Any advice on orientating a new grad at a SNF?

Nurses General Nursing


I'm trying to orientate a new grad at my SNF. I've done a lot of orientating, but usually it's other LPNs with experience in nursing homes or SNFs. Twice I did orientate new grad LPNs but they had done quite a bit of clinical in the SNF (both had actually done clinical at my workplace during their program) and thus seemed to "get it" much more readily than the person I'm trying to orientate right now (knowing the charting, where stuff is, etc.)

I don't think he's ever worked with a paper MAR before or used a med cart with the punch cards like we do. It's all very different than the computerized systems at the hospitals and everything is completely new. It's so hard because there is only so much time to explain things because I still have my full 20+ pt assignemnt to complete, all the meds still need to go out, the treatments need to be done, the charting completed and 100 fires have to be put out all through the shift.

I had an idea to give him his own assignment of 5 people or so at first and I would let him handle everything with that group of 5 while I was available to oversee and answer questions but in practicality it didn't work out AT ALL because we both have to work out of the same med cart and it just became a huge confused mess. So I don't think doing it that way is feasable in this setting.

I am getting resentful because he has to leave on time while on orientation per DON and I'm staying WAY late every day tying up all the loose ends and doing all the charting.

Can you tell me if these things are to be expected when someone is new right out of school: there are five accuchecks in the morning. These take the new nurse at least half an hour to obtain. Then we do the insulins. Usually 2 or 3 of the five get insulin. Doing the three insulins takes at least another half hour. Then we start meds, already like an hour behind where I usually am at this time. I am saying in my head...patience, patience patience patience!

Passing meds on one patient...half hour. Then another ten minutes after to sign them all off. A blood pressure is 10 minutes, and a set of neurovitals 20 minutes. Charting on one chart half an hour.

I am just is he going to be on his own in a week? Do I make him do the whole AM med pass even if it takes til the afternoon? I am really not sure how to approach this. I always tell my orientees that accuracy with the meds is the most imporant thing, and speed will come, but I've never had anyone start off quite this slow.

Specializes in Med-Surg, & ED.

If I were you, I would trust my inner judgement and have him do all the meds on his own, just like you stated. This will allow him to take responsibility and manage his time adequately, this will be a long time learning experience to him. He is not learning the reality within the nursing field if you cut off his nursing responsibilities by helping him, let him see and experience the need to prioritize his schedule before he is on his own. He got through nursing school already, he has the skills; let him know, learn, and work with his patients to be able to know how to work the floor. Tell him he needs to pick up his speed, being assertive is always helpful.

Specializes in ER, ICU.

You could break the tasks down into parts. For example, you pass the drugs while he documents. This lets him focus on one thing and learn the paper MAR. The next day he passes or whatever. Given the short orientation time I would focus on only the critical areas like meds. Good luck.

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