Will it get better??

[tess16]

Hi all! I graduated from LPN school in May, and passed boards two weeks after graduation. I had a job at a LTC facility, and from the day I passed boards, I have been working. We have approximately 30 residents, and many right now are acute. PICC, IVs, Wounds, GJ Tubes, PEGs, NGs, etc! Typically, I get two aids if I'm lucky. We are required to do 5 baths, and sometimes I don't get a TMA. I end up putting 4 or 5 residents to bed at night, while trying to get them their medications and treatments. I recently had a few days off, and when I told them I wouldn't be able to work, they continued to ask about other shifts. 12 missed messages worth of begging me to work. I tell them no, and they continue to ask. Not to mention I only received 4 days of orientation as a new grad. Most nights, I feel so overwhelmed. I feel like I am a failure of a nurse. This facility is paying for me to advance my education, and I am very grateful. But my heart breaks most days because I feel as though I am failing my CNAs and residents, who I think deserve so much more. Any tips or advice from people who were in similar situations?? Did you stay or find a new job?

[djh123]

You're not a failure. You're new, you're not being given enough help (you should have 3 CNA's instead of 2, and I don't know what a TMA is that you mention), you didn't get enough orientation (neither did I in my first job)... but I get it re: you feeling like you're not doing enough for your residents.

[tess16]

Thank you! I appreciate it!

[cyc0sys]

I'd consider leaving if you can't get more CNA. 10 Pts to a CNA is the minimum I'd feel safe working with.

The first thing you need to understand is that it's not all doable. That being said, you are correct in your assumption that your playing life boat politics.

Prioritize medications. Get all of your critical meds out first. If Mr. Jones doesn't get his mirlax or melatonin it's not going to kill him. Cardiac meds and IV vanco needs to run on time or bad things will happen.

Treatments are similar. Start with postops and then pressure ulcers. If a bandaid on a skin tear goes a few days it's not a big deal. Some dressing don't need to be changed QD. It actually causes skin break down and slows healing.

It takes a while to find your rhythm.

Schedule skin checks and showers together if you can.

Make sure your med and treatment carts are stocked before shift.

Ideally, you should pass dinner meds than HS meds. If your working 3-11pm, I start treatments first with bed bound before dinner and then finish up with the walkie-talkies at HS. Sometimes its easier to do spot treatments than running down a schedule or list.

If certain medications can be given together or earlier. Write an order and change the time of administration to streamline your med pass.

Plan on passing pain meds with HS meds for postop Pts. If its possible, have the Doc schedule pain medication and minimize PRN at least for the first 3 days in facility.

Document everything that can't be done and pass it on shift report.

[tess16]

Thank you! This really is helpful!! I appreciate it!

[CapeCodMermaid, RN]

"Some dressing don't need to be changed QD. It actually causes skin break down and slows healing." If you don't change the dressings when ordered, yes, even bandaids, you aren't following protocol. Most dressings do need to be changed every day, with the exception of hydrocolloids and wound vacs. At the very least you need to assess the area...unless you're an LPN and in that case you can only observe it. Doing a half ass job or skipping ordered medications because you think they're not important will get you in a heap of trouble...PS. Miralax IS an important medication in the elderly.

[tess16]

I agree with you to an extent. But at my job, we have HS pass. So we have from 630-1030pm to do the medications and tx. I took that as prioritize your important medications, and come back to your medications that don't need to be given as early. As for dressing changes, of course I'm going to follow the providers order with changes. A lot of times wound changes are scheduled for mornings, if it's 1x a day. If BID, TID, QID then prioritize those as well. Is the dressing CDI? Are they in pain? If both of those are a no, move along and come back to it. Doesn't mean not do it. Just how I took it. :-) I am still learning daily what I should do first. I am starting to get a routine, but a lot of times something happens that interferes with it (a fall, feeding tubes clogged, patients want to speak with me, bed alarms go off, etc.) and then I'm trying to jump back into where I was. Lol. But thank you both for the advice, and I can see where you're coming from, CapeCodMermaid. People do find it OK to skip things or take short cuts so often in the nursing homes, and that is part of what bothers me. The residents tell me they feel rushed, or they feel like nobody answers their lights in a timely manner. And it's sad.

[middleagednurse]

On your days off, don't answer the phone if the facility is calling. They can leave VM, then you can decide if you want to call back or not. You are in a battlefield and you have to protect yourself. Don't let them guilt you into working OT. It is not your job to save the world.

[Blackcat99]

Will it get better? NO. But it usually doesn't help to find a new nursing home either. Most of the nursing homes are all the same.

[tess16]

Thank you both for your responses. I am so torn between resigning, and not resigning. At this point I feel as though I would be happier working doing anything else. And that is so saddening. I LOVE these residents. So so much. But I cry most nights because they beg me to not leave them alone after I finish their treatments because they're afraid nobody will come back for them. But then I think that if I leave, where does that leave the residents that I love so much? I also struggle with another nurse. She is extremely rude to me, and has several times called me "a stupid idiot" in report, in front of other staff, residents, and occasionally their families. I will suggest a Tx plan for a resident that I feel may work for them, and she laughs and says that's ridiculous. And then brings it to the DNS as her own idea. I am so conflicted at this time.

[middleagednurse]

Don't tolerate the bully. Hard work is one thing, insults are another. Write her up every time she says anything insulting. Management might side with her but at least you will have stood up for yourself.