Any advice for a New nurse starting in LTC??

JB2007, ASN, RN · Feb 23, 2009

I started out much like you. I was a fairly new nurse with no experience as an LPN in LTC (I was an aide for several years in LTC). Here are some tips that I can give.

1. Ask questions! Three days is not enough time to understand how the paperwork is done let alone the million other things that you are expected to know/do as a nurse. Personally, I am happy to anwser questions even when I way behind myself, so ask questions.

2. Wear comfortable shoes. You will sit very little thoughout your shift.

3. Know where the P&P book is and follow it. I do not care if nurse so and so has been doing it this way for years. If the crap hits the fan you want to be following the P&P.

4. Bring a couple of good ink pens. Mine develope legs during my shift and walk away.

5. Learn to laugh at the silly things that happen. You will drive yourself nuts if you take yourself and those around you too seriously.

You will work very hard, but the rewards are worth it. The residents need good staff that will care for them well both physically and mentally. Some of these residents do not get visitors and the staff is the closest thing they have to family. Treat them well even when you have too much work to do. I will ask myself how I would want my loved one treated and that is how I try to treat my residents. Even the PITA and believe me somedays the PITA makes that very difficult.

I could go on and on as you can see. Good luck with your new career.

pgf7638 · Feb 23, 2009

Wow, sounds like my first experience all over again! That was 12 years ago and I am still in LTC. What I've learned is that nursing school gives you the foundational knowledge to be a nurse, but your experiences on the floor are what makes you a nurse. Never be afraid to ask questions and never pretend you know something you don't. It's ok to say, "I'm not sure, but I will find out." As a brand new grad I worked the night shift alone with 2 C.N.A.'s in a 70 bed facility, I learned very quickly that "when in doubt, ship them out!" I would rather send a patient to the hospital and be wrong, then not send them and have something bad happen to them. You will gain experience every day that you work. Hang in there. If I could do it, so can you!! Good Luck:twocents:

evilolive, BSN, RN · Feb 24, 2009

"When in doubt, ship them out" indeed! I don't have this happen fairly often, but you should ask about the paperwork involved (for me, a pg. 1 and 2 for the ambulance/ER, copy med sheets/Tx sheets, copy of the DNR attatched, and get the MD order!

If you are an RN you should be aware of the policy/procedure for RN pronouncement. Ask your supervisor or ADON about this, you never know when someone could pass away (thankfully I had another RN orienting me the first time this happened).

I'm not sure what shift you're going to work, but try to get a simple routine down after a week or so. For example, do meds, do treatments, paperwork, etc. It never really happens the same way every day, because things do come up, but as long as you know what you need to complete before the end of shift, you'll be good. For me as an 11-7 nurse I have to time my AM med pass just the right way to complete it in time for me to go back and finish my morning charting.

Good luck from a fellow RN only 10 months out in LTC!

JeanineLPN1984 · Feb 27, 2009

Good luck and I'm glad we have new nurses excited about working in LTC. LTC has changed alot since I started in 84. We have some that have more complex issues that your education will give you a good basis for care.

The most important thing I will tell you is to care and respect the residents, all the routines will come with practice, you will know each and every med with time. The nursing home is their home and although you are the nurse remember you are a guest in their place. You will learn each residents little things that make them happy, make them tick and generally improve their lives just by caring. It goes a long way to making them healthier.

Respect everyone you work with- housekeepers, aides, dietary, maintenance, therapy and say thank you frequently. You can't get your work done without cooperation from all staff. I love where I work, I sing during med pass, everyone smiles, all staff goes out of their way to help the residents. There is no " that's not my job". I work with 2 other nurses and 6-8 CNA's. Attitudes are contagious and I start each morning thanking my staff, giving report and telling them what we need to get done and I know they will do great work.

During the day I make sure the staff is doing good, ask them if they need help, etc. I never let them leave without telling them thank you for all their hard work and have a great day. Keep in mind I'm in charge of 26-28 mostly skilled therapy residents, med pass for them at 8am, 12 and 4pm. Charting on all my Medicare skilled and part B residents.

The point I'm trying to make is a happy, upbeat attitude at all times will make a tremendous difference in the staff and result in happier patients.

( The other 2 nurses have the same amount of patients as I do)

katbird21 · Mar 3, 2009

I appreciate everyone taking the time to give their honest advice and tips. I read over them all and I felt much more confident going in for my first day. :nuke:

However....after a week of being taught how to do unthinkable illegal things, learning that state is trying to shut them down, and that there are two lawsuits pending in my unit....I backed out. It was the most unorganized chaotic mess I never thought I would encounter. I feel bad in the way that I'm not there to advocate for the residents but I can't jeopardize my license one more day there. I know it's hard to find jobs for new nurses in my area but I'd rather be unemployed than gambling with a resident's well-being and my new license...

missyd1991 · Mar 4, 2009

My best advice is don't be afraid to ask questions we all start out as new nurses. Talk with the nurses, CNAs, dietary and housekeeping staff they are a wealth of information. The first couple of shifts watch everyone around you and then come up with a plan of attack so to speak. You will do great and just relax there are always people there to help you out and vice versa. Be willing to help out your aides they will be your best friends trust me, without them the nurse homes would be lost.

Mobiusrain · Mar 8, 2009

Ask, ask, and ask. I'm a new RN myself who just started in LTC. I was oriented 4 days and now I just finished my 2nd day on the floor by myself...I take so long on med pass that I need to take 2 extra hours overtime to finish everything else. I'm completely burned out right now . It's hard when you don't know your residents yet and haven't developed a routine to speed up your med passing, but like everyone says, it would get easier as you go.

Personally though, I'm looking for another job in a different setting. Maybe hemodialysis perhaps. Even if I get better at LTC, I just don't think this is the kind of nursing I would enjoy doing on a long-term basis...it's just too much redundant paperwork, too much patients for one RN, and no opportunities to use your med-surg skills (no IVs, trach care, etc...).

JB2007, ASN, RN · Mar 8, 2009

I appreciate everyone taking the time to give their honest advice and tips. I read over them all and I felt much more confident going in for my first day. :nuke:
However....after a week of being taught how to do unthinkable illegal things, learning that state is trying to shut them down, and that there are two lawsuits pending in my unit....I backed out. It was the most unorganized chaotic mess I never thought I would encounter. I feel bad in the way that I'm not there to advocate for the residents but I can't jeopardize my license one more day there. I know it's hard to find jobs for new nurses in my area but I'd rather be unemployed than gambling with a resident's well-being and my new license...

Good for you! You were able to recognize a situation that you do not want to be in so quickly and for getting out of it. Not all LTC facilities are like the one you worked at, but there are some out there. Staying to be a advocate is not the best call. If the facility is that bad management knows it and they do not care. All they want is a warm body that they can blame for their troubles when the crap hits the fan. I wish you luck in finding a job that is safe for both your lincense and your residents.