Can someone give me the 411 on getting started?

[tsm007]

Having a major freak out tonight! I am a new nurse. My first job was on a specialty floor that does not usually hire new grads. I lasted 4 weeks. I just took a new very part time job at a nursing home. I actually was not terribly nervous about working as an RN until getting fired. Now I am getting panicky about making mistakes and getting fired again. I just want to do a good job! (I didn't really make any mistakes at my last job, just wasn't able to handle enough patients fast enough.)

Anyhow, I have never worked in a nursing home. I never did any of my clinicals in a nursing home and basically have no nursing home experience. The closest thing I did to nursing home was a rotation on a rehab floor at a hospital. I do not have much experience with paper charting. I don't feel like I have a clue about how to organize my day in this setting. Also, not sure about assessments? How often are they done?

Okay let me break this down into questions that I have so my rambling might be easier to answer?

1. How many patients is one RN usually responsible for in a nursing home setting?

2. Do you still do head to toe assessments? If so how frequently are they done? What about vital signs? Are those done on every patient?

3. Meds - How do I organize getting everyone's meds?

4. Brain sheets? Does anyone have any for LTC?

5. Codes? One of my friends was talking about her daughter and how she was a nurse and a patient coded and they didn't even have a defibrillator there. Holy cow that just caused me massive anxiety! I don't even know if I'd know what to do with a defibrillator. I mean yah, I took CPR, but hell I've never had to do it.

So any thoughts on codes?

I really need to get this! Any books, tips, ideas, suggestions for getting off to a good start. And I really hope all this doesn't make me look like a horrible nurse since I'm listing so many things I don't feel confident in or unsure about. I am also reading through the threads on this forum, but there's so much here that it may take me some time to work my way through it all.

[TheCommuter, BSN, RN]

1. How many patients is one RN usually responsible for in a nursing home setting? Each nursing home staffs differently. In my experience I had 1:18 in the short-term Medicare wing and 1:30 in the LTC wing.

2. Do you still do head to toe assessments? If so how frequently are they done? What about vital signs? Are those done on every patient? Head-to-toe assessments were done once weekly at all of the nursing homes I've previously worked, unless the resident's payor source is Medicare. Medicare guidelines require a nursing assessment once every 24 hours.

3. Meds - How do I organize getting everyone's meds? Start 60 to 90 minutes early. If you have at 8:00am medication pass, start at 6:30am. Spend only a few minutes per resident, and do not allow any one resident to manipulate you into sucking up time.

4. Brain sheets? Does anyone have any for LTC? Yes. I'll create another post for that.

5. Codes? One of my friends was talking about her daughter and how she was a nurse and a patient coded and they didn't even have a defibrillator there. Holy cow that just caused me massive anxiety! I don't even know if I'd know what to do with a defibrillator. I mean yah, I took CPR, but hell I've never had to do it. Most nursing homes where I've worked didn't have defibrillators. You basically initiate CPR and call 911. To be perfectly honest, the chances of an elder recovering after cardiopulmonary arrest are less than one percent, whether you use a defibrillator or not. It's all futile and I prefer residents with DNR orders.

BTW, I am no longer in the LTC setting. I worked in LTC from 2006 to 2012 and made my unceremonious exit in a blaze of burnout. The ride was good while it lasted, but I reached a point where I stopped giving a rat's ass.

[tsm007]

BTW, I am no longer in the LTC setting. I worked in LTC from 2006 to 2012 and made my unceremonious exit in a blaze of burnout. The ride was good while it lasted, but I reached a point where I stopped giving a rat's ass.

Thank you so much! That was very helpful. I will keep an eye out for your brain sheet. I am not sure if I will do LTC long term, but I think it's a good place for me right now.