Specialties Geriatric



I have a few questions pertaining to my job in LTC. I graduated in 2001,but only started working in nursing at a nursing home 5 months ago. I am the only nurse on second shift, with 2 and a half aids. I had three days of orientation and I basically do ok. Unfortutely, I barely know anything about the paperwork. Everytime I inquire about something, I get told not to worry about it, but at the same time I feel they (The other nurses) are looking at me like I am stupid. Now for my questions, I do fine on day to day organization, but if an emergency arises, I am lost. We had a 48 yo patient with chest pain and I took her vitals, which were normal, and gave her nitro X's 3, which had no effect and sent her out in the ambulance. I felt totally out of control when this happened. I couldn't think straight. I don't even know if I should call 911 for things or the ambulance service. I am afraid I am going to hurt someone.

CoffeeRTC, BSN, RN

3,734 Posts

I think confidence will come with experience and time. I remember feeling the same way. When I first started 7 yrs ago I was the only nurse in the facility on 11-7 (we have 48 beds and 2 CNA). I always call 911 for emergencies and the ambulace service for non emergent transfers. One of the basic things to remember in emergenies is the ABCs (airway, breathing, circulation) Also what helped me was knowing a little about the residents. (code status and primary dx) Getting back to the paperwork, how about asking the DON if you can come in for an extra day or two for some training and review. Don't let the other nurses get to you. Ask questions to them and make them feel important and that you value their answers. My bigest piece of advice is never let them see you sweat. I think some of the nurses/ CNAs enjoy eating thier young. HOpe this helps a little.

night owl

1,134 Posts

Confidence is learned over time and experience is the best teacher. There are times I get that I DON'T KNOW WHAT I'M DOING feeling and I stop for a few seconds and take a deep breath. If at any point I become too overwhelmed, I pull out my little cheat sheet and take a peek to make sure I'm covering my ground...they sure come in handy when you draw a blank in emergencies. You'll do fine with time. Keep the faith!


26 Posts

Thank you. I really appreciate the encouragement. I have been thinking I need a refresher course since I have been out of school over a year and just started working. I have asked to have a day of paperwork. So that will be happening.

Now, do you always call 911? Or just for serious emergencies? Do you only use the ambulance service for routine appointments?

CoffeeRTC, BSN, RN

3,734 Posts

I think it depends on your facility protocol, the type of emergency and the general response times for your ambulance service. In my area the 911 response in 2-5 minutes. I will call them with all my emergencies (cardiac, respiratory, etc) The ambulance service response time varies. Most often I ask "what's your ETA?" I use them for the none emergent transfers.

I know what you mean about not working for a while and feeling a little left out. When I took materninty leave, I kept up by checking these boards and reading journals. Good luck!


250 Posts

I'll have to agree with everyone....Time and experience will only help you. Plus, your nursing supervisor should be available to you in situations like this! To help you make assements and call an anbulette or ambulance according to the severity of the problem.

You may feel overwhelmed and that's natural. But hang out with us, cry if you need to, and do something everyday that makes you feel good! It can only get better from here!

mixed-smiley-008.gif Like sands through the hourglass, these are the Days Of Our Lives.....


218 Posts

Only 3 days of orientation is not enough. Did you tell them you felt like you needed more? Why is there only 1 nurse on pm's? I have worked in LTC and am now working CBRF which I love. I worked the sub acute area of LTC, and there were other nurses to assist or get feedback from. The same holds true for assisted living. Your supervisor should also be there for you when you need her. How many pts. do you care for? If this is to overwhelming for you and you cont. to not receive any type of help, I'd seriously think about finding another place to work. As the others have said tho' it does take time to feel comfortable in your new role. Wishing you the best. :)


414 Posts

I worked in LTC for 22 years and when I first started I felt just like you. As someone else stated, getting to know your residents will increase your self confidence. During the 22 years, I was DON for three years. During that time I did come across some nurses that just do not want to help the new nurses. I do not understand that and never will. It is important that you let your DON know that you are unsure of yourself and would like some extra orientation in some areas. Put it in writing so that you have something to back you up in case something comes up. Keep a copy for yourself. Who works as your supervisor on your shift. They should be able to help you. Let us know how it goes. You are always welcome to vent with us.


26 Posts

Kayzee, to answer some of your questions. Yes, I have asked for more orientation. I am supposed to be working with the day charge nurse for a week or so, but so far it has not been able to happen do to staffing issues. There is only one RN on every shift, that is it. We have a med tech on AM's from 7-10am. We have 30 patients that are medically stable. It just really stinks, but I enjoy long term care very much.


155 Posts

I agree with everyone here. Time and experience will give you the confidence. Don't feel out of control. Just go by "the book" and you'll do fine. Paperwork is always a hassle and by the time you figure it all out, they change it. L. My first few days at a LTC was "panic". Yes, I had orientation too, but who remembers it all? I prayed every day for a quiet shift, and no problems. One tip I can offer you is to carry a little notebook on you. Use it to write important info from report and all the important things that need to be done from the Tars. I like to circle dressing changes and IVs so they stand out. Heel protectors, site cleanings, etc., all go in the notebook. I stop frequently and take a look at I keep things to be done in focus. When I go on a break, I take it with me too. That way, I have everything organized for the shift. Anything new I find, goes on my sheet or in the notebook. Paperwork comes when everything else is done. Good luck to you!


258 Posts

LUVLIFE- I graduated this past August, and started working in September at an LTC. I have now been there for just over seven months. I work dayshift- so I only have one "hall" of residents to take care of. It's usually about 25 people when census is ok. It has taken me months to feel comfortable here. To have the amount of time vested to be able to say "I know these residents, and can really pick up on unusual behaviors/changes". Like every other new nurse- I was terrified at first when I was on my own. I felt like I was constantly running to another nurse for verification of what to do. I was luck enough to have a great team who was very supportive of me- and let me learn things. I asked alot of questions and listened intently. And- while I still have my molments- I no longer have the butterflies when something goes wrong. I have much more confidence in myself. I can handle the little ups and downs better- I no longer stress over the paperwork. My time management has improved greatly- and I can now do more than one thing at a time! :)

One of my instructers told me once that you can't fairly judge a job for the first six months your there. That you really need that time just to feel comfortable. While I don't necessarily think it takes that long if the job just flat out doesn't fit- she was also very right. Six months ago- I was scared to death and overwhelmed. Today- I'm comfortable and not so freaked out anymore. It will come in time. You can do this. It's what you went to school so long for and worked so hard for. Give it time. Let us know how it works out, ok? Good luck!


26 Posts

Thank you Jenac, I agree it does take a while to feel comfortable. I have been there about 6 months now and I still feel very lost and incompetent (Sp?) I don't have another nurse to ask questions, I am the only nurse in the facility. I have to call the DON at home when I need to ask something. I love the patient and most of the staff...and I don't want to start somewhere new again and feel lost all over again!!

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