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

serenidad2004 · Aug 24, 2012

That kind of pt load seems terrible!!!! I thought our SNF that i used to work at was bad and the most i would have on days or evenings was 14.... and that was hard sometimes with 9yrs experience...

Wish I could give u words of advice or tell u it will get better... but that just sounds unsafe

lorren2002 · Aug 24, 2012

Welcome to the world of LTC! I would like to encourage you, but I must also be very honest about this area of nursing. It's not for everyone. Speaking from personal experience, LTC nursing is one of the most difficult areas, but it can also be the most rewarding. Actually, the patient ratios that you mentioned for your job are pretty low. Our facility usually assigns 40-60 pts on the LTC halls to one nurse and the sub-acute/rehab nurse usually will get 25-30 pts( Many of them with feeding tubes, trachs, Picc lines with back to back ATB therapy, wound vacs, multiple meds, and so on). I swear, sometimes you don't have time to inhale or exhale.

It's hard for new nurses to get a job, and nursing homes will usually take a chance on new grads, but nursing home work is absolutely the worst job for a new nurse. A seasoned nurse has a hard time doing this job if they are actually trying to do it the right way. If you can hang it there, you will have a better comfort level at six months and actually be comfortable after a year. Never do anything that you feel is unsafe for a pt. If you don't know how to do something, be sure to ask for help. Sure some of the nurses may get peaved for having to teach you, but it's better than hurting the pt and once you learn it, that will be another thing under your belt so to speak.

Try to always sign out any prn meds when you give them, I know this is time consuming, but things can build up quickly. I see so many nurses going completely crazy at the end of the shift trying to sign out narcs and prn meds. Speed with your med pass will come once you get to know the pts better, and get a comfort level with the meds you are giving. Make up a sheet with the pt census and mark how each pt takes their meds ( whole, crushed, thickened liquids,etc.) You can also write your blood sugars on this sheet, pts with oxygen, etc.) It is best, when possible, to get your most demanding/alert pts out of the way first. They can make you nervous, by staying on the call light and yelling till they get their meds. If you get to a room and the pt is not there, just mark the MAR( some MAR's have pull out tabs that state" missed medication") and move on to the next pt. don't try and look for each pt. It will burn up too much of your time ( unless it's insulin or a med that has a very strict time frame). You can find the other pts, when you come off the hall.

I am sorry you are having a difficult go of it. I truly know how you feel. I have been there once upon a time, and I still have my really difficult days. I hope it gets easier for you. Maybe once you get about 6 months under your belt, you will be able to get hired in a hospital or health clinic. Also check into dialysis. They are usually willing to train new grads with extensive training, but that is wild in itself, but at least you are focused on one type of pt and most of the meds are injected into the pt's lines. ( no p.o. med pass). Let us know how it's going for you, and what you decide to do. Best wishes! :)

MountainRN53 · Aug 25, 2012

I agree with you 100% JCPRN! I am swamped with my job at a LTC. Have to fly through a med pass and I have those ones that roll up to my cart (from the other hallway) wanting their meds NOW! If a wrench gets thrown in like an admission, a burst colostomy bag or someone wanting a new O2 tank I become majorly behind. I try and do have an upbeat personality but inside I'm about to burst! I love the job and I'm making the highest here I have ever gotten paid as an RN.

To those looking for work in home health...I did that for 13 years. Even though you get milage reimbursement, is not enough for tires or watching your beloved car go to places you could never imagine! Had one patient where I had to stop and open a cattle gait, drive thru, and close it...in ALL kinds of weather! :bugeyes:

MountainRN53 · Aug 26, 2012

I feel your pain. I have been an RN for 19 years working LTC and home health in 4 different states! Everything you write is everywhere in LTC. I just started last week at a LTC after relocating to the area. Even with experience I too, made several mistakes and sometimes you DO have to consolidate...everyone does it so don't feel guilty. My preceptor took many short cuts but then said don't do this when STATE is here. I even had trouble with an insulin pen but I can change colostomy bags all day. I keep telling myself that the job is not hard its just time consuming. I layed in bed last night thinking of the patients I can recall, how they take their meds etc. Some other nurses can be very difficult and might be that way because of their life. I was feeling intimated by someone like that once and was told by another nurse she hated her life and her job so thats what I have in my mind when other nurses are tough or mean to me...You can use this mind-set if you like:twocents:

MySonIsAdorable · Aug 31, 2012

Sounds like you weren't expecting all this work, and I am sorry that you are overwhelmed. You need to take deep breaths and remind yourself why you wanted to be a nurse. I completely agree with the cheat sheet idea you don't even have to put what they need that way you go to the MAR too sign off just a check mark or maybe a T if they need a treatment and if its a different time the put that in the box say (15, 30 ect)...

Just remember that LVN/LPN's take on much bigger amounts of patients as new grads and to the same thing you are going to be doing (yes even admissions assessments in LTC only) like 65 for instance doesn't that sound crazy? Well at night there usually is only one LVN per floor or unit.

And if you do end up getting a job in a hospital you will be changing patients frequently and will have to know how to be flexible anyway so this is good practice. I know RNs who have to provide basic patient care in addition to everything else where as in LTC the CNAs have a lot of value to your time management. Treat them well, and remember that you are no better than them, help when you can and they will help you. Do you best, and just try to breathe and keep pushing on. Give yourself some credit you can do this & good luck!

alyiana · Sep 2, 2012

I am also a new-grad RN and am working in LTC. After 5 days of orientation on 3 out of 4 of our halls, I was stuck out on my own. Luckily I've been on the same hall since orientation. I have 28 residents, 2 CNA's and a Med-aid that shares work with another hall. I'm grateful for my support staff because they are the ones who taught me what my residents are like, and what their needs are. The Med-aids are trained to just give medicines, so I'm left with treatments, assessments, and of course documentation (ie all these incident reports from the falls). When I had to fill out my first incident report for a new wound on somebody, I had no help what so ever, I just had to fill in the blanks and guess what needed to be done and hoped for the best.

I still feel like I have to ask stupid questions frequently, but when I was hired my DON said if I don't do so for the first few months she would worry about the quality of care I am giving. So don't be afraid to ask questions and make a few minor mistakes. I've gotten a few lessons, but as long as you remember your lessons, you'll be okay. We'll get through this.

Isitpossible, LPN, LVN · Sep 2, 2012

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. OP: i feel your pain, i too am a NEW RN in LTC... just the other day I worked the post acute floor and had less patients than my long term..guess what?? it took me LONGER to pass meds... WHY???? when I dont know the pt, I tend to go a little slower and keep double checking everything, which really slowed me down... On top of that you indicated you had several falls? Falls require paperwork/documentation/phone call to families/physicians etc... and then you have the patients that consistently call you.. Yes thats ALOT to deal with ... If your unsure of that process, yup you will be slowed down... LTC is not an easy area for new grads, Im sorry...Unsure if your medication impacts your ability to be a supernurse... . You really should request a steady floor with the same patients, I think it will help you tremendously... Good luck to us all and as alyiana says we will get through this!!! :)

amoLucia · Sep 2, 2012

There seems to be one thing that I'm not seeing here in this post (and others like it on AN in the LTC forum). Do these places NOT have floor supervisors??? On 3-11, it's usually a floating super, while on 11-7, it may be a floater or "working the floor too". Supervisors are usually supposed to be making rounds and esp checking with new staff nurses for problems, yes????

As super, if my nurses had a problem, then I had a problem to explain to the DON. I've worked all 3 shifts; even when I super'd/did the floor, I touched base with the other floor nurses, most esp if it was a relative newbie or agency nurse. And YES I DO know about the supers who just run hde and don't know which end is up on the floor!! (That's a whole other issue re incompetent supers; and there may not be supers at some places also). But new nurses really should rely on their supers, esp if they're sinking!!!

Sometimes I just CAN'T be much help if I've got other projects of my own to handle (and DONs do give us projects), but when I can, I'll grab a med cart and do 2 rooms to give you breathing room. Or I'll make some of your phone calls (families LIKE it BETTER when it's a super who tells them about a fall). I'll pull the paperwork for your incident report (you get the honors to do it, though). And I can hang your GT, or do a fingerstick. But you need to let me know! Some nurses don't let on there's problems. If you tell me, "Oh, I'm OK", I'll take your word for it and move on as I'm busy too.

My job is not TO DO your job, but I will try to help. You need to come up to speed yourself ASAP. I am evaluating you and your skills/abilities as I show you O2 tank setups, suctioning, declogging GTs and 'tips' of the trade. I know my other staff too, nurses and aides, and I'm in tune with what's going on with them and the unit. They all have their own responsibilities to do; perhaps that's part of the reason why they're less than enthusiastic about having to stop and help you.

Back to OP and some of you other posters - some of your nurse/pt ratios are VERY, VERY GOOD. Take my word for it as I've been there, done that, and had to move on when nec. You should be able to utilize a super; that's what they get paid more for!

One last thing - if you've had trouble handling something and DID NOT alert your super, you've taken on the full onus/burden of responsibility for you action/inaction. Again supers are there to problemsolve - use them when you must and when you can.

Sorry about the print size - don't know what I hit!

wyogypsy, RN · Sep 2, 2012

Unfortunately too many LTC facilities do not have any type of floor or unit supervisor. Then you can ask another nurse for help, but often they are just as swamped as you are. However, the ones that have been there a long time usually have a great routine for themselves and have a little time where they can help (if you work with a nice one).