New grad, LTC job offer...advice? - page 2

I'm a new grad LVN in CA. My hope was to work in acute care but hospitals in my area are going to all RN staffing. My clinical experience was mostly med/surg. I accepted an offer from the best LTC... Read More

  1. by   debRN0417
    Do you have on-call staff or a supervisor on your shift, someone who you can talk over things with or consult if you have questions when you are on your own? My staff can call me anytime with concerns or questions on what to do, or when to "call". I hope you have someone...we all need a "second opinion" sometimes.



    Quote from tiona
    Thanks for the advice Deb. My preceptor gave me the same advice. I think that I'm doing pretty well for a newby, but I really need to become very familiar with the residents and know "what to do if....this happens" ya know what I mean?

    I'll have a pow wow with the DON this week. Thanks
  2. by   tiona
    I've been told that I'll be able to page the DON when needed....another number I don't yet have. I think the biggest problem is that the nurses who are orienting me are so busy that they really don't have time to go over the detail stuff with me. I think that I'll get copies of all the paperwork involved...careplans, incident report forms, staffing sheets etc. just so I can look them over at home.

    I'm a worrier and a tinksy bit obsessive, so I'm probably putting myself through more stress than is necessary. Thanks for your advice. I'll probably have more questions for you as the days go by.
  3. by   CapeCodMermaid
    At the facility I just left, orientation for new hires whether they were nurses for 2 months or 20 years was 5 days. The first 2 days in a room with videos and the SDC...day 3 spent on the floor with one of the floor nurses. The new person watched the med pass. The next day the new person did the med pass while being watched closely. The last day, they were basically on their own with "distant supervision". My DON would hire new grads and then tell me to "be their mentor and help them along so they will want to stay"...then she'd say "I need them to be on their own TODAY"...yikes...no wonder the turnover rate on the subacute floor was so high.
    It's possible to take care of that many people IF you don't care about them...shove the pills in them, slap a bandage on them,and whatever you do, don't stop to really listen to what they have to say or you'll never get done.
    As long as we continue to get the job done, administration will continue with horrible staffing levels. We had a state survey last year...the surveyors said we were severely understaffed...of course we secretly rejoiced thinking it would force the corporation into hiring more nurses. They didn't.
    Good luck with your state survey. YOU being a new grad are probably the best person for them to watch doing a med pass because you most likely do it the way you were taught with every rule and reg. still fresh in your mind.
  4. by   tiona
    Interesting you should sat that. I am pretty methodical about my med passes. I had a different preceptor today and I could tell that I was making her fall behind because she was trying to do the med pass "right."

    There are 66 residents in my facility and not all have armbands and/or photographs, so I'm anxious to just be able to put a name to their faces. This is not my dream job, but I want to give it my best. I'm just going to try my best to set my priorities. Insulin needs to be on time, for example. I sure wish we had a treatment nurse. In fact, I'd like to be it. I just got off work, so I'm feeling pretty overwhelmed. I start evenings later this week, so that will be another new experience, with a new preceptor. GROAN.

    I just heard that Sutter and Kaiser are starting to hire new grad LVN's again in my area, so at least I'll have a little hope for employment if this doesn't turn out well. I have oodles of notes so my med pass tomarrow should go ok. Thanks y'all!
  5. by   CapeCodMermaid
    One thing I did when I was the nurse manager for the floor was to make up a roster. Eight patients per side. It had the room number, their name, the doc's name, their code status and how they took their meds (all at the top of the square). At the bottom of the square, I listed their diagnosis. The space in the middle we used for writing down the vitals, or anything else we needed to know, especially for charting or giving report to the next shift. I'd also use it to TAKE report. Anything from 11-7 I wrote in red, and MY info would be in black.
    The agency nurses liked it because they at least had a clue about the patients. And it was a great tool to hand the state surveyors because they wouldn't constantly be asking what someone's diagnosis was.
    The only hard part was keeping it updated on a very busy unit.
    You'll find a method that works best for you and if you do go on to the hospital, it'll probably be a cake walk after LTC.
  6. by   sharlynn
    To top it off, the state is expected to show up any minute for the anual review. Ugh! Tell me about what THAT is like![/QUOTE]
    Annual Reviews are a necessary evil in LTC. Where I am working, administration goes absolutely nuts! And it affects everyone including the residents.My opinion is " If you are doing your job correctly, you have nothing to worry about!" I have been at this particular place for eight years and it the same every year. I have learned to ignore the panic that comes every time the state is due.I just make sure I am doing everything I am supposed to and everything is documented properly. Remember, it isn't done unless it is documented!
  7. by   pgrsctrn2be
    My first job as an LPN was in a 120 bed LTC facility. I had 60 pts on my wing and was the only nurse with 4 CNAs to supervise. Lucky for me they were (for the most part) an great group of CNAs and able to do their jobs with minimal supervision. I got my routine down on the 3-11 shift and was able to pass the meds in 2 hours. The CNAs would only come to me during the med pass if it was absolutly necessary otherwise I had a note pad on the med cart and they could leave me a note if something needed my attention but could wait until the meds were finished. Of course falls, skin tears, breathing problems, etc..... had top priority.
    Best of luck to you in LTC! It can be rewarding and you will learn so much in that setting! Just remember to listen to your patients they will teach you so much about nursing and life in general. I still visit the nursing home were I started out 12 yrs ago to see three of the most special people I ever met...
  8. by   NursesRmofun
    Quote from capecodmermaid
    one thing i did when i was the nurse manager for the floor was to make up a roster. eight patients per side. it had the room number, their name, the doc's name, their code status and how they took their meds (all at the top of the square). at the bottom of the square, i listed their diagnosis. the space in the middle we used for writing down the vitals, or anything else we needed to know, especially for charting or giving report to the next shift. i'd also use it to take report. anything from 11-7 i wrote in red, and my info would be in black.
    the agency nurses liked it because they at least had a clue about the patients. and it was a great tool to hand the state surveyors because they wouldn't constantly be asking what someone's diagnosis was.
    the only hard part was keeping it updated on a very busy unit.
    you'll find a method that works best for you and if you do go on to the hospital, it'll probably be a cake walk after ltc.
    the person who had the job before me did this as her last chore before she left the facility on leave. she is coming back part-time in another postion. she has to teach me how to do it. never thought about updating. thanks for reminding me. so much to learn as a new manager.
  9. by   tiona
    Well, today I went in to continue orientation to find out that my preceptor AND the assistant DON had called in sick. I was on my own. YIKES! I managed the med pass and treatments. To top it off it was wound day, which is not generally taken very seriously, but since the sate is coming the DON flagged them in the tx carts. I do take wounds very seriously and made certain that the paperwork was done. The CNA's are (for the most part) great and the DON and administrator expressed great appreciation and praised my every move.

    The DON told me that she was going to keep me on orientation status for an extended period so that I can be guaranteed 3-4 days of work per week. Currently I am considered "on call." There are a few days they want me to go it alone toward the end of the month, but I'm sure that days like todaywill happen.

    LTC is tough, sepecially for a new grad. Just when I reach the point where I'm thinking "I CAN'T DO THIS!" I do; and it gives me a little boost. I have already learned a lot. But I feel old and tired and guilty because I have no energy left for my family.

    This was day 5. I didn't sit down for the entire shift. I figure that I need to become really familiar with the workings of this facility, and I need to get the job done. Hopefully, someday I'll be able to take breaks. There is ALWAYS somebody interrupting my med pass. Hospice, PT, OT, ST...families, staff, emergencies. Jeeze, it feels impossible. We need a desk nurse and a treatment nurse. 33 residents might be managable if we had just another nurse or 2. Darn it!
  10. by   tiona
    Just a quick update...I'M DOING IT! I'm working with a great group of people (I'm staying out of the gossip circle). I've heard through the grapevine that the DON thinks that I'm doing such a great job that they want to train me to do some supervisory stuff. The nurse supervisor goes on vacation next month and I'm scheduled to orient with her next week. As a new grad I really don't think I'm ready for that and don't want to rock boats with long term nursing staff. Already, they are refusing to pay the regular staff double time for OT because I've been hired.

    Anyway, today I'm feeling like I can manage LTC and hopefully become really good at my job there. My biggest frustration is not having enough time to spend with the residents and assess them properly. I appreciated all of your words of encouragement, because I really questioned whether or not to even hang in after the first few days. Thanks.
  11. by   dekatn
    Congratulations, I knew if you could hang in there for a while it would get better, you sound a lot more confident. Just remember, one day at a time, and each day it will become easier for you. Keep us posted and the best of luck.
  12. by   renerian
    Good job. I read the entire post groups and I hope things go well for you. Just don't let people dump more supervisor stuff on you to turf it off their desk. I say that as it happens alot. Take your time.

    I always thought subacute would be good. I just think the ratios are awful and it is very saddening for the patient.

    renerian
  13. by   sixes
    Quote from tiona
    Thanks for your replies. I started work Weds and "they" say I'm doing very well. My preceptor told me that I'm the best nurse she's ever trained, new grad or not. Why then do I feel Sooo overwhelmed. I managed to do the med pass, and treatments for 33 people...not on time I might add. I haven't started charting yet and there are so many, many things that I don't know how to do. They want me to work evenings...only one other LVN in the building. Do you all find that evenings are slower paced. Fewer tx and meds?

    There is a big issue about OT in this facility....meaning one is not allowed to work OT. So what should I do? Stay on my own time, or not get all of my work done. I suppose they could "write me up" either way... Suggestions?

    It is not humanly possible to get everything done in 8 hours and I refuse to cut corners or otherwise fake it by signing out on something that I didn't actually do. I suppose it'll get easier as time goes on...do ya think?
    I don't nknow what LVN stands for sorry in Ontario we have RN, LPN, & hca/PSW.
    When I am on as a Supervisor I Have 157 residents & staff (evening shift) I also have 3 RNA's who do the med pass and 1 RPN from 1600-2000 who does treatments, vitals etc. I have 4 HCA per floor (3).
    On Nights (3) floors I have 1 RPN & HCA on 3rd and 2 HCa on 2nd and 2 HCA on 1. On weekend days it's the same as evenings.
    If we are short a RPN I have to do meds on that floor ( doesn't happen often)
    I have recently been promoted to a temporary Charge Nurse stricktly days and every other weekend. I find this harder then when I supervise. I have only 57 residents on my floor but with the paper work, families, Doctor's and all the care plans etc. I find I don't even have time to change my mind never mind anything else. My DON believes this is because I spend too much time doing other people's work Ie toileting, feeding, Lifts& Transfers etc. I like the hands on. I especially like being in the dining room at meals and doing the treatments. I usually have to stay 1.5hours after my shift to do paper work and this weekend I went in on my own time to do care planning.
    I'll eventually get organized and learn to prioritize but until then I guess I will feel constantly behind the 8 ball.
    I get great reviews from my staff as well as the DON, for my enthusiasum and dedication.
    I love my job and all the the staff a very dedicateted including management which is rare
    You'll do fine. If you are feeling overwhelmed. Ask your supervisor for direction.
    Good Luck

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