Struggling NEW Nurse at LTC with questions

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Hello there. I'm a new nurse working at an LTC. This is my first nursing job and while i started out loving it, we now have a new DON that is making me feel like i'm not doing a good enough job. Like some other people who have posted before, i struggle with being slow on my med pass. I want to do a good job. I don't like taking shortcuts if they're illegal or i think they're unsafe. I was already insecure about this before she took over and really started pushing all of us to be done before 0900. I've been actually working as a nurse for 7 weeks now. She wrote me up last week for not getting done before 9am and for not getting done with my charting and stuff and being out the door by 2:15. I have been improving on my time. I'm down to 9:30 on the days when it all doesn't go to crap in the morning. Sometimes it's just chaos and it takes me a while to get finished with what ever needed done and get back to my med pass. (admitting, falls, new orders ect, sometimes interacting with the pts takes the most time, but i try not to cut back on that). I didnt get any orientation or real training except following around another nurse for 3 days. Was supposed to be 4 but they needed me to be by myself. STATE is coming soon, so i know that is why she is trying for us to get faster because of the rule that you have to be done the hour after it's due or it's a med error (is this true?). Also, should i request for more training? I like my job, the location, and the pay (which is more then i thought i would get). But is that enough to keep me here, putting up with a woman who is constantly asking me how much longer i have. She may be acutely trying to help. but i would never go about it the way she has. Any advice or tips/tricks to pass faster would be much appreciated.

thanks!!!

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We're on the same boat, I'm a new nurse working at an LTAC too. I've been working since late October 2015 & believe me I sometimes go home crying because it's so stressful. Especially during med pass, to be honest with you I think it comes with practice you'll get faster. I use to be 30 mins late on passing meds and recently I've got down to 10 mins late. Most of my patients have antihypertensives and I always like to check the BP myself before I give it and that takes up time too and more if they need to be crushed. I tend to pass my meds to the patients who are easiest like those who swallow whole pills.

As far as training goes, you should ask for more because if you are a new nurse i don't understand how they can possibly think it's okay to only give you 3 days of training. I had maybe 5 weeks and I still didn't think it was enough. I'm on my own now and I'm developing my own routine. It will get a little better but just keep in mind that every nurse has good and bad days.

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Specializes in LTC.

Yikes - I definitely would not have found that kind of pressure helpful at all when I was a very new nurse. So sorry that is happening to you.

There are many wonderful experienced LTC nurses in these parts and I hope they chime in with some advice. In addition, use the search function if you haven't already done so as there are many great posts with helpful tips about working in LTC.

My best tool of the trade as far as medication passes go and being able to leave on time (if no emergencies) is having a good "brain sheet" - a one sheet page with all the things I need to accomplish for the shift - like who diabetic, on antibiotics, treatments, which residents am I doing weekly/monthly/quarterly charting on, and some blank space to write down stuff that comes up during the shift. In the beginning, the brain sheet also had information on how the residents took their medications. However, I now work the same floor all the time so that information is burned in my brain.

Another thing is to minimize interruptions during medication pass. This was one of my problem areas particularly with residents who love to chit chat. I would feel bad not spending time listening to their concerns but I had to learn to just focus on passing their medications and, if warranted, return later to talk more to them about an issue/concern that they had. After all, there is only one of me and 25+ residents and if I stop to chat I will not get my job done. Such is the harsh reality of the terrible ratios of LTC.

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Specializes in Geriatrics, Dialysis.

Sorry you were written up for this. This new DON must not be real experienced with the unique world that is LTC. I have never in 20+ years heard of a facility being cited by state for meds given outside of that magical 1 hour before and 1 hour after window. Hopefully after she survives her first survey as DON and sees that this isn't an issue she will back off on that requirement.

Realistically meds can be passed in that time frame IF nothing goes wrong and there are no interruptions. I am actually pretty fast at med pass and it takes me around 2 hours give or take 20 minutes or so to finish everything for 28 residents so if you are already close to that time you are doing very well indeed!

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Specializes in Dialysis.
Sorry you were written up for this. This new DON must not be real experienced with the unique world that is LTC. I have never in 20+ years heard of a facility being cited by state for meds given outside of that magical 1 hour before and 1 hour after window. Hopefully after she survives her first survey as DON and sees that this isn't an issue she will back off on that requirement.

Realistically meds can be passed in that time frame IF nothing goes wrong and there are no interruptions. I am actually pretty fast at med pass and it takes me around 2 hours give or take 20 minutes or so to finish everything for 28 residents so if you are already close to that time you are doing very well indeed!

Exactly. And when State does show up, you have assistance magically crawling out of the wood work from management

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Specializes in Geriatrics, Dialysis.
Exactly. And when State does show up, you have assistance magically crawling out of the wood work from management

No doubt! It is pretty funny watching the Administrator, DON and ADON answering call lights and passing trays. I mean state can't possibly be so clueless as to think that's a regular occurrence, especially as management really sucks at even these simple tasks!

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Did my old DON come to you cause that's what it sounds like [emoji23]

Some bosses will work with you to help you grow. Some won't. I'm a newbie nurse in LTC too and I now have a new temp don who never puts me down. The other nurses tell me I've progressed and I can see it. Track your progress. Get a notebook and write down things you'd like to improve, things you do well, and things you've already improved, every newbie is a work in progress lol including myself. We have room to grow we just have to stay positive and acknowledge our downfalls

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To answer your med pass question too.. When I started out I was slow (been a nurse for 8mo now) but I was constantly being interrupted and I learned to put non emergent things on hold. That being said you can't put emergencies on hold.. Delegate whatever you legally can to your CNAs and just take deep breaths. Anxiety will slow you down. Keep saying to yourself "I got this" and just prioritize. One thing after another. That's all I can say and that maybe they need better staffing. Most of the time it's s staffing issue and the blame falls on us hard working COMPETENT nurses [emoji21]

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Yikes - I definitely would not have found that kind of pressure helpful at all when I was a very new nurse. So sorry that is happening to you.

There are many wonderful experienced LTC nurses in these parts and I hope they chime in with some advice. In addition, use the search function if you haven't already done so as there are many great posts with helpful tips about working in LTC.

My best tool of the trade as far as medication passes go and being able to leave on time (if no emergencies) is having a good "brain sheet" - a one sheet page with all the things I need to accomplish for the shift - like who diabetic, on antibiotics, treatments, which residents am I doing weekly/monthly/quarterly charting on, and some blank space to write down stuff that comes up during the shift. In the beginning, the brain sheet also had information on how the residents took their medications. However, I now work the same floor all the time so that information is burned in my brain.

Another thing is to minimize interruptions during medication pass. This was one of my problem areas particularly with residents who love to chit chat. I would feel bad not spending time listening to their concerns but I had to learn to just focus on passing their medications and, if warranted, return later to talk more to them about an issue/concern that they had. After all, there is only one of me and 25+ residents and if I stop to chat I will not get my job done. Such is the harsh reality of the terrible ratios of LTC.

When s resident gets chatty, although I love and appreciate talking to them, I say " i have to give pain med and I'll try to come back when my time allows im So sorry" lol it works

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