jayni87

Hello! I was recently promoted to interim unit manager. I feel overwhelmed and frustrated by the lack of organization and accountability throughout the unit. The staff are for the most part good at their jobs, but there are many systems, or lack thereof, which make it difficult for them to complete all of their paperwork. Since starting, I reworked the shower days and skin checks to actually coincide, instituted a new system for aides reporting changes or skin issues, and have started audits of many aspects of the unit. The pneumovac audit was horrendous, the ppd audit was mortifying, etc. People are generally on board with my changes, and the only issues I've had with staff involve the fact that I've only been a nurse for 8 months yet I WAs the one promoted. My response to that is generally 'Did you apply?', then they get the 'Oh, well I guess I shoulda done that' look. My main concern is trying to get all this finished by the time state roles around so we can pass our survey. I feel like by the time I get one thing fixed, five other things have gone wrong. It's this constant battle to keep my head above water. Any advice for a new unit manager would be greatly appreciated. I'd love to hear from both unit managers and cart nurses so I know what is expected of me, as well as the best ways to help my staff. We have a lot of trouble keeping nurses, partially because we regularly work short. But that's because we can't seem to keep nurses. The nurses who have been there for a while are burnt out, and the new nurses are frequently scared off within a couple of weeks. I suppose I'm just looking for ways to get organized quickly, and for systems to put in place to make the nurses and aides lives easier at work. I look forward to hearing what everyone has to say!

I think we all know that LTC is no joke. Some places are better than others, and some are struggling to get by. In the end, it's always the residents who suffer. I'm a new nurse, one month into my new job. I absolutely adore the residents. I'm on the dementia floor, and some of the personalities we have make me laugh out loud. Others are very combative, but even they need someone looking out for them. The facility I work for does not screen their residents at all, they basically accept anyone. It's actually something I somewhat admire about the facility: everyone receives care, no one is turned away. At the same time, if our census is down more than 5 or so (out of 189 beds), management takes a nurse off each floor. Normally we have 3 nurses on my floor, each with 24 patients. When we have 2 nurses, we're looking at 36 residents each. It's doable with 2 nurses, and I feel like I'm providing good patient care. With two, it's a mad-house. First shift is angry at the night shift for not finishing all the orders, second shift is angry at first shift for the mess at the nurses' station and the 6 orders still up, and night shift is angry at second shift for the 2 orders we couldn't get to. Heaven forbid a fall or a new admission should come through. It's a revolving circle of bitterness and frustration. The nurses are responsible for passing all meds, doing all treatments, ensuring that tube feedings are up on time, changing colostomies (on occasion several times a shift...as I said, dementia unit so they don't always stay on), completing nurses notes, 24-hour report, our "adopt" program paperwork, 15-minute checks, re-ordering meds, as well as anything else that may happen throughout the day. A fall report takes a good 40 minutes to complete properly, an admission takes a good hour and a half to do properly, and we are constantly running down the hallways towards a chair beeping to make sure no one has fallen. Next: whether there are three nurses or two, we are expected to clock out at the end of shift exactly. There is no lee-way, we will get written up if we stay late to finish our paperwork. As a new nurse (both to the facility and nursing in general), I did end up staying 45 minutes or an hour late on the days that we only had two nurses so that I could complete all my paperwork. Even the seasoned nurses couldn't get it all done in time. This is adding to our cycle of bitterness and anger. I've heard around the rumor mill that they will be losing a significant number of their staff. People are fed up. I actually had to take five minutes the other night, walk outside, and repeat to myself "Don't quit, don't quit, don't quit" in order to get through the night. So, while I am certainly frustrated, I'm not ready to throw in the towel. There are probably many people out there who have been through similar situations. Are there any solutions that could be instituted? I have this insane idea that if I bring management both a problem and a solution, I could make a difference. Am I crazy? As I said, I adore the residents here. Some of them don't seem to hear or understand a word I'm saying, but I chat with them as I give them their meds nonetheless. Others understand me, but think I'm their granddaughter. Others give me suspicious looks as I coax them into eating their applesauce. I adore each and every one of them, and I want to try to help making their lives better. Please leave comments with ideas on how we can fix this. I'm completely flustered, and look forward to hearing from you all. -Jayni

Firstly, thanks for the Kennedy Ulcer. I'd never heard of that, so that was a good research project. Also, OP, please go on and become an RN! You obviously care about your patients, you're very literate, and we need more nurses like you!

Every situation is different, but speaking as an LPN, I wish I had been able to go straight through to BSN and get it over with. My husband was military though, so I only had time to do an accelerated LPN program. I'm looking to go back to get my BSN now that he's out of the military and we're settled. But as I said, every situation is different. There are definite pros and cons to each. If you want to work at a hospital as an LPN before continuing on though, remember that most hospitals (esp in big cities), do not hire LPN's any more. Your job while getting your BSN would be limited to home health, LTC, or rehabilitation. :) Just a few things to keep in mind while making your decision. Good luck to you!

Thank you for all the help! I'll definitely look into some of those options.

Wow, I'm in love with this post! It really has so much information, as well as some attitudes and ideas I hadn't considered before. I'm about to start my first job as an LPN, and it is in LTC. I will be working with 25 patients after 3 days of orientation, all on my own. I did the math, and if I spent 20 minutes with each patient, that would be my complete 8 hour shift. I can only imagine how much I will need the help of the other nurses, both in time management and in policies. This was a very interesting read, and I think I'll start my job with a much more open mind having read this. Thank you!

Hello! I recently graduated and took the Practical Nursing NCLEX. I'm now an LPN, and start working in 3 days! Hooray! However, I know I also want to go back to school and get my BSN while working. I've been looking around online for quite a while now, and it seems most BSN programs out there require you to already have an associates RN. I wasn't very intrigued by bridge programs, and wanted to just get into an ordinary BSN with no pre-requirements in the way of licensing or previous degrees. My question is: am I looking in the wrong spot, or are there really no BSN programs out there with no associates degree requirements? Do I need to do the LPN to RN bridge program, then do yet another bridge and do my RN to BSN? I currently live in Richmond, Virginia (in case anyone lives around here and knows of a good school). Thank you for your help, I'm looking forward to reading some feedback!

From what I can tell, the supervisor acted unprofessionally. All I can say is do what you feel and know to be the right thing. It's very difficult to make those types of decisions, as reporting his actions could lead to a worsening of your life if you do nothing. At the same time, if you report it, he could perhaps get the jolt he needs to remain calm and collected at work. No matter what your decision, there is always the risk of a negative reaction in some way. Just weigh the possible outcomes along with your conscience, and do what you think is the right thing to do. I know that's vague, but I'm not one for telling someone what to do in situations. :) I hope everything works out for you, and I'm sorry that you're under stress!

Wow, thank you so much, SquishyLVN! I wrote down everything you suggested so I can address it during my very short orientation. I hadn't thought of most of those, but they are all something I would be unsure of how to do properly! Whatdidigetmyselfin2, thank you for the advice! I'll be sure to make sure my cart is fully stocked, and that I know where everything is. You're right, that could be a potentially huge time saver! Any other advice out there? We new nurses are soaking it all in. :) And a huge thank you to all you wonderful experienced nurses who are so giving and helpful with advice and knowledge. Nothing can beat experience, and unfortunately there were no chapters in our textbooks on calling in labs.

Unfortunately, this is going to happen all throughout school. However, keep this in mind: depending on how your school works, things may get better. Our class started off with 25 people. At the end, we were down to 6. The first few semesters often weed out the trouble-makers who are more focused on reliving their highschool years than becoming safe-practicing nurses. There will always be students you don't particularly like. I had to swallow my pride quite a few times during school and do what would calm the situation/appease others rather than stick up for myself. It's a frequent battle between "What will make this situation better?" and "I did nothing wrong, so why am I in trouble?". Often, if another student who misbehaved witnesses you, a model student who follows the rules take her lashings without a word and with humility, they will calm down and take it too. If they have any decency, they'll remember that moment and try to improve their behavior as well. The most important thing, though: if someone irritates you and you want to say something to them, don't! Swallow that! School, in the long run, is the first part of you career as a nurse. Don't burn bridges, and maintain your professionalism at all times. You never know when having a friendly, or even a polite relationship with someone will come in handy. Hope this helps! Keep your chin up, and always remember to count to ten. :)

Hello! It took me a little over a month to find a job. It can take other people a little longer, or a little shorter. Don't be discouraged! Firstly, even if the posting says it requires one year experience, still apply. Focus on a cover letter, and never apply to a job without one. Make it personalized to the company, and mention that your school and clinicals gave you everything you need to be a successful and devoted nurse. It never hurts to apply. The job I ended up getting had an "Absolutely need 2 years experience in LTC", and I'm a new grad. Next, Linkedin.com! Once you apply to a company, wait 2 days then run a search on Linkedin to see if the company's HR representative has an account. If he or she does, send them a quick email. Make it short and sweet, thanking them for the opportunity to apply and mention that you'd love to get a chance to work for their company. The hardest part of getting an interview is getting your resume actually seen. Most online job databases filter out 75% of the applicants based on key word searches, etc. If your resume doesn't have the key word they're looking for, the HR department will NEVER see your resume. That is, unless you make contact yourself and they look you up specifically. Network! Anything you can do to make yourself more appealing, or even interesting, increases your odds of getting an interview. Make your resume merely show that you're qualified. Make your cover letter show who you are as a person. You can get more of yourself across in a cover letter than you can in a resume. Hope this helps! I know how frustrating it can be finding a job. It can make you doubt yourself so much, but just keep at it and think positive.

Just a thought: keep a pair of clean scrubs and socks in your car. You never know what will happen...it's best to be prepared. :)

I recently graduated and got my license. I start my new job in 4 days, starting with 3 days of orientation. I'm planning on having a boat-load of questions to make sure I'm as prepared as possible when I get on the floor. It's a LTC facility, and it looks like I'll be looking at a minimum of 25 residents. I know I can do all the skills, and we actually had a few clinicals at two different LTC facilities during school. However, we were only assigned 2-3 residents as students. I did have the opportunity to follow around several of the nurses there, and one of them had some really good advice on how to keep track of what you still need to do for the day. I'm planning on following some of her ideas, which should help out a lot. You're absolutely right that school doesn't prepare us for the workload that is common at LTC facilities. That is one of my anxieties about starting this new job. One of the things that may help is if people leave advice on how to deal with the workload. The nurse who gave me advice kept a piece of paper with her at all times (I plan on using a notebook and shredding used pages at the end of the day.) She used the front to take notes of things she saw needed done during her 9am med pass (this included who needed finger sticks, who had an oddly timed med due, who needed wound changes, etc.). She used the back to jot notes on her interactions with patients. If one had a complaint, she'd write the time, patient, and a quick reminder of what the complaint was. If one refused a med, she'd note that. If she did wound care etc, she'd note that. Once she had the time to sit down and write her nurses' notes or chart, she would refer back to that page to ensure she didn't miss anything. It's not meant as a write-everything-that-happens-down, it's merely a quick reminder to herself of what happened so that nothing would be missed, and her notes were insanely thorough at the end of the day. I know this is a simple thing, but I've noticed a lot of nurses try the "I'll remember this" method, and eventually something is going to get missed, especially as a new nurse. An experienced nurse who knows all the patients well may not need something like this, but it's a good idea for new nurses or nurses starting a new job. So, anyone else have any tried and true methods to help things along as a new nurse? Are there any questions that are often overlooked that need to be addressed during orientation? Hopefully my post helps someone somewhere, and I look forward to hearing what others have to say!

Hello! Congratulations on starting your program! I'm sure you'll do great. I actually just finished school and passed my NCLEX two days ago. What got me through it was a combination of things. Before each class I would "skim" (don't read it, you'll get burnt out too quickly...skim first) the chapters pertaining to the next class, then I would sit in the front and take notes during class. (Another thing to consider is recording your instructor. You need to ask their permission, but I learned best from listening to lectures.) If the instructor is too fast, ask if they can slow down a little. The worst they can say is no! If fellow students are irritated by it, it is their problem. As far as tests, don't stress! Just read over your notes the night before, go through the test review if you have one, and get a good night's sleep and a decent breakfast in the morning. Staying up all night trying to cram does more harm than good in 99% of cases. On the morning of the test, I would sit outside and relax (I'm a smoker, so I would grab a cigarette and chill.) until 3 minutes before class-time started. I would then go up relaxed, refreshed, and having avoided all the other students freaking out thereby stressing me out more. Anyway, good luck! Everyone studies and prepares for schoolwork differently, but hopefully something I did helps you. You'll do great! Whatever happens, just don't give up.

Hello! I just took my NCLEX-LPN yesterday and got the news today that I passed! Hooray! I've been sending out resumes today, but wanted to ask for any and all advice on my hunt for a new-grad job. My husband was in the Navy and got out a couple of months ago. I finished school where we were, then relocated to join him in Richmond, Virginia when I was done with school. I did very well (I think) meeting people and gaining contacts during clinicals, but all of that seems for naught as I won't be working in that area. I went to school about 2 hours from where I currently live, so I don't have any contacts for finding a job out here. That's a bit frustrating, but that just means I'll have to work harder to find a job which is not a problem. Anyway, any advice for me on job hunting in a new city with a new license? Thank you! I'm really looking forward to starting my career!