I'm two weeks off of a 3 week orientation. First job in LTC. I LOVE the job, the facility and residents.
I have alot of support from DON and other Nurses, there is always a RN supervisor on if I have questions. I am always working with another nurse (usually a LPN with alot of experience)
The CNAs will come to me when they find something with a resident, and sometimes I'm not even sure what the right thing is to do, I have been calling the RN supervisor with my questions, but when will I feel confindent to make the decisions, how do you know what to do without the experience behind you.
for example: walking by a resident, hear her coughing sounds really congested, I took her vitals, listened to her lung sounds (which I'm still not good at) she sounded course but cleared with coughing, she had no temp... but I wasn't sure If I should give her something, call the doctor, just keep monitoring her....
another resident (has MS bedbound) refused all his bowel medication, later that night asked for kaopectate. He is on alot of narcotics, he didn't have a order for it. So technically I couldn't give it anyway, but the lpn med nurse wasn't comfortable giving it with all the meds he was on, I didn't think this would have any reaction... called the RN supervisor AGAIN, she said don't give it without the order anyway....
Another CNA called me in the room found a small amount of blood coming from resident foley. There was not blood in the bag, bleeding stopped.. I assumed he probably yanked on the foley. I told her to call me in when the did rounds later and I would assess again, but I'm never sure what to do. ( it wasnt bleeding, made a note in the nurses note for the next shift)
When will I feel confindent to make these decisions and know what to do. I neve worked in healthcare and havent been around alot of situations.
I want to be the best confident nurse I can be. Is there anything else I can do? More classes, books...ect
I wasn't going to log on tonight but I saw the title of your thread and laughed. Been there, done that. Changed specialties, same thing.
The change will come gradually. One day you'll know dietary's phone number off the top of your head. A family member will have a question and you'll know the answer or who to call for the information. One day you'll fly through tasks that used to take a long time and a lot of effort. Getting an order from an MD will not be a big deal, you'll know what information needs to be at your fingertips. You'll anticipate what will be ordered or needed. New hires will be coming to you with questions and you'll know the answers. You'll be the one to help them check out a patient's lung sounds. How great will that be?
What's wonderful is all this, is happening now. By using your resources to back up your instincts and knowledge, you are learning what you couldn't in school or clinicals, there just isn't enough time.
I work as a supervisor and I love to answer questions, assist with assessments and teach what to do when. I find it rewarding to see someone grow and gain confidence. There's nothing more fun that watching someone get an IV in a dehydrated pt. with rolling veins. The look on their face, priceless...it's this "wow, I can't believe I did that."
Lung sounds by the way are best learned the way you described, having someone listen with you and confirm what you hear, or add to what you are hearing.
Be as kind and gentle with yourself, as you are with your patients. Best wishes in your career.
I wasn't going to log on tonight but I saw the title of your thread and laughed. Been there, done that. Changed specialties, same thing.
The change will come gradually. One day you'll know dietary's phone number off the top of your head. A family member will have a question and you'll know the answer or who to call for the information. One day you'll fly through tasks that used to take a long time and a lot of effort. Getting an order from an MD will not be a big deal, you'll know what information needs to be at your fingertips. You'll anticipate what will be ordered or needed. New hires will be coming to you with questions and you'll know the answers. You'll be the one to help them check out a patient's lung sounds. How great will that be?
What's wonderful is all this, is happening now. By using your resources to back up your instincts and knowledge, you are learning what you couldn't in school or clinicals, there just isn't enough time.
I work as a supervisor and I love to answer questions, assist with assessments and teach what to do when. I find it rewarding to see someone grow and gain confidence. There's nothing more fun that watching someone get an IV in a dehydrated pt. with rolling veins. The look on their face, priceless...it's this "wow, I can't believe I did that."
Lung sounds by the way are best learned the way you described, having someone listen with you and confirm what you hear, or add to what you are hearing.
Be as kind and gentle with yourself, as you are with your patients. Best wishes in your career.
I wish all the nurses were as helpful as you. I am looking forward that someday I'll be able to work with a supervisor with such amazing attitude as yours, helping & guiding nurses specially to new grads. Unfortunately, I dont have a supervisor like you. My QA supervisor always answer me this every time I asked her:" that's ok? that's good!" even without reading or looking and I asked her can u help or show me how to do it next time? on some certain procedure or paperworks and really got nothing from her till this time, no matter how aggressive am I to learn, worst thing she always tell me is that " leave it there I'll do it, dont worry about it". But thanks to this thread Bea, all the comments above really motivates me, very encouraging, so true it takes time since nursing is forever learning career.
You will get there :) And knowing what you DON'T know will save a lot more people....I used to cringe when a newbie never asked questions, and felt I had to follow them everywhere (and sometimes did).
And, every time you change jobs (which most nurses do) you start all over again with new information- even on the same type of floor- a lot of places tend to do more or less of some types of diagnoses. But you still go in with the stuff you learned at the other places, so this is the hardest time.
Every day, you will have something seem more like second nature- and each time you learn more about a diagnosis or medication, you build on the foundation that you got in nursing school.
That's something I don't think students get enough of the message of: Nursing school is a foundation. It teaches you how to not kill someone on purpose
When you get turned loose, you're just out there (sounds like you've got good folks with you, though)...and that is terrifying. If you weren't concerned I'd be scared !!
You're not dumb. The dumb ones don't know they don't know everything....seriously. You have to have some brains to know you have stuff to learn
Thank you all so much for your encouragement. I love hearing from you "experienced Nurses" It helps me realize that I too will be there some day. I can't wait for the day that I feel confident enough to help out a new nurse and help her get through the tough beginning
I am on the same boat. I have been a working as an LPN in ltc for 1 year and 3 mos. A couple of weeks ago, a diabetic resident had a hypoglycemic episode. She was unresponsive (did respond to pain per sternum rub). I went and got a glucagon gel from the e-kit and tried to give it to her PO. She was not swallowing. I called the ER and spoke to the DR on call, he said I should be able to administer the Glucagon IM as long as it is in our standing orders and it was. I got the Glucagon IM from the e-kit which looked like one of those plastic eyeglasses box with a syringe in it that had 10 ml of fluid and a vial. I went and ran to the resident's room and administered. I found out later on that I had only injected the saline water and missed to dissolve the actual glucagon that was in the vial. Spell d-u-m-b. The EMS came minutes after that because I had already called them too after I called the ER, just in case and I'm glad I did.
I went home and BAWLED. I was so embarrassed and mad at myself. Whatever tiny bit of confidence I thought I had went POOF - just gone. MY supervisors, the RN's and my DON were very supportive and understanding about the incident. But I just could not forgive myself. Still couldnt. This thread made me feel somewhat better though, I don't feel so alone anymore.
I am on the same boat. I have been a working as an LPN in ltc for 1 year and 3 mos. A couple of weeks ago, a diabetic resident had a hypoglycemic episode. She was unresponsive (did respond to pain per sternum rub). I went and got a glucagon gel from the e-kit and tried to give it to her PO. She was not swallowing. I called the ER and spoke to the DR on call, he said I should be able to administer the Glucagon IM as long as it is in our standing orders and it was. I got the Glucagon IM from the e-kit which looked like one of those plastic eyeglasses box with a syringe in it that had 10 ml of fluid and a vial. I went and ran to the resident's room and administered. I found out later on that I had only injected the saline water and missed to dissolve the actual glucagon that was in the vial. Spell d-u-m-b. The EMS came minutes after that because I had already called them too after I called the ER, just in case and I'm glad I did.
I went home and BAWLED. I was so embarrassed and mad at myself. Whatever tiny bit of confidence I thought I had went POOF - just gone. MY supervisors, the RN's and my DON were very supportive and understanding about the incident. But I just could not forgive myself. Still couldnt. This thread made me feel somewhat better though, I don't feel so alone anymore.
Hugs. Next time you'll be ready and there's always a next time.
Hello beatrice! That is a feeling that everyone has to experience sometime, I know I did, and still do at times. When I finished LPN school, I felt like the biggest idiot on the planet. During my orientation, I had that feeling A LOT! It did get easier the further along in orientation.
Finished RN school, and had the same feeling - this time, as an RN, I had the stress of learning to charge, ect and that brought new stressing and new feelings of "what in the --- am I doing???"
I get it when I transfer to a different specialty - when I transferred to OB, I thought I was the worse nurse in the history of OB/GYN, and figured I'd never learn to work in the C sections.
ER gave me new experience, but also new feelings of "what am I doing???!" Never thought I'd learn to do my job in a trauma.
OK, so my point in rambling, it does get better and easier in time. Try not to panic and feel like u can't do something - and please remember the only stupid question is the one u should have asked and didn't.
I am on the same boat. I have been a working as an LPN in ltc for 1 year and 3 mos. A couple of weeks ago, a diabetic resident had a hypoglycemic episode. She was unresponsive (did respond to pain per sternum rub). I went and got a glucagon gel from the e-kit and tried to give it to her PO. She was not swallowing. I called the ER and spoke to the DR on call, he said I should be able to administer the Glucagon IM as long as it is in our standing orders and it was. I got the Glucagon IM from the e-kit which looked like one of those plastic eyeglasses box with a syringe in it that had 10 ml of fluid and a vial. I went and ran to the resident's room and administered. I found out later on that I had only injected the saline water and missed to dissolve the actual glucagon that was in the vial. Spell d-u-m-b. The EMS came minutes after that because I had already called them too after I called the ER, just in case and I'm glad I did.
I went home and BAWLED. I was so embarrassed and mad at myself. Whatever tiny bit of confidence I thought I had went POOF - just gone. MY supervisors, the RN's and my DON were very supportive and understanding about the incident. But I just could not forgive myself. Still couldnt. This thread made me feel somewhat better though, I don't feel so alone anymore.
I had been off of work for maternity leave and when I came back the advair inhalers were just being ordered....you should have seen me try and work that one....(I ended up asking the resident) Same thing with the pill inhaler (darn I can't think of the med name)
Moral of the story...nursing is always changing....I was only out for a few months and have been an nurse for almost 10 yrs at that point. When you start thinking you know it all that is when you need to check yourself!
I had been off of work for maternity leave and when I came back the advair inhalers were just being ordered....you should have seen me try and work that one....(I ended up asking the resident) Same thing with the pill inhaler (darn I can't think of the med name)
Moral of the story...nursing is always changing....I was only out for a few months and have been an nurse for almost 10 yrs at that point. When you start thinking you know it all that is when you need to check yourself!
Oh, yeah!! The Spiriva, or whatever?? I felt like a real idiot when I saw that in a patient's med drawer for the first time!! Glad it wasn't just me.
Oh..I forgot about the IV meds with the powder that needs to be mixed. That was funny too. I knew you needed to get the solution into the vial, but how? Gosh...that was quite a few years ago now. Solumedrol for injection too
The dumb ones don't know they don't know everything....seriously. You have to have some brains to know you have stuff to learn 
The Spiriva, or whatever?? I felt like a real idiot when I saw that in a patient's med drawer for the first time!! Glad it wasn't just me.
nola1202
587 Posts
I wasn't going to log on tonight but I saw the title of your thread and laughed. Been there, done that. Changed specialties, same thing.
The change will come gradually. One day you'll know dietary's phone number off the top of your head. A family member will have a question and you'll know the answer or who to call for the information. One day you'll fly through tasks that used to take a long time and a lot of effort. Getting an order from an MD will not be a big deal, you'll know what information needs to be at your fingertips. You'll anticipate what will be ordered or needed. New hires will be coming to you with questions and you'll know the answers. You'll be the one to help them check out a patient's lung sounds. How great will that be?
What's wonderful is all this, is happening now. By using your resources to back up your instincts and knowledge, you are learning what you couldn't in school or clinicals, there just isn't enough time.
I work as a supervisor and I love to answer questions, assist with assessments and teach what to do when. I find it rewarding to see someone grow and gain confidence. There's nothing more fun that watching someone get an IV in a dehydrated pt. with rolling veins. The look on their face, priceless...it's this "wow, I can't believe I did that."
Lung sounds by the way are best learned the way you described, having someone listen with you and confirm what you hear, or add to what you are hearing.
Be as kind and gentle with yourself, as you are with your patients. Best wishes in your career.