Orienting As Charge Nurse Tomorrow Morning... I'm Freaking Out!

  1. 2
    I graduated from nursing school last september and just took my board.this November 8th... I did pearson trick and knew i passed... 2 weeks later i recieve my offical result and am hired at the skilled nursing facility that i've been working as CNA. I was told that i'll have 5 days of orientation 7-3 starting this monday and honesty i'm extremely nervous! I can't sleep. I feel ive forgotten everything learn in school. i can't believe i passed with only 85 questions that was a miracle! I know only a few meds, labs , etc so i feel like i'm gonna be the most incompetent charge nurse ever hired please if you can give me advice on what i will need to know tomorrow to help me prepare i will dearly appreciate it
    Joe V and JoyfulNurseLPN like this.
  2. 11 Comments so far...

  3. 1
    Hey CaliCat,

    I too was oriented to charge days after my graduation, actually before I took my boards.
    I have to say I too was nervous and didn't think I would do well, but when I got there
    and met with my preceptor my training kicked in and I did very well.

    As a charge nurse I'm assuming you will be handing out patient assignments, taking
    orders, monitoring the sicker patients on your report list and charting. It sounds
    overwhelming, and might be for the first day but you will quickly get the hang of it.

    Just remember to communicate with your supervisor well, keep track of the 'sickies',
    document thorough and make sure the staff you are in charge of are doing everything
    that they're required to do.

    Keep track of the call bells and make sure none have been ringing for longer than 3
    minutes. Monitor the staffs break time and make sure they aren't going over.

    Keep track of your I/O's, BM flow-sheets (anyone with 3 days no BM needs to start
    with the bowel protocol if your facility has one). Make sure you remind your med nurse
    if you are assigned one that she/he should be checking for meds that need to be ordered
    from the pharmacy and have them notify you if any meds aren't there. When their med
    passes are done for that shift, make sure there's no missed med notifications on their
    computer, or if they use a paper MAR make sure each med has been signed off on the
    whole book. Also look at the treatment record and make sure the same thing is done.

    Make sure during mealtimes everyone that is needing to be fed is assigned an aide
    or nurse to help feed them. Make sure all of the meal consumption is documented
    accurately and report anyone that ate or drank less than 50% of their meal.

    At the end of the shift, make sure all of the turn and position sheets are electronically
    or physically initialed and that any resident on a turn and position schedule is on the
    ''side they're supposed to be on''. Make sure each client is comfortable, medicated for
    pain (if applicable) and has their call-bell and fresh water within reach. Make sure all
    tube feedings are running per order or not running per order, and also make sure that
    all foley catheter bags have been emptied and the output recorded.

    Finally, check over your 24 hour report sheet or similar flowsheet to make sure all
    issues are relayed to the appropriate supervisory staff and make sure your report
    sheet is accurate, then give your report to the oncoming charge nurse.

    Your day is done!

    Trust me, you'll do fine.
    nursel56 likes this.
  4. 0
    Addendum;

    Any new orders coming need to be checked, double checked and verified by your
    precepting nurse. Transcribe them, notify the med nurse of the change and
    call the order into the pharmacy or order it on the computer. Check for any
    med interactions with the current ordered meds and the new med. Then
    do a final check on the med, making sure you time it when other meds are
    given out (if indicated).

    Make sure all patients on O2 have oxygen in the tank and that it's at the
    correct level that's ordered (IE. 2L). Make sure any portable oxygen machines
    are also maintained and running at the appropriate level and that any oxygen
    has a water bottle for proper humidification of the o2.
  5. 5
    CaliCat...girfriend...you got this!!!
    You will be a huge sucess and this is why I say that...
    1. You have been employeed at this facility as a CNA so you already know the ins and outs of this particular place. You know who to go to for help and whom to avoid.
    2. This facility knows you. Obviously they would not have given you this job if you didnt already prove yourself worthy as a CNA employee.
    3. You passed and graduated school and your boards, you are a competetent nurse, now go knock it out of the park!
    Best of luck.
    NRKB, SwansonRN, sharonp30, and 2 others like this.
  6. 1
    I too was hired as a charge nurse shortly after graduation. I felt that the long-term LPNs there knew more than I did and never missed an opportunity to learn from them. That said, the job entailed loads of paperwork, and I didn't feel as if it it was advancing my nursing skills or career at all. I was uncomfortable with the fact that my license was on the line for anything that might go wrong since there were no other RNs or medical professionals on board during my shift. Even if I wasn't responsible, because I was newly licensed I was sure people would assume I was responsible. Being a CNA employee does not prove you worthy. It means you have a personality they like and are good with patients. I think in order to do the job you have to have some experience. The posts I read on this site said the same but I ignored them. I graduated among the top of my class, but I think experience is more important. Might be better to work on the floor before assuming charge responsibilites.
    skittlebear likes this.
  7. 0
    Did you graduate last september 2011?
  8. 1
    You have been a CNA in this facility, so you know the place like the back of your hand. Watch, listen, learn and add what you need to to make your practice your own. You will (or have, as it is now Monday night) get the job done. Don't be overwhelmed, and to echo the seniments of the above poster, you got this!!
    irisheyesRsmilin likes this.
  9. 4
    What you need to know is it is okay to say "I don't know." I doubt you will need to say it much....you sound like a great nurse....but it is okay to say it.

    No one, the most experienced nurse or doctor, can not, will not, can ever....know all the answers, know all the drugs. Do not feel bad when you don't know something. Ask the nurse giving you report.....hay..I don't know about that treatment....that type of wound vac machine.....who that doctor is.....Ask you co-workers, anybody...CNA's, LVN's, etc., ....they might know about things you don't know about....because NO ONE CAN KNOW IT ALL.

    Of course don't just trust someone else's advice without doing some critical thinking on your part or accessing a policy or computer or book to double check what they tell you.
  10. 2
    OT, but thank you, both OP and commenters for not saying "orientate." It drives me crazy!
    sharonp30 and sapphire18 like this.
  11. 0
    It's very understandable for a new grad not to know all the meds...just make sure you have a quick way to look them up. Don't ever pass a med without knowing what it is. I've seen this done before and the patient or family member will ask the nurse what it is and the nurse doesn't know....not a pretty site. Take the extra minute to be prepared!


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