Will I ever hack it?

Published

I've been a nurse for a year and a half. The majority of that time, I worked in a pediatrician's office. I started my current job at a LTC/SNF working .8 seven weeks ago. I float to 5 different units, each about 35 residents each. I've started to develop a routine on the 2 units I spend most my time on as I have started to become familiar with the residents. Some days go prettt smoothly where I pass meds on time, get only a couple labs where I have to page the MD and enter new orders, and have no incidents or admissions. Many other days, I get held up from being able to pass meds on time due to multiple labs to call on, multiple new orders to enter, family calling, a fall with neuro checks and all the charting that goes with that....and I end up not leaving my 3-11 shift til 2:30 am.

I haven't had a problem with this as I assumed it was normal for it to take time to develop a routine that works best for me. However, my confidence that I was gradually learning and progressing was completely shaken last night when a night nurse came on and, trying to be helpful, bluntly told me that my being behind last night had nothing to do with the fact that the unit I worked is the most challenging unit and that I don't have much experience on that unit (to the point where I have a routine down like the others.) 3 trach's, 4 g-tubes (one of which came out and I had to reinsert a new one) 8 accuchecks, all with insulin, a colostomy that leaked all over an abdominal dressing (changed the colostomy bag and the dressing -big mess) 1 IV running, a fall occurance with neuro checks, 5 labs which took time looking up the necessary info the doc would need to know such as prior lab results and current meds, all with new orders, 2 pharmacy requisitions...oh yeah, and then there were all the meds.

So at 11 when the night shift came on, I still had 3 residents to give narcs to and 1 resident of a fellow nurse orienting to administer meds and a bolus feeding to (she needed me to teach her how to do it.)

The night shift nurse said it had nothing to do with my being not the most familiar with the unit, nor the labs that came in. I said, "I'm new, I'm still learning new things every day, I'm still trying to find a routine that works best for me." He said no, I'm unorganized. He basically said that by now, it shouldn't matter if I'm familiar with the unit or the residents or not. I try to be organized. Still trial and error.

So at week 7 should I be further along by now with getting things done faster, no matter my famiarity with the unit or number of labs or family phone calls or incidents/occurrences?

I'm trying my HARDEST. I bust my butt. I thought I was making progress. Is this faulty thinking on my end, or the night nurse not remembering how busy PMs are? Both?

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Specializes in LTC.

Yes you will get it....it is pretty unfair of that nurse who I will presume to have been there for a long time and has lots of experience, to point this out. However, ask this nurse "what can I do to be more efficient with my time?" There may be things you can learn from this person.

LTC is tough for new nurses....you haven't had time to develop yet....but it will come. Be patient with yourself!

Ask your facility to keep you on one unit as long as possible.....cluster days together so you can get a good routine down.

Best of luck and keep smiling!

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Specializes in Clinical Research, Outpt Women's Health.

It sounds like you are progressing well. What a load!

However, if there is a chance there is any truth to you not being well organized then get some tips. It can only help you tremendously.

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Specializes in adult psych, LTC/SNF, child psych.

I think I honestly spent 8 weeks on orientation and then still felt shaky. I was constantly asking questions of the other floor nurse, thankful for the unit manager being at the nursing station for most of the shift and feeling like my med pass was taking forever and I would be passing meds for 3 hours because of so many interruptions.

Eventually I got down a routine. Highlighters of 5 different colors - one for fingersticks, one for 1st med pass, one for second med pass, one for vitals, one for labs. Also a flowsheet kinda helps for the predictable stuff, like treatments and checking on tube feeders. Unexpected things do happen, but things like stocking your cart, having extra supplies on hand, having a list of labs due or drawn and a list of residents and their docs, as well as phone numbers is essential.

But wait - you have 35 residents all to yourself? Is this LTC or rehab? Our units max out at 34 but every unit has 2 nurses on days and on evenings. I've never had more than 18 and that was really tough. I work nights now and do have a whole floor to myself but nights is a different animal than evenings.

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I've been a nurse for a year and a half. The majority of that time, I worked in a pediatrician's office. I started my current job at a LTC/SNF working .8 seven weeks ago. I float to 5 different units, each about 35 residents each. I've started to develop a routine on the 2 units I spend most my time on as I have started to become familiar with the residents. Some days go prettt smoothly where I pass meds on time, get only a couple labs where I have to page the MD and enter new orders, and have no incidents or admissions. Many other days, I get held up from being able to pass meds on time due to multiple labs to call on, multiple new orders to enter, family calling, a fall with neuro checks and all the charting that goes with that....and I end up not leaving my 3-11 shift til 2:30 am.

I haven't had a problem with this as I assumed it was normal for it to take time to develop a routine that works best for me. However, my confidence that I was gradually learning and progressing was completely shaken last night when a night nurse came on and, trying to be helpful, bluntly told me that my being behind last night had nothing to do with the fact that the unit I worked is the most challenging unit and that I don't have much experience on that unit (to the point where I have a routine down like the others.) 3 trach's, 4 g-tubes (one of which came out and I had to reinsert a new one) 8 accuchecks, all with insulin, a colostomy that leaked all over an abdominal dressing (changed the colostomy bag and the dressing -big mess) 1 IV running, a fall occurance with neuro checks, 5 labs which took time looking up the necessary info the doc would need to know such as prior lab results and current meds, all with new orders, 2 pharmacy requisitions...oh yeah, and then there were all the meds.

So at 11 when the night shift came on, I still had 3 residents to give narcs to and 1 resident of a fellow nurse orienting to administer meds and a bolus feeding to (she needed me to teach her how to do it.)

The night shift nurse said it had nothing to do with my being not the most familiar with the unit, nor the labs that came in. I said, "I'm new, I'm still learning new things every day, I'm still trying to find a routine that works best for me." He said no, I'm unorganized. He basically said that by now, it shouldn't matter if I'm familiar with the unit or the residents or not. I try to be organized. Still trial and error.

So at week 7 should I be further along by now with getting things done faster, no matter my famiarity with the unit or number of labs or family phone calls or incidents/occurrences?

I'm trying my HARDEST. I bust my butt. I thought I was making progress. Is this faulty thinking on my end, or the night nurse not remembering how busy PMs are? Both?

Seven weeks is barely time enough to get over the 'culture shock' of the workload in LTC. Added to that you are being floated, and have had to orient another new nurse? And if you are disorganized, has that coworker offered any suggestions to help you, or would he prefer to have to deal with a revolving door of constant new staff?

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Specializes in Pediatrics, Emergency, Trauma.
I think I honestly spent 8 weeks on orientation and then still felt shaky. I was constantly asking questions of the other floor nurse, thankful for the unit manager being at the nursing station for most of the shift and feeling like my med pass was taking forever and I would be passing meds for 3 hours because of so many interruptions.

Eventually I got down a routine. Highlighters of 5 different colors - one for fingersticks, one for 1st med pass, one for second med pass, one for vitals, one for labs. Also a flowsheet kinda helps for the predictable stuff, like treatments and checking on tube feeders. Unexpected things do happen, but things like stocking your cart, having extra supplies on hand, having a list of labs due or drawn and a list of residents and their docs, as well as phone numbers is essential.

But wait - you have 35 residents all to yourself? Is this LTC or rehab? Our units max out at 34 but every unit has 2 nurses on days and on evenings. I've never had more than 18 and that was really tough. I work nights now and do have a whole floor to myself but nights is a different animal than evenings.

^This.

Short answer-yes.

Case in point: haven't done a cart in two years; at my current job few and far in between; but I still get out fairly on time-because I have a system in place-meaning, no more than 1-10 minutes over the shift. :yes:

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This sounds like what my nursing instructor told me, but I am about to go into LTC myself, after 9 years as an LPN, with clinic only experience. Keep going, and don't give up. Cheers for all the support and advice, and I wish you the best of luck:)

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3-11 is the most challenging shift, in my opinion. As an LTC night shifter myself, I'll just say that the other nurse is entitled to his opinion, but don't take it as gospel and don't let it keep you from feeling like you're making progress. And if you're staying that late to tie things up, it means you're not shoving work onto the next shift, which is wayyy more than I can say for some of my 3-11 coworkers...

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