Really struggling with first job in nursing home

eldragon · Nov 28, 2009

First - ask your charge nurse to get everyone who isn't wearing an ID bracelet - an ID bracelet. State will cite the facility if they aren't wearing them.

You don't need to memorize the cart. You just need to understand where things go. A well organized med cart could/should be operated by anyone at any time - including an agency nurse.

Take your time and try to relax. It gets better over time. I worked LTC for 18 months and while I was always busy - I was bored to tears of the same monotony everyday.

Don't worry though, you'll get it.

sasha2lady · Nov 28, 2009

It does get smoother with the kinks included. A nurse told me when I was new "it's not about how fast you are,it's about how accurate you are." and she was right. It's overwhelming, the huge load you are given in a snf and expected to get it all done. What has been a Huge help to me (I can't emphasize this enough) is the trusty bright colored sticky notepad. When I am going through my hall with my 27+ residents if something comes up like a new antibiotic or if one c/o cough etc I not down info on my nite and stick it on their mar so that when I do my charting I'll see it and remember that I have to make an entry about that person. I also put all my charts out in front of me at one time and as I complete each one I put it up. I make a list as I do a pass of what I need to restock on my cart (otcs,needles,lancers,alcohol pads etc) and before I start my hs pass I restock and then head on down . These things helped me pick up speed and keep me better organized. As for the I'd bands I know the kind we use come apart too easy or the residents take them off but we have pics on each mar which helps. Always ask if you don't know who a pt is . It will naturally be harder for you since you only get prn exposure but hang in there and it will ease up.

Pegasus65 · Nov 28, 2009

Hi you guys and thanks for replying...

I did mention the ID bracelets the first day I was there. I actually don't feel I know where anything goes or even where to get anything. I constantly have to ask where this or that is. I keep being told that I will learn to cut corners here and there to save time and to only worry about doing it "right" when I am being "observed by state", which I must say makes me wonder if I need to be here as a newbie. I know that everything can't always be done by the book like we are taught in school, but if you get into a habit of doing things wrong just to "speed up" isn't this bad? I am also expected to sign off on some of the meds I didn't even pass. That scares me because I know who is going to be thrown under the bus if there is a mistake somewhere... it won't be them.

As far as pictures in the MAR.. there are NONE, which also struck me as odd since the facility I did some of my clinicals in definitely had them. I know I am green as grass and easy to get anxiety but I am dreading going in there each day and that shouldn't be the case. I think this facility has already been through like four DON's in the last year or so.

I have a sheet I have been making notes on so as to aid myself in any way possible, but I am not sure even that is going to cut it. I will be there today and tomorrow with someone, off mon-fri of next week and then totally on my own next weekend. I just hope I can cut it lol.

Have a great day!

jensmomrn11 · Nov 28, 2009

I also started in LTC per diem straight out of nursing school and I too work every other weekend. I only had 5 days of

orientation on day shift and was then put on weekends on 3-11 shift, which in my opinion, is harder than day shift. On 3-11

you have 2 big med passes. I have been at my facility for 6 months now, and still dread going to work and still am not totally

confident in my skills. I still have nights when I am doing a procedure for the very first time. Thank goodness the experienced nurses on this shift are understanding and are always willing to help. We have pictures of our residents attached to the MAR and also how the resident takes their meds (whole, crushed,etc). This is a big help, especially since there is always someone new after not working for 2 weeks. It took a little bit of time, but I can now recognize a majority

of the residents and know most of their little quirks. I am still nervous every shift, but I can say I am not quite as nervous as I was 6 months ago. Every time I end a weekend, and everyone is OK, I feel a little better about myself. I know confidence comes with time, but I can't wait for the day that I feel like a real nurs.

kat7ap · Nov 28, 2009

I've been told that nursing home residents are not required to wear ID bracelets. After all they are "residents" not patients. The nursing home is their home. So this is not an uncommon problem. Photos on the MARs should be in place. I've found that just asking the other staff members who is who is the safest best way. I wouldn't rely on asking a patient are you "john doe"? Half of them might just say yes, when they are not really that person. It's better to ask them to tell you their full name if they can respond to you. LTC is hard and it may seem like you are expected to work miracles half the time. Keep at it and you will become more proficient. When you get time, try to organize the med cart better. Make notes on residents and their needs. In time you will usually be able to anticipate when/what is needed etc. etc. There are going to be days that are miserable though, but try to get through it to at least gain some experience. I decided LTC wasn't for me, but I put in almost a year before I was able to move on.

princezzzz · Nov 29, 2009

i feel exactly how u feel. im also a new grad, and wasted a lot of opportunities bec of anxiety.

ive already quit 3 jobs, my longest was 1 month. ^_^ i know its wrong.... but im just trying to get in to my previous job when i worked as a cna and Im gonna feel better.

its really hard, but we have to start from somthing. 30 pts is not bad.

my recent job offer was 50pts, and low pay rate, so i turned it down. :down:

but i still thank them for giving me a chance.

still now i dont know how to start my vn career.

so for you i suggest to hang on, and dont be like me.

Ilovehospice · Nov 29, 2009

Hey cheer up just try to stick with it if its something you want to do. I tried it when I got out of school and I lasted a couple of day. I just couldnt do it. I didnt want to push a cart around and it was too much for me. I went to work at a locked psych facility afterwards for a couple years and then I did adult psych but not in the hospital . I then discovered that I wanted to do hospice and I have been at it for 6 years. I was so happy I found what i loved. I knew what I didnt like very quickly though. Now when I go in SNF's I am just going in for about an hour and I am so happy to leave. Its such a depressing place sometimes. But its takes a certain person to do a good job in a SNF just like it takes a certain person to work ED or NICU. I know I dont want and could not do either one even if I was an RN. You give it a chance and try not to get too stressed out.

Pegasus65 · Nov 29, 2009

Hello again everyone,

I am going to give it my best shot for the next few days because I truly do not like just "giving up" without a fight lol. I go in this morning and then they have me off until next weekend. I am not sure that skipping an entire week after this short of an orientation is in my best interest though. I have done 7 days of orientation (I was told I would get 5) and another new LPN there told me they gave her three weeks and that they would give me more time to if I asked for it. I realize that I am going to have to get out there on my own at some point I just want to be safe. I passed a lot of the medication yesterday, but for some reason I am uncomfortable with the tube feedings. I am going to ask if they will let me come in perhaps one more day towards the end of next week. I have a dental procedure tomorrow so want to give myself a couple of days after that to recuperate, as it really caused me to have TMJ issues last time.

I love the elderly folk. One lady there has told me each day what a pretty smile I have and that she likes me:) When I gave one woman her eyedrops yesterday she looked genuinely surprised and says, "hmmm I almost never get these". However, like the previous poster said I am not sure that pushing a cart around is going to be something I want to do. Maybe I will eventually find my niche.. I sure hope so!

Have a great day everyone!

jeweleebleu · Nov 30, 2009

:ancong!: to all of the new grads. i am also a new lvn grad patiently awaiting for my initial license in the mail so i can start working. but just a word of encouragement...it is obvious that the facility you are working for saw qauilities that will be an asset to their team. just remember anything is possible and you only fail when you don't try. i work as a cna in a ltc i know that the two scopes of practice are non-equitable but i can say that when a resident pays you complement or tells you that you have done something that no other staff member has done it makes you feel as though you are the best at what you do... even if the gesture is small!:redpinkhe

i think that using a post it pad is a great idea! definitely address the id band situation!!! one poster stated, "residents do not need id band because they are residents". this very well may be true but...we must remeber that asking another staff member is fine but there may not always be a staff member at our disposal. not only that but the staff members in the building are not the only people who come and care for the residents. what about the doctors, hospice, or even phlebotomist who are drawing samples? it is for the safety of the resident and reduce liability and malpractice of the facility (it happens!).

don't feel pressured into signing for a medication that you did not pass or a procedure that you did not do you have the right to say no and if the facility makes it an issue you have to stand back and question their professional ethics and values. i wouldn't want someone to force my hand like that either because at the end of the day when it is all over said and done that is my licensing at stake and i wouldn't want to be stand before the nursing board begging for my license. :crying2: :sniff:

just remember to stay true to who you are and what you believe and the reasons why you went into nursing. you have a positive attitude about the situation and you are going above and beyond to do your best...and that is all you can do. before you know it you will have this down to the science and you will be teaching someone else the in and outs. good luck!!!:dncgcpd:

kat7ap · Nov 30, 2009

it's not that id bands aren't neccessarily needed, it's because the resident has a right to not wear one as they are a resident of the facility and it is their home so it is viewed as a quality of life issue. at least this is what i was taught in nursing school and cna school. when i worked in ltc really no residents wore id bands. it is really not that difficult to learn your residents after a few days.

i think that using a post it pad is a great idea! definitely address the id band situation!!! one poster stated, "residents do not need id band because they are residents". this very well may be true but...we must remeber that asking another staff member is fine but there may not always be a staff member at our disposal. not only that but the staff members in the building are not the only people who come and care for the residents. what about the doctors, hospice, or even phlebotomist who are drawing samples? it is for the safety of the resident and reduce liability and malpractice of the facility (it happens!).

Pegasus65 · Nov 30, 2009

Hello everyone,

Here is another update on my "lovely" situation lol...Well yesterday was day 7 of orientation. I have talked to many of my classmates who have went to work at other facilities and each of them was given at LEAST TWO WEEKS of orientation before being expected to go it alone for the first time.

I must say yesterday pretty much showed me I am NOT ready to fly solo yet. My preceptor was called away to try and find someone to come in and cover a shift on ANOTHER hall. For some reason the Unit Supervisor didn't feel SHE should have to do this. If I agree to take this hall they have me on for this upcoming weekend.. THIS is the woman who will be over me. I will be strictly on my own, as she is way down on another hall. They consider these halls to be one unit. They only have a Unit Supervisor on the weekends as the individual Unit Managers are off for the weekend. I can tell by the way she treats the staff that has been there for some time she will have NO patience for me or any questions I might have.

I was left yesterday to pass meds for about an hour and a half alone. Although I kept it together and moved as fast as I could while still trying to maintain accuracy it was nothing short of chaos. The residents were crowded around me in a semi-circle like kids in a candy store waiting. I could barely bend over to open a drawer. The medicines are CRAMMED in it in long sheets with little tiny plastic sections with room numbers. I had to LITERALLY PRY them out in order to find out, which med is for which time, while trying to go down the MAR and make sure I am giving it correctly. Then not to mention the OTC medications, which are in one top drawer... about 30 bottles of different stuff all lying on their sides that I have to go through trying to find what is listed..vitamins, colace, iron etc.... not to mention various odds and ends that are laying on top of those. I mentioned to my preceptor that I was having problems finding the stuff because of all the clutter and she had begun to straighten it up some when she was called away to try and find someone to cover that shift. One of the previous posters mentioned something about a cart being organized so that even an agency nurse could run it... hmmmmm well they did tell me when I was hired that they didn't use agency nurses... Methinks this could be the reason LOLOL.

I have thought about it and decided that I am going to call the scheduling coordinator and tell her honestly that I am not comfortable with this situation and that I don't feel like I am adequately orientated to handle this weekend after a week's absence. I am going to request to go in for two days later this week and then two days next week and begin my first solo day upon next Friday when the individual Unit Manager will be there to oversee me. She is a kind woman that I know will aid me if I need it. I was hired to work every other weekend and every other Monday and Friday. I figure if I can get through that Friday and then the following Monday, perhaps I can handle the following weekend alone there with no aid. If they are not willing to work with me then I see no other choice but to look for something else. I don't want to look like I am milking training hours because that is honestly NOT the case and I hate sounding like a whiny brat... but I have to put the welfare of all those residents first and not to mention my own newly obtained license. The only good thing I feel comfortable about is that I have pretty much learned all the residents... guess that is better than nothing lol.

Thanks for listening and have a great day!