wow-ltc is crazy!!!!

[pn5437]

After 3 days of orientation, I started on my own as an LPN at a skilled nursing facility. My patient load consists of about 30 residents and these include lots of g-tubes, tube feedings, accu checks and of course lots of meds! I work a 7a to 7p shift and I cant believe how crazy it is from 7-3. Being my first day, of course i was beyond overwhelmed. I learned how to give meds via g-tubes in orientation, but tube feedings and iv meds i had to learn my first day on my own. I was lucky enough to have a very nice nurse on my floor to help me, but i knew she was busy herself so I was worried about asking her too many questions.

The most frustrating thing about the day was not being able to find alot of the patients meds. I wasted alot of time searching for medications that I just never found. I assume most of these meds are being borrowed from other residents, but because I'm not familiar with what each resident gets, I couldnt go through the entire med cart looking for each med that was missing. I ended up not giving at least 13 medications on my one shift because of this. Of course I had a patient who fell, 2 patients who couldnt breath, 2 patients who would not stop calling me in their room and a family member who was complaining about the CNA. I had a hospice patient that needed to be suctioned, and I've never done this before so I asked for help. Long story short, I had 4 other nurses trying to suction this patient and they couldnt figure out why the machine wasnt suctioning. We finally got another machine, and that one didnt suction either. After almost 30 minutes of this, I ended up leaving the other 4 nurses to suction this patient because it was 2pm and I still wasnt done with my 9am meds!!

In the end I ended up leaving at almost 9pm and I couldnt even do my charting bc I was worried about getting in trouble with overtime since I am new. Is this the norm? I mean, I know its hard in the beginning but how long did it take you to become adjusted and HOW did you do it?? How do you organize your feedings and accu checks so that you dont waste so much time? And how do I tell the CNA's to please not chit chat with me at my med cart so I can actually do my job?

[LTCangel, ADN, BSN, LPN]

Hi, first I'd like to say so sorry you didn't really get much orientation. I just changed from being a hospital nurse back to LTC. The reasons are too long to go into right now, but when I started I fully expected to get a bare bones orientation but it is 4 weeks and if I don't feel comfortable I can ask for 2 more weeks!:yeah:I was so pleasantly surprised. This SNF is owned by a very large corporation and my orientation package closely resembles the one I had in the hospital. I will get one on one days with the Wound care nurse, the Respiratory therapist, along with several days of computer charting competencies. I have a large stack of skills comps to be checked off on along with 2 weeks with the night shift nurses that I will be working with. I have been warmly welcomed by everyone and the DON is terrific. I feel very blessed. You will get better as you go along. even in the hospital, we all have to learn what organizational pattern works best personally. It is overwhelming but it goes with the job category of nurse! Just try to go with the flow, learn your residents and CNAs and it will all come together. A year from now you"ll look back and be able to give advice to other new nurses. But I feel you were definitely done a huge injustice by not getting a better orientation, it's unsafe for you and your residents. God bless and Good Luck. the fact that you are even worried about it says to me that you will be an EXCELLENT nurse.

Lisa:nurse:

[WittySarcasm, BSN]

I can say from experience that yes, the first few days/weeks will be hard for you. I was in the same boat, my first nursing job was nursing homes. It is hard at first, but as time goes on and as you learn the residents it will be easier.

One thing for sure- cluster care! What I do is when I first get on the floor after count is I grab the med book and quickly flip through and write down times that meds/finger sticks/whatever is due. This helps me from flipping needlessly and allows me more time to get other stuff done in the middle of meds.

Remember the golden rule an hour before and an hour later for meds. I say golden rule because I've learned it helps a lot.

As for family I found step back, take a breath (especially at this point you want to scream) and discreetly look at a clock or your watch. Allow the family member to vent for a few mins- whatever you feel you have time- sometimes just letting them vent will help a lot. If not, then find a place where you can break into the conversation and tell them 'I understand how you feel, if I this had happened to my family member I would feel the same way. Let me talk to the aide and I will come back to you.' And of course remember to come back (eek it's bad when you don't come back).

As for the broken equipment, I feel your pain there. On my unit almost everything is broken (which we all find to just joke about). I mean our hoyers have been known to freeze in mid-air, our vital machines usually have to be done 4-5 times to get a reading. And just today we found out our blanket warmer just kicked the bucket. But this is also common in LTC.

I know it is hard and tiring at times. But I promise this is a rewarding job. Especially when you see your residents smile at you and you can talk to the family. As time goes on, and they get to know you, they will get to trust you and incidents with them venting will become shorter. Also they will get to the point where they will not question your answers, job or even you and they will trust you. I've gained several family members trust now.

Good luck!

[LTCangel, ADN, BSN, LPN]

Haha, broken equipment is also a big problem in hospitals. After working in one for 14 yrs, I used to say "This would be great place to start a hospital!" Especially after looking all over for diffferent things that should have been readily available in order to adequarely care for acutely ill and post-op patients. Just sayin', it's not just LTC!