New grad and first job as lvn but has no idea :( help!

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Hey! Im a new grad and just got a job and im on orientation for 6 days. Just finished my first day and i thought i was gonna learn alot but didnt. UnfortunTley the lvn that i was shadowing was too lazy to teach me stuff and orient me..so my question is for those who are working ad lvn, what do u do first after clocking in and making ur rounds? What are the steps from start to finish? And i know that the facility has a book of change of conditions so u can chart them, but who does the change of condition? Like who writes on it? Because i know that we lvn if we see a pt. that has a coc we chart them..pls help!

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Hard to say,where are you working? Sounds like long term care. During your school rotation what did you do?

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We passed meds and helped adls on pt, we were more on hands on..we did some charting but no one really showed us who to chart or how an lvn does his/her job from start to finish..im actually going for my second orientation today and hopefully i get a new lvn who is willing to help me learn and answer all my questions b4 i go to the floor by myself..

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Do an assessment and check when each pt. meds are do and who needs them first.

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After receiving report (find out who is diabetic, who is on ABT, tube feeders, trach, thicken liquids, etc) and do walking rounds set up your cart. Make sure you have your water, pudding, insulin needles, etc. Start your med pass as soon as possible, it's nothing more aggravating then being on your cart all morning. When you get your first break try to do some of your charting. Do your Medicare charting and abt charting, whatever you can get done. I've been nursing for about 2 yrs now but I remember my first day and my facility only gave me 3 days of on cart training. My first day was hectic, I went home crying but I stuck in there and now I'm training new nurses. So if you ever have any questions I would gladly answer them. Good luck!

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Omg! I knooowww! I have 6 days of orientation and this is my 3rd day and yesterday i passed meds and did 3 charting on patients and almost cried! Theres so much paper to do i cant remember how to do them and for what they are used for..its very stressful..by ABT do u mean change of condition? Thank u so much for the help!! I really appreciate it..i just need to be really quick and know my patients and plus the paper works..

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After receiving report (find out who is diabetic who is on ABT, tube feeders, trach, thicken liquids, etc) and do walking rounds set up your cart. Make sure you have your water, pudding, insulin needles, etc. Start your med pass as soon as possible, it's nothing more aggravating then being on your cart all morning. When you get your first break try to do some of your charting. Do your Medicare charting and abt charting, whatever you can get done. I've been nursing for about 2 yrs now but I remember my first day and my facility only gave me 3 days of on cart training. My first day was hectic, I went home crying but I stuck in there and now I'm training new nurses. So if you ever have any questions I would gladly answer them. Good luck![/quote']

Soo true...best to make sure u try to have some schedule and ur day will go smoother and then you will become a pro and do with your eyes close... Stick in there! You can do it!!

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Hey! Im a new grad and just got a job and im on orientation for 6 days. Just finished my first day and i thought i was gonna learn alot but didnt. UnfortunTley the lvn that i was shadowing was too lazy to teach me stuff and orient me..so my question is for those who are working ad lvn what do u do first after clocking in and making ur rounds? What are the steps from start to finish? And i know that the facility has a book of change of conditions so u can chart them, but who does the change of condition? Like who writes on it? Because i know that we lvn if we see a pt. that has a coc we chart them..pls help![/quote']

I always see people posting how they only have a few days of orientation so I was super scared to start working but I got a job last week and start this Monday with 5 weeks of orientation! From what I see on this website this isn't the standard but I'm so relieved. I think maybe it's so long bc not only am I a new grad but I will be the charge nurse ( bc I'm the only nurse) for my shift when orientations over. So I guess they want me prepared. Thank goodness! Hang in there is all I can say and if u really feel unprepared after orientation I would speak with the supervisor about extending it or look for a different job that offers longer orientation.

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Specializes in ER, Trauma, Med-Surg/Tele, LTC.

This is going to be lengthy, but since you asked for a step by step, I'll be more than happy to provide if it helps you in any way ;) I generally work 2nd shift (3-11), so it's tailored to that, but 7-3 isn't really that much different.

>Clock in

>If it's my first day back in a few days, I hunt down a copy of the census/roster. This is actually more difficult to accomplish than it sounds, but the business office (or whoever handles billing) is your best bet. I try to find the most recent one I can, since I can't always get that day's or even yesterday's. Sometimes it makes me feel annoying that I do this to the business office people every week, but they've gotten used to me doing it (since I'm the only one who does this anywhere it seems like). It helps me tremendously because I work in skilled nursing, not LTC, so the patients change frequently enough. If it's my second, third, etc day back, I just use the one I got on my first day and update when I make rounds. And even if you work in LTC, where the patients generally stay the same, as a new person to a facility (new grad or experienced) having a census helps in times when other people only refer to a person by either name or room number, but not both. For example, you see a patient in the activity room and read their armband as Mrs Smith, but you don't know their room by heart, so how do you know off the bat what page in the med book to turn to to get their meds ready? Or you pick up the phone and someone asks to speak to their mother Mrs. Smith, so you'd need to transfer the call to their room, but you're not familiar with that room. Having one just helps when you're new, period.

>I make my own rounds and compare the census to the patients in the rooms. I make note of who is new to me so I know to ask about that patient in report.

>I go to the change of condition books, both 24 and 72 hour, and make notes of what looks like needs to be done on my shift. All of this before receiving report, so I have an idea of what I'm going to be asking the day nurse during report.

>I get report.

>I check if any labs have been received and do any MD follow ups immediately. Keep in mind I work 3-11, so it's best to call the MDs while they are still in office hours. I don't want to wait until after med pass to call about, for example, a PT/INR result b/c 1) that's a pretty annoying thing to be calling a doc about at 8pm when they're at home when you could have done it earlier (you'll get yourself a real bad reputation with the docs real fast if you make a habit of doing that) and 2) Coumadin is usually passed during the 5pm med pass, so it's good to have the new order before you're supposed to be giving it.

>I stock my cart. Water, juice, apple sauce, cups, spoons, straws, alcohol wipes, lancets, syringes, and house supply meds.

>I check all my blood sugars, but don't give coverage yet. It's important to get blood sugars done BEFORE they start eating.

>I start my med pass and give insulin coverage to those that need it when I give them their meds.

>After med pass, I look at the treatment book and do any treatments that need to be done. Or report critical lab values that have come in during med pass.

>Make quick rounds to make sure everyone's ok.

>Lunch break =)

>Finish treatments if not done. Chart.

>2nd med pass.

>Chart. Make sure everything that needed to be done during my shift from report is completed.

>Write in the 24 hr communication/change of condition book (You want this done BEFORE the next shift comes in).

>Rounds, report.

>Go home.

Of course you're always going to be interrupted throughout your day with all kinds of things (I couldn't tell you the last day an actual shift worked out like this), but this is the schedule I generally follow. Everything up to "I get report" is the same for morning shift. I stock my cart after report in the AM. The MD follow ups get moved until after 1st med pass. I don't check blood sugars either. I just start med pass because the AM blood sugars are done by NOC shift. I don't do treatments doing AM shift either, there's a treatment nurse for that. But some places do not have a designated treatment nurse in the AM and they still do their own treatments. You just need to adjust your schedule to your facility and your own preferences.

To answer some of your questions (hopefully), charting usually involves your change of condition charting (which includes ABTs as another poster mentioned), medicare charting, and weekly charting. You as the charge nurse are usually responsible for doing all such charting. Different facilities vary. For example, at one facility I work, the RN supervisor does the medicare charting, but at the other facilities, the LVN is responsible to complete it. You are most likely definitely responsible for the change in condition charting. Change of condition charting is added as they occur. For example, if you received an order to start antibiotic treatment, you would carry out the order, which also includes writing it in the the change of condition book. This old topic has a good step by step from TheCommuter about carrying out an order: https://allnurses.com/geriatric-nurses-ltc/ltc-617067.html. Even if a new order wasn't received, but something happened to the patient that was out of the ordinary, you would still put that on the change of condition so that patient can receive monitoring. For example, a patient has an episode of SOB that is resolved with PRN oxygen that he already has a standing order for. You notify the MD and receive no new orders. You would still put that patient on the change of condition for monitoring for episodes of SOB because having SOB is not his normal condition. Generally speaking, COCs (changes of conditions) stay on that list for 3 days (72 hours), but there are some exceptions, the most common being antibiotics. Antibiotics (ABTs as the other poster referred to them) are kept in the change of condition charting for the duration of the treatment. This is to ensure the monitoring of adverse reactions to the antibiotic. Some facilities continue to have the patient on COC charting for 72 hours AFTER ABT treatment, others don't. Follow your facility's policy.

Hopefully that helped more than it confused. Feel free to ask any more questions. I hope you're doing well in your orientation.

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Thank u sooo much!!! U help me alot! U have no idea..and as a matter of fact my shift also starts at 3-11, so thats a plus! Im actually getting everything but except for paper works..i know how to chart but some paper works are still kind of foreign to me, i know how to do it but im not sure how. Im still on my orientation tomorrow and im gonna ask the chrge nurse lvn to help me with the pPer works and TO and how to use the phone..thanks for the link!!! It helped even more!!! Do u mind if i ask u some other questions that im unsure about? Once again thank u so much for the help!

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Specializes in ER, Trauma, Med-Surg/Tele, LTC.
Thank u sooo much!!! U help me alot! U have no idea..and as a matter of fact my shift also starts at 3-11, so thats a plus! Im actually getting everything but except for paper works..i know how to chart but some paper works are still kind of foreign to me, i know how to do it but im not sure how. Im still on my orientation tomorrow and im gonna ask the chrge nurse lvn to help me with the pPer works and TO and how to use the phone..thanks for the link!!! It helped even more!!! Do u mind if i ask u some other questions that im unsure about? Once again thank u so much for the help!

No problem. Feel free to ask any time.

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I got just over 4 wks of orientation. The downside was that I rotated so I got bits and pieces of every dept but not really a strong sense of how any ONE of them works...has taken me a couple weeks, I think I am holding my own. I won't do a skill alone if it's one I haven't done before. This doesn't make me any friends but I am acting prudently....as a good nurse should.

I don't really care if the other nurses don't like having to supervise or demo something. That's what you are SUPPOSED to do.

Where I am....let's just say that nurses do eat their young and leave it at that.

Slowly I am getting more confidence in my ability and finding my voice.

It takes time.

I am thankful for that orient time. I am forever grateful for the nurses who help me and who remember what it was like when they were new grads.

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