First job out of nursing school in LTC...any advice

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I start orientation at a LTC facility tomorrow. This will be my first job out of nursing school. At the end of the interview the DON that done my interview said that LTC was unlike anything I had experienced during clinical & that for a new grad it can be over whelming at times.

If there is anyone out there that has any advice they could offer it would be greatly appreciated. Thanks in advance.

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My advice is to get out of LTC and into a hospital setting as soon as possible.

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May I ask why?

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Everyone is different and some people love LTC. I think EVERY facility/hospital is overwhelming at times and all DONs think their facility is more overwhelming than others. It's all the same. Don't get freaked out, if you want to do the job than you'll be fine.

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A job is a job is a job, especially in this economy - so be thankful that you have one. Many are of the school of thought that new nurses should begin in a hospital setting for the acute care experience, which is perhaps why it was suggested by the above poster.

LTC can be overwhelming because there is one nurse for usually more than 15-20 residents. I've seen 1:36 :nono: In LTC they usually give you a daily patient roster for you to work off of - use that sheet to keep track of your to-dos. Ask questions, expect to feel overwhelmed. It will take time to become familiar with paperwork, routines, facility policy etc - so don't beat yourself up if it doesn't come right away. Even when it seems you do not have the time, make sure to nourish yourself (even if you need to carry a snack in your pocket). There are some ok LTC facilities and there are some dreadful ones (lack of supplies, many residents with bedsores, poor administrative support etc), you will know once you start working if it is the latter. IF that be the case, you should look to leave pronto.

Good luck!

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Specializes in LTC, Psych, Hospice.

LTC isn't for everyone. You've got to like geriatric pts. You must be able to manage your time well. Be prepared to stop in the middle of a med pass for an emergency (a fall, an incident, a death). You'll be slow w/ your med pass in the beginning, but as you get more practice (and learn your residents) you'll get better. Get refills faxed to the pharmacy when there is one week left on the card. You don't want someone to run out of meds.

Chart, chart, chart. Sign your MAR as you go. Some nurses sign at the end of the med pass, but that isn't safe. Are you SURE you gave that med?

Learn your residents. What things do they enjoy? What don't they like? Do they want to sleep until just before breakfast? It's their home you are in. Respect them...they are your elders.

Talk w/ your CNA's and treat them w/ respect. A good CNA is your right hand. They will let you know when Mrs. Jones is beginning to get a breakdown or Mr. Smith hasn't had a BM for a couple of days.

If a pt has a PRN for pain and they need it, PLEASE give it. This is one of my biggest pet peaves w/ some LTC nurses. "Well they didn't ask for a pain med" and the pt is non-verbal.

Ask lots of questions. The only dumb question is the one that wasn't asked. If you don't know something, don't be afraid to admit it. "I'm really not sure, but I will find out for you."

I treat every pt the way I'd want to be treated. Good luck in your new career!

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I just got my first job at LTC after getting a FL RN license. I have 2 years of hospital experience in Europe though. I am getting my fingerprints taken tomorrow, and then I guess I'll start working soon (how long does it usually take; and another question - should I dress like I did for an interview, or are jeans and a blouse good?).

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Specializes in Hospice.

Realize that in a LTC setting, you will not be able to give equal time to all of your residents.

On any given day there will be one or two residents that will require more of your time for one reason or another. (Extra BP checks, extra blood sugar monitoring, an actively dying patient etc..). You will need to prioritize care for these residents.

The rest of your residents will have stable conditions, and won't require much more than their meds, and the occasional treatment. Do that, and move on. Really. It's OK. Don't feel guilty.

I would just add that you need to give yourself time to adjust to your new job. I've seen too many postings on here from new nurses that start in a LTC facility and want to quit a week later.

Give yourself time to learn the facility, learn the patients, and learn how to budget your time.

Good Luck and enjoy your new career!

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First off I have advice for any new grad no matter where they may be working.

Remember when you were a kid and the things your parents would do just didn't make any sense sometimes? Remember thinking that when you were an adult you would do things different and better? Now, do you remember becoming a parent and realizing that some of the stuff you parents did made sense and (shocking) you are now doing some of the exact same things you swore you would never do.....Well, it is the same with nursing!

You will come out of school with rose colored glasses. You just know that you will never do some the things those older nurses do. You will do it "right" and "better".....Trust me the time will come when you will look back at your nursing career and realize maybe, just maybe instead of judging the those other nurses you should have been taking notes!

Disclamer: I am not talking about the parents who beat their child, or the nurses who endanger patients.

So my first bit of advice is go in with an open mind nursing school is nothing like real nursing. The best way to annoy your preceptor is to go on and on about "well in school....." Believe it or not your preceptor went to school too :)

When you are caring for 20+ patients you will have to get into a triage mentality. If you don't prioritize well you will find yourself swamped rather quickly. Find out who your diabetics are, who has wounds, infections,who has cardiac or respiratory problems. You unfortunately will have to learn to put people off. If you have to tell someone "not now" write down what they wanted and get to it when you can.

Will you be the one doing the med pass? If so this will probably be the biggest hurdle for you. Take notes on how residents take their meds...Crushed, whole in fruit, whole (but only with apple juice to drink lol). Remember your 3 checks and 5 rights. Make notes of who takes PRN's like they are scheduled. Speed will come with time right now focus on safety.

Have a good relationship with the CNA's if at all possible. They are your eyes and ears and the good ones are worth their weight in gold. They know the residents, what is normal what is not. Don't dismiss their concerns.

Remember to be kind and cheerful. Please and thank you go a LONG way with residents and staff.

LTC is hectic, hard work. For me once I got past the hectic part the routine part was just as challenging. I love my residents though.

I could go on and on but I will end with this:

If a resident is not feeling well make sure they have had a BM recently. You would be shocked at how many times a shot of MOM can take a poor old resident from being "desperately" ill to literally thanking God you were able to help them :)

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My first job out of school was in LTC. I found my experiences there more valuable than any. I didn't care for my hopital rotations all that much and I love my geriatric pts. There will be skills that you won't be able to practice like you would in the hospital, but depending on what type of facility you're at, you may be doing IV's. Count on dressing changes for wounds, falls, sending pts out to the ER, talking with family and MDs a lot, and ofcouse count on heavy med passes and paper work. Once you get used to it (and it will take time) it really isn't bad. One thing you will hopefully gain is great assessment skills. In LTC facilities we don't have an MD in house to assess in acute situations. That is all on us as nurses. Good assessment skills means great resident care!

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Specializes in hospice, HH, LTC, ER,OR.

1. prioritize 2. delegate 3. ask lots of questions. Take a small pocket notebook, pocket drug book, and anything else you see fit. Snack or lunch, comfortable shoes. Get ready for the patients to try to pull the wool over your eyes because you are a newbie. HUGS! you will do great. Take your time and worry about the rest later.

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Working in any new job can always be overwhelming, everyone and everything is new. It is where the rubber meets the road. You always set high expectations of yourself but you should give yourself time to adjust. Below are a few tips I've learned to make myself more organized, to make less mistakes (and you will make a few, but that is how you learn), and to better manage my time at work:

- at start of shift, always check for new physician's orders and that they have been noted in the MAR

- for new meds, check to see if the family has consented before you administer

- make yourself a chart (cheatsheet) of residents and how they take their meds: for PO meds - do they take them whole or crushed (needs a pysician's order), prefer with apple sauce, vanilla/choc pudding, ice cream, etc... do they have swallowing problems, need to take vitals (HR, BP) before meds, etc...

- know who diabetics are, fall risks, 1/2-person or standby assist, diets and consistencies

- do frequent routine checks as it will save you a lot of work and documentation requirements that go with it (esp falls). at NOC shift, I check bed rails, O2 nasal cannulas are patent, IV sites are intact/patent, etc ...

- CNAs are your eyes and ears

- know what to do, who to call in case of emergency, i.e. fire

- be familiar with your unit's policies and procedures

- DONT LOSE YOUR KEYS TO THE MEDCART!

LTC for starters can be a great working experience, but you must spread your wings. Goodluck!

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