1st lpn job ltc 4months in :-) :-(

xtxrn, ASN, RN · Aug 11, 2011

4 months in Long story...New grad only 2 days Orientation on 1st shift to work night shift (big no no) from start. I started off as a weekend nurse 7p-7a(no balor) 1 day shadowing on nights with a PRN nurse who was unfamiliar with residents, unorganized medcart (straight nightmare med pass ridiculous) To cut out heaviest 9pm medpass n 3-11 lazy Cnas who were always MIA. Less than 90 days a full-time 11-7p M-F every weekend off came open I took that to free my weekends Still having 46 pts (ugh very overwhelming) still with no night shift supervisor bc she quit with 3 brand new lpns on 11-7 to cover more than 120 skilled & rehab residents. Our on- call nurse phone always goes to voicemail when in need. My 46 residents consist of skilled nursing 2 trachs 3 colostomys 3 g-tubes, ABT via IV, po, Im, 2 contact precaution residents, Dementia, bipolar, 3 Hypoglycemic residents (scary) I&O, changing out foley catheters......+ caretrackers, MDS, weekly, incident reports, Calling Dr in middle of the night, just to get fussed out about critical labs that has been passed down from previous shifts falls etc.. On top of that lazy Cnas that been there for a long time set in there ways..Very exhausting nights I have. On top of it all Brand new management just came in replacing the good ones with there own n leaving the bad ones.3 new nurses held a brief meeting with out aides to make our work a little easier and to let them voice their issues so we can work them out as a team but little to say it got better for a week or two. Now I have to turn into the bad nurse n rake action bc who really matter the most is the residents health and safety. I really love geriatrics but I want to explore my options to see what/where I feel comfy bc its not at this facility and by talking with my classmates at other ltc facilities its about the same, they are a little more organized than ny facility. I would like advice from other new n older nurses on what you think of my situation, because I need this experience to put on my resume at least 6 months n it will look better.Help Advice please.( sorry for grammor error/typos, needed to vent)

OK- first off, I don't know of a state that does NOT require RN availability 24/7 if they get Medicare patients. Second- you have rank over CNAs- if they don't work/disappear- write them up. Something has to change fast- and you are as much in charge as the other LPNs- and definitely over the CNAs. I know it's hard (and it's not fair)...but you can do it:)

Not all LTCs are like this :) You're not a 'bad' nurse for enforcing good care- you don't work for the CNAs- and they don't work FOR you- they work UNDER you (respectfully)...you all work FOR the residents :)

The 11-7 Mon-Fri is a good thing- and worth a lot if you like weekends to have fun. And, on nights, the brass is home (obviously) and out of your hair (though someone needs to be available for emergency questions). Once you get the CNAs wrangled- and make it fun, or as much fun as you can- things will seem better. You do have a lot of treatments to deal with- you'll get your own routine down.

But my big 'red flag' is the night number going to voice mail. That's not right- and if you get actual honest to God Medicare/rehabs you have to have RN coverage- not just the phone number of some RN who may or may not know where her phone is.. :uhoh3: That can be a big problem for you. If you can't get this straightened out, I don't think you have much choice but to get out of there. If something happens, and you can't get ahold of the RN, call the doc - if he gets ****** enough he will call the facility. You are only going to have to call if something is wrong- so the RN shouldn't get her knickers in a twist- it's her JOB!!! And the doc can be mad- you need to CYA if something isn't right. And if something is really bad, really fast- know the facility policy about calling 911, and the doc second- some places tell you to do that. That way, you're getting the resident help- and that's the big thing....be sure to ask the RN about that AND find the policy yourself.

I'm so sorry you're in the weeds like this- but it sounds like you're really up to speed about what should be going on- that's huge :)

If things can't be worked out- check other LTCs (other people at those places may be as overwhelmed as you are because they're new too- it doesn't hurt to see for yourself.... from what it sounds like, there's no where to go but UP

(((hugs))))

Midwest4me · Aug 11, 2011

OK- first off, I don't know of a state that does NOT require RN availability 24/7 if they get Medicare patients. Second- you have rank over CNAs- if they don't work/disappear- write them up. Something has to change fast- and you are as much in charge as the other LPNs- and definitely over the CNAs. I know it's hard (and it's not fair)...but you can do it:)
Not all LTCs are like this :) You're not a 'bad' nurse for enforcing good care- you don't work for the CNAs- and they don't work FOR you- they work UNDER you (respectfully)...you all work FOR the residents :)
The 11-7 Mon-Fri is a good thing- and worth a lot if you like weekends to have fun. And, on nights, the brass is home (obviously) and out of your hair (though someone needs to be available for emergency questions). Once you get the CNAs wrangled- and make it fun, or as much fun as you can- things will seem better. You do have a lot of treatments to deal with- you'll get your own routine down.
But my big 'red flag' is the night number going to voice mail. That's not right- and if you get actual honest to God Medicare/rehabs you have to have RN coverage- not just the phone number of some RN who may or may not know where her phone is.. That can be a big problem for you. If you can't get this straightened out, I don't think you have much choice but to get out of there. If something happens, and you can't get ahold of the RN, call the doc - if he gets ****** enough he will call the facility. You are only going to have to call if something is wrong- so the RN shouldn't get her knickers in a twist- it's her JOB!!! And the doc can be mad- you need to CYA if something isn't right. And if something is really bad, really fast- know the facility policy about calling 911, and the doc second- some places tell you to do that. That way, you're getting the resident help- and that's the big thing....be sure to ask the RN about that AND find the policy yourself.
I'm so sorry you're in the weeds like this- but it sounds like you're really up to speed about what should be going on- that's huge :)
If things can't be worked out- check other LTCs (other people at those places may be as overwhelmed as you are because they're new too- it doesn't hurt to see for yourself.... from what it sounds like, there's no where to go but UP
(((hugs))))

Excellent response---I totally agree! Hope the OP takes your advice!

simplyme83 · Aug 11, 2011

Thank you so much on the advice, It's crazy bc after I posted this yesterday, I go in last night and my Cna refused to give patient care( shave) @2400 once resident asked her several times and she told him and me no I informed her of insobornation she said "SO" that struck a nerve and least to say I wrote her up. I have to show them whose in charge.. DON said she's gonna make her an example ;-)