First nursing job LTC facility need advice on how to survive !!!

Kooky Korky, BSN, RN · Mar 20, 2017

So where was everyone?

Who was supposed to do VS?

Who did feeding, bathing, toileting, ambulating, blood sugars, etc.?

How long was everyone gone?

How many patients did you have?

How many other staff are there?

Did you have a secretary?

You are going to have to lay down some rules.

You might want to talk about this with the DON before doing it. Let her know what you told us about people all MIA, no VS done, etc.

Tell her that you want her suggestions for how to handle that and that you have some ideas of your own. Ask her what she thinks of them.

Such as: assigning break and meal times

everyone must get permission from you when you are in Charge,to leave the floor

Let them know that this is because on (whatever dates) you couldn't find anyone from (times)

It sounds like you work with some real scumbags. Or maybe you just didn't know where to find them? Not that you should have to search.

Good luck.

RNOTODAY, BSN, RN · Mar 27, 2017

I just need to clarify, is this the setting that you specifically chose to work in?

arose26 · Mar 27, 2017

Initially yes I thought this was going to be the perfect environment for me to get experience but it did not work out and had to resign fory own well being , standards and need for quality training . I should have done better research and I take the responsibility for my error. Life is all about learning from your mistakes and setting your priorities in order. After this whole experience I have a little clearer vision of what I want and need to be the best nurse I can be.

TheCommuter, BSN, RN · Mar 28, 2017

I thought this was going to be the perfect environment for me to get experience but it did not work out and had to resign fory own well being

Since you have already resigned, the following advice is for others who choose to embark on a career in the LTC/rehab setting.

I worked in LTC/rehab for a number of years. In fact, it was one of my first jobs as a new grad. In the geographic area where I work, less than a week of orientation is the norm. This is true even if you are a new grad and it is your very first job. Managers in my city will roll their eyes if you dare ask for more orientation in LTC/rehab.

Although there are notable exceptions, most LTC facilities do not have extensive funds for training and onboarding, so they want new hires on the floor ASAP. Personally, I never received more than four days of training in this setting, even as a new grad nurse.

Time management is king. This may sound brusque, but it must be instilled in our awareness that LTC residents and their families are not our buddies. We certainly must be respectful, but there is no need to schmooze with the same resident or family for more than a few minutes. Pick up the pace, pass their meds, change any dressings, and rapidly start on the next resident. Do not permit any individual to monopolize your valuable time.

A 'to-do' list kept me organized. Below you will find one of my old to-do lists with names changed due to HIPAA. I worked 16-hour weekend double shifts (6am to 10pm) on a LTC/rehab unit years ago and usually had about 15 residents. At the start of the shift I would look through the MARs and TARs and wrote down all tasks that needed to be done in my notebook to formulate my to-do list. As a result, I wouldn't forget to do anything.

9-23-20XX

DIABETICS, FINGER STICKS: Linda (BID), Nancy (AC & HS), Bob (AC & HS), Pixie (AC & HS), Rex (BID), Jessica (BID), Eve (AC & HS), Marcy (0600, 1200, 1800, 2400)

NEBULIZERS: Marcy, Eve, Bob, Jessica, Pixie

DRESSING CHANGES: Pixie, Bob, John, Jessica, Lorelei, Rosa, Merle

IV THERAPY: Pixie (Vancomycin), Linda (Flagyl), Rex (ProcAlamine)

COUMADIN: Linda, Rosa, John, Merle

INJECTIONS: Linda (lovenox), Aurelia (arixtra), Rex (heparin), Bob (70/30 insulin), Eve (lantus), Marjorie (vitamin B12 shot)

ANTIBIOTICS: Pixie (wound infection), Rosa (UTI), Rex (pneumonia)

1200, 1300, 1400 meds: Marcy, Marjorie, Rosa, John, Merle, Nancy

1600, 1700, 1800 meds: Rosa, John, Rex, Shelly

REMINDERS: assessments due on Linda, Nancy, and Merle; restock the cart; fill all holes in the MAR; follow up on Aurelia's recent fall, fax all labs to Dr. Scott before I leave, order a CBC on Rex...

caffeinatednurse, BSN, RN · Mar 28, 2017

I currently work LTC/short term rehab. Time management skills are not be underestimated in this environment. I worked med surg prior to coming to LTC/short term rehab and I just thought I knew what time management skills were about. While there are some days when I don't manage to leave on time, those are usually the days when the you know what has hit the fan and I find myself dealing with a fall, an admit, a transfer to the ED, and family drama all at once. However, those days aren't every day, so I am usually able to survive on my own time management skills and some hard work.

A few tips:

- If you have a fall, go by your facility policies. At our facility, it sufficient to perform a neurological check, assess for any injuries, and then continue on with the med pass - incident reports, notifying family members, etc. can wait until later as long as the resident is okay. The same can be said of finding bruises, skin tears, etc. I will usually go ahead and apply the tx for a skin tear and then move on. I can fill out paperwork later, but the meds have to be passed in a timely manner. To help with the paperwork, I will usually write down any pertinent times and information.

- If you have to send somebody out to the ED, call to give report to the ED, fill out your paperwork for EMS, then call EMS last. EMS can show up anywhere from 5-20 minutes from the time that you call them, depending on where they are and who takes the call. Unless it's an emergency, you want to make sure that you have your packet of paperwork complete to hand to them. (If it is an emergency, then do the very best that you can but understand that you may only be able to get the essentials down before they show up.)

- Support from your coworkers and charge nurse is nice, but don't come to depend on it. I have had charge nurses who stayed several hours after to help clean up the mess from a shift from hell, and I've also had charge nurses who walked out the door at 11pm. The same can be said of coworkers. At some point you have to be able to stand on your own two feet, even if that means staying over to ensure the next shift doesn't inherit a nightmare.

- Develop a routine for your shift. If I'm on the short term rehab unit, I usually do assessments during the 4pm med pass since it's usually pretty light. Then I do Medicare charting during dinner time, since there are usually no meds during that time. After the 8pm med pass & any tx, I chart PRNs and any changes or new information. If I'm on LTC, I chart as I go along because otherwise I will always be behind. On both units, I do my treatments after I've finished passing meds.

- Assess any new orders at the beginning of your shift. If you're not sure if the nurse giving you report has taken care of them, ask. If you're still unsure, go ahead and fax them to pharmacy, notify the family, etc. Assume that it hasn't been taken care of until you have concrete proof that it has indeed been dealt with.

- Document everything. Any refusals, skin assessments, family drama, abnormal VS, communication w/providers or what have you. Document what you know and what interventions or actions you took. CYA at all times.

- Don't be afraid to contact a provider. Trust your instincts. If you think your full code resident is circling the drain (or that your DNR resident has had a change in condition and needs a change in care plan such as a hospice referral, or whatever it may be), don't wait for your supervisor or DON to climb on board. Advocate for your resident's well being, your reputation as a nurse, and your nursing license.

Fearless_leader · Apr 1, 2017

This is good information. I was just hired in a LTC. They give 2 weeks orientation and that's it. I was wondering how I'm going to handle 20-30 patients as a new grad Nurse.

ROOKIELZ · Jun 30, 2017

I am a new LPN. I was given 3 day shifts for training and 2 evenings. I requested 2 more evenings as my training nurse said both shifts were crazy and not sufficient for orientation.

I havent heard back about the evening shifts.

I just worked my first solo day shift. It was a bit nerve wracking but I felt reasonably good overall about it.

Do things safely ask questions and document. Then see what worked for you and what didnt. I work again tomorrow and that is my plan. Each day is an opportunity to learn and improve. Perfection is not my first goal. Learning and improving and building my confidence are my goals. I have 30 residents to care for and I am the only nurse on, with a DOC just a text or call away.

Good luck!

CapeCodMermaid, RN · Jul 4, 2017

Years ago when I was a new nurse working in the hospital, I had 6 hours of orientation...all on IV pumps. Got to the floor and was told I was in charge because I was the RN. They didn't care that the ink was still wet on my license. Luckily I had gone to a hospital based nursing program and knew how to take care of people.