Bunch of Questions for LTC LPN's.. Help I'm new!

LovebugLPN · Mar 5, 2007

I believe that what you are feeling is totally normal. School does not totally prepare you for working. You will be fine once you start working. They will give you training and if after that you still do not feel ready then let the DON know and ask for more time for training. You will do well and try to take a deep breath.

antidote · Mar 5, 2007

I agree as well! When I first passed my exam, I was on shock! I didn't know what to do and considered right away (on the spot) of doing something else (even after 3 years of college or so).

My advice would be to make good friends with this forum :) - as there is definetly some great advice and information around that could help you with your job. As far everything else goes, take a look in Borders and pick up some nursing books which are made for reference on the spot! I remember the first book I bought when I got out of school and still even use on an almost daily basis which is called "Nurse In A Can".

Congrats on passing the exam! I'm pretty sure that it would work out for you! Different hospitals have different procedures for different things so don't worry - you'll get the hang of it!

TheCommuter, BSN, RN · Mar 6, 2007

I have spent most of my short career in LTC. It is easy and fairly rewarding, in my opinion.

In the beginning, I carried around a tablet that listed all of my blood sugars, nebulizers, wound treatments, and tube feeders. I would get the treatments out of the way first, then pass my medications.

After a couple of months, I was at the point where I no longer needed a tablet to remind me to do these things. It is unrealistic to do full assessments on all of your patients in nursing homes, because you will not have the time to fully assess 20 to 40 patients in 1 shift. LTC patients tend to be in stable condition with predictable outcomes, so I assess when the need arises (antihypertensive meds, digoxin, pain scales, or when something is out of the ordinary).

ITsurvivor06 · Mar 7, 2007

i recently started working in ltc (new grad dec. 06). i followed a nurse for about three shifts, then was followed as i did all the meds and treatments for three shifts. that ended today; tomorrow i am off and the next day i am on the cart by myself.

what works best for me is to have a cheat sheet according to time. i work second shift, so i carry a list of early meds, blood sugars, nebulizers, etc. for example, it reads:

4pm blood sugars/insulin

thelma

lillian

mildred

nebulizers

thelma

lillian

meds

margie

irene

eyedrops

ruth

(then there are the five oclock meds passed in the dining room)

6pm flush gtube, phenytoin

jo

nebulizers

harriet

agnes

anna

8pm blood sugars/insulin

thelma

lillian

mildred

(pass 8 and 9pm meds also)

you get the picture......when i organize according to time, i don't miss anything.

hope this helps. and yes, the job is where the learning really begins. but your studies will give you a good foundation. the paperwork varies by facility and no one expects you to have that down right off the bat.

marieLVN · Mar 9, 2007

My first job out of Nursing school was at a Ltc facility, and it was pretty scary at first, but after a couple of weeks it gets better. It is not hard but you will find that you will be pretty busy for the most part of the day, giving meds, CBGs,dressing changes and other treatments. charting is usually toward the end of the day, usually only for those that have a change of condition, are on daily charting for Medicare or had a fall etc. You will find that you will need a note pad at first to keep track of things and that you will need to know who can swallow pills whole or needs them crushed, and the CNA's are very helpful with this. You also need to follow up on labs and take Drs orders as they come in and do their rounds. It does seem overwhelming at first, but after a while it will be pretty routine, and you will find a routine that helps to make the day flow easier. Try to assist the CNAs if you have a moment and they will be there for you. There is nothing worse than having a resident continuously on the call bell and nobody is there to answer it and you have 10 other things to do! Most facilities have some med books and such on hand, you can also bring some of your own for quik referenc, but mark them with your name and put them away in a good spot so that you know they will be there when you need them! Your assessment for most residents will be a quick look at them when you give meds to see that there is no change in con. and that they are still breathing/talking/eating/pooping/peeing, etc. not a full body assessment like they teach you in nursing school. Only if there is a change in con., then do vitals and assessment so that you can give this info to the DR. and remember to keep an eye on those that have a tendency to become confused and may be at risk for fall. Nothing worse than to be all ready for med pass and find out resident just fell and head is bleeding or worse, but it usually doesn't happen to often if CNA's are alert and communicate any unusual occurances to you, bring resident near you so you can watch him/her. Hope this helps, you will be fine. give yourself some time to absorb everything, it is'nt all learned in a day.

antidote · Mar 10, 2007

I just found an awesome resource for all of you LPN's and LVN's our there. The information (from my knowledge) is accurate and reliable! I'd suggest you take a look at it as a resource:

http://www.free-ed.net/free-ed/HealthCare/default.asp

vangar · Mar 10, 2007

Take a notepad and an open mind and ask plenty of questions. Ask you DON about what they want you to chart on. Like where I work we do medicare charting and any chages or Incidents that may have happened. And what you can't remember write down or any thing you may have to follow up on. So you always have something to reference to. Also, any thing you may need to look up to get more info write down. And it will get easier as you go along. Don't forget a sharpie.

jelorde37 · Mar 12, 2007

hmmm my typical day usually starts off with a report fromt the previous nurse, then i talk to my CNA's regarding things that needed to be done, then ill check the MAR and then ill do a round and pass meds that needed to be passed. after the med pass ill relax, do some charting, follow up orders or labs. then ill do my second round and handle my gt tubes, wound care, traches, etc etc. then ill relax and do some charting and then another round, then ill relax again. before my last round(which is usually the heavy med pass) ill go over everything that ive done and make sure that the things i needed from my CNA were accomplished. then its med pass and report to next nurse. i know that my shift looked like i had alot of time to relax, but i work the NOC shift and my patients are usually asleep, now AM and PM is a different story. AM is a warzone and PM could get pretty brutal as well.

wearingmanyhats, RN · Mar 18, 2007

I am an agency LPN, and most LTC facilities are the same (or similar) -- pass meds according to time... the places I go most often now, use a computerized med pass. They also have a list of who needs charting on every shift or every day (Medicare, falls, uti/uri, behaviors, etc)

Just go with an open mind, and keep your eyes and ears open.... I know when I have to train someone, I forget to say a lot of things, but watch and learn.

You will do fine.... enjoy your residents.... most of mine have come to be like family....'

Faye

Hopeslayer · Mar 19, 2007

My typical shift (11-7) goes like this:

11pm Narc count, get the cart keys.

Take report, either verbal or taped (Depending how 3-11 went)

I always go thru the MAR before I start the 12am med pass. (You never know if an order has been changed, and sometimes the prior shift may not rememberto tell you)

12AM Med pass

After med pass i will then assess any pt who is under 72 hours since admission. Also, I will assess any pt who is less than stable, or has had a status change during the day.

Next, go through the treatment book and do all the TXs. (In this way I won't have to wake anyone up until med pass in the AM)

2am By now, hopefully I have finished all of the above. At this time I will take care of any admin duties i.e. Labs, clinical referals, weekly nortons, and so forth.

4am Charting. For me, this is a good time to chart. Any status change from here on out, or PRN will be charted later as an addendum. I have found that to be more efficient than trying to chart on 10 to 15 pts all at once at 6:45 am.

5am Begin med pass

6am Blood sugar checks and all related tasks

630am Addendum charting, tape report.

7am All done

In a perfect world thats how my shift goes anyhow.

Of course, almost every night something will happen that will change your schedule, but, youll learn to roll with the punches.

Good luck :specs:

LPN01112005 · Mar 25, 2007

I had a similar cheat sheet to ITsurvivor06 when I first worked LTC. It was a valuable tool to keep me organized. However, you MUST check your MAR's before each shift and have your MAR on your cart, or there will be a new med that you could miss. As soon as I took report (sometimes, but not all the time, any new med was mentioned in report) I took my MAR and scanned over every patients record to look for new or changed meds and made a notation on my cheat sheet. I also carried a small pocket sized notebook that I recorded my assessments in for those pt's requiring assessments.

Now that I'm in the hospital, I still have an organization sheet to keep notes, but it is different from the Cheat sheet I used in LTC because the patients change from day to day.

Good luck, you will do fine. Just remember, there is no such thing as a stupid question. If you don't know something, don't be afraid to ask someone else. Everyone started out just like you.