Jen4nursing

Hi kbvn3210, I lnow it seems overwhelming at first but you will get the hang of it and a routine will develop. How long have you been working LTC? I always started my vitals for BP meds right after report and those that had foleys or circaid dressings I would do then when 0800 came i would pop the meds for each patient in the dayroom having breakfast and used a zigzag pattern to get to the ones in the rooms. Then I would chart what needed to be charted and then take a break. Unless some incident occurred lol. Then I would do wound tx and then rounds. Then the next med pass I would do all my diabetics before lunch and pass the 1300 and 1400 meds together. Then I would chart, order meds, clarify or put in orders, finish wound tx. Then 1700 med pass I would start with who was at my cart and in the dayroom for dinner and then zigzag through the rooms. Then I would catch up on more charting such as UDAs and monthy summaries. I was busy from the time I got there until I left. Give it time it takes time to get a routine that you are comfortable with and what works for you. Hang in there it will work out.

Your very welcome. Like I said if you go into LTC just remember it is going to take time to establish a routine. You will not be as fast as the other nurses and you shouldn't compare yourself to them either. Find a mentor if you can. Also please double check your medications before you give them. This is critical because I was doing a med pass on a new floor I didn't know the patients and there were no name bands so I asked the CNA if that was such and such and she said yes i put the pills in his mouth and looked at the.photo again and realized it wasnt him so i told him please spit those out. It could have been horrible. I confronted the CNA and she said she was busy and really wasnt paying attention. It could have been so bad. The guy also was almost like a twin to the other guy so it was subtle features that made me take a second look. Also never assume anything fact check it because as a new nurse this also got me in trouble. I had a psych patient and when given report the nurse told me she gave that medication (psych med injection) the medication sounded the same as another one and I just assumed she was talking about the psych med. Come to find out she did not give the psych med and he went off throwing stuff and attacking staff they said it was because I failed to fact check and just assumed. So be careful. Check check and check and for the love of God document everything. You will do great and please continue with your education it will open so many doors.

Hi Valleyval621, First let me apologize for not getting right back to you. Life has been hectic. In my first year of nursing I started as a vent and trach pediatric nurse because this gave me a specialty skill. It is in a home care setting but you only have one patient and as a new nurse I thought this would help me be more confident and not so nervous. After getting 2 years experience in that setting I moved on to geriatrics. I worked in all units the sub acute, alzheimer/dementia, and 2 ltc units. I felt more comfortable in home care pediatrics because it allowed me to not get in over my head until I gained more confidence. Ltc is very busy for a new nurse and you will feel in over your head at first. The important thing is to find a mentor (a seasoned nurse). I was lucky to have one and boy did she help me a lot. My first week I had a code and she walked me through the whole process. The med passes were crazy but once you get to know who takes what and who they are you definitley get faster at the med pass. I feel you should get the clinical experience because you are going to get your RN and if you have a clinical background this will help you land a job. Homecare pediatrics is great if you want a specialty skill but you would need clients on vents and trachs. All in all it is up to you but nursing is not easy or everyone would be a nurse. You will hear horror stories and nursing homes are notorious for heavy patient loads. I worked with 25 patients a day and when I worked nights I had 50 patients. After 3 months of working there I gained confidence in my skills and I really enjoyed it. My issue was with management shoving more work down your throat daily because other nurses were slacking and our unit manager never helped on the floor. So I had to do med pass, wound tx, charting, had 2 incidents to report one day and had a discharge, transfer, and admission all back to back and my manager did nothing to help me instead she yelled at me that they need measurements right now. I was in the room with an admission. I told her I dont have time why cant she do it and I got wrote up. So my story to you is nursing homes will give you the experience you need in a clinical setting but is also very stressful. If I was a new grad going into a nursing home I probably would have quit. However there are new grads that do great and there are nursing homes that are great to work for you just gotta find the right one. I wish you the best on your journey and if you have any other questions please feel free to ask me. Congratulations on becoming a nurse it is very rewarding.

I remember how it was my first time as a new LPN the only job I could find was homecare. Eventually 2 years later I landed a job in a nursing home. So all you new LPNs I would love to be your mentor if you have any questions that will help you on your journey please ask me if I don't know the answer I will help you find it. I know I was scared my first time my patient was a 1 year old with a trach and she desatted a lot. It was a challenge and even harder because I didnt have a mentor. So please lets discuss strengths and weaknesses you all have as a new LPN and remember the only dumb question is the one you don't ask

Thank you all for the responses I have a job now because God is great. I will definitely use all your advice in the future. Thank you

Thanks for your comments. I did have a job lined up when I put in my resignation letter because I wanted to leave on good terms but the second they got it they fired me. I found out from a friend that he was giving me a bad reference. Also I had 2 NP's as a reference so I thought I would have no problem getting that job. But the ex boss gave bad reference and I dont know if I have the job now. I have not been told they are not hiring me only that they are waiting for a position to open and they will give it to me. But I had an Interview on Monday the 13th and sent resignation letter the 13th and was called by the administrator on the 16th telling me to come get my last paycheck. Maybe I just need to wait a little longer but I am still putting in applications while I wait.

So I was just curious on how many nurses have left their jobs due to hostile environments and the boss fires them as soon as they put in their letter of recognition. I am in that boat now and I need that reference as that is my only clinical experience. How have you all dealt with bad references?

NursesRmoFun, I honestly feel that LTC facilities are just difficult period. I worked in their sub acute, Alzheimer/dementia and both LTC units and they were all horrible. The gossip and laziness were beyond control. Cnas ran every unit. They would give showeres and not tell the nurse so we could do skin checks then when they came out of the shower room I would ask do they have any skin issues, and they respond no. Had three days off came back in and same resident has a DTI. They are vindictive and when you ask why they told you the resident had no skin issues they tell you I did tell you basically putting all the blame on you. The other day shift nurse would have potlucks at the nurses station, gossip and was very loud laughing and joking with the CNAs. This was acceptable by management as she was there too. All while call lights are going off and residents foley bags need emptying. Just all around evil people. I sometimes feel I should just get out of nursing because no one cares anyway. at that facility so I am glad I left.

Kooky Korky I just want you to know that the "Don't question my intelligence" was not directed towards you. It was the other post that insulted me. Anyway I like the advice you gave and your right getting out was my only option. I just should have seen the red flags there with all the good nurses and CNAs leaving I should have left with them. Lesson learned for sure. I am halfway through my Bachelors degree so maybe that will open more opportunities for me away from LTC. djh123 That post is hilarious I was thinking that sounds like a place for me hahaha. I am beginning to think that all LTC facilities are bad. Thankyou all for the repsonses.

Thank you Smiling Blue Eyes that is so true but my problem is that I tend to not say anything until it builds up and eventually I can't take it anymore. Your right staying calm is the right way but I tend to react in the moment and I need to work on that. I also need to understand that we all don't have the same compassion or work ethic. I know I have my own faults and will work on them but I just wish those that worked in LTC were more compassionate I mean these are people's family. These patients are important to someone. I burnt out and I have only been in LTC for 2 years before that I worked pediatric trach and vent home care settings. The atmosphere is so different. I have been a nurse for almost 5 years and this is the first place I have worked that I have seen people that blatantly just don't care.

Autumn apple that is a great saying and you are correct we do deal with difficult patients all the time. Thank you for sharing that.

Rose Queen, You are correct also I did not help the situation but when your patient is almost on the floor and the CNA told you I'll be there in a minute it is what came out of my mouth I may have been in the wrong but it was not done to demean the CNA it was that I needed help now before he falls. I respect your responses everyone's in fact. Please if there are other ways you deal with insubordinate staff please share with me again thank you for all your responses.

Thank you Kooky Korky, This is the response I have been waiting for. I know how you feel on not getting recognition for your hard work. This is how I felt at the job I quit. You are also 100%correct I need to be more assertive in my position but I will always have the respect for CNAs that actually do their job its the ones that are there just to socialize that get under my skin and this is where I need to internalize the most. I treat parients and their family like they are my own. I did not want this resident to fall and I was yelled at for changing my tone when I said "No Now" right in front of the CNA this is not okay either. The CNA said he did not feel like I was yelling he said you needed my help that it was okay. I apologized anyway as I did not want him to think I was yelling. The unit manager saud thank you to me for apologizing yet the next day I was called into administration and was write up. When you get attacked daily for being an advocate for your patients it does wear you down.

Well i thank you all for your input and will definitley work on my communication skills as suggested. Just so everyone is aware I am an American born and bred and yes I am bilingual but my first language is English I am a straight A student and English and writing happen to be where I excel. I have been on the Deans List every year. So for me it is hard to type on my cell phone and when I am so full if emotion I do miss the grammar errors. So please don't question my intelligence. I am simply asking how do you handle problematic CNAs when you have no management of any kind standing behind you. I assure you I am a very kind person and all those that know me understand. You all don't know me. I respect your input and will definitely use the advice but when you have gone by the book and other nurses opinions and you still can't get through to your staff and your patient gets injured or falls because the CNAs simply won't do their job because there are no repercussions where I work then wouldn't you get fed up as well????? I am simply asking for advice on how to handle insubordinate staff when no one backs you up. Thank you all for your input.

I again apologize for the errors in grammar as I am writing this on my cell phone. I also would like to point out that I have never asked the CNAs to do anything except for their job. When I had time I helped pass trays, ambulate, change briefs, and put patients on and off toilets and in and out of bed and changed bedding. There were times when I was crazy busy and when I asked for vitals or to help turn a patient they would whisper amongst each other where I could hear "what a *****" and I asked nicely these were just vindictive women I have no other word for it. The other nurses told me to stop being nice thats why they are targeting you. I put up with it for a year before I started writing them up and when I started the write ups thats when they started complaining to management. Nothing was ever done and they knew they could get away with insubordination. An example was with another nurse and a new CNA the nurse asked her for vitals and the CNA started yelling at her and told her "dont tell me what i have to do i know my job i have been a CNA for 14 years "and the nurse told her "I am your superior and you will do as I ask it is in your job description" and the CNA continued to yell obscenities and the nurse told her "I am done talking to you". It was reported with witnesses and she still works there. This is why we have so many nurses quitting and they all said the same thing "The CNAs run the units". Also we do have a chain of command its like this: Nurse>>>unit manager>>>DON>>>>administrator. These steps are never taken it goes direct to the administrator because again the problem CNAs are related to him or they have been friends of the family for years. Its a no win situation. This administrator was asked to step down due to complaints from nurses. He has been fired from every administrator position he has had at other nursing facilities. The unit managers are LPNs and grandfathered in because to my knowledge they are suppose to be RNs. I was just wanting to see how other nurses dealt with insubordination when you have managers and DONs and administrators that wont back you up. Thank you all for responding.

Thank you for your response Ruby Vee, I do look at myself often and ask all the time i could have said bettef yes but she smokes so i know when ever she gets upset i tell lets take it outside so she knows what i meant by that. I agree management is hearing CNAs complain about all the nurses on a daily basis because they dont like to have things delegated to them but when they are taking lunch then taking another e0 minutes to eat it on the clock at the nursing station and playing on their cell phones it us a huge problem the other nurse i work with says nothing to them and they are very loud even doctors have said something to them because we couldnt hear each other talking about a critical patient and they were not nice they yelled at them to shut up. I also forgot to mention that the administrator the managers and several of the office workers and employees are family annd some have been friends for years this is why nurses dont get backed up. I agre i can work on myself too but this was 2 years running of the chaos and i got burnt out i guess you could say. I care about my patients like family and it killed me everyday to see the staff just not care. The environment was not a match for me. Although i jave met about 5 CNAs that say i was the nicest nurse they ever worked with but i never had to ask them to do their job because they just did it without question and they were good at it. Thise CNAs work PT somewhere else and they asked me to go to where they work so currently i am with the best CNAs you can get. Two of them i even talked to about going to nursing school because they were so compassionate and they are now in school for nursing. I need to work on bit letting people get under my skin and fix it before it gets to the point where i cant take it no morw but when you have complained and done write ups and nothing is fixed then you kind of feel isolated which is how i felt. I thank you for your opinion as an outsider looking in and i will take your feedback as a positive one. I think the environmnent is what did me in though.

Thankyou Tricia J RN You are corrct it is easy to fall into the trap and i do look at myself often and i need to work on my assertiveness for sure. That has always been my weakness to avoid conflict I just do it myself but as a nurse there comes a time when we need help and where i worked you were on your own. I have moved on i work with colleagues now that have the same compassion and we work well togethef and have the same work ethic. I just needed a kick in the butt to leave and find the right environment. Thank you

Thank you Qing I am respectful to my CNAs i know they have a hige workload just like me. I ask them if they need help and they tell me no thankyou we got it then i find out they tell the other nurse on Opposite days that i never help them. The other nurse never backs me up and so i am portrayed to be the mean one. I am just fed up with the insubordination its supose to be a team effort to help the patients but i see that LTC is just for highschool drama and to get away with what you can and still get a paycheck. I have a new job and the staff are phenomenal i dont have to babysit the CNAs they know what their job entitles and they care for the latients. We work as a team not plot against each other. I guess the environment was bad at my old job. All they cared about was a paycheck. This new team cares about each ither and getting each other through a shift with the best patient care we can provide as a team. I just needed an environment i could thrive in not die in. Thank you for all the responses i do take them seriously and am not offended.

Please forgive the spelling i am using my cell phone sorry

I would love to give you the whole story but it happened over a span of 2 years it would take too long to write. I love my cnas the ones that love their job they come in and they work their tails off and i gelp every chance i can but then you have the lazy ones and those are who i have been having problems with. I asked one to empty a full foley bag as i was in a med pass and couldnt stop. She said she would but when i checked it was still full this was an hour later. I emptied the foley bag and asked the cna to talk to me for a minute and her response is nope im good. You see they dont say that in front of management. Our management is never on the floor our unit managers are in meetings all day and mind you they are not discussing work for the whole meeting i have walked by for supplies and they are discussing hiw the party was great, hiw ones farher is sick, joking and laughing avout non work related issues. The unit manager us on the floor after the furst meeting fir about 10 to 15 minutes and then another meeting is called this foes on all day. The unut manager does not help nirsing staff and the nurses are stuck with doing cna work because we cant enforce the cnas to do their job and we have to answer phones, med pass i have 25 patients, w g tube and have to do wounds, measurements, admissions, COCs, talk with family and doctors, as well as do treatments and gid forbid an RMS. This gets overwhelming and is why the nurses where i work are leaving.

I get what your saying but i am not going inti extremes to write a novel i am only giving bits and pieces of what happened first off i did not continue yelling i basically talked over her to go outside so she could calm down. There were no threats made ever i removed her from the situation which left 2 other cnas at the station which is our protocol. Second you must have never worked with rude cnas or insubordinate ones at that to leave harsh comments like you are doing. You dont know the whole story as i dont have enough time to write it but i gave her every opportunity to correct herself and she still did not. You see this is my problem i am very nice to them and then they advantage and the second i stand up for myself they claim i am the mean one when i listened for over 20 minutes of her screaming profanity and how she is a nurse because cna has nursing in the initials . I could go on and on as this wasnt a one time occurence this was daily with her. The others dont listen to the nurses because we are not backed up by management so when we try to enforce care we are laughed at. I am not the only nurse dealing with this there are 7 nurses that quit already and 5 more are quitting with me. This is what my post is about. Thank you for your input.

So that you understand better i told him that i needed help with a resident before he falls on the floor he knew i needed help to pull him back up in his chair. As this resident slides oyr of his chair all the time i even tild he is almost ob the floor. The second was when i said outside she smokes so i said lets go outside if i need more detail i apologize i just didnt feel like writing a book. I wanted her away from the nursing station.She knows by outside i meant in the smoking area. But what she said at the nursing would take me 10 pages to write and the family of the decreased was right there listening to her screaming and yelling i figured if i had her come outside smoking area that i could get her out of the nursing station.

Thank you for responding Ruby Vee I tried to get right to the point without dragging on anyway it statrtes when i had trouble with a cna being insubordinate i had a patient pass away and protocol is for the nurse to call the manager anyway the cna called and notified manager when i confronted her she yelled at me at the nursing station and said she is my friend i can call her and tell her i tried to explain but she kept screaming at me so i yelled back enough we are giing outside now. She was friens with management and staff so i got a write up immediately for being mean. Anyway almost a year later and i needed help with a resident and asked nicely for a cna to help me real quick and they responded ill be there in a minute so i raised my voice a little in a sense of urgency no now. The manager came out and pointed her finger in my face and said the cnas were conplaining that i was mean and disrespecting them and that i cannot talk to staff like that. So next day i went with the manager to the administrators office as directed and i git wrote up explanation was you have a history of yelling at staff which is completely false. Third incident was when a cna refused to do her job so i reported her and sent her home she got a write up and the next you guessed it i was called in the office with administrator and manager and was told that the cnas said i was mean. So yes another write up and them saying again i have a history. Ugh feeling frustrated i went back to work anyway and ever since management takes every complaint to the administrator she never attempts to do it through the chain of command. They bully you because they know if the nurse says anything we will be written up. The gossip there is ridiculous and the residents are highly neglected by the cnas so staff has reported them and always end up fired so yes i quit i feel i did the right thing as they were lying and the administrator would not let me defend myself instead he would just stop you from talking and talk about what a wonderful administrator he is.

I will make a long story short but our administrator has been asked to step down and he hates me so for the last couple months the manager on my unit takes me directly to him for anything (all had nothing to do with nursing it was only gossip from coworkers) so I am under the assumption that they are trying to get rid of me. There are several nurses and CNAs that are also quitting and I am too after all they are trying to fire me so I believe. The administrator is a narcissist (said by many a nurse). The management run to him for everything. I have never seen such poor management ever. They are bullies and i know hes stepping down soon but i couldnt take the bullying anymore so i quit l. Should i have stayed? What would you have done?