Advice for first job in a SNF?

  1. 1 Hi everyone! I graduated with my ADN in May and finally landed my first job It's a PRN job in a SNF and I'm also waiting to hear about another PRN job in a LTC facility. I originally got into nursing because my grandmother developed Alzheimer's so these are the types of places I rreeaallyy want to work in. I've been reading a lot of forums on here to get advice and wanted to see if anyone in these types of facilities could offer me some tips for preparing myself/what to expect/how to handle everything. I'm absolutely aware that I do not know nearly everything that I need to, so I'm really trying to absorb as much as I can to prepare myself. I'm really hoping that these jobs work out, so thank you for any help you can give me!
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  3. Visit  StaceFace1122 profile page

    About StaceFace1122

    Joined Mar '12; Posts: 17; Likes: 4.

    13 Comments so far...

  4. Visit  SarahLeeRN profile page
    4
    I have a few suggestions... Feel free to pick and choose as needed...
    1. Read everything and anything you can get your hands on about time management, delegation, conflict resolution ('management' type stuff). It seems like sometimes those types of things are what can really help a person in LTC-it is great for everyone of course, but if this is your first ever nursing job....LTC is full of dynamics. My experience was that the medical end of nursing was the least of my problems at least in the first six months!
    2. Listen a ton, say a little when you are orienting. Ask tons of questions of course, but try not to get sucked into the pool of personal opinion. Figure out the dynamics of the workplace-and try to stay out of them.
    3. Make sure that you are going to get a good orientation. Use the "I am a new graduate" card and I mean REALLY use it. LTC is notorious for shortening orientation....
    4. I don't know what your particular situation is, but I would suggest at least aiming for part time work for a while-repetition is key when new.
    5. Value all opinions until you get to know all of the players. You won't know who is just trying to buddy buddy the new person etc at first. But don't ever ever ever devalue the opinion of LPNs or CNAs that have worked there longer than you have. Nothing gets crazier than what happens if the 'group' thinks a newbie is coming in really strong and opinionated-especially as a new nurse. I am not saying that you will be like this of course-I am just basing this on things that I have seen. You get a little more leeway if you have some experience but that won't come for awhile.
    6. Check out the policy and procedure book of the facility. Check and see when it was last updated-that might give you a clue as to if the facility is on top of things or not...:P
    7. See if the nurses are following the P&P book....
    8. Read up on pressure ulcers, venous stasis ulcers, wounds.
    9. Read up on dementia, look up the term "Theraputic fibbing." I found that a lifesaver. Never taken something rude or angry a person with dementia says to you seriously.
    10. Get online and watch Teepa Snow. Just Google her name. She is amazing...and will give you amazing tips for working with dementia. She is spot on.
    11. Brush up on your labs. Remember that some nursing home patients will have chronic 'off' lab work...so don't freak out unless you have the whole picture.
    12. Med passes in LTC can be nuts. If you know you are going to have the same wing the next day, save your sheet. Write down the med times on the sheet. Get a system. Highlight off things as you go. Ask the other nurses what they do to keep organized.
    13. Find out what the process for incident reporting is. They will probably tell you this, but don't ever chart that you filled out an incident report. Incident reports are for facility evaluation. If you enter that you filled one out in a patient chart it is admissible in court if I understand correctly.
    14. Use common sense. If anything looks 'fishy' don't hesitate to get out. Not all LTC are the same...some are amazing, and some are risky to work in.
    15. Have a wonderful time. I hope this helped even a little. I am sure there is more I could tell you if I could think of it....LTC can be very difficult but very rewarding. I wish you all the best!
    Siennah, Blackcat99, LTCangel, and 1 other like this.
  5. Visit  StaceFace1122 profile page
    1
    Thank you so much SarahLeeRN! I will definitely explore all of your suggestions, I'm trying to be as well-prepared as possible! I think my orientation is only a few weeks long, which is kind of intimidating, but the DON said that I have the option of staying on a little longer if I feel like I'm not ready. I wish I could work more regularly, but PRN was all that was available and I have to work another full-time, non-nursing job to pay bills I think I will be reducing my full-time job to 30 hours each week so I can pick up more nursing shifts. I'm hoping to learn as much as possible! Thank you again so much for your response
    Blackcat99 likes this.
  6. Visit  Sweeti738 profile page
    4
    Hey hun! I graduated in May and got my first RN job at in LTC. I would definitely say don't let the pt to nurse ratio intimidate you because on paper it seems impossible, but you can do it! You have to remember this is NOT a hospital and things are done very differently. Also the med pass can be ridiculous, but you'll get through that too Always carry a highlighter, a sharpie and two pens. Try to stay out of the workplace drama and NEVER gossip because there are always people who will be friendly to your face and talk behind your back. And the number one thing I can tell you is if you don't know or even if your unsure ASK! Its much easier to ask than to have to fix a mistake. Good luck!!
    newgraduategal, Blackcat99, LTCangel, and 1 other like this.
  7. Visit  Blackcat99 profile page
    3
    Be prepared for many days of "utter frustration." Pharmacy sometimes won't send you the narcotics you need. You go into the ER kit to get the narcotics that pharmacy didn't send you only to discover that the ER kit too is also empty of the meds you need. It's also fun when you have a bunch of IV antibiotics to give and you discover that there is hardly any IV supplies such as normal saline flushes, heparin flushes and the proper equipment to even hang an IV antibiotic. I also love it when they have no big white cups for the G-tubes and the only big white cup available is marked with last week's date. I really enjoy being disturbed by huge pharmacy deliveries when I am already running late with the med pass.
    Mandylpn, NurseKatie08, and Sweeti738 like this.
  8. Visit  brendacg profile page
    3
    Get personal insurance for your license.
    DavidKarl, Mandylpn, and Blackcat99 like this.
  9. Visit  aspivey80 profile page
    0
    Wow... A couple of weeks for orientation?!?! Thats pretty amazing!! I had one day to shadow basically (a Monday) one day for paperwork (a Wednesday) and one final day with a nurse watching me to see if I was doing okay (a Thursday) and then a day off Friday and that weekend I was on my own, literally... Just me and my CNAs. Talk about throwing you to the wolves. That was rough!!!
  10. Visit  Mandylpn profile page
    0
    Quote from brendacg
    Get personal insurance for your license.
    ABSOLUTELY, IT'S NOT THAT EXPENSIVE EITHER!
  11. Visit  PankaD89 profile page
    1
    Quote from Mandylpn

    ABSOLUTELY, IT'S NOT THAT EXPENSIVE EITHER!
    How do we go about doing that?
    Sweeti738 likes this.
  12. Visit  Blackcat99 profile page
    0
    Try nso.com for malpractice insurance.
  13. Visit  PankaD89 profile page
    0
    Ok I've checked it out my quote is for an annual premium, so does that mean I only have to pay that small amount once a year to protect my license?! If so, that is MORE than worth it!! Awesome
  14. Visit  StaceFace1122 profile page
    1
    Thank you all so much for the advice! My first day is next Monday and I'm starting to feel a little nervous
    Blackcat99 likes this.
  15. Visit  dolphinz4vr profile page
    0
    1. Use a table for a cheat sheet and make a copy of it use it during report.. Write down each pt name / room number lengthwise during report. Then divide widthwise into sections for each patient: medication times(8,12,2 days) (5,8,10 pm)(0000,0400,0600 nights) look in the MAR for each pt, in report ask the nurse if their meds are crushed/whole write next to pt name on your cheat sheet, BG check in the MAR, treatment, sat level, changes(to write note for something the cna reported or you observed. Use different colored highlighter for med time because not all pts will get a two o'clock med it will make med pass a little quicker easier, bg checks, tx nor do all pts are diabetic needing a bg check, same for treatments.
    2. If you need help or dont know ASK.
    3. Do charting, summaries, tx after each med pass, new orders, labs and follow up on cna reports.


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