A day in the life of an LTC RN

NurseSati · May 2, 2014

I got a job in LTC at the place I worked as a CNA right out of school. I just finished my training a few weeks ago. These past few weeks have been such a surprise!! In school all the clinicals were in hospitals. The nurses at my job just seemed to be on the phone all day or doing paperwork. From what I can tell you over the past few weeks from my experience, there is a lot of assessment. There are a lot of decisions to be made. At my facility there are around 300 residents. There is one nurse on duty to oversee care. Med aides do medication admin. My first day on my own someone fell. Had no pain. I really kind of froze on my assessment. No pain with ROM. Stood him up, his leg went out. Called family, they didn't want us to send him out. I did anyways. Get a call later that he had broken his hip. Often I am approving medication orders to make sure they are transcribed into the mar correctly. Most of the time they are wrong. I do a lot of teaching with families and residents. Ileostomy bag changes and straight cath. Really whats been my biggest hurdle is being by myself. No other nurses on duty to bounce information back with. There is a lot of assessments. A lot of times family or resident does not want to be sent out. It can be really nerve racking when someone has been throwing up for three days. There is a lot of wound care. Tons of little stuff. Some big wounds that don't have home health orders or what not. I feel like I am often running around putting out fires and fixing things. It's a lot different than the hospital. I have learned I have to trust myself. Especially being such a new nurse. I like it, but look forward towards moving into a hospital job.

NurseQT · May 2, 2014

It'll depend on the facility, the shift you work, and what type of staffing you have. Sadly in LTC there is more paperwork than patient care. At my old job a typical day shift for me went like this: get report, count narcs, set up cart for med pass, did med pass, do some assessments and treatments, so some charting, set up cart for second med pass, finish assessments and treatments, finish charting, give report, count narcs. Try to squeeze in some sort of break. On top of this there may be admissions, discharges, care conf, falls, doctor calls/rounds, and families that have to be taken care of as well. I work NOC shift now which is a whole different ball game from days..

x19amanda · May 3, 2014

I've been working in a LTC/Rehab facility for almost a year and far from the contrary it has truely made me a strong nurse and even though I dont utilize many skills I have to say I am thankful this was my first job. I have learned so much in regars to documentation, critical thinking, communicating with doctors and other staff members, and time management. I work both 3-11 and 11-7 which are two different ball parks. 3-11 RNs consist of getting report, receiving any labs from the fax, (usually a lot of PT/INRS, BMPs, CBCs), then I do a quick round to ensure all residents are accounted for and any who have alarms have them on their person. Next, I review the MD message board, and collect all charts, meds, info pertaining to what I need to convey to teh doctor as well as any charting from previous shifts and think up any recommendations. After that, I usually review the charting from teh daytime, and then look through the communication book which may alert me if family members or other areas need to be contacted. If there is any admissions, I have to do all of this and the long process of an admission. All together, this takes quite some time, especially if there is many labs and admissions. Also, if there is an MD in for rounds I assist with this, and chart document and writer off any orders made. In between all of this, if somebody falls, any skin issues, or needs to be sent out I am responsible for all of this as well which can be quite time consuming because documentation needs to be thorough to cover your ass. Also, you spend time helping your aides toilet and answer call lights. At night, it's a whole other story. Mainly, youre super short staffed, have paperwork to get ready for teh day, documenting falls, hospital admissions, etc. Also, toileting many many residents. Enjoy!

TrivaNurse · May 9, 2014

I'm a RN working my first job in a LTC facility and I've been there for about 5 months. I work night shift (6p-6a) and here's a basic run-down of what I do on my shift:

1). Finish any skilled sheets left from day shift (head to toe assessment plus extensive charting regarding their care needs)

2). Finish any admissions (paper work, assessing the patient, writing orders for them, etc)

3). PRN medications plus a few scheduled meds

4). 5a PEG meds

5). Standard charting on patients with FC, ABT, ISO, etc as well as any behaviours

6). Busy work (checking fridge temps, testing glucometers, crash cart checklist, etc)

7). Labs at 4a

8). Stocking med room, med cart, etc

9). Treatments

10). Managing the building. This is the toughest one for me because obviously as a nursing student you never manage anyone. I'm responsible for making sure everyone shows up to work, calling management if someone doesn't, re-assigning halls to the CNAs if we're short staffed, and occasionally even calling other CNAs to see if they will come in to work. I loathe this part of my job. Such a waste of time that could be given to residents.

Hope this helps:)