venousr3tuRN

I thought it was too short as well, but my hospital is a very small community hospital and doesn't even have a new grad program to offer. There's a second floor Med Surg that also takes Tele. They mostly have all the post-surgical and bariatrics patients.

I see. At my place they have standard ratios depending on Medical and Tele patients. So if you have all medical patients, you can have up to 5 patients. But if you have at least one Tele patient, you can only have 4. My unit always has at least 2 nurses take all medical.

Hello AN! It's been a long while since I've been on here. Anyways, I finally was able to make the switch to my first acute position in a Med Surg/Tele unit after working in LTC for the past 2 years. I only got 3 days of orientation but I hit the ground running and absolutely love it. It's a new challenge everyday, but the support I have is incredible. Besides that point, I was wondering when they give out assignments, how is it chosen who gets Medical patients and who gets Tele that day? Some weeks I've been Medical and others I've been Tele. I notice that if we have LVNs on the floor, they'll automatically be Medical. I asked my charge nurse once but we were so busy there was no time to talk. It seems like it's chosen randomly at my place. How is it done at yours? Just wondering

Be prepared for a long one... So I have been working at my first nursing job in a LTC facility for about 8 months now and generally like the job. It has its quirks but I have grown to care for all the residents in the facility now that I have gotten to know all of them. A little background, I started out on the floor as a charge nurse passing meds, writing orders, calling doctors and all that good stuff which really helped to instill the basis for what my next position would encompass. After 4 months, my then DON who hired me, ended up resigning due to health reasons with the precursor being that we sent her out from the facility 911 after passing out. She was out for some time and I knew in the back of my mind that she was not coming back to work at my facility. As it happens, the morning RN supervisor was asked to fill, in which she accepted and I believe does a great job at it for what she was left with. So with such short notice we needed a morning supervisor. There's only a handful of RNs at my facility, including myself, so I figured the current 3-11 supervisor would take the position. She declined confiding in me that she could not be able to work with both the new DON and the Administrator at the same time. Long story about that but the gist is that we are on our 3rd admin since I've been there and I've noticed that staff morale has gone down from what I notice. Anyways, our admin asked all the other RNs if they were interested in supervising with each one declining including the other new RN I was hired with. When she asked me I accepted because I wanted to help out my facility and I did not want my coworkers to be without a supervisor. So after only 4 months of experience as a floor nurse, I became the new morning supervisor. It was a rough start at first going from doing medpasses to overseeing that they are done and being a resource for my charge nurses, many of whom have years more experience and knowledge than I. For the most part, all of the charge nurses were very receptive to my new role. So now after 4 months of supervising I have become a little better in tuned with the position but still continue to ask as many questions as I can and ask for help when I need it. I still consider myself a work in progress as a supervisor and have noticed vast improvement in all the areas of nursing skill set and confidence from when I first started. I finally started feeling a little more useful and gaining the trust and confidence of my peers. We have 2 nursing stations in our 99 bed facility and everyday I find myself constantly traveling between the two to help my nurses out in any way that I can. I give a little more time to the newer nurses so they feel they have that support, which I unfortunately did not feel when I started, and more trust and autonomy (within reasonable scope) to the seasoned nurses to show that I value their experience and knowledge and am there when they need but won't constantly hover around them. The seasoned nurses are good about letting me know what they are working on and any new developments throughout the day. I answer every resource questions that my nurses have, to the best of my knowledge and experience, and when I truly don't know will have them ask the DON for backup resource. I handle all admits and discharges so my nurses can focus on their residents. I help my nurses out with their orders, doctors, family, labs, dietary and pharmacy reqs, do all the tasks and meetings required of the supervisor and act as a liaison between other disciplines like rehab, social services, dietary, housekeeping, and so on. I can't say that I do it all perfectly but see myself improve everyday. So to the point finally...my DON has told me that she has been pleased with my quick progress and my dedication to helping out by working doubles and my days off, if needed, to cover shifts when short staffed. However, one of my nurses recently confided in me this past week that she overheard the DON talking about me to other staff in the break room. She allegedly said that it was useless to have a supervisor on shift when all I do is walk around the facility "looking" like I'm doing work. She supposedly goes on to comparing the work she did as the supervisor and her handle on the staff. I deduced that something to that effect was said only from my experience with her constantly slamming other staff to me. I cant expect that I would be exempt from such talk, you know. When she does that, I try to pose underlying reasons for work performance instead of just superficially passing judgement. I investigate if it is a deficit in knowledge or skill, personal factors, or any other plausible reason. I take my nurses aside and have a conversation with them about how they are doing, how they feel their work performance is going, and any way we (as a facility) can help facilitate, improve, or change their working conditions as possible. One thing I don't do is talk about my coworkers behind their backs, mainly because I don't know the whole story and I like to give everyone the benefit of the doubt. Now i cant say that my moral compass always faces true north and have been known to resign to similar actions in fun, in anger, in stress, and so on. I try to analyze those behaviors and see how i could have better handled those situations. To reiterate, I'm a work in progress. People have actually slammed the DON comparing her performance to the previous DON. I don't full on defend her but I tell them that they have no clue as to all the unfinished work that was left for her to deal with on short notice and all the deadlines she is still expected to meet. I basically imply that it is easy to judge from the outside. I'm actually privy to a lot of the work that she has to do and still feel she is doing a fantastic job as our DON considering our situation. It hurts a little to think that I'm possibly not shown enough respect from my DON to be criticized to my face and to other people no less. I've grown thick skin in my short experience and do not feel it a full on personal attack. I just do not want to work with that aura over head. I want to know these things so I can improve and be more efficient and useful at my job. I keep my DON in the loop of everything going on in the facility even general perceptions of staffing, management--including her--and working conditions without ever naming names. I want my staff to feel like they can be truthful without fear of retaliation. I'd rather work on finding solutions than wasting time and energy on pointing fingers. My nurse told me of all the DONs supposed chatter this past Friday after our shift ended while we were walking to the parking lot. I'm off on the weekends so I plan on having a meeting with the DON on Monday to discuss what was supposedly said and get her side of the story, if any. I'm sure I will find some truth in the middle of both stories and will ask for advice on any areas that she feels I could improve upon. I still value her expertise, knowledge, and dedication to resident care in the end as a seasoned professional nurse. As a person though, she may have been knocked down a peg in my eyes. Have any of you experienced this kind of situation with your DON or management as a whole? How did you handle it? What advice would you give? Thanks for taking the time to read my long situation.

I'm here to tell you that you aren't alone in that feeling. As a new grad myself, I have gotten chewed up and spit out by the other nurses and supervisors for some similar reasons. It's a learning experience and we are bound to make mistakes and it won't be the last time we make mistakes. I think as long as we haven't caused irreparable harm and learn from these mistakes, then all will be well. For me, it sometimes feels a little stressful as I feel like they want me to function at the level of their seasoned nurses and I know right now that is not just going to happen overnight. Just try to remember that they saw something in you or else they wouldn't have hired you. Try to find some support in the other nurses. There's bound to be at least another nurse who can answer your questions. Don't be afraid to admit what you don't know. Sure they may looked shocked but remember that you're still getting used to the medications and have only worked with them for 3 months versus other nurses years of exposure to these meds. I always ask questions about all the meds I don't know and I'm sure they are tired of me always asking. I just wanna make sure for the safety of the residents. Just think, one day you'll look back at this and chuckle about not knowing what bacitracin was. It'll be a little story for you to tell future new grads to help them get through their first mistakes.

My position is as a charge nurse and we do our own medpasses, write our own orders, admissions, etc. We do have one supervisor on the floor to help with the admits and follow up labs. The treatment nurse takes care of all the residents with skin breakdowns and basically only report back to the charge nurse if any new breakdown has occurred which the charge nurse is responsible for charting the COC. I'm still fairly new--been there a little under 2 months--and take some time to do the medpass which leaves me little time to chart. I usually end up having to clock out for my break and chart through it to catch up, if at all. If a COC occurs, I end up staying after. At first, I was staying on my own time, but our administrator talked with us saying that we can stay over as long as we get supervisor approval and that they have the budget for overtime if we need it to finish all of our charting. However, I've experienced much indignation from the supervisors about having to stay over to finish. I've now resorted to clocking over 30 min to an hour of overtime and then working the rest on my own time to appease them. And yes, we have a couple VIP residents that require the q-shift skin checks due to the copious amounts of complaints made by the family about marks on the residents which are caused by the residents themselves due to the fact that they exhibit continual non-purposeful movements and on medications that cause them to bruise easily. The resident I missed the skin check on happens to get at least 1 COC per day if not more. Her chart is thick with the paperwork. It's very challenging, day to day, and I have noticed my anxiety has gone up a little working there, but I still maintain hope that it'll get better. I just wish that we had a little more support.

I'm only about a month and a half into my job and I'm still trying to catch my bearings. I'll admit that it's gotten a little better since my second shift, but its still a challenge every day. People say that it takes at least 6 months to start feeling confident in your job. They also say it'll be 1+ years until you feel like you truly know what you're doing. Trust me, there have been many shifts where I felt like I wanted to break, being pulled in so many directions and not knowing what to do next. Whenever I feel like that I just take a deep breath, compose myself for a moment, and take it one task at a time. I'm starting to prioritize a little better but I know there's always room for improvements. I wish I had more time to give to each resident, but with all the paperwork they require, it makes it next to impossible. I try my best though. I got chewed out for the first time by a resident's family for not waiting for them to arrive to give meds. My DON, Administrator, and coworkers were really supportive which helped a lot. My DON even called on her day off to see how I was doing and saying that I have the full support of the entire staff. I think as long as you have really supportive management and coworkers, you should be able to manage. LTC is a very challenging job from what I've experienced so far. You're going to be a little behind when you first start but know that it is normal and that it is expected that you won't be able to function at full capacity while you're still learning your new role. Ask your coworkers for help. There's no harm in it, even if they are busy. From my experience they will-more often than not-help you as much as they can. Lastly, there's ALOT of documentation, ask for examples of how it should be done. Better yet, ask your DON how he/she wants all the documentation done. My DON actually showed me how she wanted it and even helped to improve upon some that I've already done. The gist, take advantage of all your available resources. Good luck

Just take a deep breath and let it all out. I know exactly how you feel. I have been working off orientation now for about 5 days and still am struggling on every shift. I learn more each day even though I'm still getting used to all the residents and their intricacies. My facility is 99 bed and I'm in charge of over 25+ patients on any given shift. My second shift on my own was a disaster and I seriously thought about not going back because I didn't get home from work until around 1:30 am and I had to be back at 7 am. I decided to stick it out because I didn't go to nursing school for nothing and I am determined to be the best nurse I can be by learning from my experiences. The next shift was better as I felt like I got a little more of a handle of my shift from what I learned the night before. It really is a learning curve from school to actual practice but if you stick it out, you'll learn so much and be better for it. My advice: take your time with your med pass because the worse thing you could do is harm the patient by giving the wrong medication rather than being late by an hour. I know you have a two hour window, but I think 3 hours is pretty standard for new grads just starting. Just focus on doing it right and know that speed will come in time after you've gotten used to everything. I still take about 3 hours but I notice myself getting a little faster each shift. Don't be afraid to ask for help, even if the other nurses are busy. I also work with an amazing team of nurses and CNAs. They help me out so much when they can. I believe as long as you ask, they will always try to help when they are able to. Ask your DON for help too as he/she is one of your greatest resources as they know every single patient you have. My DON has helped me numerous times on my documentations because I needed help with all the paperwork. She has an open door policy because she wants her staff to be successful, and in turn her facility successful. Lastly, remember to enjoy in the fact that you are now a working Nurse. It is definitely no small feat getting through nursing school and passing the NCLEX. Your hard work and perseverance has culminated in your first opportunity in the Nursing profession. If you can stick it out, it will eventually open numerous avenues to pursue. If you truly feel you can't or feel like the support is not there at work, then other opportunities will present itself as long as you search for them. I say stick it out. They hired you because they saw something in you. You should start seeing it too. Good Luck!

Yeah I plan to apologize to her the next time I see her. I really want to take responsibility for it so I think Ill talk with the DON tomorrow. I have the day off so I can't do it as early as I wanted to. I'm nervous now because I work the next 6 days in a row. I'm just hoping things go a little more smoothly in the coming days. Thank you for the advice I definitely will ask what I can do to better acclimate to nursing in LTC.

So I started my second day on my own after training for about 21 days. This morning when I woke up I told myself that today was gonna go smoothly. I guess I jinxed myself because as soon as I started my shift, the day started to not go my way. I worked the 7 - 3 shift and came in early and before I clocked in I did my rounds to make sure the residents were still here and still alive. I clocked in and then we had our morning huddle to endorse anything that happened during he night. There weren't too many tasks that needed to be followed up on so the morning started of great. At about 730 the RN supervisor tells me that one of my residents is having difficulty breathing and that we're gonna have to send him out. I'm totally lost on the paperwork that you would need to send someone out because there's a million things you need to add to it. I get some help with it which I appreciated and we sent that resident out. The supervisor was kind enough to do the computer documentation needed for that resident and let me start my medpass. I was already now about an hour behind when I am allowed to start passing, and on top of that I missed a qshift skin check for one of our VIP residents so I start it at 9. I'm still getting to know the residents there so the pass takes me about 3 hours to complete. I spend most of the day trying to catch up with the pass. I finish the first pass and already have to start the noon pass. After completing the second pass I now have about an hour left before shift ends. It is now 2pm and I still have to do my weekly summaries, charting that I need to do on about 4 residents, and Medicare charting on 3 residents. I barely finish one of my summaries when the Treatment nurse informs me that I must do a "change of condition" or COC on one of the residents because she hasn't been eating well. So she helps me with that and we are able to finish it fairly easy. Then 15 minutes before the next shift comes on one of the CNA tells me that while she was assisting a resident, he acquires a skin tear. So now I have another change of condition to do, including other documentations because of the type of incident. So right when the next shift comes on they do a skin check for the VIP resident and find new marks. I'm horrified because I missed the skin check in the morning so now it makes it hard to say if the marks were there on my shift or the start of the next. Another COC must be done now. I still have yet to finish my regular charting. I stay there on my own time to finish my charting and start those COCs. I have never really been trained properly on all the paperwork so I struggle and ask all the questions I can but can only get little help as everyone is busy themselves. I stay until 7 pm finishing all my charting. I was only able to start the COC documents for the 3-11 nurse before the RN supervisor tells me I should just go home because I've had a long day and the nurse will be able to handle the rest. I feel really bad because the 3-11 nurse was called to the DONs office and word was she was possibly getting chewed out for what happened with the skin check coming on to her shift. All of the nurses were really encouraging saying that it happens and that it'll be okay. I feel really horrible for putting the rest of the work on the 3-11 nurse. I just need to manage my time passing to 30+ residents better. It's just so hard since I'm still getting to know them and what they take and how. I'm trying to do everything correctly and trying to get faster at it so I have enough time to chart and whatever else happens. I just feel so behind. Sorry just needed to vent.

Elkpark, thank you for your suggestion. I'm looking into the United Way in my area and will definitely call their hotline for credit counseling. I actually haven't stopped looking for another job ever since getting this one. I'm only PT at my current facility and was hoping to also get a FT position somewhere else, preferably a hospital. I live with a roommate right now so that does help with some of the finances.

Thank you for all the advice. My parents unfortunately live in central California which is over 300 miles away from me. I live close to where I work and wouldn't be able to move back. I'm in the process of calling the lenders and seeing what I can do. So far they have just told me to go through forbearance and have yet to offer any help other than that as of now. I'm gonna call them again to see what else can do.

Hello AN! Hope I'm posting this in the right section. So 6 months after graduating nursing school, I was finally able to land my first nursing job. It's in LTC and although not my ideal, after being there for almost a month I have grown to love all of the residents and found kinship with my coworkers. The pay is great, but with the extent of my loans, it is not viable for paying them off on a standard plan and being able to live. Now for a little back story: I have kept nursing on the back burner through college and slowly took prerequisites for it while majoring in other things that interested me. I switched my major twice until finally realizing that nursing was what I really wanted to do. After finally completing my prereqs I applied to various nursing programs around Southern California. I was put on various wait lists, most likely due to the fact that my core science GPA was only slightly above average and not the best as most schools I guess look for. After 3 years of waiting, I couldn't wait any longer and just wanted to start my nursing career sooner. I decided to go private--West Coast University--and ended up taking over $80,000 in private loans (Wells Fargo and Sallie Mae). I know that I should have waited for a more affordable school option but I didn't want to find out how long that wait would be. This is where I could use your guys' advice: I have been looking everywhere in Southern California for any lender, both big banks and credit unions, that can help me consolidate my private loans so that the payments are more affordable. With my private and federal loans my monthly bill comes up to $1500 and that is about how much I make in one paycheck but I also live on my own and have those bills to deal with as well. I'm in the process of lowering the federal loans and hope to hear good news from that, until then I'm in forbearance. My parents are helping me pay one of my private loans while I take care of the other. I really don't want to have my parents have to foot my bill, at least when I know I can take care of it if I can just get them consolidated. Has anybody gone through a similar situation and if so, we're you able to find a lender that would consolidate such a high debt? I've tried with Wells Fargo but got denied with a cosigner. Other lenders couldn't help me because my school made me ineligible for their program, or my debt was too high. Does anyone know a lender in California that would consider consolidating a student loan debt this high? I've been trying to figure this whole thing out during my days off, before work, and after work. With just barely starting my job, I've been stressed out trying to learn my job and figure out my finances. I have found that there is no time to relax. I'm keeping up hope though and am still really excited to finally begin my nursing career. A little random fact: I was able to get the interview for the LTC facility because I share the same exact name, first and last, with the DONs nephew. I also kind of think that's how I got the job.