New RN, 6 days orientation, night shift. Seeking advice!!

  1. 0
    Hi everyone, I am a new RN, and found a job in a skilled nursing facility. I had six days of orientation already, day time. But I will do night shift once I start working. While I am learning and improving everyday, I still think I will be overwhelmed when I am on my own. I need to pass meds to more than 40 patients at night, and at the same time, I will be the charge nurse of the facility. I really need your valuable suggestions and tips. Please help me! Thank you very much!

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  2. 10 Comments...

  3. 0
    I've never worked LTC and don't have any desire to. 6 days sounds generous for LTC based on what I've read here.

    40 is a lot. I'd say do the best you can. Ask aides for help on what each resident likes so you can get to know them. Don't get bogged down the with trying to be a super nurse. Delegate when possible. Don't make dangerous shortcuts. I've read so many stories on here about how short cuts made someone lose their job or put patient safety in jedorady.

    Good luck in your new position. I'm sure there are plenty of nurses who can offer more advise. I'm sure your experience will be great for any future endeavors you pursue.
  4. 1
    I've just come off of a very short orientation as well. I just did my first night shift in charge of the facilities low care, high care and dementia unit. Luckily the AINs (Australian for CNA) were very experienced and practically ran the show. I did have a few incidents where I had to use my nursing judgement. I utilised my AINs and offered to help them when I could as well. I saw an amazing team of nursing staff come together and they all helped me out with the med passes. Because they know the residents I had one come with me in each unit and they took me to each residents room. So that saved a lot of time, and being night shift my only meds were at 05:00 and 06:00. I took a couple of BSLs and BP's through the night on residents that woke feeling dizzy and flushed. Assisted another resident through a huge constipation battle, poor thing.

    Overall my very limited advice is to start by taking a deep breath and backing yourself. Beleive in yourself, you have the knowledge to do this now you just need the experience. Utilise your CNA's and remember they are there for the residents and for you as you are responsible for the care they give to your residents. Ask them to help you out as much as is within their scope of practice. Don't cut corners, although many show us how to do that, really don't do it and try and find your own way that is also time efficient but safe.

    My toughest part of the night was handing over to the morning RN (who made it a point of telling me that SHE had been a Nurse since 1973). She was rude to me, wanted me to cut corners with the morning meds, complained that 'why didn't they call in someone more experienced like her to do the night shift', whinged about me not getting the DR folder out for rounds (I showed her the large red writting that said 'Don't worry about that'), and then she whinged to my AINs about me... I know she did this because one of them told me not to listen to what anyone else has to say, because I did a fantastic job last night. So I held onto that and forgot about the cranky morning RN who didn't listen to me give handover (report) but then before I left asked for my handover sheet. LOL.

    Have a great shift. You will be fine.
    sallyrnrrt likes this.
  5. 0
    Quote from eatmysoxRN
    I've never worked LTC and don't have any desire to. 6 days sounds generous for LTC based on what I've read here.

    40 is a lot. I'd say do the best you can. Ask aides for help on what each resident likes so you can get to know them. Don't get bogged down the with trying to be a super nurse. Delegate when possible. Don't make dangerous shortcuts. I've read so many stories on here about how short cuts made someone lose their job or put patient safety in jedorady.

    Good luck in your new position. I'm sure there are plenty of nurses who can offer more advise. I'm sure your experience will be great for any future endeavors you pursue.
    Thank you for the suggestion!

    You are right, don't make shortcuts! They can be dangerous! But I have a concern, if I check everything before I give meds, I will never finish the job on time. For example, three checks when you give meds as we were taught in nursing school.
  6. 0
    Quote from snazzy-jazzy
    I've just come off of a very short orientation as well. I just did my first night shift in charge of the facilities low care, high care and dementia unit. Luckily the AINs (Australian for CNA) were very experienced and practically ran the show. I did have a few incidents where I had to use my nursing judgement. I utilised my AINs and offered to help them when I could as well. I saw an amazing team of nursing staff come together and they all helped me out with the med passes. Because they know the residents I had one come with me in each unit and they took me to each residents room. So that saved a lot of time, and being night shift my only meds were at 05:00 and 06:00. I took a couple of BSLs and BP's through the night on residents that woke feeling dizzy and flushed. Assisted another resident through a huge constipation battle, poor thing.

    Overall my very limited advice is to start by taking a deep breath and backing yourself. Beleive in yourself, you have the knowledge to do this now you just need the experience. Utilise your CNA's and remember they are there for the residents and for you as you are responsible for the care they give to your residents. Ask them to help you out as much as is within their scope of practice. Don't cut corners, although many show us how to do that, really don't do it and try and find your own way that is also time efficient but safe.

    My toughest part of the night was handing over to the morning RN (who made it a point of telling me that SHE had been a Nurse since 1973). She was rude to me, wanted me to cut corners with the morning meds, complained that 'why didn't they call in someone more experienced like her to do the night shift', whinged about me not getting the DR folder out for rounds (I showed her the large red writting that said 'Don't worry about that'), and then she whinged to my AINs about me... I know she did this because one of them told me not to listen to what anyone else has to say, because I did a fantastic job last night. So I held onto that and forgot about the cranky morning RN who didn't listen to me give handover (report) but then before I left asked for my handover sheet. LOL.

    Have a great shift. You will be fine.
    Congratulations to your first noct shift!!! Ignore the negative comments from the rude nurse.

    Yeah, I found out the CNAs are very helpful. I think teamwork is important too. Otherwise, how can we do the job just by ourselves?

    BTW, How many residents are you taking care of? I will have more than 20 accuchecks to do in the early morning.

    Keep up with your great work!
  7. 0
    I am also a new RN and I have been working at my current SNF for 9 months. I work the 11pm-7am shift and work the floor as well as function as charge nurse. I pass meds for 37 residents at the moment, and 1-2 nights a week I also have to pass meds for our ALF hall (which really only 5 residents get meds on my shift, but on these nights I am also the only one available to handle PRNs, treatments, etc. for this hall). The only advantage I see that I have over you is that I worked the 3-11 shift for 4 months prior to being asked to be the charge for nights...

    So... suggestions and tips? The first thing is to make sure you feel out your staff. In LTC, probably more so than most hospital specialties, your staff is your make-or-break when nights get rough! Staff-resident ratios, volume of paper work and "political" quirks are very unique in LTC when compared to working, say, a med surg floor in a hospital. You are expected to get A LOT done in a small amount of time. Knowing how your staff works and having their support is key! Secondly, everything will get easier once you get to know your residents. Knowing their preferences, tendencies, medication regimens, personality quirks and the like will truly make your shift work easier, but that can only come with time, as most things. Don't fret if you feel inefficient or insecure of yourself as a nurse at first. This is not only normal for a new nurse, but also especially common in the LTC culture where a ton of work is expected of you all the time. As with any new job, don't be afraid to ask questions and seek help. Your more experienced co workers already know these residents well, and that can really help out when you seem stuck on something or something seems "off" to you. Speaking of things feeling "off", one piece of advice that I rarely see in LTC threads that I believe is GOLD when working with this population is to TRUST YOUR INTUITION, especially after you've gotten to know your residents. After a couple of months, you will know these people VERY well, and, trust me, you will get a spidey sense when something just isn't right. Always investigate further because many of our Geris are demented, confused, etc. and cannot always communicate what they feel or need. They also tend to decompensate quickly, much like Pedi's.

    Wishing you the best of luck! You can do it! You will have some rough nights occasionally but remember it's all an experience!
  8. 4
    You shouldn't have to give meds to 40 people on the night shift. People should sleep at night...not take medication.
    NutmeggeRN, noc4senuf, Blackcat99, and 1 other like this.
  9. 0
    Quote from AngelRN27
    I am also a new RN and I have been working at my current SNF for 9 months. I work the 11pm-7am shift and work the floor as well as function as charge nurse. I pass meds for 37 residents at the moment, and 1-2 nights a week I also have to pass meds for our ALF hall (which really only 5 residents get meds on my shift, but on these nights I am also the only one available to handle PRNs, treatments, etc. for this hall). The only advantage I see that I have over you is that I worked the 3-11 shift for 4 months prior to being asked to be the charge for nights...

    So... suggestions and tips? The first thing is to make sure you feel out your staff. In LTC, probably more so than most hospital specialties, your staff is your make-or-break when nights get rough! Staff-resident ratios, volume of paper work and "political" quirks are very unique in LTC when compared to working, say, a med surg floor in a hospital. You are expected to get A LOT done in a small amount of time. Knowing how your staff works and having their support is key! Secondly, everything will get easier once you get to know your residents. Knowing their preferences, tendencies, medication regimens, personality quirks and the like will truly make your shift work easier, but that can only come with time, as most things. Don't fret if you feel inefficient or insecure of yourself as a nurse at first. This is not only normal for a new nurse, but also especially common in the LTC culture where a ton of work is expected of you all the time. As with any new job, don't be afraid to ask questions and seek help. Your more experienced co workers already know these residents well, and that can really help out when you seem stuck on something or something seems "off" to you. Speaking of things feeling "off", one piece of advice that I rarely see in LTC threads that I believe is GOLD when working with this population is to TRUST YOUR INTUITION, especially after you've gotten to know your residents. After a couple of months, you will know these people VERY well, and, trust me, you will get a spidey sense when something just isn't right. Always investigate further because many of our Geris are demented, confused, etc. and cannot always communicate what they feel or need. They also tend to decompensate quickly, much like Pedi's.

    Wishing you the best of luck! You can do it! You will have some rough nights occasionally but remember it's all an experience!

    Thank you soooo much!!!

    Yeah, I am getting to know my residents now, not like the first day anymore. Today I passed meds, and I did feel less scared than the first time. I think all of us have to go through this stage. At night, I will pair up with an experienced LVN. I heard she is very patient and helpful. So hopefully the first night will go smoothly. I also think the CNAs are helpful, too. Some of them offered to help me actually. I really appreciate that. I will do my best and see what will happen. Thank you again!
  10. 0
    Quote from CapeCodMermaid
    You shouldn't have to give meds to 40 people on the night shift. People should sleep at night...not take medication.
    I meant the meds night shift nurses have to give, like the 6:00am meds. Thank you very much!
  11. 0
    There should not be that many meds being given in the early morning. The thought process these days is to let the resident sleep and awaken on their own. Can any of these meds be given later? I have in the past realigned when meds were given to stop most of hte ealry morning ones. For a night shift, try and complete your charting earlier in the night. You can observe/assess at the begining of the shift and start your charting by 1:00 - 2:00, if there are any changes after that, a note can be added. This will free up your time later in the shift for any meds, treatments, incidents you will need to handle.


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