First job! How can I be a great LTC RN?

  1. So I accepted an offer for an LTC facility, working on the night shift (which has me SO freaked out). I swear to you all: I did well in school, I passed NCLEX with flying colors, and I have spent the last 4 months (post NCLEX, not working as a nurse) volunteering with Medical Reserve Corp and at a hospice. But OMG I don't feel like a nurse at all! Whenever I think of school, I'm like, "I didn't even DO anything!! I just did meds and assessments! I can't start an IV, I can't even draw blood!" I feel positively useless and panicked.

    Orientation starts next month and goes for 4 weeks. So far, I've been trying to prepare by doing medication problems online, reviewing my old books/notes, and reading AN, lol. I did order a couple geriatric-focused textbooks to help me focus my nursing skills to suit the facility. But... what else can I do? What should I be prepared for??

    I just know that going into the night shift is going to mean a lot of responsibility and autonomy. I want to do this right. Obviously the facility knows that this is my first nursing job, and they wouldn't offer my the position if they didn't think I was competent. But, god, I just really want to succeed!

    So, if anyone out there has general advice, or even just "I wish I had done this before I started as an LTC RN" I would appreciate it!
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    About anashenwrath

    Joined: Jan '10; Posts: 213; Likes: 131
    LTC RN; from US


  3. by   CrunchRN
    If they are giving you 4 weeks orientation it must be a good place. Don't worry we all learn it all on the job these days. After being a nurse for 17 years (not acute care) I finally learned how to do phlebotomy 3 years ago...... you will be fine.
  4. by   CapeCodMermaid
    I've been an RN for 30+ years. I still learn something new every week.
    Take your time. Don't expect to know everything your first week or month or year. Pay attention to what you are doing. Do what's right without taking shortcuts. Don't get involved in the facility drama. If you have down time, read the charts to get to learn the residents. Don't be afraid to ask questions. Make sure you have the supervisor's number or the DNS' number if you have a question and there is no one around to ask.
  5. by   LTCRN4LIFE
    Love CapeCod's advice to you. I agree. Don't get caught up in the facility drama. Read charts in your down time following the residents history and what the Drs have ordered and why. Do rounds checking on your residents making sure they are getting turned and fluids as needed and pain has been addressed. Good luck.
  6. by   MomaNurse
    When your patient is going down, do not forget the basics. Hungry, thirsty, tired, constipated, retaining urine or in pain stimulate some impossibly wild behaviors. Most times you don't have to dig deep to get to the answer.
    And volunteer for projects. Any way you can start participating in things that will broaden your knowledge base in geriatric management will keep you in good graces and improve your patient care.
  7. by   chrisrn24
    Get to know the staff that you can. You may not know a lot of the day and evening crew and office staff. I always introduce myself "Hi I'm ChrisRN. I work nights."

    Direct your aides and make sure they are doing what you ask. And if not, listen to their point of view. Lots of times they know little tips and tricks to help with certain tasks.

    Have a smile on your face, put aside personal problems when you're with residents. Don't bad mouth other shifts to residents.

    Use your cheat sheet! Sometimes with 20-30 or more residents you need that piece of paper. At the beginning of the shift go your your MAR and TAR and jot down what vitals you need.
  8. by   dlrrn2013
    great advice! read the charts, catch up on what dayshift couldn't accomplish because they ran out of time! be a team player! you will learn so much in your first year and every year after. ltc nurse have to be skilled in all health conditions because you deal with many co morbidities! biggest advice, never stop learning. Research one thing a night you was not clear on! always be learning.
  9. by   anashenwrath
    Thank you so much everybody. this is really some great advice and is calming me down immensely. And I'm definitely noticing themes in the advice, so I will definitely be sure to review charts, ask questions, and be a team player!

    I'm so excited to be going into LTC and I really want to do a great job! Gah, I could start getting weepy over this! :P

    Special thanks to CapeCodMermaid, bcs she's actually been giving me advice from day one. Cape Cod is where I'm heading! So long New York City!
  10. by   amoLucia
    And remember to take care of yourself, esp in the beginning. Nurture your body by eating, drinking & sleeping as best you can And enjoy your time off.
  11. by   sunshyne17
    I start at a LTC facility in a few weeks and I only get a week orientation. I am very nervous with the high patient to nurse ratio's but so far, the staff is nice. I had all of my clinicals in the hospital setting so I feel as if I will be floundering. It's so great you get 4 weeks!
  12. by   bankssarn
    Congrats on the job! I work in LTC as well. I didn't read all of the replies, but I would suggest forming a good relationship with your co-workers. Teamwork is crucial in LTC, so it's best if you have a rapport with fellow nursing staff. Don't be afraid to pitch in if you have down time! A lot of nurses in LTC (at least that I've seen) are unwilling to help with personal care (toileting, bathing, etc). If you're willing to lend a helping hand to the CNAs, they will appreciate you and respect you in return! Be an advocate not only for your residents, but their families as well. And don't forget, document, document, document! Something as simple as a telephone call to a family member should be documented in the progress notes. CYA! And don't worry about not being able to start an IV or draw blood. I worked on tele and med-surg before I returned to LTC. I rarely started IVs and never drew blood! There's a lot that you don't learn in nursing school. As others have said, you'll learn as you go. Nursing is a forever learning field! Be nurturing and compassionate and you'll do great!
    Last edit by bankssarn on Oct 24, '13 : Reason: spelling
  13. by   anashenwrath
    thank you! luckily a lot of my downtime during school was spent toileting, etc, so I'm definitely willing to help out on any of that! in fact, i'm worried that i'm going to be more comfortable with those tasks than nursing tasks.

    and the advice on documenting is very welcomed. like they say: if you don't document it, it didn't happen.