a very, very long time.... A Good Night Sleep!!! GOOD NIGHT FUTURE NURSES OF AMERICA!!!!

Thanks for sharing your story. I really appreciate it. It actually does make me feel a little better knowing that you passed. I know that doesn't guarantee I will pass, but your story did give me some hope. Congratulations and good luck to you in the future. I will definitely continue to pray. God Bless.

Is everyone here waiting 2-4 weeks for the NCLEX-PN or NCLEX-RN in California? Because I think the wait time for the NCLEX-PN is 3-4 weeks and the wait time for the NCLEX-RN is 7-10 days (Althougth some have received it in 2-3 days). Are you guys waiting 3-4 weeks for NCLEX-RN? I just took it on Friday April 10th and I was not planning on waiting 3-4 weeks for my result. I know for sure they have all my paper work because this is my second time taking it.

Thanks!!! It makes me feel a little better knowing that someone passed while getting a math question wrong. It'll make me feel even better to know that I passed. It was weird. Calculations/conversion were one of my top strengths while studying. Oh well, what's done is done. It'll probably be another few days till I find out my result. Thanks again.

Summary based on past posts: So let me get this straight. If you try to re-register for the NCLEX-RN within a few hours of finishing the exam, 1 of 2 things can happen. 1. After filling out a questionaire, your grad date, school etc.. a pop-up will show stating that you unable to register for this exam at this time and to contact your board. (And this is suppose to be a good thing indicating you passed). or 2. After completing the questionaire, your are taken to the payment option window. (And this is a bad thing indicating you failed) This is very interesting. I believe in any experiment, you need to examine all corners and possibilities. So far, the only post I've seen are those who have experienced scenario 1 and passed. We should work together, share and get to the bottom of this. Has anyone experienced scenario 1 and failed or scenario 2 and passed? Maybe indicating your state and if it uses Quick Results may help. I just took the NCLEX-RN this Friday afternoon and got scenario 1, however have not as of yet confirmed I passed. I took it in California, does not use Quick Results. Good luck everyone.

Oh my God!!! I am so upset with myself. I just took the NCLEX-RN today and it stopped at 76. I'm not worried about the number of questions I got because the postings on here convinced me that the number of questions you got have no bearing on your result. BUT!!! And I do mean a BIG BUT!!! Toward the end of the 76 questions, I got a math question. I had a lot of math practice while I was studying and felt very confident going into the exam. But for some reason I froze at converting mcg to mg. I know, bone head mistake. I was getting some weird number like 24,863mg/min. I know, didn't make sense. I was seriously stuck on that question for good 7-8 minutes. I knew for sure I got it wrong. I memorized the questions and solved it when I got home. My question is, since I know I got that wrong, the exam stopped at 76(without giving me an opportunity to redeem myself) is that a good indicator I failed. I think I read some where on a thread that Math questions were considered easy level questions. I was so upset with myself after that question, I was begging the exam to give me another math question. What do you guys think?

I am using the book too. I think it's a great study aid for the priority questions. My favorite are the ones that give you 4 patients with different conditions and ask who to see first. I always get a few wrong but I learn from it just in case a similar scenario is asked on the exam. Take everyone's advice, don't use this book as a diagnostic test of how well you are doing. Focus on each question and learn why you got it right or wrong. Reading/understanding/retaining the rational is key. This book came highly recommended among my classmates and others on this website. I failed the first time and planning to take it in a few weeks and I can honestly say that this book has given me more confidence than I had before. Good Luck.!!!

Do you mean in Saunders or just any Med Surg book?

Does anyone have a quick and easy way to learn Infection Control... Airborne, Contact, Droplet, Standard, Isolation? Thanks

I noticed you had near passing standard in every category. I was curious if you had 265 questions. I had near passing standard in every category too and was wondering how you studied the first time.