the main differences between LTC and acute care?

[cherubhipster]

Hello friends! New graduate nurse here, about to start my first job in a LTC/rehab facility for the elderly. I'm getting those nervous jitters trying to figure out what to expect. I've never been anywhere other than hospitals for my acute care clinicals. I'm trying to figure out what the biggest differences will be in how I spend my day? So far I know that charting is different, because the exception is what is charted, and you dont chart on every patient every day. I also know that when you do have to document its usually very involved. I know vitals in some instances are only taken once a month as opposed to q8h. what else should I know? What tips do you have for me? Thank you!!!!

[KaitRN]

When I started in LTC as a new grad, I found there was a lot to remember, but once you got a routine down, you were golden!! Is your facility computerized? I'm sure that will make a huge difference in the documentation aspect. Mine was not, so I would keep my report sheet with me at all times. In report, ask the reporting nurse who needs pulse ox's done q shift, blood sugars, treatments, and how each resident takes their pills (i.e.: whole in applesauce, crushed, g tube, whole with nectar thick liquids, etc.)

Once I had my report, I would look through my ADL book and assign vitals, bowel assessments, etc to my CNA's. Usually you only chart on "skilled" pts or pts with acute problems that day. Use your discretion. Then I would do my blood sugars and start my med pass. While passing meds to each pt, do a very quick assessment: "how are you feeling today? Any pain? Quick look at the whole pt". Med passes take several hours in LTC so try not to get off track! Delegation to your CNA's is key!!!! They are your life savers!

After first med pass, start treatments- wound care, dressings, designate creams to CNA's if possible because you won't have time and they are more likely to apply it when they do basic care!

Also, before I forget- make a list of what you need to report to the MD for that shift. My MD would only call once a shift so you had to relay all info to him at that time and he was not happy if you had to call him back! Write down on a piece of paper, or highlight on your report sheet what you need to tell him that day- for labs write the previous few labs so he gets an overview and trend...

I hope this helps! I enjoyed LTC and it is challenging!!! I'm just starting orientation on a critical car unit now and its so different! I'm nervous! But LTC has definitely helped in my managerial, time management skills!!! Good luck!!

[cherubhipster]

Thanks so much!! This really helps a lot. :) Possibly stupid question, but I keep hearing this and I didnt hear people use it in the hospital. What do you mean treatments? Is that just a blanket statement for anything that isnt meds? when I hear tx I think chest pt or something. I know i know, that sounds really dumb...

[KaitRN]

Not a dumb question at all! I had no idea what it was until I starting working LTC too! (btw: ask as many questions to your preceptor as you can, regardless if you think its dumb! It's probably not as dumb as you think!!:) ) Anyways- you will most likely have a "treatment book" aka the TAR. Similar to the MAR (medication administration record). Both are basically a binder (again, this may be different if your facility is computerized), which has tabs for each patient. Within the seperated tabs, it will have a paper that looks like grid or graphing paper. It has 31 spaces across for the 31 days in a month. on the left side it will list either the medications (for MAR) or in your TAR it will list treatments. You sign off when you give that medication or treatment... Kind of confusing to explain until you see it, as I'm sure each facility is different. But let me give you a few examples of treatments that are likely:

Check pulse ox q shift: you would sign your initals in the TAR and prob have a space to write what the pulse ox was

Change g tube dsg qd and prn if soiled: you would initial in the TAR

Apply dimethicone cream to reddened left buttocks q shift and prn: you would initial (i would usually check with my cna's for this one, as this cream is usually applied with brief changes and will be in the patients basin)

Cleanse stg II pressure ulcer with NS f/b solosite gel f/b clean dry dsg q shift and prn: sign your initials in the TAR and also intital and date your dressing.

these are simply examples but were very common treatments in my facility.. Basically you just start at the beginning of the binder and read, gather all supplies and treat the patient, sign off in the binder, then turn the page and continue in that fashion. I hope that helps!!! :)

[cecilsgirl]

make you a good cheat sheet too, they are priceless!! and remember, ( one nursing instrutor told me this once) THE ONLY DUMB QUESTION IS THE ONE NOT ASKED!! Good luck to you, we always need good nurses in LTC, I've done it for 20 years now, I love my Residents, and even though it is so hard- I feel blessed to be there , to help them, to learn from them, EVEN to be with them in their last hours, Just like a L/D nurse-- gets the start of one's life, I feel honored to get the end stages of one's life too--It sure humbles you. ( but some do get better and get to leave and that is soooo great too!!)