Long-Term Care & The Newly Graduated LPN

  1. You've passed your Boards...you're excited with the prospects of being a nurse, your earnings potential, etc., etc. You've no experience and you muster through interview after interview. Then you get a phone call and are offered a position at a LTC facility. You accept. You're eager, enthusiastic and excited. Sound familiar?

    What you soon discover is that nursing in the "real world" is not exactly everything you learned in nursing school. You quickly become overwhelmed and question whether you know anything at all...you're not even sure how you passed your nursing boards after a few weeks~! Alrighty then...let's take a look-see at LTC nursing based upon this writer's experiences.

    You spend 1-3 days in corporate orientation. Next begins shadowing (orientation) on the floor & med pass. The nurse may be an RN or an experienced LPN. She may enjoy teaching...or...she may view you as a burden given her shift responsibilities. You sit in or report...you listen, observe and make any notes you deem appropriate. After report, you follow the assigned nurse and med pass begins. You're thinking...this looks easy...it can't be all that hard~! Really?

    As your orientation develops you're beginning to realize just how great the responsibility is and just how little time you have to complete your med pass, do your treatments, chart and document plus the myraid of incident reports and comprehensive evals you need to complete...oh, yes...and then there are the "emergencies"...and the lack of UAP's...and the call-offs. Uh-huh...it's starting to get real now and hit home right?

    In candor, your first two or three months are a roller-coaster of what not-to-dos and learning the key players. You will see the "right thing" and you will see a host of "shortcuts". Ultimately, it is up to you to always know and do the right thing. Are there consequences for the choices you make during a given shift? You bet your life there are~! You arrive home after a very long 12+-hour shift and then you begin to reflect on the day's events. What did you do right. What did you forget. What didn't you do. How did you handle a given situation. Did you do all the requisite charting - remember, 'not charted, not done'. You're tired, you're feet hurt and mentally you're feeling the strain and asking yourself what you've gotten yourself into.

    Here are some do's & don'ts:

    Do take your breaks and eat lunch during your shift - you need to replenish, you need fluids, restroom stops but most of all you need a few minutes to "regroup" your thoughts and re-focus.

    Do ASK QUESTIONS~! There are NO stupid questions. Errors or omissions do not count as "ignorance is bliss"...ASK for clarification...ASK for help...ASK to see a particular procedure...ASK...ASK...ASK. You may not be received with open arms but ask anyway.

    DO learn to stand up for yourself. Be ASSERTIVE but don't be aggressive.

    DO keep the lines of communications open as between you, other nurses, your charge nurse or supervisor, the ADON and the DON.

    DO try to observe and learn who you can go to...who you can ask to mentor you...who will be there when possible. It will not be easy and the old adage "nurses eat their young" will stare you in the face at nearly every turn. What peeves me more so though in this vein is the little "tips" nurses can give or show you to make your job easier and go more smoothly. Oftentimes, nurses will keep these "aces" in their sleeves until you've proven yourself and "paid your dues".

    DO ask for written updates on your performance and progress. While your requests may be shuffled under the carpet, if you can get it in writing, you have a legitimate guide to work from and later compare as you progress.

    DO find out which residents have appointments or are going out of the facility and the times...you need to know this PRIOR to the start of your med pass in terms of time management and smooth progression.

    DO ID your patient's wristbands - and get to know each resident on your floor/wing. It comes with time but it is key to your completing a timely med pass. Know a resident's preferences and idiosyncrasies is a huge timesaver and helps to build trust and rapport as between you and your resident.

    DO research and know your medications and respective side effects. Generally, you will need to figure out a way to list them and research them on your own time. Keep the list handy for reference.

    DO keep a notepad in your pocket along with 2 black ink pens, a red ink pen, a sharpie, and a hilighter. You also need your scissors, pen light and stethoscope. Use your drug handbook and 'when in doubt - check it out' beforehand.

    DO NO HARM - this is the cardinal rule.

    DO LISTEN to your residents - assess orientation, skin, neuro-musculo functions while you are giving each resident his/her medications.

    DO report absnormal findings to your charge nurse for follow-up. Learn to question if a resident doesn't seem right to you.

    DO trust your gut instinct~! What is it telling you? Listen to it and act on it when appropriate.

    DO try to chart as you go - if you leave charting til the end of the shift - you are out of time and scrambling not to mention you may not remember all the details. Chart precisely, accurately and factually. Use measurements or something which draws a mental picture. For example, you've done a wound dressing change...you didnt' measure it but it was the size of a dime...this is better than "dresssing changed per physician order" which is ambiguous on its face. Remember, the medical record is a legal record. Only the facts Ma'am...just the facts.

    DO complete your treatments. Do READ what you are signing off when charting in the treatment records...don't just initial~!

    DO ensure your Narcotics book is properly signed off - when you take a narcotic from your drawer, after it's been given, sign not only your MAR but be sure to sign in the Narcots Log Book as well.

    Chart by the rules - if you do not know them - ASK. Most nurses are only to happy to guide you and instruct you in this area.

    DO chart legibly and include your title. Progress/Nurses Notes should always denote date & time and be written in proper order. Late entries should indicate "late entry".

    DO ensure you are charting in the correct resident chart.

    DO thank your UAPs, dietary, housekeeping and any other ancillary personnel after they have lent assistance. This can go a long way and helps to build respect and rapport. Also, thank those nurses who've help you during your shift. Be sincere and genuine~!

    DO LAUGH and have FUN. Find ways to bring humour into your daily working routine.

    I'm sure I've left numerous other things out ... it's a start tho.

    Now on to the DONT's:

    DONT violate HIPPA or resident confidentiality - know your facility's policies & procedures - KNOW WHERE THE MANUAL is KEPT - consult it OFTEN.

    DONT participate in gossip or comment on staff members. Keep your opinions to yourself - MUM's the WORD here. Listen and observe - but do not join in EVER.

    DONT hide your mistakes or cover up. Be HONEST and ADMIT to your MISTAKES as soon as you discover them. Remember, you are a professional nurse and you must maintian your own integrity and reputation.

    DONT make accusatory remarks or "tattle-tale". This breeds animosity among other things.

    DONT call off unless you are genuinely ill.

    DONT show up to work late - always be 15-minutes or more early. Be ready and prepared for each shift before you start your shift.

    DONT usurp the chain of command - learn who's who - and follow accordingly.

    DONT be afraid to introduce yourself to physicians. Make eye contact, smile and be pleasant. You may not know the physician(s) but I guarantee you he/she does know who you are~!

    DONT do a procedure you are unsure of or not competent to do. An example would be starting an IV when you have not been checked off on the procedure by the Nurse Educator. Remember, 1st do no harm.

    DONT whine or complain about your workplace while on shift. It wastes valuable time and breeds animosity & contempt.

    DONT take on more than you can handle with regard to working extra shifts, etc. If you do too many and wear yourself thin, you've only done yourself and your facility a disservice.

    This writer has worked in LTC for a brief time and in no way means to come across as having all the answers. Time-management, communications, observations, active listening and a sense of self, having confidence in your own abilities - are all essential for overall success. Remember why you are there...rejoice in the rewarding moments...and at the end of a very long day, know you've done your best.

    If you are doing it right from the get go, it won't matter who walks through the door - you'll be doing as you should.
    This writer underwent the scrutiny of the watchful eye of State Inspectors as a new grad and new nurse. It was reinforcement that "yes, I'm a nurse...professional, diligent, text-book, caring...yes, I did it - and so can you~!

    Nursing is demanding and comes with high levels of responsibility. The hours are long. The pay short. It can be unforgiving and it can be filled with great humankind rewards. It comprises a league of men and women who are dedicated, professional, educated, skilled, and always learning.

    Continue to educate yourself in every way you can. Choose your mentors wisely. Network. Join chatrooms for nurses. Become a member of professional nursing organizations. GET MALPRACTICE INSURANCE - protect yourself. Susbcribe to magazines. Talk to your Pharmacist when in doubt r/t medications. Follow the Rights of Medication Administration - ALWAYS.

    Don't ever lower your standards or settle for that which you know you shouldn't. Aim high...be strong...confident...poised and respectful. Remember, it's not always who you know...it may very well be 'who knows you'~!!

    Respectfully, I am to all in the forum. I welcome your comments, thoughts, suggestions. Thank you.

  2. Visit Boston7 profile page

    About Boston7

    Joined: Jun '09; Posts: 11; Likes: 15
    LPN; from US
    Specialty: LTC, Med-Surg, Hospice


  3. by   Cherybaby
    I think you covered it thoroughly
  4. by   j3school
    good advice, i am a 52 year old male lpn who just graduated in june of 2009, got my license in sept. and started working in ltc in oct. although there are some rewarding moments it is just about more than i can take emotionally and physically. i am trying to decide whether or not to go back for my rn. they want all the work done but don't want you to be on the clock at the end of your shift. and it is so hard emotionally to see people with alzheimer's every day. my mom is in a nursing home with this horrid disease. lt is so stressful and distressing. is working in a hospital any better . if not, perhaps i just need to do something else for my own emotional health. burnt out but trying to hang in there.
  5. by   Cherybaby
    Quote from j3school
    good advice, i am a 52 year old male lpn who just graduated in june of 2009, got my license in sept. and started working in ltc in oct. although there are some rewarding moments it is just about more than i can take emotionally and physically. i am trying to decide whether or not to go back for my rn. they want all the work done but don't want you to be on the clock at the end of your shift. and it is so hard emotionally to see people with alzheimer's every day. my mom is in a nursing home with this horrid disease. lt is so stressful and distressing. is working in a hospital any better . if not, perhaps i just need to do something else for my own emotional health. burnt out but trying to hang in there.
    I have found a lot of satisfaction working in private doctors offices. LTC was not for me either. I also work in surgery centers per diem which a lot of fun and very interesting. There are other ways to go. LTC is not for everyone. Don't feel defeated just yet. There is a whole lot to love in nursing.
  6. by   maxcat
    This is one reason I'm glad to be working as a CNA before going for my LPN... I'm getting used to the LTC environment. Once I have my LPN, I'll be working at the same place... I know the duties will be different, but at least I'll be familiar with the residents, coworkers, and facility... It is challenging, for sure. But I'm not as overwhelmed as I thought I'd be-my coworkers seem great, so far!
  7. by   Boston7
    Thank you Chery~! Nansea
  8. by   Boston7
    Thank you as well for your comments...utilize network support...continue to plug along...do consider furthering on to RN...options are out there and it takes time to find one's niche...gut instinct tells me a new grad may go through 8-10 jobs at the onset to find the right venue. Like you, I struggle along and am considering the RN route as well...meanwhile, we learn as much as we can, realising that each position we are Blessed with...lends more experience, greater confidence levels and increases and/or solidifies knowledge...one thing for certain...we learn what is not right for us...keep your options open...test your marketability...keep searching...keep smiling & keep shining. You're a nurse and you've much achievement to get to where you are today...baby steps all the while
  9. by   j3school
    Thanks for replying. I am new to this site and could not find your original post again after sunday night. Not sure what i am going to do yet. still working in ltc but getting tired of working "off the clock hours" sometimes have some very gratifying times with my residents but could almost work as a security guard the same amount of hours and make the same with 1/16th the stress. ltc can be extremely stressful emotionally. thanks for the encouraging reply.
  10. by   pagandeva2000
    Beautifully written and thoroughly articulate!
  11. by   Boston7
    Thank you very much
  12. by   Boston7
    Indeed, this is true. I'm 55...I have moments of joy...most times...stress levels off the charts, too much work between med pass, tx, charting & documentation + reports, etc. - long hours - coping w/call-offs - BUT - there are moments when I know I've made a difference for those WIMC...this is what propels me forward I guess...keep up the good work I've no doubt you're doing...give it time...before you leap...best wishes...Nansea
  13. by   Boston7
    You are very wise to do especially if you're comfortable in the work environment...only caveat I'd say is with role change...yet I can tell you'll be 'right at home'~! Best regards to you and your successes. Nansea
  14. by   j3school
    thanks nansea, your advice and support is very encouraging. perhaps, if not a nurse you should be a counselor! i am going to be giving all options ( i used to be in outside sales, landscaping, painting) with much prayer. if i knew how to make people permanent contacts on here i would definitely make you one. thanks for your help and encouragement!!!!