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New to LTC, need some advice :)



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Jan 06, 2009 05:31 PM

New to LTC, need some advice :)

by StudentNurseForever Platinum Member

Hello! I haven't posted much because I was working 7p-7a at a hospital and was always too exhausted to post! I'm still going to school, have a 5 year old and the whole shebang that goes with having a family. I wasn't happy at the hospital because I was always exhausted and they were transitioning (rather poorly) to computer meds and charting. It was almost impossible to pass meds in a timely manner and I was there many a morning charting until 830 or later. I am looking at taking the transition from LVN to RN in Jan '10 and I had no clue how I was going to manage it. Until I found out about double weekends! I just worked my first double weekend, and let me tell you, I almost hit 40 hours!! ((YIKES)) I have went from 5-6 pts to 20 residents. I am used to charting on a computer and charting acute care garb that could be taken wrong in LTC (for example, charting that an independent person was told to use the call light with needs could be taken as trying to encourage the resident to stay in their room) I have 10 (i think) medicare residents that have lots of charting to be done. It was a very eventful weekend. (and not in a good way) but that's another thread! At the hospital I had a "brain" that I used to chart my assessments and activities. I need one for here, too. I have to take full vitals on my medicare patients and assess them each shift, and I have to take blood pressures (and chart them in the MAR) for the blood pressure meds on certain patients. and then of course there are the blood sugars and the insulins, I need a way to keep up with it all! Any suggestions?


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4 Comments
No. 1
from kermitlady
Old Jan 06, 2009, 08:07 PM

Default Re: New to LTC, need some advice :)
It takes time to get used to LTC nursing; it really does. Just keep in mind that you WILL get faster. You'll begin to learn who gets what and when (i.e. you'll be able to remember who needs an accucheck before breakfast and be able to make a list). Personally, I make a list and do my accuchecks before anything else. Then, I do the morning med pass (it takes awhile w/20 some residents - I work days). Then, I'm in the dining room for breakfast. After brkfst, I do those things that aren't med-related; charting, tx's, VS, etc. Then it starts all over again; get the noon accuchecks and then pass the noon meds. It takes awhile to get used to the routine but just remember you WILL get faster. And once you know the residents it helps, too! Good luck.
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No. 2
from Rascal1
Old Jan 07, 2009, 07:33 PM

Default Re: New to LTC, need some advice :)
I go through the MAR before I start meds.,take notes, who needs B/P,pulse,FS.,etc.,who's meds. are in fridg. and so on. Also,I check med. cart for any low stock meds., or other needed items that might be missing to eliminate 14 trips back to the med. room !! Sometimes,I ask the previous shift nurse during report,did she notice anything I might need to restock? Charting on Medicare pts. needs to be specific of course with regards medically to why they are on med.A. You do get faster as you get to know the residents. Good luck...
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No. 3
Old Jan 09, 2009, 04:48 PM

Default Re: New to LTC, need some advice :)
thanks for the advice! I think more than anything it is such culture shock to go from acute care where you are expecting the worst, to their "home" where I had so much hit the fan in such a short amount of time... It just made me wonder if there was some organizational thing I was missing, ya know? I agree, time will make all the difference!
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No. 4
Old Jan 25, 2009, 05:39 PM

Default Re: New to LTC, need some advice :)
I have been in LTC for 16 years. It takes alot of getting used to, but the major part is organization, because you are doing the same things day in and out. Grant, you have admission/discharges, therapies, doctor appointments, and those oh so lovely Incident Reports.... and unless everyone on your unit is a DNR, you have Codes too.... Mostly, you can detect when people are getting ill, you get to intercede before they get very ill, and start IV's and manage PICC lines... and thats the gratitude. Families saying.. I know with you he is always going to be OK. or .. I expect declies but here I know that he is getting the care he needs. And dont forget if you are a larger institution, its MDS's too... dont for get to update the care plans every time there is an episodic issue(illnesses that will resolve/self resolve), and update the care plans every quarter..with appropriate changes for improvement or declines.

Organizing your day is key, but you need to know how to get THEIR stuff done, as well as your own and let them overlap if need be. The needs of the paient will continue to superceede your paperwork, and with desire, you can do it!!
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