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| |  New Grad with no experience, starting in a LTC. HELP!!!
My situation:
-New grad RN, BSN in December 2008, 27 y/o male
-No hospital (CNA,LVN) experience
-Got a job in a LTC in California $30/hr
-DON expects "aggressiveness" out of me and said my ratio is 1:30 with CNA's and LVN's assistance.
-Don't know my shift yet, I start some time next week.
-I have been a server/bartender for about 5 years.
My Questions:
-I know I'm going to struggle for the first 2-3 months or so. I've been told everyone usually does. What are the top 3-5 tips/advice you can give based on my situation?
-What is the worst thing I can do? For example, "Don't ever, ever do....." And I know the obvious, don't kill anyone, any other scenarios will help. What is the best thing I can do? For example, " You should always, always do this........"
-How can I gain respect of CNA's, LVN's, peers, and staff? Some of the people here look older than me and have been there a long time. How does a young, new grad come in and give them orders while gaining respect?
-What does a normal, routine day consist of for an new grad RN? What does a catastrophic day consist of for a new grad RN?
-I loved being a server/bartender for 5 years. In the back of my mind I'm thinking 1:30 ratio may bring me back to my serving days. I understand that there is a lot more risk involved and more critical thinking required, but do you think my serving/bartending experience will help me care for my patients?
-What are the top 3-5 tips/advice while being oriented? What are the top 3-5 things that should consistently replay in my head as my shift goes on?
Thanks in advance for all the responses, tips, advice, and experience shared. I really appreciate it!!! I really want to develop into a great nurse. The beginning is very important. I finally get an opportunity to begin my career. I believe that putting in time/work off the floor will help you be better when your're on the floor. That's why I'm trying to get as much information now. Thanks again.
-J
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Jun 05, 2009, 09:48 PM
Re: New Grad with no experience, starting in a LTC. HELP!!! Originally Posted by ChickenJoyRN,BSN  My situation:
-New grad RN, BSN in December 2008, 27 y/o male
-No hospital (CNA,LVN) experience
-Got a job in a LTC in California $30/hr
-DON expects "aggressiveness" out of me and said my ratio is 1:30 with CNA's and LVN's assistance.
-Don't know my shift yet, I start some time next week.
-I have been a server/bartender for about 5 years.
My Questions:
-I know I'm going to struggle for the first 2-3 months or so. I've been told everyone usually does. What are the top 3-5 tips/advice you can give based on my situation?
-What is the worst thing I can do? For example, "Don't ever, ever do....." And I know the obvious, don't kill anyone, any other scenarios will help. What is the best thing I can do? For example, " You should always, always do this........"
-How can I gain respect of CNA's, LVN's, peers, and staff? Some of the people here look older than me and have been there a long time. How does a young, new grad come in and give them orders while gaining respect?
-What does a normal, routine day consist of for an new grad RN? What does a catastrophic day consist of for a new grad RN?
-I loved being a server/bartender for 5 years. In the back of my mind I'm thinking 1:30 ratio may bring me back to my serving days. I understand that there is a lot more risk involved and more critical thinking required, but do you think my serving/bartending experience will help me care for my patients?
-What are the top 3-5 tips/advice while being oriented? What are the top 3-5 things that should consistently replay in my head as my shift goes on?
Thanks in advance for all the responses, tips, advice, and experience shared. I really appreciate it!!! I really want to develop into a great nurse. The beginning is very important. I finally get an opportunity to begin my career. I believe that putting in time/work off the floor will help you be better when your're on the floor. That's why I'm trying to get as much information now. Thanks again.
-J
I have no RN experience, but I do have management experience. One of the first things that came to mind was this statement you made: "How does a young, new grad come in and give them orders while gaining respect?" First of all, you do not "order" them around; you ask for their cooperation in an authoritative, yet respectful manner (I know you probably didn't really mean "order," but somewhere in the back of your head, that whole dictatorial management style is present and there is a notion that that is how you will operate.....If you can meet this and change your way of thinking, it will do you a world of good and will help you to gain the respect of your fellow coworkers.)
Congratulations and good luck!
| | No. 2 |
Jun 05, 2009, 09:54 PM
Re: New Grad with no experience, starting in a LTC. HELP!!! Originally Posted by greenfiremajick I have no RN experience, but I do have management experience. One of the first things that came to mind was this statement you made: "How does a young, new grad come in and give them orders while gaining respect?" First of all, you do not "order" them around; you ask for their cooperation in an authoritative, yet respectful manner (I know you probably didn't really mean "order," but somewhere in the back of your head, that whole dictatorial management style is present and there is a notion that that is how you will operate.....If you can meet this and change your way of thinking, it will do you a world of good and will help you to gain the respect of your fellow coworkers.)
Congratulations and good luck!
Thanks. And your're right, I didn't mean it in that manner. I understand we all work as a team and I will do my best to act in an authoritative and respectful manner. Such a new grad(rookie) move!!! My apologies. Thanks again
| | No. 3 |
Jun 05, 2009, 10:12 PM
 Re: New Grad with no experience, starting in a LTC. HELP!!!
I was in your shoes a few years ago, some tips for you:
If you have the same patients all the time you learn their likes/dislikes, etc. Your med pass will flow nicely after that. Expect it to take you a lot of time at first.
Everyone has their own way of keeping organized. I typed a nice report sheet with the resident's names & bed #'s on it going down the page. They may already have this for you. When I got report, at first I wrote who needed meds crushed or could swallow whole or who was a diabetic. Also, who was sick, tube feed times, medicare charting, blood sugars, etc. I used this sheet to check off meds, vitals, blood sugars, it kept me organized. I always got vitals and checked on medicare patients and my sick patients first thing. Helps you to get a baseline on them. We had great CNA's but timely vitals was not their forte, they would get them at shift end so I always did my own.
With regard to supervising nursing assistants: be fair and consistent and never act too "good" to do anything. If a call bell rings and you are standing outside the door, go and answer it! It is less work than hunting the CNA down who is 99% likely to be busy helping another resident!
As a new nurse I bugged everyone who had a procedure, machine or med I wasn't familiar with to show me how to do it and let me try myself. Most nurses are glad to share their knowledge with you.
You already have the "customer service" aspect covered from your job so I'm sure you will do fine! Best of luck!  | | No. 4 |
Jun 05, 2009, 10:37 PM
Re: New Grad with no experience, starting in a LTC. HELP!!! Originally Posted by ChickenJoyRN,BSN My Questions:
-I know I'm going to struggle for the first 2-3 months or so. I've been told everyone usually does. What are the top 3-5 tips/advice you can give based on my situation?
-What is the worst thing I can do? For example, "Don't ever, ever do....." And I know the obvious, don't kill anyone, any other scenarios will help. What is the best thing I can do? For example, " You should always, always do this........"
-How can I gain respect of CNA's, LVN's, peers, and staff? Some of the people here look older than me and have been there a long time. How does a young, new grad come in and give them orders while gaining respect?
-What does a normal, routine day consist of for an new grad RN? What does a catastrophic day consist of for a new grad RN?
-I loved being a server/bartender for 5 years. In the back of my mind I'm thinking 1:30 ratio may bring me back to my serving days. I understand that there is a lot more risk involved and more critical thinking required, but do you think my serving/bartending experience will help me care for my patients?
-What are the top 3-5 tips/advice while being oriented? What are the top 3-5 things that should consistently replay in my head as my shift goes on?
I'm a December BSN grad. Just finished my first three months on the job. Perfect? No. But I believe I've gotten off to a good start. Some thoughts:
Rule No. 1: No matter how far behind you are, don't rush -- and don't let anyone rush you. It's too easy to make a mistake when you're trying to maintain a pace that is probably unrealistic anyway. Always, always safety first.
Recognize that the aides and LVNs have a lot to teach you, and thank them when they help you learn. Respect should be mutual. Acknowledging your own inexperience -- and respecting theirs -- is a first step toward earning it. Don't just delegate tasks. Offer to help them when they're taking on something you haven't done before. You'll lend a hand and learn at the same time. The CNA I work with most is a great instructor.
Ask for feedback constantly. My greatest ally at work is my nursing supervisor. We talk at least once per shift about what's gone right and what could go better. Don't wait for a formal review for management comments. Initiate the conversation yourself. Have that conversation with everyone on the team, not just your manager.
I don't have a typical day. My unit works at a very fast pace. I haven't had a catastrophic day (yet!) but I think that's because I recognize my inexperience. Ask for help as soon as you realize you're in over your head. Remember that saying "I don't know" or "I need help" is not a sign of weakness. You are instead demonstrating that you know what you don't know, recognize your limitations, and put patient safety before your own ego.
Finally, recognize what you have to offer: You're new, you've just been taught the latest standards and techniques, and you bring energy and enthusiasm to the unit. Not everyone wants to help a new grad. But among those who do, you'll remind them of why they are nurses, and they just might take that extra moment to give you the constructive feedback you need.
Will being a bartender help? I think so -- but that's because I think life experience of any kind helps you to be a better nurse. Some nurses struggle to talk casually with patients. Maybe your experience will make it easier for you to establish rapport.
Good luck, and congratulations on your new job.
| | No. 5 |
Jun 06, 2009, 03:22 AM
Re: New Grad with no experience, starting in a LTC. HELP!!!
I am experiencing the exact same thing right now, I was a bartender for 12 years and am a new nurse in LTC. I would say that the number one thing you need to work on at first is to develop a system. Once you get your day organized in a way that works for you, things flow much better. Your CNAs are your eyes and ears. Treat them with respect and they will treat you with respect. My CNAs know that I never did their job and worked myself up into nursing, but they also know that I don't think that I am above giving them a hand if they need it. Do not demand things of others that you are not willing to do yourself....in general. On the same note, do not let them walk all over you just because you're new either.
You will find your serving/bartending skills coming in handy, I promise. I doubted this until the other day when I had to deal with a difficult family member....people skills developed in the service industry are of definite value. When your income depends on how well you deal with people, you tend to become creative, even in the most difficult circumstances...good luck to you  | | No. 6 |
Jun 07, 2009, 04:55 PM
Re: New Grad with no experience, starting in a LTC. HELP!!!
Right at the end of your shift analyze your Med pass. if the same thing keeps popping up, ask co workers, what they do. example, this little tiny blind resident was always up set with me, she had a ton of med and I always tryed to give them all in the door way of her room, i asked my co workers, she want just her tylenol, at her door way and then some just before she at Breakfast, and the rest after Breakfast. she was in that Nursing home for 25 years, and it was her way of controling her environment.
| | No. 7 |
Jun 18, 2009, 09:01 PM
Re: New Grad with no experience, starting in a LTC. HELP!!!
Thank you to all responders. I just finished my second day of orientation today and it was my first day on the floor shadowing an LVN. I have to say that I was overwhelmed....even though I was shadowing an LVN. I had the 7-3 shift. I asked a ton of questions during the morning med pass. I can see how easy it is to be distracted my residents and co workers. There are a lot of medications to know(generic names too). Some are similar but there are a wide variety. I took some of the advice and wrote down some of the residents' likes and dislikes. I wanted to be aggressive, so I requested to do the 1300 med pass. My trainer agreed and said she is going to let me do it all by myself while she charts MD orders in the nurses station. I was shocked because I was expecting her to shadow me. But I decided to go for it, but always kept in mind to slow down when flustered and always ask when in doubt. I've never block out simultaneously so much in my life. Its like I knew what had to be done but for some reason could not do it. She told me that it okay, I'm just starting and started shadowing me. At the end of our shift we stayed till 400-415 charting. I wanted to stay so that I can get the whole charting experience regardless if they where gonna pay me or not.
So at the end of the day, my biggest concern is knowing all the residents' face, name, room number, diagnosis, MD, and family. I feel that would be a big part in my development. I also learned that I need to have a system for med pass and brush up on drug names and purpose. Thanks again for all the advice and responses. Any others would still help a lot. Thanks all and wish me luck!!!
| | No. 8 |
Jun 18, 2009, 09:24 PM
Re: New Grad with no experience, starting in a LTC. HELP!!!
Good luck! You can do it. You want to learn and you are seeking advice. This shows that you take your job seriously and you really want to do well.
| | No. 9 |
Jun 20, 2009, 11:03 AM
 Re: New Grad with no experience, starting in a LTC. HELP!!!
Congratulations on your job J. I too am a BSN RN with no hospital experience, graduated in December, 2008 and passed boards in April. In my past life, I was an applications support analyst in an IT department of a law firm. I quit my job in March to concentrate on the NCLEX and to concentrate on finding a nursing position. I didn't think it would be this hard. Finally, I was offered a position in LTC on a subacute unit. I will be starting this Wednesday at corporate orientation for 3 days and then will start my orientation on the unit. I will be responsible for 20 patients with G-tubes, trachs, IV's and treatments (Is this doable?!? Is this a common patient to nurse ratio for this type of unit). I will be working the 11 - 7 shift and would appreciate any insight that others can provide as to what to expect. I'm pretty sure there cannot be too many treatments done at night- right? Anyway, any tips and encouragement would be much appreciated.
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