Advice for LTC

  1. Hello there all you wonderful LTC nurses . I was wondering if you could spare some advice. I am starting in an LTC facility on the 7th of October. I am a brand new LPN and I was wondering what I should do and not do during my orientation. I want to be sure to start out on the right foot and not come across as to niave or with a know it all attitude. For those of you who have trained in new nurses, what do you expect of them and what do you wish they would not do.
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    About Little Panda RN

    Joined: Aug '05; Posts: 843; Likes: 258
    RN; from US
    Specialty: Assisted Living Nurse Manager

    13 Comments

  3. by   MDSlady
    I have been a LTC nurse for 8 years, and congrats on being a new grad!!!!:mortarboard:

    Remember just to be yourself, and do NOT let them put yourself on your own UNTIL YOU ARE READY!!!! Some facilities think after a couple of days, that you can be on your own. Remember, if YOU are not comfortable, don't do it. And also, if you find that it is a facility that you cannot ask questions, which by the way, you may have alot of when you begin, find another job. You will learn much more if you can work in a facility that works as a TEAM!!!!

    Again, best of luck!!!!!
  4. by   LaxNP
    I have worked in LTC for a while. It was my first job as an LPN and I;m gonna be heading out this year when I'm done with school. The previous post said to be yourself and I think that is true. What helps me is to remember that I really do become part of the residents life and to thier families also. I work with a lot of MS patients and they are really young so they get kinda mad if you use the same tone as you would an elderly patient. I try to talk to them as though they are my friends but not to comfortable, and they seem to respond very well to that. I worked with a new nurse a few months back and she was way over the top on how she treated the residents, although the treated them great, I felt that she was a bit condesending. But, I'm sure you'll do great!
  5. by   HARRN2b
    How do you work with ms patients? That is actually what I would like to do. Not that I do not want to work with seniors but I have a special place in my heart for ms and parkinsons patients as I had family members with those diseases.

    Thanks!

    Holly
  6. by   Little Panda RN
    Excellent advice, I knew I could count on all you wonderful nurses to help out. I am looking forward to the job. My mom was an LPN and always loved geriatrics. She kept telling me to give it a try since I love working with the elderly and of course anyone else who needs it. I am hoping I find my niche.
  7. by   Little Panda RN
    Quote from MDSlady
    I have been a LTC nurse for 8 years, and congrats on being a new grad!!!!:mortarboard:

    Remember just to be yourself, and do NOT let them put yourself on your own UNTIL YOU ARE READY!!!! Some facilities think after a couple of days, that you can be on your own. Remember, if YOU are not comfortable, don't do it. And also, if you find that it is a facility that you cannot ask questions, which by the way, you may have alot of when you begin, find another job. You will learn much more if you can work in a facility that works as a TEAM!!!!

    Again, best of luck!!!!!

    I actually have 32 hours of training scheduled so far. I am working on some weekends and wed nights, since I work a full-time job in a clinic. I very much agree with you and will be sure to let them know if I do not feel ready to be on my own. By the way do you think 32 hours is enough training or should I ask for more? Thank you for helping this new nurse out . If there is anything else that you think of I should know, it is really appreciated.
  8. by   lovingtheunloved
    Quote from nd_mom
    Hello there all you wonderful LTC nurses . I was wondering if you could spare some advice. I am starting in an LTC facility on the 7th of October. I am a brand new LPN and I was wondering what I should do and not do during my orientation. I want to be sure to start out on the right foot and not come across as to niave or with a know it all attitude. For those of you who have trained in new nurses, what do you expect of them and what do you wish they would not do.
    Your CNAs are your friends. Utilize them. I try to bend over backwards for new nurses and nurses that have never worked LTC. Or really, any nurse, but especially the new ones.
  9. by   pyrolady
    First of all, congrats on graduating and on choosing LTC. Please remember that LTC is usually a skilled nursing facility. Geriatrics is a unique specialty onto itself - like peds, med/surg, ortho, etc. I wish people who are in this field would take advantage of some of the geri classes offered at community colleges to give them the unique perspective of the older patient. Also, you will find that because it is a SNF that there are a lot of younger patients these days too - many are there because of bad decisions - drugs, gunshot wound that left them paralyzed, etc. others to gain strength and have PT/OT/ST. LTC is more diversified than they used to be - no longer is it a place that elders to to live out the last of their life. When you have orientation to the floor one of the better ways to do it (my opinion) is to shadow your nurse for two or three days, then build your patient load by taking about 25% the first day or so until you are comfortable, move up to more and then the final full patient assignment. Also, take time to spend a shift behind the desk looking at the charts, lab orders. where are emergency numbers, how does your facility handle call-ins, etc. Remember to that the family of the patient is now also part of your care - and sometimes they are worse than the patient. Also, a good hint: PAY ATTENTION TO YOUR NURSE AIDES WHEN THEY TELL YOU SOMETHING !!!! They spend the most time with our people and know when something just isn't right with them. Treat them as part of your team, which they are. Make sure to get an evaluation after set periods of time (ie: 30 - 60 - 90 days) to see how you are progressing. Good luck to you - and remember, there are a lot of career ladders in LTC too. Nurse, ADON, DON, In-Service Educator, Infection Controll, MDS specialist, Administrator (just a state and federal test that you can study for), Clinical consultant, and if you are owned by a chain there are also corporate opportunities. Have fun, enjoy, and realize that you cannot always go full steam ahead - make time to rest or you will burn out.
  10. by   Little Panda RN
    Quote from lovingtheunloved
    Your CNAs are your friends. Utilize them. I try to bend over backwards for new nurses and nurses that have never worked LTC. Or really, any nurse, but especially the new ones.

    I have heard it said many times, to cherish your CNA's and a good CNA is worth their weight in gold. I truly believe this and will do what I can to make sure that the CNA's I work with, know that I appreciate all their hard work. I have never worked as a CNA, but during nursing school as all of you know you have to do the nursing and CNA part of the job and boy was it back breaking work. I am sure that it was only a glimpse of what CNA's do in LTC. I am positive that the new nurses or any nurse for that matter that you have had the chance to train appreciated your thoughtfulness and willingness to give them the best training possible. I can only hope that I end up with a nurse like you for training
  11. by   Little Panda RN
    Quote from pyrolady
    First of all, congrats on graduating and on choosing LTC. Please remember that LTC is usually a skilled nursing facility. Geriatrics is a unique specialty onto itself - like peds, med/surg, ortho, etc. I wish people who are in this field would take advantage of some of the geri classes offered at community colleges to give them the unique perspective of the older patient. Also, you will find that because it is a SNF that there are a lot of younger patients these days too - many are there because of bad decisions - drugs, gunshot wound that left them paralyzed, etc. others to gain strength and have PT/OT/ST. LTC is more diversified than they used to be - no longer is it a place that elders to to live out the last of their life. When you have orientation to the floor one of the better ways to do it (my opinion) is to shadow your nurse for two or three days, then build your patient load by taking about 25% the first day or so until you are comfortable, move up to more and then the final full patient assignment. Also, take time to spend a shift behind the desk looking at the charts, lab orders. where are emergency numbers, how does your facility handle call-ins, etc. Remember to that the family of the patient is now also part of your care - and sometimes they are worse than the patient. Also, a good hint: PAY ATTENTION TO YOUR NURSE AIDES WHEN THEY TELL YOU SOMETHING !!!! They spend the most time with our people and know when something just isn't right with them. Treat them as part of your team, which they are. Make sure to get an evaluation after set periods of time (ie: 30 - 60 - 90 days) to see how you are progressing. Good luck to you - and remember, there are a lot of career ladders in LTC too. Nurse, ADON, DON, In-Service Educator, Infection Controll, MDS specialist, Administrator (just a state and federal test that you can study for), Clinical consultant, and if you are owned by a chain there are also corporate opportunities. Have fun, enjoy, and realize that you cannot always go full steam ahead - make time to rest or you will burn out.

    Hello Pyrolady,

    First off I am really interested, how did you choose your user name? It is unique, maybe there is a story behind this name. Your words of wisdom are great. I have never thought about the career ladder in LTC before. You have really given me something to ponder as I wonder where my career will take me. If I enjoy this as much as I think I will, I want to quite my clinical job and go full-time with this facility. The ADON was very nice and took the time to explain to me how each unit is staffed and what measures they take for call offs. It seems like a nice facility, one that really cares for its residents. I am nervous about the charting and making sure I do it correctly. I am also nervous about passing meds to so many residents. But, I guess as I am told every new nurse has these concerns. I am really looking forward to my first day. Oh yes, please do share how you got your name! Enquiring minds want to know
  12. by   geniann
    I agree with the others regarding the CNA's. One other thing is to remember is to not only listen to them, but make sure they understand YOU are THEIR supervisor. Most cna's will not take advantage but the ones who do will become your worst nightmare. LTC can be very hectic especially during the normally long med pass times- and during these times if you cannot find your cna's, you will wind up putting people on the toilet/bedpan, feeding them, or getting glasses of water. Of course, I do these things and don't mind, but once your start your med pass, you should not be interrupted. It can be dangerous. Let the cna's know that you will work with them, but they need to do thier work. Oneof the other nurses said something about not trusting everything you get in report- this is true. Especially if you deal with agency nurses. Do your own mini- assessments and take your own vitals. I had a resident who was on BP meds- for a week the other nurses were charting his BP as 160/80. I took my own and got 100/60. This is a big difference and was cause to hold his med. I don't know if the nurses or the cna's were taking the vitals but they were way off. Since he was a big man, I kinda think they thought that seemed right for him- I know some cna's would assume certain vitals were right- Yes ASSUME. I guess the best advice I can give, is CHART, CHART,CHART. This will save your butt even when you really don't think you should. I had a CNA turn me into department of children and families JUST because she didn't like me!! She never even worked with me- NEVER. Thank God my charting saved me. Best of luck and just remember- they will live if you give them thier meds REALLY late. Have fun and let us know how it is going- Geni
  13. by   Little Panda RN
    Quote from geniann
    I agree with the others regarding the CNA's. One other thing is to remember is to not only listen to them, but make sure they understand YOU are THEIR supervisor. Most cna's will not take advantage but the ones who do will become your worst nightmare. LTC can be very hectic especially during the normally long med pass times- and during these times if you cannot find your cna's, you will wind up putting people on the toilet/bedpan, feeding them, or getting glasses of water. Of course, I do these things and don't mind, but once your start your med pass, you should not be interrupted. It can be dangerous. Let the cna's know that you will work with them, but they need to do thier work. Oneof the other nurses said something about not trusting everything you get in report- this is true. Especially if you deal with agency nurses. Do your own mini- assessments and take your own vitals. I had a resident who was on BP meds- for a week the other nurses were charting his BP as 160/80. I took my own and got 100/60. This is a big difference and was cause to hold his med. I don't know if the nurses or the cna's were taking the vitals but they were way off. Since he was a big man, I kinda think they thought that seemed right for him- I know some cna's would assume certain vitals were right- Yes ASSUME. I guess the best advice I can give, is CHART, CHART,CHART. This will save your butt even when you really don't think you should. I had a CNA turn me into department of children and families JUST because she didn't like me!! She never even worked with me- NEVER. Thank God my charting saved me. Best of luck and just remember- they will live if you give them thier meds REALLY late. Have fun and let us know how it is going- Geni
    Thank you for the words of wisdom Geni. It is such a great help when the more experienced nurses share the ins and outs of this profession. Believe me my fellow nurses I am taking all this wonderful info and storing it in my little brain , actually I think I am going to write it all down. Keep it coming!!!
  14. by   CritterLover
    Quote from geniann
    do your own mini- assessments and take your own vitals. i had a resident who was on bp meds- for a week the other nurses were charting his bp as 160/80. i took my own and got 100/60. this is a big difference and was cause to hold his med. i don't know if the nurses or the cna's were taking the vitals but they were way off. since he was a big man, i kinda think they thought that seemed right for him- i know some cna's would assume certain vitals were right- yes assume.


    [font="comic sans ms"]just wanted to echo something in this post. if you are even a little bit uncertain about the vs, take them yourself.

    after my first semester of nursing school, i worked in a ltc facility for 3 months (that is all i could take). now, we were checked off on vs during our first semster, so i already had learned those skills. we had also been taught t/p/r/bp during our cna class.

    however, once i started working, one of my fellow cnas (more experienced than me as an aide) laughed at me for trying to get a bp on a skilled patient with a weak pulse. he told me just to "get the top number, then put it over the pulse." :uhoh21:

    another aide was caught making up pulse rates on the locked dementia unit. he wasn't even creative enough to vary the rates. imagine that -- all the patient on the one unit had a heart rate of 78. hmmm.

    i have worked with many wonderful, caring aides, both as a cna and as an rn. but remember, if it looks suspicious, verify it yourself.

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