Advise for new job at SNF , new grad RN

Kittypower123, BSN, RN · Jan 1, 2012

I use a form I created to organize everything I need to do during my shift. I arrange everything according to when it is due. I have a clipboard that I carry with me and mark off each item as I do it. I have a space for noting any PRNs given, who is on O2, has a colostomy or foley, and who I need to do follow-up charting on (for falls or abts). Throughout my shift I only have to reference my clipboard to know what I have done, what I haven't, and where I'm at. I work 2-10 so the set-up would be different than for night shift, but it works well for me and I don't have a bunch of pages sticking out of MAR (the way everyone else flags what they have to do). I also don't have to keep flipping through those pages to make sure I didn't miss anything.

Kittypower123, BSN, RN · Jan 1, 2012

I work 2-10 at a SNF. I get that patient load too. I have a one-page form that I use to organize myself. I arranged it so that for each hour of the shift I can write down what I need to do - who has meds, txs, accu checks, etc. I also have a space for any PRNs I give so I can let the next shift know (they really like to know when the last pain med, anxiety med, sleeping med, etc. was given). I have spaces for noting who has O2, colostomy, or foley, and who I need to do follow-up charting on (for falls or abts). I mark each item off when I complete it and only have to look at my clipboard to know what I have or haven't done and what I need to do at that time. It's a system that works well for me.

sls73 · Jan 1, 2012

Give yourself time to learn everything....you are not going to get it overnight. I have seen good nurses give up on themselves because they think they have to have it all down by the end of orientation. Ask about the orientation program and if you are not comfortable at the end of it, will they extend? Ask questions of anything you are not sure of. There are days it can be overwhelming but then there are days you leave saying to your self "I made a difference in someones life today".

CapeCodMermaid, RN · Jan 1, 2012

I would say every day in long term care we can say "I made a difference in someone's life today."

croppyRN · Jan 1, 2012

I have only been at a short term rehab/LTC facility for about four months on my own, but I won't sugar coat it for you. It is very overwhelming at first. You will be intimidated by the other nurses who just soar through the shift, knowing all (or most) of the residents, knowing the routine, etc. Please try to keep things in perspective. You are brand new. It is going to take some time. It will be hard at the beginning. I don't know if you will experience this, but I felt as though the clock was my enemy. But above all remember that safety has to be foremost in your mind. Be sure to focus on giving the right meds to the right patient, the right dose...you know what you learned in school. If you have questions, don't feel stupid about asking. You will probably have to ask the same question more than once, too. That's okay. Some nurses are willing to help, some not. Don't plan on finishing your shift on time, either. The oncoming nurse should understand, because they were in your shoes once, too. Some will be nicer about this than others, but try not to let it get to you.

As others have suggested, use all the orientation time they offer and don't let them intimidate you into going on the floor early. (For so many of these LTC places, they want a paid worker on the floor ASAP). Also, if you feel you're still not ready after orientation time is up, ask your supervisor or DON if they will give you any extra time. If they tell you no, you will have at least tried. It never ceases to amaze me how willing LTC places are to put new grads on the floor with barely any orientation/training. Then they end up having to deal with the paper work and problems associated with the inevitable mistakes new nurses will make. It doesn't take a genius to figure out that a better trained nurse will perform much better than a poorly trained one.

I hope that I haven't frightened you to death. You will find so many aspects of your job rewarding. For many of these residents, you are their only family. Once you begin to feel more comfortable with your routine, you will find yourself getting attached to these people. Of course, some more than others

AngRN6726 · Jan 2, 2012

Thanks Kittypower!

Those are great organization and priority setting tips!

I love that! That is good to know info. I will definitely incorporate that into my system and I know it will help tremendously.

Thanks again!

AngRN6726 · Jan 2, 2012

Hey Sls73,

Thanks! I always feel like on first days , overwhelmed and having anxiety wishing I did have it all down by the end of my firsts days. But I know thats not possible and helps to be reminded of that.

But I agree with you that at the end of the day all that matters is that I made a difference in someones life.

AngRN6726 · Jan 2, 2012

Very true CapeCodMermaid!

AngRN6726 · Jan 2, 2012

This is wonderful advice CroppyRN!

Thanks for the taking the time in giving me your comment! Really appreciate it! Thanks to every one!

You didn't frightened me but made me aware and that will help me a great deal when I start. I will definitely try to remember about safety first, they couldnt stress that enough in nursing school and it is critical to remember at all times. I do hope they give me enough orientation if not I will try to ask and see if they extend it if I don't feel comfortable on my own. And I was thinking that my shift is supposed to be 11 to 7 but I have a feeling I wont be going home till prob 9 or 10 just to make sure I did everything, especially cause I the kind that I can't go home till its done.

I know I will have a great experience especially getting to know the residents.

and thanks again CroppyRN , I hope I am as strong as you are by my four months.

I will keep you all updated!

Thanks again everyone!

Kittypower123, BSN, RN · Jan 2, 2012

One more piece of advice - ask for help when you need it. The other nurses will be focused on completing their tasks and may not notice that you need help. Be bold and ask - it really helps relieve the stress when you know that you can ask for help and get it. You'll learn who to ask and who not to. When you're more comfortable and are able to do things more quickly, you can return the favor. It's a great way to build teamwork.

huangsoRN · Jan 6, 2012

I am BSN new grad and started my first RN job in LTC a month ago. I had 4 days of orientation and I asked my DON to extend my orientation so they gave me extra 2 shifts. I have total 20 residents in my hall way and 7 of them are diabetic. I am still struggling with paper works especially when there's new admission or incident report that I need to complete. Orientation is going to give you a general idea but I personally didn't absorb much information that was given to me in the orientation until I actually encounter the situation. It's going to be over whelming in the first week. But once you get to know your residents and their medications, it will be easier. I always have my "brain" with me and I write what Tx needs to be done at what time in the beginning of the shift to keep me organized. It's good to note who is diabetic and when their CBG needs to be checked. Ask the nurse who is orienting who's glucose tend to drop fast so you have a better control of what time you need to give their insulin. Nursing school did not prepare us to the real world so it's very important to establish a good relationship with the co-workers. The nursing assistants are great source to go for skin issues when you first start because you don't know if they are new or they have been there for a long time. I work 12 hr shift 0630-1900 but sometimes I don't leave til 2200... What I found most helpful is to know who you can go to when you need help. Some nurses may not want to help because they got their own stuff to worry about especially it's their time to go home. I am glad I have found a co-worker who is resourceful and willing to stay and help me when I got 3 admissions in one afternoon. Best of luck to both of us!

PS. your legs will feel sore in the first few days... but it will get better I am getting a pair of compression socks asap.