1st RN Job, feeling discouraged and disappointed

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I passed boards in the summer of 2012 and finally started my first nursing job in december at a LTAC facility. Nursing is not at all what I expected, not that I was naive. Nursing school/clinical showed me the reality of the job. But working at this place is beyond words. The is one nurse per hall of 15-18 patients for a total of 3 nurses to run the entire floor. There is no secretary or chart person. It is all paper charting and the nurse is responsible for ALL aspects of orders, admissions, discharges, labs, etc. The CNAs flat out refuse to do their part and get all bent out of shape if I ask them to get a blood pressure on patients to whom I need to admin BP medication. They "don't have time" or they are "going on break". By the time I get the vitals myself and answer all the call lights, it's already 0900 and I haven't even started passing meds! Management just keeps repeating the "Teamwork" mantra because they aren't going to hire more people as we are "overstaffed"! But you can only squeeze so much juice out of a lemon! You are not supposed to stay past your shift, but if you dont complete everything and all parts of new admissions, you will be in trouble. I now understand why the majority of staff are agency nurses, the turnover is very high. I try so hard to be as organized as I possibly can, but it seems like no matter how much I do, I cant accomplish everything. I cant be as thorough as I need to be or know everything about every patient. I am only one person! I feel like I'm screaming the obvious and no one is listening. Am I alone here or are other LTAC places this way? What are your experiences?

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Read 'what's the worst you've been dumped on?' post, for some experiences. I myself cannot fathom a LTAC= SNF is bad enough, without having a hall full of spewing trachs?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Are you sure you work a Long Term Acute Care? In another thread you stated you work a sub-acute which is not a LTAC hospital. LTACH's have patients that are vented, trached, on monitors with IV's infusing, chest tubes and complex drsgs. These are patients that have "run out" of hospital days but continue to require intense medical treatment.....the goal is for the patient to go home. These patients have IV's and PICC lines for their complex care.

Some LTACH companies, like Kindred, have LTC/SNF facilities in addition to the LTAC facilities. If this is a LTACH/LTAC and you have 15 to 18 patients and the management allow the CNA's get away with this behavior......this isn't nursing and you need to start looking for another job.

The first year is the hardest.......organization is key. What you need are a few brain sheets to help. Feel free to use them or change them for you.......here are a few.

doc.gif mtpmedsurg.doc

doc.gif 1 patient float.doc‎

doc.gif 5 pt. shift.doc‎

doc.gif finalgraduateshiftreport.doc‎

doc.gif horshiftsheet.doc‎

doc.gif report sheet.doc‎

doc.gif day sheet 2 doc.doc

doc.gif ICU report sheet.doc‎

critical thinking flow sheet for nursing students

student clinical report sheet for one patient

I wish you the best! :)

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The facility has both types of patients. One floor is trach, IV, WOC, post op, etc patients and the other(where I work) is mainly long term care. However, one of the halls on my floor has overflow patients from the other floor, so I have both types of patients. Thanks for sharing the organization sheets. I was always searching for and creating sheets during nursing school! Its hard to keep track of everything I need to deal with when there are constant distractions. Its hard to implement teamwork when I can't even get the CNAs to look at me, let alone have a 30 second huddle. So I tried using a communication sheet. Each morning I would fill out the top of the sheet with the CNAs'/sitters' names, assignments, break times, and info such as which patients needed showers, weights, were going out for appointments, etc. I am all for self-improvement so I recently made myself a reminder sheet so that, as things come up I write them down in one place and address them when I can. My "Reminders" sheet looks like this:

Weights:

Showers:

New Issues:

Missing Meds:

Meds to Reorder:

New Orders:

Call MD:

Labs to Collect:

Labs to Report:

Referrals/SBARs to Do:

Fluid Restriction

Skin Assessments

BMs

Bed/Chair Alarms:

Cond/Changes to Inform CNA:

Chart Behavior:

Find Out:

Chart:

Reminders/To Do:

Info to Pass Along to Night RN:

And the "RN/CNA Communication Sheet":

Communication Sheet

R.N.-

CNA- CNA-

Sitter- Sitter-

Tentative Break Times:

Transport/New Admit/Discharges-

Showers-

Weights-

~ Please have vitals to me by 8:00 (4:00p for eve). Let me know of any abnormal VS

~ Let's aim to get the weights before 12:00 so they are done and out of the way

~ Please come see me at change of shift so we can review/plan the day

~ Make sure pts get fresh water in a.m. and a cup of water when collecting pitchers

~ When you take your breaks or go to the dining rooms, communicate to CNA, sitters

and me: who will be covering your assignment and when you will be back

~ On vitals/I&O sheet, please document snacks, Ensure/2 cal and use of bed/chair alarms

~ If you put lotions, creams, or powder on pts, please write it on your sheet or tell me so

I can chart it in the treatment book as being completed

~ Please let me know of any status changes, skin issues, or other concerns

~ I will help with anything you need when I can, just ask!

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Are you sure you work a Long Term Acute Care? In another thread you stated you work a sub-acute which is not a LTAC hospital. LTACH's have patients that are vented, trached, on monitors with IV's infusing, chest tubes and complex drsgs. These are patients that have "run out" of hospital days but continue to require intense medical treatment.....the goal is for the patient to go home. These patients have IV's and PICC lines for their complex care.

Some LTACH companies, like Kindred, have LTC/SNF facilities in addition to the LTAC facilities. If this is a LTACH/LTAC and you have 15 to 18 patients and the management allow the CNA's get away with this behavior......this isn't nursing and you need to start looking for another job.

The first year is the hardest.......organization is key. What you need are a few brain sheets to help. Feel free to use them or change them for you.......here are a few.

doc.gif mtpmedsurg.doc

doc.gif 1 patient float.doc‎

doc.gif 5 pt. shift.doc‎

doc.gif finalgraduateshiftreport.doc‎

doc.gif horshiftsheet.doc‎

doc.gif report sheet.doc‎

doc.gif day sheet 2 doc.doc

doc.gif ICU report sheet.doc‎

critical thinking flow sheet for nursing students

student clinical report sheet for one patient

I wish you the best! :)

Impressive forms. Hard they will find anything so clear and comprehensive. Bet the schools won't allow the students to use them though- it's just too logical.

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You're not alone, I promise. I'm on a floor in LTC with 36 patients on the 3-11shift. I had another nurse from 3-7 then would be on my own. Within just a month of being there, the demographics changed completely. We received many highly combative, anxious, screaming, noncompliant and just generally more intense residents. I voiced my concerns over and over to the supervisors, ADON and DON and was told I was having trouble because I was a new nurse. I knew that while a small part of it was that, the other part was that these residents were far too complex for one person to pass meds much less address any issues or concerns.

I ended up with pneumonia and was out for a week. When I returned, all of a sudden they had on two 3-11 nurses. When questioning the other nurses, no one really knew why but I am fairly sure that one of the supervisors or administrators had to work the floor and realized I wasn't just being a frantic new nurse. It was actually a mess.

LTC is not my favorite place. I had two nights of orientation and then was let go on my own. Now, if I ask a question or just want to bounce ideas off a more experienced nurse I get heavy sighs and irritated answers. One supervisor actually put her head on the desk and said, "Seriously?" when I asked about a very involved admission form I had never even seen before. I'm just trying to keep my head down and push through to get my year of experience and get out. The facility is actually one of the best in my area and the staff all really care about the residents but the lack of any sort of real training and inconsistancies are driving me crazy. I actually found out half of what I was told in orientation was false and completely against regulation.

One supervisor told me to forge a document that I had forgotten to follow up on the night before. She actually said, "Just make up some numbers. It'll be fine" I told her obviously I would not do that and she said, "Well, that's on you" And all I could think was, Yes, Yes that is on me. I made a mistake and if I get reprimanded for it then it's for good cause. I'm not going to lie, period, but especially not on a patient record.

Anyways, just a few of my horror stories. Know you're not alone and any nurse I've talked to says the first year is horrific but once you get your feet wet, and can get into a field that you enjoy more, it's worth it.

Best of luck with everything.

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Hang in there baby! It's not you it's Health Care these days (profit driven, not acuity driven.)

Survive for a year then get out! Look for a Hospital position that lives up to it's Magnet Status PR (not all do) Getting in will take a long time because turnover is low but it will be worth it. Meanwhile stay safe, use your head and don't listen to Supervisors or peers who tell you to do something you know could get you in trouble with theNursing Board. Study your areas Nursing Practice act and back your comments up with the latest evidence based research. Take Care!

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sound workin @ LTC in NY!!!!... i relate with your story, i almost cried most of the time workin in nsg home.....they sound pathetic to the situation, but the truth admi cover only their ass, they dont care about your wellbeing as long as somebody on that shift on duty.They dont want to get help from agency because they cutting expenses....no break most of the time, even bathroom break was gone...i develop GERD, leg pain workin in this area.They even pay attention to the error you made than the good thing you contribute....the worst thing some co-worker does not even happy enough you did some of their job, they still complaint and write you up.

i remember when i started workin in LTC, one senior nurse told me " dont work for them, work for yourself".....i kept that in mind and used it as my philosiphy.....because at the end of the day its me suffering(worse thing get into accident) and end up alone injured meanwhile they can hire new nurse in replace of me.. take everyone advice, take it as your experience to added up to your resume, and look for other job that your happy about.

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Specializes in psychiatric nursing.

These experiences sound similar to mine as well. I work at a snf/rehab facility. I am a night nurse, and it's me (RN) for 60 patients and 2 CNAs, some are very acute with trachs, IV's, etc. Not to mention they have recently been admitting some patients with severe dementia who are combative with staff and other residents. We are not equipped to handle severe dementia patients.

When I have asked other nurses questions, some of them are quite nasty to me too.

I have managed to survive for 10 months here. I am actively looking for other jobs.

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Sigh.

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I have only worked at my LTC for 4 mths. There are only a few people who were there before me (by a few month). My LTC sounds like yours. I will leave if I got other job.

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