1st RN job, nursing home, 17-24 pts night shift,could use support

Novo · Aug 16, 2012

Sounds like a nightmare. Only thing I can suggest is that you keep searching for a job - don't wait for the job to come to you. I'd talk to your manager about lightening your workload or something. For now I'd try and catch up on sleep as you could kill someone by making a med error.

blinky, ASN, RN · Aug 16, 2012

by "med mistake" i mean i didn't sign for a scheduled med that I gave. Other RN's have the same or higher pt load, and because of "census" they won't schedule more RN's to lighten pt load. It's all about money they are a company.

I only got this job as someone I knew works there, previously had been applying for 6 months with only one call back that didn't even lead to a interview. Every hospital wants experience, I have yet to see a job posting at a hospital for "graduate RN" or does not require experience.

CapeCodMermaid, RN · Aug 16, 2012

The patient load seems more than doable even for a new grad. I don't know why you would expect 8 patients if you were told the ratio was 12-15. Something doesn't sound right to me...is it the adderall? It shouldn't take that long to pass evening meds to that number of people even if you are new. You need to take a step back and see if you are up to this.

blinky, ASN, RN · Aug 16, 2012

The patient load seems more than doable even for a new grad. I don't know why you would expect 8 patients if you were told the ratio was 12-15. Something doesn't sound right to me...is it the adderall? It shouldn't take that long to pass evening meds to that number of people even if you are new. You need to take a step back and see if you are up to this.

I was expecting 8 as i knew little about the place, at my interview I was told 12-15 so that is what I was expecting. I worded that poorly.

3 hours i was estimating, I talked to other RN's that have been working there and they take 1 1/2 to two hours to pass meds.

-That night I had two mew admits and two falls,and i had to constantly stop med pass to give pts pain meds. Falls i hadn't experienced yet, and had to learn how to chart/document.

My previous experiences passing meds on my own avg'd one and a half hours, with 17-20 pts. Those were long term pts who were "not with it" I.E not demanding etc, so took a lot less time.

what i wrote about was on the sub acute part of the unit and pts were "with it/ demanding"

I wrote that after my 14 hour shift which may explain things.

also i dont follow what you mean by "Something doesn't sound right to me...is it the adderall?"

CapeCodMermaid, RN · Aug 16, 2012

Many people in long term care are 'with it' and I don't think it's being demanding to ask for pain medicine. Adderall is used to treat ADD and ADHD is it not? Perhaps you are not organized or are too scattered. You have to bet into a routine and prioritize what needs to get done.I've had 30 sub-acute patients to care for on a day shift. You need to offer pain meds while you're in their room. Assess what you can while they are taking their meds and talk to the doc and the pharmacy consultant about getting rid of duplicate therapies.

blinky, ASN, RN · Aug 17, 2012

Many people in long term care are 'with it' and I don't think it's being demanding to ask for pain medicine. Adderall is used to treat ADD and ADHD is it not? Perhaps you are not organized or are too scattered. You have to bet into a routine and prioritize what needs to get done.I've had 30 sub-acute patients to care for on a day shift. You need to offer pain meds while you're in their room. Assess what you can while they are taking their meds and talk to the doc and the pharmacy consultant about getting rid of duplicate therapies.

I've gotten into a general routine, then they keep changing my set.So instead of my routine being A, B C it's A, D, B E, C. etc If that makes sense.

Demanding is poor word choice by me. Over night my confidence went from a 8 to like a 5

-I do have ADD hence the adderall.

I don't know what you mean by "duplicate therapies" ?

I feel rushed through training and now they want me on my own with half a set 10 pts or so.

first two days "shadowed" a RN who didn't really seem happy about me being with her and I basically felt i slowed her down. Second two days a different RN, again "shadowed". She tried to show me stuff, but was to busy with all the pts, she had me pull meds and that was about it.

Finally the "preceptor RN" came back and i got hands on doing stuff for 3 days.

Then he went on vacation again, and last two days im back with the RN who i just feel is annoyed i got put back with her to train.

Management/Director of Nursing gives me no feed back, which maybe good I'm not sure? But it'd be nice to hear im doing something right/good from someone i train/work with...

jcprn · Aug 17, 2012

I understand your situation. I just started working in a LTC on the rehab unit 7p - 7a with 24 residents. It takes me four hours on a "good" day to do my 8pm med pass. We have many residents who are diabetic and need their regular scheduled insulin plus sliding scale coverage, there are also treatments and skin checks that must be completed, as well as vital signs for about ten of the residents. It is very frustrating and I dread anything going awry because there's no time - I hate thinking like that, but I can't help it. I also find that my critical thinking is poor due to feeling pressure to complete the med pass and all the treatments. I am also a new nurse and can't understand how it is safer to have new nurses responsible for 20+ patients in rehab or LTC than being responsible for 6 patients with much more support staff in hospitals. I have even tried applying for home health nursing, but was told that I need med/surg experience - the facility I applied to trains skills and honestly, I know that my critical thinking would be much more clear with only one patient in front of me than it is in front on one resident, watching the clock and worrying about the other 23.

I know you were looking for advice, but I just wanted to let you know that you are not alone. :nurse: UOTE=blinky;6827341]first few weeks went alright shadowing then with preceptor, then doing everything myself with preceptor. went to a different hall this week 16 pts sub acute part of nursing home, needy [pain meds] demanding, two admits.

started shift 7pm shift ended 845am no breaks [suppose to get 2 15 min and a 30 min dunner break]

made med mistakes [preceptor caught] didnt finish all treatments for 4 or so pts, no charting. Another new RN did the admit work in the computer.

previous week i had 18 pts in long term care part and it was so easier.

Problem is i am told i will not have a steady "set" of pts for some time. My experience on the sub acute floor was a " normal/ good" night [she's been working that part for 6 months now]

after 7am trying to " think critically" just doesnt happen, and ya I take adderall Rx. Mind was just fried, then they wanted me to work my third day same set tonight to continue training had to say no.

Took 3 hours for me to pass 9/10pm meds on this set, other sets[17-24 pts] was about 2 hours, on my own.

One pt[new admit] fell twice and eventually sent to hospital, barely got paper work together for dialysis pts as well [ 2]

Basically if that is a good/normal night and I would be working this set, or the other in the sub acute I don't feel safe doing it for pts or long term for my stress/mental stability. And I can't imagine a "bad night" where I'd be on my own. At nights in the sub acute section basically 2-3 RNs [depending if any others are training]

On hiring I asked about pt to RN ratio and was told 12-15, was expecting 8. Up for 15 hrs, slept for maybe 4 feel exhausted, but can't sleep.

I have no "seniority" so the set I would like to work i don't think they would give me...

What would you do/advice? I'm moving out soon and can't afford to not have this job, hospitals won't hire me as "no experience" of course...

blinky, ASN, RN · Aug 19, 2012

appreciated. I'm so concerned with getting things done on time med pass, treatments charting,new orders, ivs, pain meds. 20 pts 2 n half hour med pass last night i think. Then one RN called off on our station so was we had to split their share.

med pass is taking me so long as im walking back and forth to much, for blood sugars, vitals, from pt to my med cart...

wyogypsy, RN · Aug 23, 2012

Try making a cheat sheet for your residents so that you know when you get to them who gets blood sugars, vitals, insulin, updrafts, treatments, etc. I do my cheat sheet by times - AM, noon, PM, HS, early AM - whatever works for your facility. Some treatments are OK to do with meds, others need to be left til later. When new, I just did my meds then went back for the treatments. Also make you a cheat sheet for treatments. You are still responsible for what is on the MAR or TAR, 'but' it does give you a quick reference and then you can check for changes which is much less time consuming. I used to get overwhelmed by treatments until I made a cheat sheet and then I could put it in perspective which helped me. Do you take your med cart with you? I take it up and down the hall, and when I go into a room I place it in front of the door, with the drawers facing inward towards the room. That way I don't have to walk far to get anything. Just focus on doing it right and you will become somewhat faster with time, but never as fast as the nurses that skip steps or don't do what they are supposed to do, cheating the residents in the process.

hiphippo · Aug 24, 2012

I too know exactly how you feel... :cry: . I am also a new grad RN working in a snf. Last night was my first night passing meds to 30 patients all by myself. My training with med pass involved only one day where I took over one of the carts to pass to 10 patients. Even on that day I took the whole shift so you can imagine me doing it all by myself with 30 patients let alone not being real familiar with the med cart itself and not knowing where anything is, taking blood sugars on half of the patients, taking BPs with a manual cuff, hanging tube feedings, dealing with patients who you have no idea what they are saying due to language barrier or unable to get real words out, CNAs telling you rooms blah blah blah are in pain, and the list goes on! I made a lot of med mistakes as well by not signing for scheduled meds because it was honestly too late to pass em and so many of my patients missed their 5pm meds. It was so bad that 3 nurses had to help me which I am very grateful of because one helped out with the goodness of her heart because she saw me struggling (and she was already working for the subacute side) But the other one ended up being my mentor who definitely was not happy to see that I hadn't even passed half of my 5 pms meds when it was already 9p. Exactly like you, I've been up for 15 hours and 3 hours of sleep. Literally after stepping out of the building last night, I balled my eyes out. This morning I woke up with panic because there were a lot of things I realized I didn't do last night and hoping nothing bad happened to any of my patients over the night. I'm dreading to go into work today because I'm so ashamed of how it went and scared to see what my preceptor has to say.

There are some nurses who say don't worry, it'll take time. I do believe that, but I honestly feel like I have to fall flat on my face a billion times in order to get better or even comfortable passing meds or being charge nurse which scares me to death because falling on my face means making mistakes which I don't want to! At the same time, I'm trying so hard to do everything right that I end up making mistakes anyway. I've never felt so defeated. I don't know what to do. My husbands uncle got me the job so I feel even more pressure to do good and not to quit even though I badly want to. I hope anyone out there has some encouraging words or support that will get me through this horrible experience.

blinky, ASN, RN · Aug 24, 2012

ya we got the cheat sheets, very helpful indeed. will comment more later, appreciate the feedback guys.