!st LPN job nightmare

[Ultreya816]

I am a newly graduated LPN., not afraid of a heavy workload or extra hours. I have always worked with the elderly in some capacity and am a great advocate. My first job, a large LTC facility . My first day on the job, 3 days ago, I was informed that I would be placed as charge nurse and given a float position in this facility of over 300, after orientation. Orientation consists of 5 days. Each floor will have 30-40 residents. My first day after 12 hours I left in tears. The residents were awesome but the practices of the staff I witnessed, and was told to participate in were unacceptable to me. I was taught in school to never ever chart something that I didnt do and to DO everything that was included in my residents plan of care. My first day I was told that we dont have time to actually check that each resident has the required safety equipment, alarms, hip pads, etc so we just check off that they have them. I was told to check off that a resident has her heels floated when in bed. This person has breakdown on her heels which are never floated because they said we didnt have time to babysit her and make sure that she keeps them in place. If the state was due to come in, then we would put all of these required devices in place. I found another lady in bed covered in blood because she had scratched and dug holes in her leg. I was told to treat it but not to document it due to the time consuming paperwork involved. I have been told to take meds from other residents because there was no time to order new ones for a res that had run out. On my third day, no new meds were yet ordered and when I asked to be shown how to place the order I was told that my orientation nurse would get to it one of these days. I attempted to give a res her meds last night but she wasnt in the mood to take them. Her son was with her and insisted that I leave the meds with him to give to his mom later. There were narcs in that cup too! When I refused to do this, suggesting that Id come back in a few minutes to try again, the son complained to my trainer and my nurse GAVE him the cup of meds and shook her head at me! I told this nurse that I worked too hard for my license to jeopardize it and that I needed to witness my res taking their meds, not leaving them with family members. This nurse also laughed at me when I insisted on taking a res back to his room to flush his PEG rather than do it in the dining room. I have seen tube feedings not hung and documented that they were. I have seen res crying in pain and being ignored as "complainers" while having standing prn orders for narcs that were signed out but never given. Before I left last night I went back to check on an actively dying woman who had earlier held my hand and cried and was told we didnt have time for this. So my nurse escorted me back to the nurses station where she joked around with another nurse for 45mins and I sat there until it was time for me to leave. Then my nurse complained to her friend that she'd be staying over a few hours again to do her paperwork.At the end of my first day when my nurse checked my charting, she shook her head and initialed all the things I refused to because I was told not to either do something or check on something. My third day finds me still not knowing how and where to chart because my nurse insists on waiting until the end of the shift to do it all and then complains about having to stay 2-3 hrs over, without pay to finish up. Alot of the nurses here told me that this is normal and they dont get paid for it.I have only a few days left of my orientation before they float me all around this huge facility and I am not ready. I was told that Id catch on but each station is different so Id have to see how they manage on each unit. NO, I dont get a different nurse to train with as SHE is the "best" I was told. I was told that I would be well trained. What they have taught me thus far is that I will never allow a loved one of mine to enter this facility as a patient. There is chaos and nurses quitting or just calling off at every station everyday! A 20 yr veteran nurse who was hired with me quit yesterday. If I were an experienced nurse Id probably want to stay here and try to make changes but I feel as a new nurse I wouldnt survive here. I have classmates who tell me they LOVE their new jobs! I leave my 12 hr shift knowing that I have not done all I needed to do for my res and that is unacceptable to me. It concerns me that the facility would allow a new inexperienced LPN to take charge of a 30 - 40 bed unit that is already in chaos and short of aides. Sorry this is so long! I am not a quitter, but I do feel like going elsewhere. I feel that my license may depend on it.I want to learn to be a good nurse from someone who takes their own job seriously. Id like to hear from anyone caring to comment, as to my post. Ive been told by other nurses here that its the same in any LTC facility. Thanks.

[SouthernLPN2RN, MSN, RN, APRN, NP]

One word for you: RUN!!

Some LTC's are like that, not all of them. In my experience, a smaller, private pay nursing home will usually have better conditions for its employees and residents. You are a new nurse, and I'd hate for you to pick up the bad habits around you. I worked at a NH that would expect the nurse to go back and initial meds/tx from weeks before when they weren't even in the building on the day in question. I wish you luck!

[04/04/1950's]

Your story is painful to read;I can't imagine how difficult it is to be involved in! You will not be able to fix the mess. There are times when walking away is the most reasonable decision to make. Staying there and trying to do the impossible will cause you to compromise who you are.Before anything happens that you regret, resign. Do not give them two weeks notice either. You shouldn't be counted as staff during your orientation. Did you have a mentor at the practical nursing program you attended, or someone else you like and trust? I might consider talking with a professor or mentor about making a contact with the agency who regulates this LTC . But I would talk that over with an RN from the program I graduated from first. There are good places to work and you'll find one. This is not it.

[gonzo1, ASN, RN]

You need to quit immediately. The veteran nurse recognized this and has done so already. You will not have any trouble getting another job. This type of situation happens often. New grads are taken advantage of. This facility will keep hiring until they find someone who doesn't understand the importance of safety and ethics and someone who just thinks it's cool that they are "charge". This is a very dangerous position for you to hold because if state or someone comes in and fines this establishment you can bet that you will be the one holding the bag.

Good luck to you and keep learning and growing. Some day in the future you may be able to come into a situation like this and make a difference but not as a new grad. It is too much.

[santhony44, MSN, RN, NP]

Leaving there isn't being a quitter, it's the only sensible thing to do. Your license could very well depend upon it.

I would, however, be careful about talking about this facility in future interviews. Try to leave your reasons for leaving fairly vague- "I just wasn't comfortable there," "I would prefer to work in a smaller facility with fewer residents," "it just wasn't a good fit for me," etc. You don't want to be perceived as badmouthing an employer even if they fully deserve it.

[skye1]

I totally understand your feelings,I too have gone through the same things you have. I even went so far as to find maggots in a patients dressing after the hospice nurse who came to the facility said she had changed the woman's dressings the day before! In the past month I was terminated for charges that were untrue and yet I was the ONLY nurse in the facility taking care of up 90 patients! There would be 2 emergencies at one time and I had to CHOOSE who would be cared for first. I had NO HELP and yet I was terminated for not doing my job???? In the 9 months I was there I never *lost* a patient and the meds were done as was the treatments.I forgot to sign off 2 meds that I gave and they said I had to sign the MAR 2 weeks later yet on my termination papers they stated I had NUMEROUS errors. I had 2,other nurses had up 47 errors! But I was the one they terminated.The other nurses had a second nurse to help them,I didn't! Hang in there and look elsewhere for somthing smaller,it builds confidence when you succeed and build your way up to the bigger jobs.

[JohnBearPA]

I certainly understand your feelings, and really, if I were you, I'd look for another facility. Not all LTC's are like this, but unfortunately some are. I think you'd be taking on quite a battle trying to "fix" things, and believe me, sometimes it's just better to walk away. I wish you the best, and my prayers are with you.

[banditrn]

Ultreya - I could almost cry for you!! When I started my job, I only had 5 days orientation - it wasn't enough, and I've been a nurse for a long time. As a new nurse, you definitely need more!

I thought some of the things at my facility were bad, but geez, some of the things you mention sound terrible - not flushing the feeding tube in their room blows my mind.

Yes, I think you should RUN.

[carol72]

I commend you for using your common sense & immediately noticing things are not right at this LTC facility. Please, never lose this sense of right & wrong. Sounds like you just fell into the wrong facility.

[anaknisupernurse]

First of all, I would like to ask what state you work for. I guess the inspectors are not scaring the hell out of your nurses and administrators. Where I work, those nurses would lose their jobs(if they get caught).

[anaknisupernurse]

To the others, do you all work in nursing homes? I've been working for 7 years at the nursing home and I can't imagine anyone fast enough to check off each entry in the cardex one at a time. During the day, the nurse takes care of 28-30 patients. Sometimes, there are medicine aids who administer the medications. It's such a great help. But when they are not around, nurses have to administer the meds themselves. Then there are orders to take off, dressings to do, residents to feed, G-Tubes to flush, charting to write...Pretty soon it's time to go home. So when can the nurse actually check all the other things in the treatment cardex? For the past few years now, I have wrestled with this dilemma and decided that I there is just no way that this could be done. So now, I go through the book. List the things like alarms and dressings and just sign off everything. It's not the right way but that is how the system is set up. If I move to another nursing home, it would be the same way unless they have a much better nurse to patient ratio-which is not going to happen because of the way the country's healthcare system is set up.

And as for holding somebody's hand while they are dying, I'm sorry to tell you that the healthcare system does not pay for that. I guess the only time you could really do that is if you want to stay after work. I used to love being able to give something more of myself at work. That is what nursing is supposed to be about anyway, right? But it seems to me like nurses get more and more paperwork to do. And for what? To ward off more lawsuits? To keep from getting in trouble with the state inspectors? What all these people(regulators, administrators...) seem to forget is that just because something is documented does not mean that it's being done. At work there are many nurses who are good writers but lousy nurses.

To the new LPN, the only suggestion I can give is for you to get your RN as soon as you can so you can work at the hospital. Maybe it's better over there.

[allele, LPN]

I agree with everyone, leave that facility! You're right, you worked too hard for your license for it to be jeapordized! I wanted to cry when I read about the things going on at that nursing home. Is calling the state (anonomously, if you prefer) and option? I really think they need a surprise visit!! I can't believe and nurse is willing to document on things not done and leave narcotics with family members!! Good luck, I hope your next job is what you're looking for!