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Advice and words of wisdom needed.


Hi everyone,

I graduated in 2010 with a BSN, but I'm just now entering the field since I have been a stay at home mom for the last 4 years. I was hired at a LTC and rehab facility. I'm very nervous starting this position since I will only be in orientation long enough to complete a checklist of skills and after that I'm on my own. The facility has 103 residents with 2 RNs and 4 CNAs on every shift. Despite reading my state's nursing practice act, I'm feeling a little confused about what exactly I can and can't delegate to CNAs. I'm also concerned that the facility appears to have a large staff turnover (I know, not uncommon for LTC) and I've already noticed some practices being utilized that are not evidence-based.

I'm wondering what advice you would have for me coming in as a new (old) grad and if you could recommend any reference books or a comprehensive guide to evidence-based practice in LTC and rehabilitation nursing? Any "does or don'ts" I absolutely need to be aware of that might easily be overlooked by a new grad?

Any input would be greatly appreciated! I totally feel like I'm in over my head.


Specializes in Long term care; med-surg; critical care. Has 9 years experience.

Take a breath, you can do it. Not knowing the acuity of your population it's difficult to say, but those ratios do seem a little bit high, so you may be in for a challenge. Do you know anything about the facility as far as a rating from the state or just experience from families? All state records should be public and on-line and if there are numerous citations, you might want to reconsider. If it seems like a decent place, just go by the policies. Every facility has a whole book of policies and while it may seem impossible to find the time to read them (or even one), if the safety of your residents is at stake, you want to make sure you're doing things properly. Good luck, it can be a fun field to work.

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

What state? You must be very clear what you can and can not delegate and I can understand that if you have never practiced this can be confusing. The nurse to pt ratio does seem high so it is essential that you know what you can delegate. What kind of popultaion does this LTC serve beacause I would be brushing up on care of that population. You will need to be very organized and I would not depend on the facitly to provide me a report sheet or format to do so . What technology will you have access to? What shift is it? Do you have a medication nurse or aide or are you it?

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

Two nurses and only four CNAs for 103 residents?! I don't know about your state, but in mine the ratios are 1 CNA for every 7 residents on days, 1:9 on evenings, and 1:17 on nights. The nursing ratios aren't as clear, but usually nurses have up to 35 residents on days and evenings, and up to 60 at night.

How is it legal for a CNA to have 25+ residents, especially on day shift? And how can a facility have only two nurses (again, I'm assuming it's a day shift) for that many residents? Why, it's just impossible......that is as unsafe as it gets, especially if you don't have a treatment nurse and/or med aides. Wow. :eek:


Has 26 years experience.

Caveat emptor. this sounds like bad mojo if your numbers are accurate.