[nurse_wannabe]

Hello all. It's been a long time since I've posted anything. I am starting my very first LPN job tomorrow night in a LTC facility.

I will be working the 10 pm - 6 am shift. The DON has made mention that there is a lack of leadership on that shift involving the CNAs and the previous LPN wanting to be their buddy instead of their charge nurse.

I was wondering if you guys had any good suggestions for me in regards to the CNA issue, how to stay awake, sleep during the day, organize my shift, or anything else. I am scared to death, really, so any ideas or words of wisdom would be greatly appreciated. I don't know what to even expect, so that in itself is very stressful!

Thank you in advance!

[NebbyLPN]

The DON probably means that the CNAs have buffaloed the other charge nurse to looking the other way when they do wrong things because she's so friendly with them. It's OK to be friendly, but there are lines that have to be drawn. Don't be a desk jockey. Get out on the floor frequently if only to take a walk down the hallways--sometimes you can prevent some tragedy (a fall) happening with a patient, and it keeps the aides on their toes if they never quite know where you are or what you're up to. 5am is probably the worst time of the shift. If you get tired, get up and move around (take a walk down the hall). I'm sure the day is going to come when an aide has done something wrong and you'll have to say something to them. Hopefully, it won't be tomorrow tonight. Stay up late tonight. Set your alarm clock and only sleep a couple of hours. That way when you lie down around 5pm or earlier tomorrow you will be able to get to sleep.

[Chicklet2]

Hey, just so you know your not alone. I just did my first shift as an LPN in LTC last monday. I was sooo scared, but it wasn't that bad. The NA's were soo super

[LoriAlabamaRN]

I'm an RN who works the 11p to 7a shift at an LTC facility. At nights I am the only RN in the building. While the LPNs are in charge of their individual halls, I am in charge of the facility (make sense?) Do you not have an RN manager at night?
Working the night shift does take a little getting used to. With the CNAs, I recommend having a friendly relationship (after all, you might need to ask them to work understaffed, or need them to volunteer to work their day off, etc so its a good idea to have a good rapport) but also to draw the line when it comes to them trying to take advantage of you. They are probably going to test you at first. What I did was gather them together my first shift and explain my ground rules:

1. Since there are going to be slow periods on this shift, you are allowed to watch TV in the day room (with the volume low enough for you to hear call lights) or look at books, magazines, study etc when you are not making rounds. However, if rounds are not being made on schedule or if call lights are not answered quickly, this won't be allowed.

2. No sleeping. It is one thing to nod off for a moment while typing or resting between rounds, but anything else will not be tolerated. If you can't stay awake while sitting on the couch watching TV between rounds, then do not do it. (some of my CNAs sit together and talk, take walks, etc because they would fall asleep if they were watching TV).

3. Smoke breaks are just that - BREAKS. Not sitting outside for 45 minutes as a group simply because you are between rounds. No more than 2 people can go smoke at a time, and for only 5-10 minutes. When you are outside, you can't hear call lights.

4. We are here for the residents. I will be making compliance rounds several times a shift to check for cleanliness, dry diapers, call lights in reach, etc.

5. I am not the type of person to write you up for every little thing. I think we are all adults here and first I will always talk with you about any problems. Usually it doesn't have to go further than that, but if I feel people are taking advantage of my lenience, it will stop.

6. We are a team here. I am not asking you to do anything I am not willing to do myself, and I will help you when I can. However, you need to understand that I do have my own work to do, work you cannot help me do, and sometimes I will be too busy to assist you.

Since my little meeting, I really haven't had much of a problem. Just remember to respect and value your CNAs, and be willing to learn about your individual patients from them- they will know them well.

As for sleeping during the day, try to darken your bedroom as much as possible- aluminum foil over the windows or blackout drapes work well. Let everyone in your life know you will be sleeping during the day so not to call or visit after 9am or before 8pm. Turn the ringer off of your phone if you have to. During the night, drink caffeinated soda or coffee, I also take Goodys powders for a "pick me up" but not on an empty stomach and no more than two a night. If I am sleepy, I get up and take a walk around the facility. I also keep a small fan on my desk blowing on my face- sounds silly, but it really helps me stay alert!

You're going to do fine.
Lori

[barefootlady]

Great advice mostly but I do not agree with TV watching unless it is out of sight and sound of residents. It will amaze you how many residents do not sleep well at night and attempt to get OOB to join in the TV watching. Now, if there is a national emergency or bad weather and you are monitoring the local channel for updates, that is another story. I prefer a radio, at the desk, very, very low but still able to get all of the local info a person needs, expecially in the winter with snow, rain, ice on roads. Also school closing are announced very early on the radio, so you may get a heads up before some of the call-ins start and can call the DON/ADON if staffing gets to the dangerous, unacceptable level.
CNA's are no different than any other health care worker, they do what needs to be done mostly, but there is always one or two who will goof off, dodge tasks, and make the job harder on every other staff member if allowed to get by with this behavior. Be professional, be polite, attempt to have a witness present if you speak to staff regarding incidents. It will save a possible problem later when CNA reports your lack of respect for the,. ( have had this happen before and never reprimand staff w/o witness.
Good luck and I am sure you will do a good job. Remember, it is a learning process for you too, ask for assistance if necessary from DON/ADON, other nurses and good CNA's.

[cantoo]

I am an ADON in a long term care facility. The above posters comments are excellent! I worked nights for a long time. I never had a problem with my CNA's. I think if you treat them with respect, they will be just fine. They are adults and professionals. Never talk down to them. They are the back-bone of the facility and they work so very hard. It also helps when they know that you will pitch in when you can and will never ask them to do anything you wouldn't do.

As for working nights, it helped me to maintain a night schedule even on my days off. I nearly went crazy trying to revert back to a day schedule on my days off. At the time I had little ones, so I would come home, put them on the bus and sleep while they were in school. I got a pager and gave that number to their teachers for emergencies so I could turn the phone off and wouldn't be worried that the school couldn't reach me. Then I had all evening to spend with them doing homework or whatever.

I'm so glad you chose long term care. It seems as though the government has just thrown away our elderly population. The funding for these wonderful people is pathetic and many times they don't even have family that cares. It takes some creative thinking to even get these folks the clothes and shoes they need....let alone the meds and such. Medicare sucks! It's always an up-hill battle and it can wear on a nurses reserve. It's not an easy job. You will need to have good assessment skills...many can't tell you what's wrong or where it hurts and you can't always count on having a doctor at the ready. Most LTC's now have sub-acute units as well. These folks can be down right sick and most should still be in a hospital. The old thinking that nurses in LTC just pass out pills all day is gone! In my LTC, we have patients with mediports, PICC lines, PCA's, IV pushes....you name it.

I wish you luck and I know you will do just fine! Just give it time and don't give up!! We need good nurses!!::