EEK! Any tips before I start my LTC job?

Specialties Geriatric

Published

Specializes in Hospice.

Hi all! So I have been posting in students for a couple years, and I graduated my RN program a few weeks ago. I have accepted a job in the LTC facility where I have been a CNA for a year and a half. I will be sitting for boards soon, but I am supposed to start working even before that during the 90 day post graduation period that you can work before boards. I know my orientation will be very brief, as is typical of LTC facilities. I'm nervous and excited! Do you experienced LTC nurses have any tips for how to make these first weeks more manageable? I don't know if I should have my own cheat/report sheets made up, if I should make a little notebook for important notes to myself...... I'm clueless. Any and all tips are appreciated!

Specializes in Neurosciences, stepdown, acute rehab, LTC.

I just made up a new training sheet at work that consists of diagnoses , cognitive status , activity , diet , fall risk , how they take their meds , and "other" I'm not sure if it's going to be helpful yet but I think that's a good way to start and keep everyone safe. Also, try to get through the most important parts of the policies manual (elopements, fires..) and .... I remember finding it helpful to read the list of standing orders.

Specializes in Hospice.
I just made up a new training sheet at work that consists of diagnoses , cognitive status , activity , diet , fall risk , how they take their meds , and "other" I'm not sure if it's going to be helpful yet but I think that's a good way to start and keep everyone safe. Also, try to get through the most important parts of the policies manual (elopements, fires..) and .... I remember finding it helpful to read the list of standing orders.

That's what I was wondering, if I should have like a little flip wire bound index card set that's alphabetized that lists those things you mentioned there. You mentioned exactly my thoughts though, I feel like I need those important facts about each resident right at my fingertips. I know them all as a CNA, but I surely don't know what I need to know about them as a nurse. Thanks for the info about the policy manual, I wonder if that will be different as an RN than it was as a CNA. Have you started your LTC position yet? I'm nervous/scared/excited. :)

Hi, I worked in ltc as a CNA,LPN, an RN. I made a folder with important info, falls,elopement, fires, weather, transporting to er, death, standing orders, important phone numbers. I kept it at my desk to lookup info quickly. As for report sheet I took the vital sign sheet (where I worked had all the residents names listed), whited out the vital sign stuff an put DX, as activity, diet, meds an other important info. For treatments I made a spreadsheet with all the patients an treatments they needed by hour, so I could quickly look an see that I had finger sticks due at 8 along with breathing treatment. Ask your preceptor what they do an the other nurses

Specializes in Hospice.
Hi, I worked in ltc as a CNA,LPN, an RN. I made a folder with important info, falls,elopement, fires, weather, transporting to er, death, standing orders, important phone numbers. I kept it at my desk to lookup info quickly. As for report sheet I took the vital sign sheet (where I worked had all the residents names listed), whited out the vital sign stuff an put DX, as activity, diet, meds an other important info. For treatments I made a spreadsheet with all the patients an treatments they needed by hour, so I could quickly look an see that I had finger sticks due at 8 along with breathing treatment. Ask your preceptor what they do an the other nurses

I love the spreadsheet idea! And I see what you are saying about the VS sheet being handy if you white out what you don't need and fill in what you do need, but I am thinking a spread sheet on the work computer would be great, because you can make any changes as needed and just print up a new one. Great ideas!

Specializes in Neurosciences, stepdown, acute rehab, LTC.

Ah yes , I've been there 5 years , I made the sheet for new people coming in to make the orientation process smoother for them . I actually just had the HUC take the form for the report sheet in the computer , and then we have Colums with each shifts report . I just had her take that same form and make new columns (meds , cognition , etc ) . It stemmed from me writing a detailed report out for one new person and she carried it with her and highlighted stuff and it really helped, so I figured why not make that an official system

I've taught clinical in a few facilities and here are some things that the nurses have done:

1) Some facilities have standardized report sheets with the room number, name, diet, if they need a fingerstick, when their vitals and weights are due, etc. There is a note section where the off-going nurse writes in any upcoming tests or apptmts, treatments, and any ongoing issues.

2) I have seen many nurses with the flip books RNotes or LPN Notes on their med cart, and many keep the drug book there.

3) If your facility doesn't have a standard report sheet, I would suggest making one and filling it in during your orientation with the main stats for the residents. That way you can research conditions or treatments you aren't familiar with.

4) One LPN told me to make a list of the most common meds you see on orientation. That way you can learn most of the medications you will be giving before you go out on your own so you will save time by not having to look everything up.

5) Look at your TAR after you get report and try to do your treatments and meds at the same time. It will save you a lot of time going back and forth. Also, there is usually a system where the CNA has a list of vitals for those who have BP meds due in the AM, but make your own list based on the MAR until you are sure their list is accurate. Do not be afraid to take the BP machine with you and check vitals yourself if you don't have time to track down the list.

6) General advice: chart as you go, try to cluster your care, remember your ABC's, you have more latitude with daily meds than antibiotics, keep your sense of humor, and listen to your CNAs when they tell you someone isn't acting right. Also, if a resident tells you they're dying, they're usually right and will unless you do something about it (sometimes they are DNR, so not everyone who says they are dying is an emergency).

Good luck!

One of your biggest challenges will be changing from a CNA to a Charge Nurse. Those who you worked along side as a CNA are going to display some feelings that you didn't know they had. The ugly green eyed moster comes along with your new license. You have to be firm, and not let them get away with anything. It is a challenge. You Can Do It!! Good Luck!@!!

Specializes in Hospice.
One of your biggest challenges will be changing from a CNA to a Charge Nurse. Those who you worked along side as a CNA are going to display some feelings that you didn't know they had. The ugly green eyed moster comes along with your new license. You have to be firm, and not let them get away with anything. It is a challenge. You Can Do It!! Good Luck!@!!

I was wondering about that! I hope that won't be an issue but it may be. I am going to be on a different shift than I was on as a CNA, which probably is a good thing, although I would like to work with my usual crew.

Specializes in Gerontology, Med surg, Home Health.

What state are you in that allows you to work as a graduate nurse for 90 days? We used to be able to work as GNs in Massachusetts but that was way before computerized testing.

Specializes in Hospice.
What state are you in that allows you to work as a graduate nurse for 90 days? We used to be able to work as GNs in Massachusetts but that was way before computerized testing.

Virginia. I think it used to be 120 days but now it's 90.

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