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first job LTC need advice

Geriatric   (1,725 Views | 18 Replies)

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good morning!! new grad here. got a job offer a nursing home. any advice on how to develop good relationships with the CNAs, LPNs? advice on time management, proper delegation, etc. any advice is welcome. I am a little nervous. very first nursing job. thank you guys

also, what kind of stuff do you guys think I should bring to work? stethoscope, notepad, etc?

Edited by thecookingnursing

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819Nurse has 15 years experience as a BSN, LPN, RN and specializes in Nursing.

490 Posts; 7,833 Profile Views

Time management and repitition will be your best friend. LTC can be very catty and nit-picky among staff and administration. You will learn alot seeing how this is your first nursing job. You dont need a fancy stethoscope, but you will need one. It's always good to take a note pad too.

If you are an LPN, get you RN fast...then leave. If you are an RN, get your experience fast..... then leave.

Keep in mind, when you pull the layers back when working as a nurse in LTC, you realize it aint nothing but a bunch of baby sitting.

Good luck to you!

Edited by 819Nurse

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buckchaser10 has 3 years experience.

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2 hours ago, 819Nurse said:

Time management and repitition will be your best friend. LTC can be very catty and nit-picky among staff and administration. You will learn alot seeing how this is your first nursing job. You dont need a fancy stethoscope, but you will need one. It's always good to take a note pad too.

If you are an LPN, get you RN fast...then leave. If you are an RN, get your experience fast..... then leave.

Keep in mind, when you pull the layers back when working as a nurse in LTC, you realize it aint nothing but a bunch of baby sitting.

Good luck to you!

Yeesh harsh words! People always say to get your experience and run but regardless there is always going to be a need for nurses in LTC. What you'll find is often your nurse counterparts are nurses who are winding down their careers and getting ready to retire. This kind of gives you an idea of the environment that it its. Whether it is because it's easier or they just want the connections with residents at the end of their career that's where they often end up. LTC is busy in volume more so than acuity. It isn't uncommon to have 20+ residents that you are responsible for. The LTC I am at the nurses pass all the medications and that is what takes the majority of the nurses time. Between med passes there is charting and treatments but it is a lot more laxed than a lot of hospital work. It is back breaking but rewarding. You may find it's not your thing and that is okay, the experience will do you well. Good luck and I hope you enjoy it!

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amoLucia specializes in LTC.

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3 hours ago, 819Nurse said:

... Keep in mind, when you pull the layers back when working as a nurse in LTC, you realize it aint nothing but a bunch of baby sitting.

819Nurse - Gee! Thanks a lot for the nurse bashing of LTC staff!!

Sorry you must have had some bad experiences, but some of us hang in there because we feel a need to be there. Tough job, yeah, but so seems the rest of the profession in general. You just did a great disservice to all of us in LTC! And that HURTS! I'd like to think that we make/made some major POSITIVE impact on our residents. Never in my LTC career did I ever feel like a babysitter!

buckchaser - Just to let you know, not all of us in LTC are/were winding down in our careers and getting ready to retire. The sad reality is that many nurses in LTC are the young ones, who are still learning. Learning clinical how-to-do skills, people skills, time management skills and others. They're the staff who are struggling.

Yes, volume is greater and true, acuity is less intense. But I can't even offer a guess about how many pts I pulled out of unstable life-threatening crises.

thecookingnursing (OP) - sorry for the thread hijack. So to address your concerns...

With LPN/CNA staff, make them your allies. Appreciate their contributions to pt care. And just know, CNAs know the residents the BEST-EST! So if they tell you something is NOT RIGHT, you better believe them! Just because you don't know the pt as well, there's 99% chance something is NOT right and you have to figure it out.

If someone tells you something, check it out ASAP. And then get back to that LPN/CNA. Tell them your findings and then COMPLIMENT them. That will mean soooo much to building your relationship. And be timely in doing so.

RE time management - do what you can as early as you can, so as to get it out of the way. Don't postpone stuff because as you'll soon learn, all doo-doo hits the fan at shift end!

Stay focused on the task at hand, don't get distracted by things that you can get back to. I used to think - this can be NEXT, but it can't be NOW. It helped to priotorize.

To delegate, you must know that the person is capable of doing it and are allowed to. Just because LPNs are allowed to start IVs doesn't mean that they know how (they haven't been certified yet) or they have never attempted it. Also facility policy may not permit it. Likewise, a CNA may have NEVER been resp for post-mortem care or colostomy care. Just know what you're delegating to whom. And then mid-way, check back to inquire completion. It shows you haven't forgot! And always be specific.

One thing about CNAs - do they have a union? That can be a help or a hindrance - all depends.

In general, WHEN IN DOUBT, ALWAYS ERR ON THE SAFE SIDE! If you don't know something, ask APPROPRIATELY. There is always someone UP the chain to whom you can ask. And don't forget the families.

Good luck in your LTC role. Stay safe.

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37changes has 1 years experience as a ASN, RN and specializes in LTC.

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OP, I’d like to hear how you are doing so far. If this thread is going to remain active ~ perhaps I will take some time to help dispel the notion that LTC “ain’t nothing but a bunch of babysitting”.

This misconception is an added layer of BS that LTC nurses have to deal with. And we have plenty as it is. “Nursing home” sounds a lot less impressive than “ER” or “ICU” ... and if you say “skilled nursing / rehab facility” most people (apparently even some nurses) have no idea what that actually entails.

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kbrn2002 has 25 years experience as a ADN, RN and specializes in Geriatrics, Dialysis.

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On 4/19/2020 at 5:25 PM, 819Nurse said:

Time management and repitition will be your best friend. LTC can be very catty and nit-picky among staff and administration. You will learn alot seeing how this is your first nursing job. You dont need a fancy stethoscope, but you will need one. It's always good to take a note pad too.

If you are an LPN, get you RN fast...then leave. If you are an RN, get your experience fast..... then leave.

Keep in mind, when you pull the layers back when working as a nurse in LTC, you realize it aint nothing but a bunch of baby sitting.

Good luck to you!

First piece of advice is read that post, get a good chuckle out of it's rudeness and then ignore most of it.

The only piece of that to take away is time management and to an extent repetition will be your best friend. I am sure you have heard that the med passes are huge, and they are. Learn the right way to do it, don't cut corners as tempting as that might be. Don't worry about being fast, the speed will come when you get to know your residents, find a rhythm and get a routine down.

You will definitely need a stethoscope, and maybe other equipment as well. For sure pens and a permanent marker. You'll use that sharpie a lot more than you would think so keep it in your pocket. Most LTC nurses I know use some sort of brain sheet to keep track of things like how residents take meds, who the diabetics are, any appointments or labs etc. If you are fortunate one of the nurses already has a great one and will probably be more than willing to give you a copy. Just be aware that any paperwork with resident's names must not leave the building so don't be tempted to take it home.

I doubt if LTC has staff and administration that are more catty and nit-picky than you will find in any other setting but you are right to think about establishing good relations with your co-workers.

Those CNA's truly are you eyes and ears so respect and address their concerns. When they ask you for help and they will do so if you can. If you can't help be honest, tell them you can't drop what you are doing but you will give them a hand when you are finished if they still need you. Unless of course it is an emergent situation and they really do your help right now! Then yes, drop what you are doing and help. That minute or two being interrupted will be a lot less time than the follow up for a fall your help might have prevented.

You can keep half an ear open to the gossip, and believe me there will be some! Just take it with a grain of salt and don't get involved. Some places have great and approachable management, some not so much. You'll figure out pretty quickly who you can count on to be supportive.

You might end up being one of those nurses that starts in long term care and leaves as soon as you can find a job in acute care, and that's OK. It's a hard darn job and not every nurse, even not most nurses that work in that setting stay there their entire career. Just give the job and most importantly your residents the respect of doing the job to the best of your ability while you are there. You also might decide you love LTC and decide to make a career of it and that's OK too. LTC can be one of the most rewarding specialties out there if you let it.

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819Nurse has 15 years experience as a BSN, LPN, RN and specializes in Nursing.

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I said what I said!

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114 Posts; 1,527 Profile Views

“Brain sheet” for the new nurse is a must. If you are a conscientious nurse, you will quickly find out that being an LTC nurse is an important job with a lot of responsibility requiring master assessment and intervention abilities. The elderly can “turn” fast and die on a nurse that is not nursing but babysitting instead.

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20 Posts; 1,419 Profile Views

hi guys. thank you for all the response and feedback. sorry I'm just now posting. I've been really busy at work (2 jobs)

So, I started at the LTC. they gave me 3 shifts to train. I am working the overnight shift, and truth be told, I think that was a blessing. After my trainer and I complete the first med pass ( that *** takes a looong time!!) we start charting, after that, we visit all the residents to make sure we don't have any falls (by this time, almost all of the patient are asleep). after that we go back to nurse's station so I can familiarize myself with the software we use to chart. if all is well up to this point in the night, we go through our cart and organize it. then a quick lunch break and a cigarette, then we continue with our second med pass (4am), but the second time is a lot easier than the first. at this point, its around around 5am and we start praying that no concern will arise from the residents (no falls, admission please). at this point, my trainer will start going over our endorsement sheet (6am). after endorsement, I get to kick back for 30 minutes then I clock out. 6:30am

just a side note, the CNAs in my shift are very proactive. They are very easy to approach. all the LPNs and CNAs keeps telling me I got lucky I got put in overnight and in that particular unit. (there are 3 units, 3 carts per unit). 

one night, I saw one CNA getting ready to bathe a resident, and another CNAs came over to help him. I was like, that's pretty cool.

I will be working by myself next Saturday, I'm a little nervous again. any advice guys I really appreciate it!!

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kbrn2002 has 25 years experience as a ADN, RN and specializes in Geriatrics, Dialysis.

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Glad it's going well so far. Don't be too concerned with the 3 day orientation. I forgot to mention that's pretty standard in LTC.  As long as you work with other nurses  that are willing to take the time to answer your questions and help you when needed you'll be fine.

Usually overnights is a bit less chaotic so yes, that is a good shift to start on. Maybe you'll love nights, many do. If you are able to find a decent work/life balance and establish a decent sleeping pattern it's a great shift. I worked nights 15 years and I have found that with a good staff there is awesome team work in that group. There's fewer staff so they are put in a position of needing to work together more and if they are an established team with a set rhythm the shift can be pretty smooth. Of course there's occasional hiccups, but overall it seems to be a little more mellow on the night shift.  

You got this. Good luck flying on your own!  

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amoLucia specializes in LTC.

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Great to hear that all sounds positive for you.

I alluded to this in my other post, but remember, if you really, REALLY get stuck for something, there's always some nsg higher-upper who's on-call.  Call them for something SERIOUS, not trivial. Check out your facility's R&R, but some DONs want to be notified for all biggy events, like a death, emerg transfer out, big fall, unusually heavy call-outs, surprise State visit, etc. Just ask to confirm.

Last thing, are you permitted to initiate your State's death pronouncement & death certificate process? You may need to be issued a State user-ID-number. So check it out.

And again, good luck. Stay safe & stay strong.

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kbrn2002 has 25 years experience as a ADN, RN and specializes in Geriatrics, Dialysis.

3,154 Posts; 30,314 Profile Views

12 hours ago, amoLucia said:

Great to hear that all sounds positive for you.

I alluded to this in my other post, but remember, if you really, REALLY get stuck for something, there's always some nsg higher-upper who's on-call.  Call them for something SERIOUS, not trivial. Check out your facility's R&R, but some DONs want to be notified for all biggy events, like a death, emerg transfer out, big fall, unusually heavy call-outs, surprise State visit, etc. Just ask to confirm.

Last thing, are you permitted to initiate your State's death pronouncement & death certificate process? You may need to be issued a State user-ID-number. So check it out.

And again, good luck. Stay safe & stay strong.

The ability for a nurse to pronounce death varies according to state laws so unless that is brought up by management I wouldn't worry too much about that.  In WI nurses can't pronounce with the exception of certified Hospice nurses. For most deaths a call to the MD to pronounce is needed.  In some cases deaths are considered reportable and the medical examiner must be contacted as well. I won't bother going through all the scenarios as whatever the process is for dealing with resident deaths where she works will be covered in the facilities policies and procedures  plus the more experienced staff should hopefully be available to help when that situation inevitably happens. 

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