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Advice for ER nurse starting in LTC

Geriatric   (3,363 Views | 11 Replies)

PAERRN20 has 3 years experience and specializes in ER.

7,144 Profile Views; 660 Posts

Hi everyone! I am an ER nurse making the transition to LTC by choice. I am tired of the trauma, drug overdoses, and narc seekers that plague the ER. I really enjoy working with geriatric patients....they are my favorite group!

Anyways, I haven't started on the floor yet but need some advice. I am not a new nurse, but I am new to LTC. My only experience has been ER, so while I am comfortable with critical patients, I am not real comfortable will calling MDs, supervising LVNS/CNAs, entering orders, etc...basically "floor" nursing tasks.

I will be the only RN in the building for approx 80-100 residents. I will not have to pass meds or do treatments. I'll just be the RN supervisor. In my state, LVNS aren't allowed to call physicians and take orders, so that will be my main duties.

Does this sound doable. I have 3 years ER experience, although I have never been charge nurse. I am worried I won't be able to handle it! What is your best advice or tips for me?

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BOOYARN has 8 years experience.

119 Posts; 3,449 Profile Views

i use to work for ltc when i was an LPN..... noticed that alot of the charge nurse/floor managers duties, were like you said deal with doctors, other managers , and family members. you will get alot of the complaints from residents/family and the staff because of assignment. i would think if your a good problem solver, you should have no problem with your new job. Goodluck and Congratulations. hopefully your doing a 3 to 11 or 11 to 7a shift....

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1 Article; 207 Posts; 5,959 Profile Views

I would have to say, having been in LTC as a CNA, then an LPN, then an RN that there are a few things that are important to remember.

#1 important thing: learn to laugh. Learn to take things lightly. There's a lot of poop in LTC, literally, I mean feces. Learn to laugh, it makes poop more bearable.

#2. Help on the floor when you can.

#3. Even if you have supervisory duties, get out from behind the desk as much as possible. Get to know your residents, it will make your job a lot easier and a lot more enjoyable.

I love LTC!

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PAERRN20 has 3 years experience and specializes in ER.

660 Posts; 7,144 Profile Views

hopefully your doing a 3 to 11 or 11 to 7a shift....

What's the reasoning behind this? I'll mostly likely work the 11p-7a shift.

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BOOYARN has 8 years experience.

119 Posts; 3,449 Profile Views

11p to 7 am is a great way to start your transition , its the "easier" shift! not a lot of family members or doctors around, also you will only have a boss for about 1/2 hour a day 7 to 730am. if you like nights its great!!

7a to 330 its the hardest shift , if your a people person, this is the hardest shift , but also the one you can advance or scale the latter higher and faster if that is what you want...

3pm -1130pm MY personal Favorite , starts out crazy but the other half is easy and you get to sleep in bed AT NIGHT!!!

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tyvin is a BSN, RN and specializes in Hospice / Psych / RNAC.

1,620 Posts; 18,040 Profile Views

You should receive a good orientation. As far as never having to pass meds or do treatments I think is something that may surprise you because ultimately you will. I was hired just like you and ended up doing the meds and treatments when there wasn't enough coverage (sick calls not able to cover etc...).

As far as talking to docs, writing orders, interpreting labs, etc...etc... that should come easy since you've worked in a high intensity place already. In LTC you are the docs eyes and ears and they depend on you to inform them of any changes that the residents go through.

In most states it's the law for facilities to have an RN on the floor or in house 24 hr daily. You will be the charge but with that you pick up everything that isn't covered. One of the most frustrating things is the call ins for calling out sick. Then it's scramble time to cover the shift/shifts.

You also need to learn how to help the CNAs. Sure I'll feed someone or change a diaper if I'm not busy. So if you're not sure about feeding patients, cleaning up doo doo, and even being able to transfer residents from wheelchair to bed and vice versa bone up; ultimately you will be in a position to do so.

Good luck

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Forever Sunshine has 7 years experience as a ASN, RN and specializes in LTC.

1,261 Posts; 16,253 Profile Views

11p to 7 am is a great way to start your transition , its the "easier" shift! not a lot of family members or doctors around, also you will only have a boss for about 1/2 hour a day 7 to 730am. if you like nights its great!!

7a to 330 its the hardest shift , if your a people person, this is the hardest shift , but also the one you can advance or scale the latter higher and faster if that is what you want...

3pm -1130pm MY personal Favorite , starts out crazy but the other half is easy and you get to sleep in bed AT NIGHT!!!

I think 3-11 is the hardest shift. We have the same workload as 7-3 but less CNA's, no PT, recreation leaves at 8. The only positive is that theres no bosses floating around yelling at us for call lights(go answer it!, the residents don't bite.. well most of them dont bite lol), and things we arent doing when we are swamped with everything else we are already doing and we get more admissions too. Also when residents are being put to bed the CNAs find skin tears, bruises, etc .

To the OP-- 11-7 is a great shift to learn the ropes and how to be independent in LTC. I pick up extra shifts on 11- 7. I admit it.. its so much more controlled and quieter(shun me) .. than 7-3 or 3-11. The meds aren't too time consuming, barely any treatments, but you won't have many CNAs so you might to go answer call bells at times when they are tied up. Do not hinder your CNAs or LPNs. We have a current supervisor who loves to delegate too many things and goes out of his way to make his job easier so he doesn't have to do the work of a CNA/LPN. Hes not favored by us. lol

You might not see this too much on 11-7, but LTC isn't what it is percieved as(residents sitting quietly in their wheelchairs playing bingo). Its actually very busy, and noisy and stressful.

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soapaddictOH has 10 years experience and specializes in BICU, ER, SICU.

33 Posts; 1,493 Profile Views

I am also going to be working in LTC- part time, every other weekend.I'll be working days. I will still be working my 40 hour shift in the ER. Not quite ready to leave yet! I've been in the ER for 8 years. I'm used to the docs being right there, we also have protocols that we can start when patients come in and are triaged. I think that will be the hardest thing to get used to. I function as a charge nurse when needed, and must do a good job because they keep letting me do it. So I'm used to dealing with irate patients, families, etc. I am going to get 2 days of orientation, which makes me a little nervous. I would like to have more, but I am starting January 8th. We will have to keep in touch, make sure you update your post as far as how you are doing!

Maureen

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txspadequeenRN has 20 years experience as a BSN, RN and specializes in ICU, PICC Nurse, Nursing Supervisor.

4,373 Posts; 29,226 Profile Views

hospital and ltc are two completely different animals ....what lvn/pn's cannot do in the hospital more than likely they can do in ltc. i think you will find that most of the charge nurses are lvn/pn's and take care of their own orders....ltc just could not function any other way. most ltc's do not have in house rn coverage 24 hours and definitely don't have a rn making all the md calls for 100 patients.

i will be the only rn in the building for approx 80-100 residents. i will not have to pass meds or do treatments. i'll just be the rn supervisor. in my state, lvns aren't allowed to call physicians and take orders, so that will be my main duties.

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88 Posts; 2,687 Profile Views

I agree with the person who said to get to know the residents. Go to all the units and meet the fall risks. Most likely you will be seeing them quite frequently and it really helps if you know them. Also make sure you know the facilities policy on falls. We have a man that will climb out of bed on his one knee and then get back up in his bed or even being assisted to the ground by staff is a fall where I work.

In my facility, if there is an emergency, the charge will take a cart while being charge. It doesn't happen much that I've noticed. Although when they take a cart, I hardly see them.

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PAERRN20 has 3 years experience and specializes in ER.

660 Posts; 7,144 Profile Views

hospital and ltc are two completely different animals ....what lvn/pn's cannot do in the hospital more than likely they can do in ltc. i think you will find that most of the charge nurses are lvn/pn's and take care of their own orders....ltc just could not function any other way. most ltc's do not have in house rn coverage 24 hours and definitely don't have a rn making all the md calls for 100 patients.

in my state lvns/lpns are not allowed to call the md and take verbal orders. they are allowed to fax notes to the md.

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tyvin is a BSN, RN and specializes in Hospice / Psych / RNAC.

1,620 Posts; 18,040 Profile Views

hospital and ltc are two completely different animals ....what lvn/pn's cannot do in the hospital more than likely they can do in ltc. i think you will find that most of the charge nurses are lvn/pn's and take care of their own orders....ltc just could not function any other way. most ltc's do not have in house rn coverage 24 hours and definitely don't have a rn making all the md calls for 100 patients.

where i am and in two other states i've worked in it's the state requirement that ltc facilities have an rn in house 24hr. also it is the rns making all the calls to the docs as the lpns cannot in my state as well. i have never seen an lpn be the charge either.

what state do you practice in?

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