New nurse to start in Nursing Home...

  1. 0
    Okay so I was offered prn work through a staffing agency that works with a local nursing home.

    They are aware I am a new grad with no experience other than my clinicals in school.

    They said they mostly do elder care, passing meds, delegation, and charting.

    My question to you experienced nurses is....what is to be expected with nursing care in this type of setting? What nursing skills will I be using?

    Also, pros/cons of day/evening/night shift? I have a few days on the schedule that are available for the pickin, they are mostly 2:30-10:30 pm and 10:30 pm-6:30 a.m. What would be the differences in patient care/skills btwn the two shifts.

    Thanks for any input you can offer.

    Excited for a position and to get experience but yet nervous....I dont think they are preparing to "train" like an intern position...I think I am going into this full speed. And I dont want to look Stupid
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  3. 13 Comments so far...

  4. 1
    Well, I can only tell you my experience. I now work in a hospital,but my first nursing job was at a nursing home.

    So here I am, a new grad:uhoh21:...going to interviews...this one particular nursing home stood out b/c they stated that I'm their 'new puppy and was gonna train me and take care of me', lol...i still couldn't believe I fell for that..anyways.

    When I first started things were good..set me up with a few different people as preceptors..and they were good preceptors...the other staff (other nurses, CNAs) were very helpful as far as how each patients are (as far as their likes..how they want thier meds, when they want this and that,etc). Now this particular nsg home had 3 units w/ 40 pt. at each unit...20 on one side and 20 on the other. For the shift that I work, 3p-11p, they usually have 2 nurses per unit (one nurse for 20 pt)..and that's not so bad when you have like 3 CNAs per side.

    I was supposed to have like a 1-2 week orientation, but, please, I was on my own after the first week and with 40pts!! I was furious!! The usual thing that happens is that someone calls out and they may ask the 730-4p person to stay over 4hrs to help me or whomever (3-11p person) pass meds and after they leave, I still have to do 9p meds for 40pts! After meds, I still have to do treatments (such as drsg changes, trach care,etc)...and then charting!! I never took a break when I wanted to..sometimes didnt' have time too. Now this is just my experience..not all places are like this (thank goodness!). The charting is really draining....lots and lots of charting! When I first started, i didn't get off till like 1am or so, b/c i was soo behind after having soo much to do. Now after about a month..I kinda picked up my own system of doing things, and began getting off earlier even before I was due off, lol.

    All in all, working at the nursing home has it's plus...the patients (such sweetheartssaint:, lol) and it's good money...but it's a lot of work...paperwork. Me being a new grad...at that time...I wanted more experience and surely I wasn't going to get it working there, so I left and I'm now working on a med/surg floor. I'm glad I did work for a nursing home first b/c it challenged me as far as prioritizing things and being able to handle more than one thing at a time. So I hope I didn't scare you too much, but wanted to be honest. Hope things work out in your favor.
    short1978 likes this.
  5. 2
    I am surprised that a staffing agency would hire a new grad. They usually want someone with at least a year or two of experience. From what I have expected in the past when i did use agency, if I had a agency nurse come into my facility I expected her to be able to walk into the building and pull her own weight and do everything an employee would do. THe only orientation received would be a 15 minute explanation of emergency policies and small tour of where things are.
    short1978 and Dolce like this.
  6. 3
    I agree. It is completely inappropriate for an agency to hire a new grad and throw them into a situation where patients and YOUR license are at risk. The agency doesn't have as much to lose as you do. You need a job where you can be trained and taught by experienced nurses. Work in one setting for 1-2 years prior to taking on agency work.
    noc4senuf, short1978, and nrsang97 like this.
  7. 2
    Here's my 2 cents: I was offered the same job working agency as a new grad in LTC a few years ago. I was unsure about taking it and instead took a full time job in LTC. It was right for me. I was too unsure to be good as an agency nurse right out of school.

    I have worked all three shifts and they differ somewhat. Day shift is hectic because you have 2 meals, PT, visitors and a big morning med pass. The upside is that shift is better staffed and you will have more support. My noon and afternoon med pass were not bad. In my LTC I had to help with feeding and be in the dining room for 1 1/2 hours a shift to help and make sure no one choked or started fights. If you don't work there all the time this will put you behind. Most treatments/wound care will be done on this shift.

    Evening shift will leave you with many dr orders to take off, less support & staffing, and a big nighttime med pass. This shift also has sundowning which I found hard to handle at first. But it did calm down at night. I almost never stayed late which was unheard of on day shift.

    Night shift will give you chart checks (checking to make sure Dr orders were written correctly) MAR recaps (monthly changes) and a big AM med pass when you are the most tired LOL. If you have an AM emergency this will KILL your med pass and you won't get out of there on time and the day shift will want to hurt you!

    The Good about working as an agency nurse is you get a feel for the facility and MANY of our nurses were agency nurses who applied for jobs because they liked our place. Also, you tend to see the same agency nurses so it is likely you will keep returning to the same places and become familiar with the residents.

    Good luck whatever you choose!
    rhondaa83 and short1978 like this.
  8. 2
    IMHO, don't do it. I too was a new grad with a regular job and looking to do some temp work. I got sent to the LTC where I did my clinicals and felt so confident and excited. In my IGNORANCE I agreed to do a 16 hr shift! Boy what a mess I made! Yes, I was comfortable with all the pts, but not all the pts AT THE SAME TIME! In clincals we had 12 pts. When I worked I had 40 pts! My skills were OK, but of course they were OK with an instructor to run too, or at least another student nearby to ask. There was a TON of stuff that I had never done that had to be handled. Treatments I did not know anything about. Meds I had never heard of. Plus, I had NO confidence with calling for orders, or dealing with families. Honestly, I even told one pt "I'll go find your nurse." I walked out of the room and realized DUH?! :uhoh21: I AM THEIR NURSE!

    By the end of the night, the charge was attached at my hip. She gave me a firm (at first rude) tongue lashing for my ineptitude. Once she realized I had just graduated she lightend up, but still told me NO ONE should do temp work w/o a year work experience. SHE WAS RIGHT! No need to jeapordize you LICENSE for a few extra bucks. Find a regular ft/pt job and learn, learn, learn!

    luv,
    newgradwhowonttempagaintilloneyearisover....
    Dolce and short1978 like this.
  9. 1
    Quote from noc4senuf
    I am surprised that a staffing agency would hire a new grad. They usually want someone with at least a year or two of experience. From what I have expected in the past when i did use agency, if I had a agency nurse come into my facility I expected her to be able to walk into the building and pull her own weight and do everything an employee would do. THe only orientation received would be a 15 minute explanation of emergency policies and small tour of where things are.
    I totally agree.

    Facilities expect agency nurses to hit the ground running.

    I really do not think agency is a good idea at all for a new grad.
    short1978 likes this.
  10. 3
    Quote from Valerie Salva
    I totally agree.

    Facilities expect agency nurses to hit the ground running.

    I really do not think agency is a good idea at all for a new grad.

    Yep....nothing but a 15 minute walk thru the building, show you where stuff is located orientation is what you will get. Agency staff should be experienced enough to walk in any building and hit the ground running. You might not get everything done, but for the most part...you are at least aware of what needs to be done. Its just about the same in all LTCs but only a different form or paper.

    Don't do it. If you want to work in LTC, work in a LTC and get an orientation (that's a whole other thread,LOL) and hone in on your skills that you learned in school.

    You didn't mention if you were an LPN or RN...not that it matters, but sometimes the RN will also have the added duties of supervior or charge nurse.

    Read thru the other threads and you will get an idea of staffing ratios, job duties per shift, meds used in LTC, skills used....
    noc4senuf, Valerie Salva, and short1978 like this.
  11. 2
    I would have to agree with above posters. If you have been looking for awhile, its probably disappointing to see all these "DONT DO IT" posts. But DONT DO IT! You will get no orientation and will have no idea of what is expected of you. Its one thing if you've worked in LTC before, as they are all variations on a theme, or had been a nurse before in another setting, but this IS a set up for failure. Keep looking and good luck.

    If they really want you, tell them you need a couple orientation shifts on each of the 3 shift.
    Valerie Salva and short1978 like this.
  12. 2
    Ok so you're a new grad with no experience and you're starting with an agency.....I don't mean to deliver "doom and gloom" but honestly, this doesn't sound good. You REALLY need to get a shift's worth of orientation to the facility. Is the agency offering that or not? When I worked agencies there was NO orientation to the facility other than a walk-through....and I'd HAD nursing experience in LTC prior to working for the agency. You will be expected to perform like any other employee.

    Other posters have echoed the same sentiment. You don't want to fail and this is a recipe for that! Not trying to be mean---just speaking from many years of nursing eperience...and trying to protect you! LTC shifts are very busy--meds, charting, family calls, incident reports for falls, skin tears, MD rounds, treatments---and NEVER has an 8-hour shift EVER been only 8 hours due to the constant interruptions, etc. Night shift may be a little less busy but then it can be busier too since you have less staff---I recall staff to pt ratios being ridiculous--in our state 1 CNA to 25 pts. On swing shift it was 1 CNA to 10 pts with NO REGARD for the acuity of the patient. Think this through very thoroughly first.
    Valerie Salva and short1978 like this.


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