New grad in LTC

[sta127]

I'm a new grad nurse in a subacute rehab facility. I don't had prior nursing experience like CNA or anything. I guess I'm having trouble getting the routine down as it seems much different than nursing school. In school, we really never had to personally deal with paperwork (sure we talked about it but student were never responsible for it), doctors, etc.

I've shadowed two nurses for two shifts this past week and they don't even have time to finish their work before the shift is over so they tell me I can just go home--so I don't really have the big picture in my mind.

I just feel like I have a lot of really stupid questions so if someone could help that would be great.

1. The CNAs in my facility dont seem to chart on the computers or take vitals. They just have their flow sheets. So what am I looking for from them in terms of the logistics--signing off on their flow sheets? do I chart anything from them in computer? I guess I feel like I'm missing something regarding the relationship between CNAs and nurses. It just seems different than the hospital.

2. Charting--- how often does each patient get charted on and to what extent. Do I write a nurses note on every patient every shift?

3. Assessments-- How often are you doing a full assessment? it doesn't really seem like there's much assessing going on in my facility---it just seems like med pass, treatments, call bells. In my facility, if you're day shift , you'll chart vitals on the odd numbered rooms but it doesn't seem like the patients get their breath, heart, sounds checked regularly. It just seems like "the patient is breathing-good". I asked

4. Doctors- so of course you call the doc if there is a major problem, to verify meds for a new admission. But, say a doctor put a new order in a patients chart. I've seen the nurses sign off and fax it back to the doctor. Then what? So what about if I were to get an order over the phone from a doctor? Do I write it down and fax it to him so he can sign off on it? How soon would it go into effect?

Anything else about when to contact the doctor?

I'm not used to the whole LTC environment because I never even stepped in one in clinical. I'm used to having a computer to roll around with me to look up meds, procedures, chart relatively etc. but I'm not even allowed to use my phone and have to run back to the nurses station to look up even the simplest of things. It just seems outdated. There reall

Is there a good med book I can carry around until I'm more familiar with meds---especially meds that are unique (like take BP before and after giving this med, etc.)

[Rose_Queen, BSN, MSN, RN]

Welcome to AN! You may find some helpful information in the Rehab Nursing forum or the LTC Nursing forum. A lot of your questions may also depend on facility policy- were you shown where to find the policies during your orientation? If not, ask and take some time to read through them.

[dianah, ASN]

Thread moved to LTAC forum

[devondk16]

Hello,

I read your original post and was very interested in hearing the response when I saw that the "thread moved to LTAC.” I looked but can't find any response. I am a licensed CNA, in my second year of an accelerated MSN program and currently working as the Director of Services at a 153 bed Sub-Acute Rehab facility. 50% of our beds are LTC (76 beds) and the other are Sub-Acute and Rehab. The reason I am working as the Services Director is that it pays better while I am in school. Most of my actual nursing floor experience is in Assisted Living facilities. All of my Clinicals as a CNA were in a Sub-Acute Rehab facility and I've done my first year nursing school clinicals in this facility. Yes it's complicated, but I am a second career nursing student with a 15 year career in corporate so I bring a lot of "other skills" to the table as a prospective nurse. ANYWAY, I was, just today thinking about all the small things that I consider to be "so wrong" about the way things are handled here. As the DORS, I round on all the patients pretty much every day so I hear all the complaints good, bad, and ugly. I have a detailed picture of what is really going on in this facility. When I started, I was so motivated and wanted to change the world and fix all the "problems.” Now after 10 months, I am somewhat discouraged by the lack of response from our Management especially when I have come to them with solutions for the problems. I'm wondering if things are like this at all Sub-Acute Care and LTC facilities or if it is just this one. So many of the points you made in your post happen here on a daily basis. As I read I felt like you had been working here alongside me:

1).Charting--- how often does each patient get charted on and to what extent. Do I write a nurses note on every patient every shift?

2). Assessments-- How often are you doing a full assessment? It doesn't really seem like there's much assessing going on in my facility---it just seems like med pass, treatments, call bells. In my facility, if you're day shift , you'll chart vitals on the odd numbered rooms but it doesn't seem like the patients get their breath, heart, sounds checked regularly. It just seems like "the patient is breathing-good". I asked

3. Doctors- so of course you call the doc if there is a major problem, to verify meds for a new admission. But, say a doctor put a new order in a patients chart. I've seen the nurses sign off and fax it back to the doctor. Then what? So what about if I were to get an order over the phone from a doctor? Do I write it down and fax it to him so he can sign off on it? How soon would it go into effect?

I want to know if this is exclusive to this facility or is it industry wide? I am in the process of choosing my specialty for my Masters and really want to make the right choice. Did you ever get a response to your original post? Thanks so much! So curious.DKSF16

[Here.I.Stand, BSN, RN]

Thread moved to LTAC forum

But this isn't an LTAC question...it's a subacute question.

[SquishyRN, BSN, RN]

But this isn't an LTAC question...it's a subacute question.

Yes, this belongs more in the Geriatrics/LTC forum, not LTAC.