First LPN Job, 5 day orientation, 1:40+ patients...advice?

  1. 2 It's my first job as a nurse...hurray! But holy crap I did not expect it to be this difficult. I haven't finished my orientation yet but I feel that a week is definitely not enough for any novice nurse to learn the routine in LTC facilities. I did fairly well in nursing school but I don't think anything could've prepared me for this. I'm eager to get the routine down but the time given is really limited. Any advice?
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  3. Visit  inky-york profile page

    About inky-york

    From 'New York'; 26 Years Old; Joined Aug '11; Posts: 18; Likes: 11. You can follow inky-york at My Website

    18 Comments so far...

  4. Visit  tiroka03 profile page
    4
    write it all done and organize it. Get an address book and write in things so that you can find it easily. For instance, with labs, they can be called more than one name and have many ICD codes. I will write Phosphorus, PHO4, Phos, and then the codes in the P section. I will write all door codes under C for codes. I will write anything that is new to me down, so I never have to ask a 2nd time. You wouldn't believe how much time that has saved me. Good Luck LTC is fast paced, as you already have found out.
    shamrokks, Anne36, inky-york, and 1 other like this.
  5. Visit  RottieGrlLPN profile page
    4
    I am having the same problem. I have about 5 days left on my 8 day orientation and I feel overwhelmed and VERY stressed. It took me about 3.5 hrs to pass meds to 12 patients out of 30. The nurse training me basically just left me to do the meds cart while she did the other half of the hall (plus the ones on my hall that I did not get to), tried doing treatments and helping the CNA's and charting. By the time it was 11:45 we finally got am meds done. I had enough time to grab a quick bite and flag my afternoon meds. It's just so frustrating. I wish there could be 3 nurses on at a time. It would take so much stress off of everyone. Anyway, I work 3-11:30 tonight. Joy. I'm trying not to let it get me down and hang in there but I feel it is futile. Hopefully I can get in my 1 yr and get the h**l out of that place.
    Last edit by RottieGrlLPN on Oct 21, '11 : Reason: Add info
    Zz SN, Anne36, newnyclpn, and 1 other like this.
  6. Visit  MrsMig profile page
    1
    This is VERY good advice - but honestly, I was told in nursing school to be weary of places like this. It sounds like a facility that's setting you up for disaster and remember - it's YOUR license and not theirs! My first gut reaction was RUN! But I realize that as a new grad it's hard to locate work and when you do, you have to work it the best you can. So I guess my next advice (on top of pp) would be trust your gut and don't do anything you 'know' you shouldn't even tho a co-worker is saying to. Also, if you have time during your lunch break - lol - I know - grab the facilities policies and proceedures and read it over...and never, never, never , work outside your scope so make sure you look @ your BON and know your scope!

    GL - deep breaths and reference your policies and books often and you will be okay - have faith in your skills!

    Cheryl

    Quote from tiroka03
    write it all done and organize it. Get an address book and write in things so that you can find it easily. For instance, with labs, they can be called more than one name and have many ICD codes. I will write Phosphorus, PHO4, Phos, and then the codes in the P section. I will write all door codes under C for codes. I will write anything that is new to me down, so I never have to ask a 2nd time. You wouldn't believe how much time that has saved me. Good Luck LTC is fast paced, as you already have found out.
    inky-york likes this.
  7. Visit  inky-york profile page
    0
    Thanks guys. Being an LPN, my choices are quite limited since all LTC facilities here have a 1:40 patient ratio. Almost none of the hospitals hire LPNs nowadays so that leaves me to either work at a clinic or LTC. I'm just not sure as to how long the orientation normally is for in other facilities - I just think 5 days is a tad bit too little. I really just want to have at least a year of experience and see where that takes me.

    I can already see myself coming in 30 minutes early, no lunch, and leaving 3 hours late in the next few weeks. Blah...

    I think for the first few weeks I'll come in really early so I can get the narc count and resident rounds out of the way and start to plan my morning. I see no other way to keep myself from getting swept away.
    Last edit by inky-york on Oct 21, '11
  8. Visit  tlc2u profile page
    3
    Know that you are not alone there must be other nurses in the building on other units that you can call for questions. Find out where the extension numbers are for the other units.

    Before you ask another nurse though see if you can find the answer to your question yourself.

    Example:
    Where do they keep a list of all the doctor's phone numbers?
    Different client's may have different doctor's the number should be on the face sheet in the front of that client's chart.

    How do I fill out a telephone order or neuro check form or fall evaluation?
    Again look in the client's chart and you should see one that has been previously filled out.

    Get familiar with where the blank forms are kept and then rely on a previous example in the charts to fill it out.

    That should help with some of the paperwork.

    Best of Luck
  9. Visit  mazy profile page
    2
    Quote from tlc2u
    Know that you are not alone there must be other nurses in the building on other units that you can call for questions. Find out where the extension numbers are for the other units.

    Before you ask another nurse though see if you can find the answer to your question yourself.

    Example:
    Where do they keep a list of all the doctor's phone numbers?
    Different client's may have different doctor's the number should be on the face sheet in the front of that client's chart.

    How do I fill out a telephone order or neuro check form or fall evaluation?
    Again look in the client's chart and you should see one that has been previously filled out.

    Get familiar with where the blank forms are kept and then rely on a previous example in the charts to fill it out.

    That should help with some of the paperwork.

    Best of Luck
    This is good advice, the paperwork, and searching for paperwork can add a lot of unnecessary time to your day. Also, it doesn't sound like a very good facility with the workload.

    Other advice:

    Don't worry about helping the CNAs too much until you get your own job sorted out.

    Once you do narc count you own the cart, so best not to do that until your shift is supposed to start. Use that time to stock supplies, especially treatment supplies -- nothing ruins your day like finding out you have a treatment due and no supplies to be found.

    If you come in early, use that time to read the patient chart, nurse's notes, doc's notes, social services notes, T.O.s, labs, face sheet info (contacts, allergies, cor status), who's on coumadin, who the diabetics are, are they brittle or controlled?

    Get to know your patients, it will make you feel a lot more confident, especially when you have to call the dr. You are the drs. eyes and ears, they've got 30, 40, 50 patients, so you need to be able to give them very specific information about the patient when you call. Because especially on 2nd or 3rd shift a lot of time you will be talking to an on-call who doesn't know anything about the patient.

    Learn which doc likes things done how -- some want some labs called in to voice mail for later pick up, some like them called in right away to the doc, etc.

    You have time for a meal break?
    inky-york and Hospice Nurse LPN like this.
  10. Visit  inky-york profile page
    0
    Thanks everyone. So far my role as treatment nurse for 2-3 floors works out for me. However, I still don't have enough experience as a medpass nurse but I'm getting there...I think.
  11. Visit  bones1096 profile page
    0
    Quote from inky-york
    It's my first job as a nurse...hurray! But holy crap I did not expect it to be this difficult. I haven't finished my orientation yet but I feel that a week is definitely not enough for any novice nurse to learn the routine in LTC facilities. I did fairly well in nursing school but I don't think anything could've prepared me for this. I'm eager to get the routine down but the time given is really limited. Any advice?

    I have my License for 2 yrs. this Nov. and I have worked in 4 different LTC/Rehab facilities...the one thing that I do not for the life of me understand why there isn't any rules or laws for providing more LPN's for these facilities.

    Yes like you I am overwhelmed by the amount of residents that we are expected to care for and I feel with all the other expetations:
    Answering the phone at all times
    Answering the call bell
    While doing a med pass constant interruptions (what happened to the rule taught in Clinicals "DO NOT DISTURB" the nurse giving medications?
    These are only a few examples.

    To me (this is my opinion) this is "NOT SAFE" nursing care never mind putting your license on the line.
    This is my third career and I am a mature women and extremely conscience person, this is a change that I did not go into lightly.
    PS: is it wrong to copy and paste a nursing note from another nurse when the resident's condition did not change from one shift to the next and only changing the VS?
  12. Visit  bones1096 profile page
    0
    I have my License for 2 yrs. this Nov. and I have worked in 4 different LTC/Rehab facilities...the one thing that I do not for the life of me understand why there isn't any rules or laws for providing more LPN's for these facilities.

    Yes like you I am overwhelmed by the amount of residents that we are expected to care for and I feel with all the other expetations:
    Answering the phone at all times
    Answering the call bell
    While doing a med pass constant interruptions (what happened to the rule taught in Clinicals "DO NOT DISTURB" the nurse giving medications?
    These are only a few examples.

    To me (this is my opinion) this is "NOT SAFE" nursing care never mind putting your license on the line.
    This is my third career and I am a mature women and extremely conscience person, this is a change that I did not go into lightly.
    PS: is it wrong to copy and paste a nursing note from another nurse when the resident's condition did not change from one shift to the next and only changing the VS?
  13. Visit  bones1096 profile page
    0
    I have my License for 2 yrs. this Nov. and I have worked in 4 different LTC/Rehab facilities...the one thing that I do not for the life of me understand why there isn't any rules or laws for providing more LPN's for these facilities.

    Yes like you I am overwhelmed by the amount of residents that we are expected to care for and I feel with all the other expetations:
    Answering the phone at all times
    Answering the call bell
    While doing a med pass constant interruptions (what happened to the rule taught in Clinicals "DO NOT DISTURB" the nurse giving medications?
    These are only a few examples.

    To me (this is my opinion) this is "NOT SAFE" nursing care never mind putting your license on the line.
    This is my third career and I am a mature women and extremely conscience person, this is a change that I did not go into lightly.
    PS: is it wrong to copy and paste a nursing note from another nurse when the resident's condition did not change from one shift to the next and only changing the VS?
  14. Visit  Anne36 profile page
    0
    Im on day 5 orienting too. I would love to hear from some preceptors. I had the worst night tonight. I didnt finish med pass by the time my shift was over. I also had my preceptor standing there the whole time, she never told me from the start of the shift I was on my own, I only realized it hours later and she didnt jump in to help.Instead when I left like i was told to, I had meds unpassed. I swear I did not know what to do, I felt like a failure and she told me to leave when my shift was over as she was staying on longer to cover part of the next shift. Any comments would be appreciated.
  15. Visit  SarcasticLVN profile page
    0
    I had a month of orientation.. A couple weeks of paperwork like helping with doctors orders and weekly charting and then the last two weeks I was on the floor with a co nurse which was like 5 ams and 4 pm shifts (I work am fulltime). By my 3rd week of orientation I could have used more orientation but I really wanted to get the first week or two over with so I could get my routine down. I float so I am at different stations every week so it's hard because stuff is changing constantly. The hardest part with me was pouring meds and trying to put a face to the name. After knowing all the residents on each station it got so much easier. I'm 7 months in and still need help lol. After you get down your medpass amd treatments the rest will come- all the orders, chartings, faxes, etc.


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