Hi everyone! So if anyone has read any of my previous posts, then you know how much I was complaining about my situation. YES! I'll admit, I was complaining a lot, and I think a lot of it comes from a place of uncertainty in terms of feeling like I am not smart enough, or not having enough confidence in myself, so I felt like I was being extremely picky. Maybe I still am. To summarize everything. I graduated in 2016, passed my NCLEX in 2017. I started working as a CNA before even taking the NCLEX, just to have a job while I waited to test. During this time, since it had been over a year that I graduated, I felt scared to be a nurse, I felt like it had been so long that I had hands on nursing experience and I had a lot of self doubt and sometimes I didn't feel smart enough. Working at a SNF, I saw how much responsibility nurses had and I wasn't sure if I could do that, so I tried staying away from SNFs which is why I could never find a job, most LVNs work in SNFs (in my area). I finally got the courage to just DO IT, and I applied to another SNF which I got a call back and had an interview! YAY! I had an interview before at a small clinic but that one didn't work out but this one just seemed more real!
Anyway, just by looking at the place it makes me excited to work there. It looks clean and more modern, it doesn't look old or like its falling apart, it seems well put together and it's a pretty big place with different units like LTC and acute care. I know I don't know the people whom I'll be working with so I can't say if I'll like working there but just by its appearance, I'm excited to work there.
Anyway, just wanted to write this because I have to say, I am proud of myself for stepping out of my comfort zone and just do what seems (to me) scary. I know it took almost a year and that's too long of a time to wait. I just want to be a nurse!
I do have some questions though:
I'll have to take care of 20-28 patients, is that a lot? Is that the average? It seems like a lot, will I be able to do care safely with so many people to take care of?
Seems like I'll only have a couple of days of training. Will I be ok? Advice?
(For those that were CNA's before nurses): Since I've been a CNA, how do you transition from being a CNA to being a nurse? How do you become more assertive and delegate to your CNAs, I'm that quiet/shy person.
I don't know if I'll get the job but IF I do...can you guys give me some advice on having a first job as an LPN working in LTC. What should I expect? How should I prioritize my care/time. How do I avoid making mistakes? Calling MDs, do you like where you work/what you do? Just any tips/advice is appreciated!
For me the transition from CNA to LPN felt like a natural one, being a CNA first defiantly helps you manage your time well and you get good hands on patient care experience (ie your not terrified to touch a patient/interact with them)
As for what is different, I think as a CNA i never realized how much the nurses truly do, you will never be bored and you will learn to multitask very well working skilled. As the nurse you take the brunt of whatever is happening because your on the front lines, patient didn't get a new order for pain meds and now there in pain? Thats on you. Your CNA was lazy/busy and mom sat in a dirty brief and now the family is livid-thats on you. Everything is on you. You learn to have a tough skin pretty quickly.
You do a lot of "behind the scenes work" the aides do not see, calling doctors and families, skilled charting, assessments, pulling meds things like that.
The best thing you can do is make up a "brain sheet" that works for you. Get a pen with multiple colors or a highlighter so you can differentiate meds/diabetics/IVs/Wound Care/dx/nebs ect. I do one with check off boxes next to patient names so I can check off who gets/got AM/Noon meds and who got PRN's when
Start your med pass exactly when the hour before starts, start anything you can as early as you can, always.
Write yourself notes, trust me you'll forget.
I think the best piece of advice is first and foremost you are there for your patients. Working in a SNF is a whole diff rent monster, with hospitals trying to curb em as fast as they can you see a lot of acute patients that in years past would be in med surg or ICU instead of in a skilled facility. Do not be afraid to advocate for your patients, never be afraid to call the MD (they might yell,but it dosent matter they are paid the big bucks to listen and take care of there patients!)
As for as calling the MD have an idea what tx you expect them to implement, know what you have ins stock in the omnicell/ on hand and what takes forever for the pharmacy to run stat, don't be afraid to ask and steer the conversation as you build a relationship with the doctors sometimes they will ask for recommendations so don't be surprised by that.
Overall expect to be scared, anyone who isn't is dangerous.
You'll do great, you have the training, knowledge and license, never doubt your training or gut feelings.
It's going to be a lot of work and ALOT more responsibility than being a CNA. Everything that goes wrong falls on your shoulders. 20 semi patients is nothing...trust me! I been work in a nursing home for 3 years now and I have over 30 patients to give meds, breathing tx, insulin and a host of other things. But after a couple of months it won't be as hard and will become like second nature. Don't give up is the best advice!! Those first 6 months will test you.
Your first nursing job is always exciting! my floor has 30 beds and we average about 27 most of the time. Ask what their ratios are. Ask how much training your entitled too. Will you be floating? Be sure to get enough shifts so that you have your responsibilities understood for your shift and get the flow of the facility. No place should place you with their patients in a hurried fashion. It is a bad sign and speaks volumes on how you will be treated as an employee. I did 6 shifts and was encouraged to speak up if I felt I wasn't ready. Advocate for yourself. If you get the job: take notes on your roster during report. It's okay to tell the nurse giving you report that your a new nurse! Ask questions during report. If you are not getting a clear picture ask these questions:who's on ABT? What for? fall risks?,diabetics? Anyone fragile? Who's on 02? How much? Coumadin? Anyone have a high INR and at risk for bleeding? Who's in pain? Is it controlled? When were PRNs given last?Anyone on a patch? Where is it? If your working 7-3 who has appointments? What activities do they go to that might get in the way of you passing their meds? Does anyone have behavioral issues? Who's on Vitals? (Typically it will always be new admits, falls, change in status, UTI watch, ABT, anyone on an IV, Med A, discharges). With the exception of a few, these people need vitals for 3 days (72 hrs)Who are your CNA's how many do you have, and who they have( keep a copy of the assignments) when do the cna's take their break? Starting out requires you to ask the questions. This is how you learn. You will do great. It will take time to get this all down pat. Good luck!
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