First day on the floor alone

[Anne36, LPN]

Hi, tommorow is my first day working the floor alone. I have been orienting for a few weeks at my first job. I have the med pass and treatments down for the most part. I may still ask questions about paperwork, but feel that I can manage it. I know where the crash cart is and what to do for a code. The only thing I feel a little apprehensive about is complaints and illness. I wont have a lot of experience with this until I start working more on my own. This population of residents is supposed to be stable. I worry about missing something and a client needs to be sent out to hospital but I dont realize it. Can I get some advice for being on my own the first night, just anything at all that you can think of might be helpful for me? Also, can anyone give me red flags or advice for trouble shooting with vital signs? I was looking up some indicators yesterday but if you know anything that comes up commonly in the elderly that is or is not a concern. Thanks in advance.

[chrisrn24]

I was so scared preparing for my first day alone. One of the things I was scared about was that someone would have a problem and need to be sent out too, because we had one of those on one of my shifts with my preceptor. I just remember, if someone is having a problem that deals with the ABCs (airway/breathing and circulation), take it seriously. Check an o2 sat, pulse, BP. If someone's sat is low and deep breathing and coughing and cranking their bed up doesn't help, don't hesitate to put them on o2. You can always call later and explain the situation to the doc and get an order.

And don't be afraid to grab your charge or a fellow nurse and say, "you know, I've only been here a month, but this, this and this doesn't seem normal with X. Will you come see her?" or grab them and have them help you.

If it's less urgent (heartburn, pain, fever, etc), go to your MAR and see what PRNs they have, and say, "You can take a ___ for heartburn, would you like something for it?" or re-position/talk to them/toilet them/get a snack/explain a symptom. I had one resident complaining about nausea the other night, and when I mentioned it to the aide, she said, "it's pretty common with her." I went to the MAR, found a med for nausea/vomiting, gave it to the resident, and she was fine.

One thing that I have noticed about elderly people is that if the person starts acting different/confused, take a temp, and assess for infection (most common I've seen is UTI or pneumonia). Confusing can be a sign of infection. So don't think "oh, X is acting different today, she must be like this and I haven't seen it yet."

[Anne36, LPN]

Thank you so much for giving me advice, I was afraid noone would respond before tommorow. I would love to hear some more tips. Also, another fear I have is that a visiting family member will ask me questions and since Im unfamiliar with the residents history and what family member has access to confidential information, I wont know what to say. I was so good at school and so stupid on the job sometimes. I called a family member last week to tell them their Mom had conjunctivits and is on meds for it, they said "how did she get that? I drew a blank.

[BrandonLPN, LPN]

When you're a new nurse, you tend to err on the side of caution and call the phys. more than you really need to. That's okay, when you get more experience you'll realize many of these cases can simply be placed on sick call and documented on. As strong as the urge is to "ship them out" (and I know it's really, really strong) just remember it's in the best interest of the facility and the resident to treat them in house. Often all these elderly residents need is some Tylenol, an ABX and more fluids.

[CapeCodMermaid, RN]

Good advice all around, but don't mistake a flat temp as a sign that all is well. Most elderly people don't have a raised temp as a first sign of infection.Don't automatically think stinky urine (a technical term) means a UTI. Give fluids before you rush to get an order for antibiotics.Don't expect to be able to handle everything on your own.DO ask your co-workers for help if you find yourself in the weeds. One day they might need your help.Good luck. Come back and let us know how your shift was.

[Anne36, LPN]

I made it through my first night alone. I was in the middle of doing report with the day Nurse and after hearing that one of my residents if fine, I get summoned to her room by the CNA because she is having chest pain. The day Nurse helped me assess her and gave her a prn antacid. The rest of my night revolved around this one resident and her complaints of chest pain. I had to call the Dr , order x ray and give prn meds, continue reassessing all night. Im sure that I spent over an hour caring for this 1 resident. How does the managment think there is enough time to give this type of care when we have a Nurse ration of 1:20+. I feel that my 8 hour shift is already barely long enough to do care on people who are stable with no complaints at all. I didnt get all the Q shift charting done obviously or I would have had to clock out late which they dont like. There are 9 Q shift charts on that hall, + all the care plans, etc. I had one quick 10 minute break the entire shift so I could eat half a sandwhich, get a drink, use the bathroom and take a deep breath.