1st job/1st week in nursing home- help!

[brown127]

I graduated from LVN school last month and was happily surprised to get a job in a little under 2 weeks. It's night shift (not a problem) 4 on 2 off (which is hard) and I'm a charge nurse over 60 patients with 2 cna's, 1 of which is great. The other disappears and is not helpful when she's there. The rest of the facility's halls are only 30 patients, but my hall is long, or something. One of my classmates started with me and was assigned to a shorter hall, and she's already quit. I've done 2 shifts by myself- the DON is off site and didn't return the one call I made to her after a fall, of which I've had 2 minor falls (one each day) and had to do neuro checks on another patient yesterday due to a fall.

I've gotten all my work done, but I've run behind on charting. Yesterday, I took an extra hour and a half after my shift to finish (notation by exception), and today it took 45 minutes.

Also, my first night state called asking for the lady I replaced (she complained to them about the ratio), then they asked if there was another nurse on my hall- which there wasn't. I didn't complain to them or anything, but I did tell them the truth. I'm a little worried that this will make the administrator mad, but I'm also not going to lie.

Mostly I'm worried about staying over for charting and not taking lunch. In my orientation, I was told that I had to take a lunch and unauthorized OT was bad. I'm seeing ways that I can improve- my problem tonight was largely due to a belligerent patient with a med order that had been changed in his chart but not in practice. That would have saved me a good half hour there. But I've got to get my work done!

So, any tips on getting through stuff quicker? Also, what experience do you guys have with OT and staying over like that? Is it usually a problem? Any insight about that ratio? I don't think it's illegal, but it sure does suck.

And yes, my plan is to work a year and find another place.

Thanks!

[brown127]

Also, would it be okay to ask my supervisor to transfer to the shorter hall that my classmate left? I don't want to be a complainer, but 60 patients is a lot.

[Guest27531]

You are definitely in a difficult situation and I'm sorry to say I don't have a complete answer for you.

There is certainly nothing wrong with requesting a transfer to another floor (it may or not be possible) but be sure you want it before you ask for it. Just because there are fewer patients doesn't mean it will be any easier. The patient acuity in that area may be higher. Before I became a nurse I worked in a nursing home in California where there were four units (four hallways). One had noticably fewer patients there, however, I was glad I was not assigned there because my best friend (who sometimes worked there) told me about the condition of the patients. They were not just weak and elderly but they had more serious medical conditions requiring ventilators, suctioning, wound care, turning and positioning, etc. Fewer patients doesn't always equal easier workload. That said, you may prefer to organize your own work (and work physically harder) to manage those nursing needs rather than to constantly be worried that your patients will fall when they try to walk to the bathroom. But do check it out as it may be an improvement over where you are now. There's no harm in asking.

I will say that when you have had the job for a longer period of time, your workload may seem easier as you learn ways to streamline your charting, increase your patient rounds (to prevent situations leading to a fall), and learn your patients better. I'm sure some patients can be left alone for longer periods of time and others must be checked more frequently. Once you learn who is who and what their needs are, your life will get easier.

Congratulations on planning to stick it out for one year, if possible. It does, however, sound like there may be problems other than just a heavy workload, as evidenced by former employees notifiying the authorities that conditions are not safe. Keep your eyes open and do your best but also don't be overly concerned about whether "administration" likes your answers. You are telling the truth, when asked, which is the right thing to do. Until you are more experienced, you may be wise not to volunteer additional information. When you interview at your next job (whether it is after one year or before) be sure not to talk about conditions where you are now working. Just say that the job was not a "good fit" for you. Even if you decide to report the organization to the authorities yourself, do not speak about your experiences at this institution to any other employer.

I wish you and your patients good luck.