Advice Needed for New Grad LPN- SNF

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Hi all, this is my first post on the site so I apologize in advance if this has been discussed already.

I am a new grad LPN (graduated in December, notified that I passed boards yesterday) and I found out last night that I am going to begin orientation at a SNF next week.

I have previously worked in this facility as a Rehab Aide for 5 years so I'm vaguely familiar with some of the policies and most of the staff, but I've never been on the nursing side of the spectrum so it's making me feel a little overwhelmed.

I was wondering if any more experienced nurses could lend some advice as to what I should expect in the position, and maybe some suggestions you may have to help make the transition from student to licensed nurse a little less stressful. Any advice will be appreciated!

I will be a floor nurse with about 25-30 patients between two halls and probably 2-3 CNA's.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I will start off by saying that I am a very task-oriented person. After all, nursing home/SNF work involves a massive amount of tasks that must be completed.

I worked on a rehab unit at a large nursing home/SNF several years ago and here is how I used to organize for the day. I worked 16 hour weekend double shifts from 6am to 10pm. I usually had an average of 15 patients to care for. At the beginning of the shift I would go through the MARs and TARs with a fine tooth comb and, as I go, I would jot down the things that needed to be done in my notebook. My notebook was how I organized my days, and I usually wouldn't forget to do anything. Here is how an old notebook page looked (names have been changed due to HIPAA):

9-23-2007

DIABETICS, FINGER STICKS: Agnes (BID), Agatha (AC & HS), Bill (AC & HS), Wendy (AC & HS), Rex (BID), Jack (BID), Esther (AC & HS), Margie (0600, 1200, 1800, 2400)

NEBULIZERS: Margie, Esther, Bill, Jack, Jane

DRESSING CHANGES: Jane, Bill, John, Jack, Lillian, Rose, Lucille

IV THERAPY: Wendy (Vancomycin), Laura (Flagyl), Rex (ProcAlamine)

COUMADIN: Agnes, Agatha, John, Lucille

INJECTIONS: Agnes (lovenox), Jane (arixtra), Rex (heparin), Bill (70/30 insulin), Esther (lantus), Mary (vitamin B12 shot)

ANTIBIOTICS: Wendy (wound), Laura (UTI), Rex (pneumonia), Agatha (MRSA)

1200, 1300, 1400 meds: Margie, June, Rose, John, Jane, Jack

1600, 1700, 1800 meds: Rose, John, Rex, Lucille, Lillian, Laura

REMINDERS: assessments due on Agatha, Jill, and Louise; restock the cart; fill all holes in the MAR; follow up on Jane's recent fall, fax all labs to Dr. Smith before I leave, order a CBC on Rex...

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I will start off by saying that I am a very task-oriented person. After all, nursing home/SNF work involves a massive amount of tasks that must be completed.

I worked on a rehab unit at a large nursing home/SNF several years ago and here is how I used to organize for the day. I worked 16 hour weekend double shifts from 6am to 10pm. I usually had an average of 15 patients to care for. At the beginning of the shift I would go through the MARs and TARs with a fine tooth comb and, as I go, I would jot down the things that needed to be done in my notebook. My notebook was how I organized my days, and I usually wouldn't forget to do anything. Here is how an old notebook page looked (names have been changed due to HIPAA):

9-23-2007

DIABETICS, FINGER STICKS: Agnes (BID), Agatha (AC & HS), Bill (AC & HS), Wendy (AC & HS), Rex (BID), Jack (BID), Esther (AC & HS), Margie (0600, 1200, 1800, 2400)

NEBULIZERS: Margie, Esther, Bill, Jack, Jane

DRESSING CHANGES: Jane, Bill, John, Jack, Lillian, Rose, Lucille

IV THERAPY: Wendy (Vancomycin), Laura (Flagyl), Rex (ProcAlamine)

COUMADIN: Agnes, Agatha, John, Lucille

INJECTIONS: Agnes (lovenox), Jane (arixtra), Rex (heparin), Bill (70/30 insulin), Esther (lantus), Mary (vitamin B12 shot)

ANTIBIOTICS: Wendy (wound), Laura (UTI), Rex (pneumonia), Agatha (MRSA)

1200, 1300, 1400 meds: Margie, June, Rose, John, Jane, Jack

1600, 1700, 1800 meds: Rose, John, Rex, Lucille, Lillian, Laura

REMINDERS: assessments due on Agatha, Jill, and Louise; restock the cart; fill all holes in the MAR; follow up on Jane's recent fall, fax all labs to Dr. Smith before I leave, order a CBC on Rex...

You have no idea how helpful that is for me.

I can't function without having things tasked and prioritized, but I really hadn't thought of a way to do it that would make sense for me. I could only think of going by what was needed per patient, and it just wouldn't be logical with the caseload I anticipate having.

Thank you so much!

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This is so helpful to me as well! As a newly graduated LVN I just got my first job last week and am already on my own floor, by myself with 2 CNAs and 1 Med-aid. I never thought about keeping a notebook but it's such a great idea. My binder on my cart is so big and whenever I have to flip through it I always lose my spot and so far it's been frustrating having to go back and forth for PRN narcs and treatments as well as accuchecks/ insulins.

I just have a question,do you then go back and sign off after you are done since you are working from your notebook? That seems like it would save a lot of time so you arent going back and forth.

Thanks for this post!!!:yes:

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I just have a question,do you then go back and sign off after you are done since you are working from your notebook? That seems like it would save a lot of time so you arent going back and forth.
I simply cross out the tasks that I have completed as I go.

Thanks for this post!!!:yes:
You are very welcome!
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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Also, I forgot to mention something. . .charting. A couple of weeks ago I wrote a guide on charting for situations that commonly arise in LTC/SNFs. Although facility policies may vary on what you need to chart, these are general guidelines.

https://allnurses.com/geriatric-nurses-ltc/ltc-charting-beginners-899111.html

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Thanks again for your help!

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What a huge help. Thanks!!!

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Everyone forgot the most important thing... Congrats on passing your boards!!!!

That being said, I am a checklist kind of person. I always had a list of who had treatments and what I needed to chart on. As soon as I finished a treatment or a nursing note I crossed it off my list. That way I didn't forget to do anything that needed to get done. Because let me tell you, it sucks to be putting your coat on at the end of your shift only to realize that you forgot to do a Medicare note on Mrs Smith..

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Thank you so much! Passing my boards feels like just the end of my first chapter in nursing, but man.. it felt like an awfully long chapter. ;)

I think that's my biggest fear- forgetting to do something important in the midst of all the tasks to do for the day.

I'm also curious to know how you complete assessments on that large of a number of patients in a time mgmt sense. In clinicals, the maximum number of patients I had was 2 (granted, this was the neuro floor at a hospital so it was a much higher acuity).

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I'm also curious to know how you complete assessments on that large of a number of patients in a time mgmt sense. In clinicals, the maximum number of patients I had was 2 (granted, this was the neuro floor at a hospital so it was a much higher acuity).
In LTC facilities, when you must pass medications to 30+ people in a 2 or 3 hour window, you can only afford to spend a few minutes with each resident. Do not spend a long time with any particular resident unless it's an emergency.
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