She Wants A Cookie, but We Only Have Crackers!!!

Brian, ASN, RN · Jul 15, 2015

I started out in the nursing home and had those same feelings of just being a pill pusher and not really using my skills. I felt intimidated by all the experience nurses who were so wise and seemed to know everything. As I grew more confident, these feelings lessened. I tried learning everything I could from all the experience nurses, I asked tons of questions, got involved with as many new experiences that I could. Eventually I found my confidence as a new nurse.

It just takes time. Be a sponge, learn as much as you can from those veteran nurses, they are full of gold nuggets! Once they know you are willing and desire to learn, they can be great mentors!

I remember having so much respect for several of the LPNs who had worked for 30 years, they were such amazing nurses and could run circles around most of the RNs. They were experts!

Best of Luck! It'll get better.

bluegeegoo2, LPN · Jul 16, 2015

I personally enjoy making my elderly people smile, if not laugh. I try to keep in mind that they sit there doing the same thing every day with the same schedule and most appear very bored. It's my mission to try to get a smile/laugh out of as many of them as possible each shift. It's kinda cool to see some of them light up when I come on, asking all hopeful "Are you my nurse today?"

Also, while passing meds (why do I think it's funny that I was auto-corrected to "mess" instead of "meds"?) you can get bits of history here and there, and assess for pain, depresssion, cognition, etc. We don't have the time for a nice sit-down conversation, but can have conversations over time. They enjoy that you remember little details of their lives and once they know you're interested in them as a person, they offer great info about themselves that helps you know who you're really taking care of as opposed to "the diabetic with a cane that has a limp."

Once you get to know your residents well, you'll be able to catch very subtle changes and implement interventions quickly, helping them to maintain a quality of life. You may not realize that you are assessing everyone you interact with but you are. It's beaten into us through nursing school.

When I started in LTC, I felt much the same way as you. I was ready to save the world and felt that I had all of these awesome skill sets that were being wasted d/t non-use. I had to change my perspective to see that it wasn't what procedure I could perform on someone, but what I could provide to that person to make their day a little brighter. Once I found what that was, (laughter) I've been off and running ever since.

amoLucia · Jul 31, 2015

Dear OP - Don't let stable pts lull you into a sense of false security/complacency! They will have changes in status too, albeit maybe not so flaming dramatic as in the acute care setting. And it's you (with your new & expanding skill sets) who will be the sharp one to catch subtle changes.

Give yourself some credit because I am.

You have inquisitiveness, interest, caring, desire, etc going for you right now and that is priceless in a setting that sometimes becomes stale & complacent. Don't change. LTC is tough for us all, but esp for newbies like yourself.

Even with all my years of experience, it took me time to get to know my pts. Most esp when I was a new employee (and I DID change jobs). I learned to rely on the CNA staff for their in-depth knowledge of my pts. Almost always when they told me something , they were correct.

You're not in nursing school anymore, so there went the luxury of those in-depth case studies that you used to enjoy. In the real working environment (even for us antique ones) it's a short, sweet and brief and absolute minimum what-do-I-need-to-know-to-get-up-and running kind of thing. The secondary stuff (the nice-to-know stuff) will come in dribs & drabs as you go along.

The 2 best pieces of the chart to learn info (for me, anyway) was to quick read the MD Comprehensive Diagnosis List and then the Social Service Notes (can be very enlightening). I made it a point to do a quickie review with a chart if & when I could. If something jumped out at me, I could look into it later.

I'm not saying I had the luxury of time to do this every time I charted on every pt but it was a starting place. And needed repetition freq.

Like PPs said, it will take time. A precious commodity in LTC!!!

You know, there are some intangibles in LTC that you or no one else can ever measure. Like how do measure the fleeting smile on a LOL when you tell her that 'her husband looked like such a handsome man' in the wedding pix on her table?? Or 'what an interesting tatoo' on a LOM's arm and then he tells you quietly that he served in the Navy at Pearl?? And that 'he still weighed the same 115 pounds that he did then?? (I once commented on one vet's cap and I was privileged to learn he was a survivor of the USS Indianapolis.) I mean, like is that a cookie or a cracker for you???

It's not meant as a clichÃ© when posters tell you to give it time. You're learning things everyday even though it's tough to measure. Just remember to allow yourself to be a non-nurse when you're not working.

Good luck and hang in there, We need caring people in LTC.

BoyNamedSue · Aug 19, 2015

Thanks, everyone. When I wrote the op, I was kind of feeling down on myself. Lately, I've been reading the charts when I don't have to, studying info on my iPad. It really gets me thinking again, and that's the one thing I really felt bad about. I felt like I was not doing anything. Now, I feel involved in the care, staying mentally fresh, and subsequently, I don't feel nearly as bad as I use to.