Need help with routines.

[Joni's Mom]

Hi,

I'm a new nurse and have been orientated for a couple of days in a LTC facility. I am to receive a total of 2 weeks orientation. My concern is that I have to take care of 18 - 20 pt. and may be floated to different units of pts that I dont know. How do you know which pt to see first, second, third and so on.

What is your full routine?

Right now I count narcs, get my cart ready, get fresh water, juice, and applesauce. I'm told by my preceptor who to see first, second and so on, but how do you know?

Please help.

[Thankful RN,BSN]

has it ever occurred to you to ask your preceptor why they have choosen which pt to see first, second, third, and so on?

[BradleyRN]

Two weeks certainly doesnt sound like enough orientation. If you do not adequately feel prepared after that tiny amount of time, i encourage you to ask for two more!

In a LTC facility, who to see first will present itself in time. I always skipped around to the people that were in pain first ( i didnt have vents or trachs). This should be the normal routine of the LTC nurse, but my patients always complained that many nurses simply wouldnt do this (they want to go straight down the line).

Then i would see those who really wanted me to see them first.

Then i may see a few of the more time consuming patients so their visit isnt looming over my head later when i am running out of steam.

Two weeks of orientation is ludicrous for a brand new nurse. If you need more, demand it. I encourage you to call around and see the length of time other facilities offer for training. Good luck!:)

[Daytonite, BSN, RN]

You learn as you discover the patient's routines. You might want to ask this on the Geriatric and LTC Forum (https://allnurses.com/forums/f22/) on allnurses. When I worked the day shift in LTC the first thing I did was give insulin and then take my med cart and head to the dining room where many of the residents were congregated. After a few days you'll learn who the fast eaters are and need to get their pills first before they leave the dining room. Otherwise, you have to track them down later and that may require some running around. Then, it was to the individual patient rooms to complete the med pass. Treatments were done after the morning med pass.

[jjjoy, LPN]

I think the catch is getting from here (not knowing the patients at all) to there (having an idea which ones should be checked on/taken care of first). The newbie may feel like they are failing in their responsibilities if they "get it wrong" the first few weeks, before they know the patients, the facility routine, etc. Is it irresponsible for the newbie to accept their role knowing that the first few weeks, they will end up giving several meds very late (cuz Mr. Smith gets stubborn if you don't give him his meds before 8am) or create potential problems (eg give Ms Jones her insulin before breakfast and then find out from the aide that she always refuses to eat anything til noon)? There's just no way for someone not only new the unit but new to this kind of nursing to be able to pull it all together for awhile. So how can the newbie feel like they aren't an irresponsible nurse during the time it takes them to get their grounding?