Trouble as New grad

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Hi everyone,

I wanted to brief you on my situation and see if you had any suggestions as to how to handle it.

I graduated with my BSN in June 2015 and started working in a skilled nursing/rehab facility 7 weeks ago. For the past 7 weeks, up until today, I had been on orientation. I spent almost the entire orientation on the rehab floor where I learned how to do wound dressings, give meds, and start IVs and TPN. I was able to learn all of the skills I needed, but it was hard to keep up the pace of the floor. I only oriented to each skilled nursing floors 1 day each (there are 2 in our building). Today was my first day off orientation, and surprisingly they put me on a long term care floor!

I had 26 patients for my shift and each had to get multiple medications at multiple times during the day not to mention the treatments I had to do for each patient. That's quite a lot of patients if you ask me. But I imagine it's the norm for the skilled nursing/rehab industry.

So, I was unsuccessful in giving the 9am medications even though I tried really hard. This was the 2nd time ever working with these patients so I'm not familiar with them or their meds. I couldn't finish in the 2 hour window (8am-10am) and many of the medications I was looking for weren't in the patients' drawer in my med cart. Talk about frustrating. I had to go search for their meds in other patient's drawers to see if they had the matching drug and dosage (which I imagine you're not supposed to do, but everyone does it where I work). Searching for medications I can't find takes forever! Many meds had to be crushed and given in applesauce, which takes time. Some had to be given through a G Tube which also takes time. I was so fortunate that I had a wonderful charge nurse who was able to help me finish the med assignment.

The other floor nurse on the skilled nursing floor I work on told me that I shouldn't be ashamed of myself for needing help with my assignment. After all, it was only my 2nd day on the floor. She said that the first couple of times she was by herself she wanted to cry. But, she said, as time went on she got faster! And she said I will too.

My question to you all is that are all new grads going to work at a slower pace than everyone else? Time is a huge factor in getting my assignment done in a facility like mine where the staffing ratios are very poor in my opinion. I don't know how I'm going to be able to relax and do my job knowing that I feel like I'm in a race against time during my shift. I felt during the day that I was going to have to resign because I'm not doing my job fast enough. But, my director of nursing didn't even approach me about my meds being late, so I guess I'm ok.

As for now, I'm going to pick myself back up and try again tomorrow! I will probably be frustrated at times, but you just have to work through it I guess. Did anyone else on here have trouble managing their time as a new grad? I feel like my time management skills are going to hurt me, despite the fact that I'm always on task and never ever just sitting around being lazy.. To all the nurses that work in a hospital setting (which is different from long term care), are the staffing ratios also difficult where you work? Do you have trouble getting your work done on time in a hospital setting as well? I hope to work in a hospital in 6 months when the new grad residencies start again in my hometown (Baltimore, MD area), but I'm extremely nervous that if I can't get my work done in a long term care setting, I would definitely fail in a hospital. If anyone has any suggestions and words of wisdom, I would greatly appreciate it.

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I totally understand your frustrations. I am a new grad RN too. I work on a short term rehab floor where we get a lot of trachs, gtubes, IV antibiotics, treatments, etc. I'll have 17-20 patients a day, it can be tough. Truthfully, I never finish my 9 AM med pass within the given window. There has been multiple times the patients will not have their medications so I'll have to reorder them and find them the medication. At the same time I get admissions, discharges, family problems, need to report labs to MD, and deal with a bunch of other stuff. Don't beat yourself up over it. It takes time to get into the swing of things. I finish my morning med pass by 10:30-11 AM at the latest now but when I first started it would take up until lunchtime or later. You will go faster each day, it does get easier. Hang in there and good luck!

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Thanks xobritney24! I glad to know the fact that another new grad is going through the same thing I am. Do you hope to stay in rehab or do you want to eventually transfer to a hospital? Do hospitals have the same issues with lots of patients and overworked nurses? Also, are you ever able to get out of work on time at your current job, or do you have to stay for overtime often at work?

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Specializes in LTC and Pediatrics.

Yes, that is very typical for a new grad. Think about it, in clinicals you had maybe up to 4 patients. When we graduate, and work on units such as you, it takes time to get to know the residents as well as their routines and meds. As time goes on and you get to know these things, you will pick up speed. I have been in my LTC position about 5 months and there are some evenings that I fall behind due to other things going on . Yet, for the most part, I do now get my med passes done on time - when I started, I felt like that would never happen.

No what concerns me is that there are not all of the meds for all of the residents. That is definitely a med error waiting to happen. At my facility, we get a month's worth on punch out cards and cards for each specific med pass. We have some meds in bottles that are kept in the bottom drawer and eye drops in the top drawer with the other two drawers for each wing of the facility. We have Stock meds for some.

Do I ever get out on time, rarely. Why? I may not get all my charting done until the end of the shift. I work 2-10 and report and narc count may not be done at 10. I figure getting out at 10:30 is "on time."

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Thanks xobritney24! I glad to know the fact that another new grad is going through the same thing I am. Do you hope to stay in rehab or do you want to eventually transfer to a hospital? Do hospitals have the same issues with lots of patients and overworked nurses? Also, are you ever able to get out of work on time at your current job, or do you have to stay for overtime often at work?

No problem! I definitely want to get back into a hospital. I worked as a nursing assistant in the PACU and loved it but unfortunately they don't hire new grad nurses so I had to leave to get experience. In the hospital setting it didn't look as bad, the patients are just more critical. And no I never get out of work on time, I do 7 AM to 7 PM and usually leave at 8-9PM because of documentation, admission assessments that take forever, giving report, narcotic count, etc. I think they should definitely lower the patient to nurse ratio because patient conditions can change in any given second. I've had to send many people out and do detailed assessments on conditions. It gets easier but its definitely already draining.

Do you stay overtime a lot too?

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I do stay later. Usually it's only a 1/2 hour or 1 hour later so that I can get all of my charting done. But when it's time for shift change all of my medications and wound dressings are done so I'm ready to hand over the keys to the med/treatment cart to the oncoming nurse

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