9 days of orientation in skilled LTC...now on my own HELP

xtxrn, ASN, RN · Sep 24, 2011

Do NOT give meds outside of the window. If something happens, and you have to send someone to the ED- you will be caught- and if something happens at the hospital that was badly effected by getting meds lumped together (like if they have to give something that doesn't go with one of the ones scheduled at a different time) YOU will be on the defendants' table in court. Seriously- it gets better and faster :)

I went from being the agency CNA to the house supervisor in the span of Saturday to Wednesday. I got 2 days orientation and 60 patients. (30 Medicare and 30 dementia). You get into your own rhythm.

But going against the medication times is a big, BIG thing to avoid....as is signing them all at once (for the same reasons re: sending someone out in a hurry).

Nurses generally don't get breaks or lunch (at least not the full time). That's not likely to change much regardless of location. As the only RN on an acute med-surg floor - 27 beds, I MAYBE got off the floor/away from being "on" 2-3 times /year. I'd rather do that than stay late.

JUST give yourself time to settle in- as you get to know the residents, med passes automatically speed up :) And you're new- if you didn't feel weird and overwhelmed, I'd think you were nuts.

agldragonRN · Sep 25, 2011

i am always out of compliance with the 1 hour before and after window. that is the reality of ltc nursing. management knows this but as long as everything gets done, they're happy.

my advice is find a couple of seasoned nurses at your job who are willing to mentor you and "show you the way." this may be difficult especially everybody wants to do their thing and get done but you should have a couple of nurse coworkers who you can ask anything. always ask when you are unsure. it is better to be safe than sorry.

good luck! ltc nursing is tough. but once you get used to it and have your own way of doing things (safely), it will be manageable.

xtxrn, ASN, RN · Sep 25, 2011

i am always out of compliance with the 1 hour before and after window. that is the reality of ltc nursing. management knows this but as long as everything gets done, they're happy.
my advice is find a couple of seasoned nurses at your job who are willing to mentor you and "show you the way." this may be difficult especially everybody wants to do their thing and get done but you should have a couple of nurse coworkers who you can ask anything. always ask when you are unsure. it is better to be safe than sorry.
good luck! ltc nursing is tough. but once you get used to it and have your own way of doing things (safely), it will be manageable.

but are you in the process of passing meds and run out of time? or do you purposely give meds at times they're not scheduled for? :eek:

another suggestion is looking at the times meds are ordered vs the actual times on the mars....we did this at one facility i worked at (and was part of mgmt :)), and got as many as possible on the am and hs passes...minimized the noon and dinner passes when everyone is nuts anyway. if the orders say bid- there's no reason to schedule some meds at 9 & 5....do them at 9 & 9 (if the head cheese signs off :)). if the noon and dinner meds are minimized, there's more time for treatments while the residents are still up and not screaming to go to bed :)

smitty10 · Sep 25, 2011

I'm not trying to be funny, but try to keep your eye out for another job! 9 days orientation for a new grad and a 1st time nursing job is not enough time, AND REMEMBER,YOU HAVE A LICENSE TO PROTECT. I was in the very same boat as you except I was punching out 2 hours late trying to get all the documentation and noting orders, and like you said without a lunch or a break!!!!!! I was thankful for the 3 weeks I was there and I did recieve 2 nice checks, but I felt like my license would be in jeopardy if I continued to stay under circumstances like that. Again not trying to be funny, but you have to protect yourself!

agldragonRN · Sep 25, 2011

but are you in the process of passing meds and run out of time? or do you purposely give meds at times they're not scheduled for?
another suggestion is looking at the times meds are ordered vs the actual times on the mars....we did this at one facility i worked at (and was part of mgmt :)), and got as many as possible on the am and hs passes...minimized the noon and dinner passes when everyone is nuts anyway. if the orders say bid- there's no reason to schedule some meds at 9 & 5....do them at 9 & 9 (if the head cheese signs off :)). if the noon and dinner meds are minimized, there's more time for treatments while the residents are still up and not screaming to go to bed :)

no, not purposely. i work 3-11 shift on one of the difficult floors in the building. i have 25 patients with 6-7 blood sugar checks, 5 gtubes, a lot on bp parameters, a lot of crush in apple sauce, one trach...i take only 10-15 mins lunch break.

motheringis4me · Sep 25, 2011

It appears to be the same in many LTC facilities...I got five days and started right in after that and floated to every unit on a regular basis! What is compliance as far as meds are concerned? It makes me crazy, management is content to have us out of compliance, do treatments, admissions, discharges and documentation as long as we are out on time! And believe me that is all the counts(the bottom line and saving the company money). I feel bad for the staff and the patients and I wish I could go elsewhere, however the job market is so tight and very difficult to find another job with full time hours. I hope this trend gets better in healthcare however I highly doubt it with medicare cuts on the immediate horizon and threats of working short and no more raises. What a time to break into healthcare.

Chrissy2003RN · Sep 26, 2011

I got 4 nights of orientation. The first two were totally useless, they weren't even on my unit. The last two were on my unit. They weren't willing to give me anymore than that. And they had me do all four nights in a row, 12 hour shifts.

I am finding it challenging also. I work nights. We have a lot of people that get just a prilosec at 6am. That annoys me, because its just a hassle when I think they Dr just gets a kick back from the Rx company. Personally, if I have to give the people who just get a prilosec one time a day, I'll give it a little early. Its not anything that needs to be spaced out.

But agreed, we have licenses to protect!!!

NewLPN11 · Sep 28, 2011

I just completed day 1 of 4 days of orientation today..overwhelming to say the least!!!! i did get some good advice..time management, time management, time management!!

Lifeofanurse · Oct 12, 2011

Wait a minute!!! 39 patients to one nurse.... uhhh SAFE HARBOR!!!!!

Is that normal?????

I'm doing a trial run tomorrow on a step down. It's days...really active. Before I was secure I could do it....now...not so sure.