I guess the jist of this post is... I don't know "how" to be a nurse. Don't know what to expect. I just passed my NCLEX and almost had a panic attack thinking of my future job (hopefully in LTC). I don't know what to do!!!!!!!!!!! Literally!
So I'm wondering what your typical day is like from the time your shift starts to the time it ends. Do you walk into each room and assess the patient or do you start giving meds (if it's the right time) and then keep a mental note that everything looks fine?
Do you carry around med books? A Notepad? What have you found to be helpful in the beginning?
I don't even know how to CHART or what to chart! I'm not blaming my school or anything but I don't feel prepared and I don't know what I should be looking for when I go into a room. I don't know what to assess. As you can tell, I've never worked in a medical setting before.
I'm so used to my old office job I had for many years.. 1st thing I did was turn on my computer, check to voicemails/e-mails and write down anyone I had to call back. From there I logged into my company's account and started on the last account I had- it was all in order. Seemed so easy and self-explanatory. Now, I'm scared out of my mind!
How am I suppose to be a nurse? Any websites, books or ideas for people like me? Did you get most of your training at your job? I feel like my school focused more on academics than on clinical time and now I really wish I picked a school with more clinical time!
I know I'll be a great nurse once I learn the way to do things- I enjoy this field and loved clinicals.. I hate feeling clueless and like a deer in headlights!
I've worked in LTC and only LTC for 3 years now since graduating as an LPN. I received 4 weeks of orientation to my assigned unit and was overwhelmed when I hit the floor solo for my first 12 hr weekend shift and quite frankly still am depending.....I work 7a - 7p on the weekend & 7a - 3p on Monday. You will find your own rythym. Time management is key with often 30+ residents on your roster. I'll share what works for me.
After arriving at my assigned unit (which may change from day to day) 15 minutes before shift start (0700), I gather my shift report and LNA assignment sheets and if report has been taped I listen to it, making notes on my report sheet and indicating any needed info for the LNA's on their sheets. Scan the 24 hour report. Check the treatment and bowel books noting on my report sheet who needs what.
Now the shift begins with narc count & verbal report if it hasn't been taped. Verbally communicate with the LNA's. I then go through the MAR jotting down med times for each resident. Do any insulins first. Begin med pass to include a breif assessment if indicated (lungs, pain..) and more often than not do any required treatments if appropriate at the time (dressing, catheter changes, topicals...)
Grab something to drink & make any MD calls needed, sign off on treatments done & do any more involved assessments as needed. By now it's 1130 finger stick and insulin time. Do those and any noon and 1300 meds which is usually a fairly light med pass for me, so I help pass lunch trays.
By 1400 the resident's are either involved in activities or napping so I use that time to get my lunch and usually bring it back to the desk and do my charting ( prefer to get out as close to shift end as possible). We write narrative notes and have charting lists developed by the unit manager indicating what to focus on as well as sheets in back of the nurses notes sections of each residents chart to refer to according to their primary diagnosis (very helpful). Required charting includes skilled residents, new admits, q shift (UTI's, med changes, behavioral issues, etc.) as well a by exception (any prn given, new developement in status). Do any I & A's if unfortunately there is a fall or new skin condition but sometimes due to time contraints I have to leave this till after the the night nurse comes on. I also document on the 24 hour report at this time and usually can accomplish this by 1530 when everyone is done with the scheduled activity or napping.
At this time I finish up any treatments not done during the morning and 1530 - 1700 med pass begins with finger sticks and insulins at 1630. I am done by 1730 so help pass dinner trays, then pass 1800 - 1900 meds usually a light pass, double check my MAR & TAR for holes then write any addendums to my notes and tape report if there is time and the 7p to 7a nurse arrives. Narc count again, verbal report if not taped, write residual notes and do any I & A's not completed. Out the door between 1930 & 2000.
Also work 7a - 3p shift on Monday, the drill is pretty much the same, except the MD calls are more numerous due to weekend follow up and faxed lab reports. I take my lunch off the floor on Monday, begin my charting around 1330 usually out by 1600. There's more auxillary staff but unit managers have meetings most of the day and are not present but I understand it's less hectic Tues - Fri as a rule. I prefer weekends.
I find a calculator clipboard with nursing references helpful and carry my favorite drug guide, lab & diagnostic tests with nursing implications and Lippincott's bokk of signs & symptoms in my nursing bag.
Don't expect to remember or know everything. I learn something new daily. Don't be afraid to ask questions and try not to take to heart less than kind treatment often exhibited by coworkers (this is especially hard). If asked/told to do something not within your scope of practice or unethical - Don't Do It - your can go down the street and get another job but you can't get another license.
Nursing school never prepared me for the reality of the profession and it seemed impossible at first but gets better. Treat your residents as you would a family member and you'll feel good at the end of the day.
You will find a mentor at your first place of employment, I hope, who will serve as a role model. I won't forget my many mentors. These were the nurses who would take the time to remember what it was like when they were the new one. She or he will be able to help. The compassion is rule one, without that you probably shouldn't be a nurse. If your heart is in the right place, you will be fine. Someone will walk you thru the rough spots. Organization comes with time. Keep a little notebook so you can jot down items you fear you'll overlook or forget. Find out where the supplies are kept, keep your eyes on the patients HINT if he or she is in serious distress, u will know. When you begin your shift, take report, do walking rounds, prioritize your day, who is in pain? Who isn't safe? Questions to ask the prior nurse, is anyone a brittle diabetic ? Is anyone prone to falling? Who is your (previous nurse) biggest concern right now? All the huge mountains you are facing will look like little hills in a couple of years. Then it will be the management that worries you! Lots of luck.
I'm lucky in that my LTC facility has a charge nurse to take care of treatments, MD visits/phone calls/faxes, falls, etc.. We have 33 residents to pass meds to. I guesstimated once that on 2nd shift, there are 200 +/- meds (our residents take LOTS of meds!) to give just at HS. My typical evening starts with getting report, narc count, making out BM list for PJ/MOM; 1600, 1700, 1800 meds; dinner for me anywhere between 1800-1830; HS med pass starts at 1900 and if I don't spend too much time talking to residents or have untypically difficult residents, ends at 2200. Then give report to charge nurse for her to tape report, clean/stock cart, do my charting. Dayshift is much worse, between doc. appointments, hair dresser, PT/OT/ST visits.. hard to stay in compliance with meds. My mentor taught me to stay calm and focused. Getting stressed doesn't help you to complete your tasks any faster; to be flexible and roll with the punches. I think that was the most valuable info she could have given me.
So, I saw your post that is dated in March. I was wondering how it's going for you. Did you stick with LTC??? I'm sure you are feeling more comfortable by now. Let us know how you are doing and any tips that were especially helpful.
I'm new in the field I'nt graduated yet looking for a good NCLEX book to start practicing for my test. Can you sugest a good one please:crying2::redbeathe
breathe............and congrats on passing the board:).........
#1. clock in, count narcs, and get report--insist on a walk through....lay hands and eyes on all of your patients with the nurse you are relieving..warning, some may balk at this stick to your guns its important. while you are in the room...check out the patient...color,breathing,pain level, mood, ect. check out machines....tube-feeders,wound vacs,IV,O2,foley's(esp. the bags!)....any wounds,ect.
#2. set your cart up ..........anything that you may need for your shift....
#3. get your blood sugars before dinner....if you have alot do them all sep. then you can start meds....alot of patients dont like their meds w/dinner or before ..they like them right after, lolol...
#4. write down everything! so that you can refer to it later when charting.
#5. verify your narcs before the on-coming nurse arrives...it is easier to find mistakes in deduction when you do dont have someone freaking out next to you.
#6.when charting write a brief note on what you observed, did and what occurred during your shift,,,, in your head see it from the beginning...EX: alert, verbal, pleasant mood, foley intact...urine yellow, % of dinner consumed, fluids, ect........chart any as needed meds and why and their effect, just a note: if it is not effective CALL THE MD! NEVER CHART THAT THE MED DID NOT WORK W/OUT CALLING HIM! When charting on skilled patients remember to write about what they are skilled for.......
you will do fine..........make sure you stay on orientation until YOU are comfortable and never do anything unless you are 150% sure ....COMMON SENSE is a good nurse! it may be easier for you too if you are on a slower paced shift....day shift goes by quick and is caotic. night shift is way slower just more paperwork. I prefer evening shift cause its still busy enough for the time to go by and the carpet runners leave by 6p, lololol
Any websites, books or ideas for people like me? Did you get most of your training at your job? I feel like my school focused more on academics than on clinical time and now I really wish I picked a school with more clinical time!
catslave
71 Posts
I've worked in LTC and only LTC for 3 years now since graduating as an LPN. I received 4 weeks of orientation to my assigned unit and was overwhelmed when I hit the floor solo for my first 12 hr weekend shift and quite frankly still am depending.....I work 7a - 7p on the weekend & 7a - 3p on Monday. You will find your own rythym. Time management is key with often 30+ residents on your roster. I'll share what works for me.
After arriving at my assigned unit (which may change from day to day) 15 minutes before shift start (0700), I gather my shift report and LNA assignment sheets and if report has been taped I listen to it, making notes on my report sheet and indicating any needed info for the LNA's on their sheets. Scan the 24 hour report. Check the treatment and bowel books noting on my report sheet who needs what.
Now the shift begins with narc count & verbal report if it hasn't been taped. Verbally communicate with the LNA's. I then go through the MAR jotting down med times for each resident. Do any insulins first. Begin med pass to include a breif assessment if indicated (lungs, pain..) and more often than not do any required treatments if appropriate at the time (dressing, catheter changes, topicals...)
Grab something to drink & make any MD calls needed, sign off on treatments done & do any more involved assessments as needed. By now it's 1130 finger stick and insulin time. Do those and any noon and 1300 meds which is usually a fairly light med pass for me, so I help pass lunch trays.
By 1400 the resident's are either involved in activities or napping so I use that time to get my lunch and usually bring it back to the desk and do my charting ( prefer to get out as close to shift end as possible). We write narrative notes and have charting lists developed by the unit manager indicating what to focus on as well as sheets in back of the nurses notes sections of each residents chart to refer to according to their primary diagnosis (very helpful). Required charting includes skilled residents, new admits, q shift (UTI's, med changes, behavioral issues, etc.) as well a by exception (any prn given, new developement in status). Do any I & A's if unfortunately there is a fall or new skin condition but sometimes due to time contraints I have to leave this till after the the night nurse comes on. I also document on the 24 hour report at this time and usually can accomplish this by 1530 when everyone is done with the scheduled activity or napping.
At this time I finish up any treatments not done during the morning and 1530 - 1700 med pass begins with finger sticks and insulins at 1630. I am done by 1730 so help pass dinner trays, then pass 1800 - 1900 meds usually a light pass, double check my MAR & TAR for holes then write any addendums to my notes and tape report if there is time and the 7p to 7a nurse arrives. Narc count again, verbal report if not taped, write residual notes and do any I & A's not completed. Out the door between 1930 & 2000.
Also work 7a - 3p shift on Monday, the drill is pretty much the same, except the MD calls are more numerous due to weekend follow up and faxed lab reports. I take my lunch off the floor on Monday, begin my charting around 1330 usually out by 1600. There's more auxillary staff but unit managers have meetings most of the day and are not present but I understand it's less hectic Tues - Fri as a rule. I prefer weekends.
I find a calculator clipboard with nursing references helpful and carry my favorite drug guide, lab & diagnostic tests with nursing implications and Lippincott's bokk of signs & symptoms in my nursing bag.
Don't expect to remember or know everything. I learn something new daily. Don't be afraid to ask questions and try not to take to heart less than kind treatment often exhibited by coworkers (this is especially hard). If asked/told to do something not within your scope of practice or unethical - Don't Do It - your can go down the street and get another job but you can't get another license.
Nursing school never prepared me for the reality of the profession and it seemed impossible at first but gets better. Treat your residents as you would a family member and you'll feel good at the end of the day.
You're gonna do great!