New Grad with no experience, starting in a LTC. HELP!!!

[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

[Acosmo27]

thats wrong..

they are basically taking advantage of you because of your new grad status..

Im so sorry that happened to you..next time... hold your ground and tell them no way!

[noc4senuf]

Whoa... new grad... two days orientation and they expected you to work a shift alone??? Sorry, but I would run far away from that facility. I have often hired new grads in the past but, they have at least 3-4 weeks of floor orientation and "must" have their 3 pg checklist completely signed off. I don't care how short they were, a manager or the DON herself should have been in there working that shift.

During orientation, ask lots of questions. Even when done with orientation continue to ask questions. I would rather they be asked then to have someone take a know-it-all approach and get it wrong.

Observe other nurse's time management and then find one that works for you.

Say the words "please" and "thank-you" often with all staff you connect with.

If you have problems, go to your manager, supervisor, DON and discuss them as soon as they come up.

[stressed5242]

Welcome to LTC !! It is horrible ! I have been at my place 5 months as a new grad...It's extremely busy & my license is in jeopardy EVERYDAY !! get your 6 months experience & get the hell out ! (if u can last that long ha ha ) Everyone that I know that works in LTC feels the same way: The work load is ridiculous, nurse to patient ratio is horrendeous, they will suck the life out of you , if you let them. We have 25 patients each , My co worker just left , she got a job in a hosp with 5 patients MAX !! She said its like a dream come true going from LTC ! If you can hang in there, the sub-acute experience will help you tremendously ! The great thing about nursing , is you can move around until you find your niche..Hopefully, the economy will improve & there will be more hospital jobs available SOON !! Good Luck :)

[noc4senuf]

Not all facilities are under staffed and horrible" places to work. I have always found it to be a rewarding experience to go to work each day and have the connection with the same residents that were there the day before.

[dekagirlsRN]

Welcome to LTC !! It is horrible ! I have been at my place 5 months as a new grad...It's extremely busy & my license is in jeopardy EVERYDAY !! get your 6 months experience & get the hell out ! (if u can last that long ha ha ) Everyone that I know that works in LTC feels the same way: The work load is ridiculous, nurse to patient ratio is horrendeous, they will suck the life out of you , if you let them. We have 25 patients each , My co worker just left , she got a job in a hosp with 5 patients MAX !! She said its like a dream come true going from LTC ! If you can hang in there, the sub-acute experience will help you tremendously ! The great thing about nursing , is you can move around until you find your niche..Hopefully, the economy will improve & there will be more hospital jobs available SOON !! Good Luck :)

Do you think hospitals will take new grads with only 6 months' sub-acute experience? I hope you're right.

[Snoopy54321]

it is always like that in nursing home. understaffed and high client ratio..

I used to work in nursing home in Pomona and I have seen the

worse...One night shift nurse did not go home until 10:00 am. She

never show up again.

First a couple of weeks will feel like HELL. but you will get used

to it and develop your own rhythm. That is how I feel in retrospect.

You are young and smart--unless the staff is not helpful, then you should

do ok after a couple of weeks.

snoopy_nurse

[Valerie Salva, BSN, RN]

Okay, I need to vent. So during the middle of my 2nd day of orientation my DSD comes up to me and ask if I can come in tomorrow for a 3-11 and work on my own because someone called in sick. I said I am available, but do not feel comfortable being by myself yet. She said I will do fine and that I can go to the other nurse on the other wing if I have any questions. She even said she lives 5 minutes away and to call her if I need help and she would come over. I would be responsible for 34 residents. I did not feel right about this at all, but my DSD said I would be okay. So I decided to give it a shot since there will be another nurse on the other side.

So as all would expect I was swamped and overwhelmed. I was a turtle during my med pass and residents were complaining they were not getting the right amount of meds. I was not doing my FSBS before dinner and I was basically about 2 hours behind everything I needed to do. But in the middle of my shift, the other nurse comes to me and ask if I can either work the AM shift tomorrow or the Noc right after my shift. I was like ***???? Is that a joke? Please tell me you're joking. Unfortunately, he was not. Our DSD called him to ask me that question. When I asked the other nurse where is she, he said not in the area. I was like WOW?!?!?!? I've never been more set-up in my life. I was really put in a difficult position.

So I took the NOC shift and was going to be working 16hours straight. I figured that was the best choice since I was behind in my charting and everything else, I would be able to catch up during dead time. The moment I thought I was caught up, it was time for the 600 meds. Now I had pre-poured meds and still ended up swamped and behind. When the Day shift came they all felt sorry for me. I looked drained and stressed. They said it doesn't make sense to put a new grad with 2 days orientation by himself for a straight 16 hour shift. I totally agreed.

So these are my thoughts.

-Are all my days/shifts going to be like this in this LTC facility? That is a lose, lose situation. The nurses are stressed and the residents don't get the proper care.

-Most of the nurses say that they all went through that, but with about 1-2 weeks orientation/training, NOT 2 days orientation. I feel like was set up.

-I don't know what they expect from me, a new grad with no experience. Is my DSD to blame? Her whole deal just seem a little fishy. She said to call if I need help, but she was about 2 hours away during my shift.

-I am strongly considering to leave unless someone tells me this is the norm in a LTC facility and this is how new grads get introduced to the environment.

-I'm so stressed out and drained and just the thought of going back to work leave a nasty feeling in my stomach.

Any advice, comments, response, tips would help a lot. I was really looking forward to working here, but this experience has left a nasty taste in my mouth. Thanks for reading.

A similar thing happened to me when I became a nurse many years ago, and continues to happen to nurses over and over again. Not only to new grads but to experienced nurses, as well.

One of the most important things I have learned as a nurse is how to say no to employers-

"No, I'm not available to work that day. No, three days orientation is not acceptable. No, I can't stay over and do a double" and so on.

If you give an inch, mgmt will take a mile. They will work you to death, treat you badly, disrespect you, and go on to the next one when you get so burned-out you quit, or hurt your back- whichever comes first.

Now you know the real reasons for the so-called nursing shortage- poor working conditions, no time to give pts the care they deserve, and lack of support and respect from mgmt. Hospitals are no better.

The experience you describe is so typical and so common in nursing. and it's a damn shame.

Welcome to nursing. We are glad to have you, but sorry that this is the way things are.

[knyc24]

I applied in an agency and soon will start orientation in LTC. I'm trying to read tips before I do the job and learned that LTC is a very overwhelming place for new grads that includes me. My question is.... If nurse to resident ratio in LTC is a burden, why are nurses stay quiet about this? I feel like a car that is about to run and about to stop. Any advice please :heartbeat My heart beats so fast now before my orientation begins.