Any tips for a new nurse working in LTC?

Specialties Geriatric


I should be receiving my license here in a few days and I can start practicing as an LPN where I work.

Do any of you have any tips or ideas to help me adjust from a CNA position to a LPN position?

Any ideas or thought would be appreciated...I just want to be the very best nurse I can be for my patients.....

Thanks everyone! :)

adrienurse, LPN

1,275 Posts

Don't let anybody tell you that this in not "real" nursing. Respect the subtle skills required such as being able to interpret needs of those with severe dementia. Keep these skills up. Read up on new information, do not let your practice get stale.

Challenge yourself to look at things differently than you would have as a CNA. Do not look at your work as a series of tasks, look at the "big picture".

Get to know wound care very well. Learn the beginning signs of pressure ulcers and venous stasis ulcers.

Get to know the difference between delerium and dementia. Dementia does not happen suddenly. If your normally clearheaded patient starts acting confused, rule out resp infection of uti.

When assessing someone who is in distress, always rule out bowel obstruction.


365 Posts

You will find many people that will tell you that working in LTC is not "real nursing" but let me tell you, in this kind of nursing you wear many hats and are many things to many people. I agree with the above post but I have to take it further having been in this profession for over 21 years. Each day will be different. I have yet to have any two days be alike. One day you have problems with one resident and the next day they are good as gold and someone else will act out inappropriate behaviors. You have to have a lot of patience and a keen eye for changes in each person. Always remember every resident is an individual and they cannot be lumped into a catagory. They will never cease to surprise you with what they can think of and don't be fooled by their states of confusion, they can still be quite clever. You must be great at calming family members and make them feel that their resident is top notch on your concern list. Listen to their concerns and act on them if they are reasonable, if not, in the kindest way possible, explain why what are are requesting is not possible, such as, "I don't know why Mom cannot keep her own Ben Gay, etc in her room." They must be made to understand that while Mom is alert and oriented, maybe a confused resident would come into the room and ingest it, and cause serious harm to them. You must have an eagle eye and be a good listener and trust you CNA's when they tell you something is wrong. They are the ones providing the constant hands on care and they can either make or break you as a nurse. Let them know you appreciate them and they are a valued member of your team. As a LTC nurse, you work rehab, psych, hospice, and at times you are called on just to listen even though you cannot change anything. Examine all the possibilites, such as if Millie is normally a quiet person who suddenly becomes aggresive and mean, maybe she is having pain but cannot find the words to describe it, or she has a UTI but cannot tell you it hurts when she urinates, check bowel sounds, such a little thing as no BM's can alter a persons personality like you would not believe. And no matter how odd their behavior is, remember, they are someones loved one and they deserve the respect of your time and concern and don't just assume they are "nuts" and acting out. Also remember that behaviors and capibilities change from one shift to another. Maybe on day shift a person is A & O but at night is confused, or they can walk in the morning bt not at night. Read up on Sundowners. Most of all treat each person as you would like your own parent to be treated, with dignity and respect and sometimes a hug or a kind word goes much further than any drug. I often say I need my residents more than they need me. The hugs and I love yous are one of our greatest benefits. As a new nurse it will take you time to learn the ins and outs but if you are sincere, you will do fine. If you have any specific questions please feel free to PM me. I love what I do, I am thankful for the pleasure of caring for my residents and will help answer any of your questions if I can. God Bless and good luck!!!!

jschut, BSN, RN

2,743 Posts

Thanks you guys...

You are both so awesome! :)

PS I think I have a little edge on most things cause I've worked in LTC for almost 20 yrs now as a CNA.

But nursing....that's a whole different role!


163 Posts

I was also a CNA for years prior to becomming a nurse. The biggest obstacle I had to over come was delegating tasks to CNAs who did not understand that on that skilled medicare unit, I could not do both jobs. I still assist w/ ADLs and answer those call lights, but not as often as I used to as now I have meds, treatments, assessments, and on and on. It took some time adjust (for everybody), but things are good now. we all respect each other.


703 Posts

Try to be as organized and efficient as you can. "Cluster" little tasks together, so you aren't running back and forth so much. Keep a piece of paper in your pocket, or a small notebook. When you're doing something, you'll get about 100 interruptions. Write a note to yourself to do --whatever-- when you're finished doing what you're doing (except things that have to be taken care of NOW, like a fall).

I tell the CNAs to leave me a note taped to the phone if I'm not at the desk. If saves them the time of needing to hunt me down just to say that Mrs. So-So wants a pain pill.

Learn to prioritize.

When a CNA tells you about something (Mrs. So-S0 is vomiting, whatever), make a special effort to get back to that CNA and tell them what you did about it (called the doctor, ordered clear liquids, whatever). That's a courtesy, but it also keeps communication flowing with your staff; and let's them know you care and that you DO follow-up on things they tell you. If they know you do something about it, they'll keep coming to you, and they're the ones who will give you the heads-up on problems on the floor.

Don't leave the floor EVER if a resident is unstable or sick. If it happened on your shift, take care of it on your shift, before you go home.

No matter how busy you get, ALWAYS eye-ball every resident at least once during your shift.

Limit the times you hassle the CNAs, help them instead. A minute helping them transfer someone doesn't take much time, and gives you a moment to eye-ball that resident's status; but don't get into the trap of doing their work for them. Goodness knows you'll have enough of your own to do. Reprimand as a last resort; instead teach. Instead of "Why didn't you turn Mrs. So-So?" Say, "It's important to turn Mrs. So-SO so she won't get bed sores. Let me show you how to position her."

Trust your instincts and judgments, and act on them.

If you're unsure of something, ask an experienced LPN or the RN, even if you have to call and wake someone up.

Always, always listen to the concerns of family members. They always pick up on subtle signs of coming problems long before the staff does. Also, it will save you a lot of grief if the family feels you care and will take care of Mom or Pop when they aren't there.

Alot of what I've said has to do with building trust with the people around you. With trust comes respect, and with respect makes it a lot easier to be "in charge."

Establish your own little "routine." Watch the other nurses to see how they organize their time.

Doctors get stressed and frustrated, too. Don't be afraid of them, and don't quiver in your shoes if they start getting disrespectful. My favorite line when a doc gets annoying is to say, " Dr. Smith, I'm not a doctor, I'm the nurse. That's why I needed to call you. Now, do you need anymore information before giving me orders?" If you work day shift, try to get to know the Doctor's office nurses. They can smooth alot of wrinkles and get alot of orders for you out of a surly doc.

Take your breaks no matter how busy you get. Your body and mind needs the rest. And you learn a LOT about your residents and what's happening on the floor by listening to what's being said in the breakroom.

And above all, keep your sense of humor! When you have 100 things that need to be done NOW, three phone calls waiting on hold at the desk, and the DON hollered at you yesterday for overtime, and you have a sick child at home and you need to get out on time, and and and, and about that time, Mrs. So-So's catheter bag breaks open and urine soaks your new pair of shoes . . . well, laugh. Because somewhere in that insanity, you'll find out what nursing is all about.

Always take the time to hug, smile, pat the hand, get a drink of water, spend a moment listening, remember to say "happy birthday," etc. for your residents. That's what makes it all worthwhile.

Good luck! And Congratulations on getting your LPN!

night owl

1,134 Posts

Everyone has said it all and excellent pointers I might add. As a new nurse you need to remember that documentation is so important and you must always cover your butt b/c if it's not documented it wasn't done. When someone slips to the floor and says they're all right, always make out that incident report and have them checked out by the MD anyway. No visible signs of injury may show at the time of the fall, but tomorrow is another day!

Always report pt abuse whether it's verbal, physical or emotional b/c remember, you're just as guilty if you let it go. Remember to be kind to yourself...don't take on more than you can do. If you can't assist with pt care, don't feel guilty. No one else can do your work. And most of all,

"To the world you may be one person, but to one person, you may be his world"

Take time to talk to your residents, hold their hand, place your hand on their shoulder, pat them on the back, put your arm around them...make them feel loved and cared for...they will never forget you for it.

Laura H.

1 Post

I can not stress ask questions, ask questions, ask questions! enough times. Being a new nurse is scary to every one of us who has ever been one. One way to continue growing as a good nurse is to ask your co-workers when ever a doubt enters your mind. I learn something new every day. I guess that is one of the reasons nursing never gets "old" for me. Also, I have learned that a little bit of TLC goes an awful long way. Love does make the world go round! The best to you as you begin your life as a nurse.

Specializes in Mostly LTC, some acute and some ER,.

First of all, tell anyone who says LTC aint real nursing to screw themselves with an enima(LOL)! A LTC is a hard place to work. I have an interest in becoming a nurse in LTC also.

I am a CNA in a LTC but I only have been for a few months.

Just remember this: Remember what it was lice being a CNA and how you wanted nurses to treat you. :) I wish I had more info for you, but I'm not an LVN yet :(


5 Posts

Good luck in LTC. I have worked my way up from CNA to RN and have worn the hats of ADON, DON, Accessment Coordinator and am presently working as a supervisor. The best advice I can give you is to always ask questions, never feel embarassed or ashamed to question your superiors if you feel the answer they are giving you may in some way violate the resident, your nurse practice act or your own beliefs. Listen to the CNAs as they know the patients best, as you well know. And listen to the families, they can be very informative in the information they have. Their little tales can be the key to major behavior problems the residents may be having on their adjustment to the facility. And lastly care about yourself. When your day is done leave the job inside the building. Nursing can be very taxing. If you make a mistake learn from it. Don't beat yourself up over it. Good luck in your new position. God bless.


1,244 Posts

Hmmm.. I went from CNA to RN, too. Advice:

1. What goes around, comes around. (The nurses who were mean to me when I was a CNA had to eat crow when I returned to that facility as an RN ;) --and they were all nice to me then. )

2. Never give up, never surrender. You can do this, and you will learn to do it well. (There will be a lot of times you will just want to cry and quit in frustration. Hang in there. Remind yourself of how much you've learned since your start date and focus on that.)

3. Be receptive to constructive criticism. (As in, "I appreciate your telling me this. You may not realize it, but you're teaching me leadership skills by your example. And who knows when that might come in handy, because I plan on doing whatever it takes to become an excellent nurse." )

4. Learn to differentiate between constructive and destructive criticism. Counterbalance destructive criticism by saying Rule #1 over and over. ;) Be patient, because you will see it come to pass. (don't gloat when it does, though; that's crass.)

5. Last but not least, LOVE YOUR RESIDENTS~APPRECIATE THEIR FAMILIES! for, as we all know, "Love covers a multitude of sins."

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