New Grad..start LTC in a week. Any advice? :)

ibmissy · Jan 12, 2005

Missy,
Keep us posted on how well you're doing....
Until Later, your former coworker

I will..Tomorrow is my first day and I am scared..More so now, because of the snow and sleet that will make getting up the hill to work almost impossible..:) Not to mention they don't know I am pregnant yet, but they will figure that out tomorrow.

Took nclex today..Not sure how I did. It shut off at 85 questions...Will find that out in two days.

kathi yudin · Jan 12, 2005

in california.. most acutes will not look at new grads.. they want a yrs experience... advice.. listen.. take your time.. don't take shortcuts... you can't be friends with the cna's.. you are their superior.. be firm but fair... learn your policies.. glad to see they are giving you a month.. that is what we do at my facility as well while most around don't...i usually will not hire a new grad for nites.. not enough experience and lack of back up in an emergency.. so.. remember your assessment skills.. hope that this helps..

Iif you want to work in hospital nursing at any time, now is the time to do it. Once you work in NH, some hospitals consider you "not hospital material".
It would be a good idea to get some hospital experience, and it usually pays beter.
Just my thoughts, in case you had never heard this.

bellcollector · Jan 12, 2005

I would have went for hosp. experience to if I could have. However you will gaim more at LTC than you think. We have way more pts to deal with than in a hospital and they are much sicker in LTC than they used to be. You will learn organizational skills as well as how to prioritize. You will run your behind off at least if you do your job right you will. You will also learn supervisory skills and good assessment skills. You will learn how to look for and spot the smallest changes in your residents this often will give you a leg up at the hospital. Good Luck and have confidence in your skills and you will do just fine.

kesneysmom · Jan 12, 2005

ok here is my expert advice!! 1)Make sure you know the proper steps and paperwork to do when you send someone to the hospital.

2) How to work the phones!!!!!

3) Never let the CNA'S see you sweat.

4) If you can, get in there and help your CNA'S!! do not act better then they are, but let them know who is the supervisor.

5) ASK QUESTIONS!!

6) Keep your med book on med cart at all times!!!!

7) If a patient is known to be combative have someone go in with you just in case, and remind the patient that you are pregnant if needed.

8) If you just have a "feeling something is wrong" it usually is.

9) Find an experianced nurse befriend her, you will need it.

10) Just take it day by day, LTC is for some people and not for others. I loved it!!

GOOD LUCK.....LET US KNOW HOW IT IS GOING!!!!!!

kathi yudin · Jan 13, 2005

i was acute hospital trained... i have to agree with you.. ltc is the best experience you can get.. i couldn't have said it better.. the assessment skills.. the organizational skills.. dealing with the pressures of getting it all done on time.. you see it and get it all in ltc.. !!. the best experience you can get!!!.... :balloons:

I would have went for hosp. experience to if I could have. However you will gaim more at LTC than you think. We have way more pts to deal with than in a hospital and they are much sicker in LTC than they used to be. You will learn organizational skills as well as how to prioritize. You will run your behind off at least if you do your job right you will. You will also learn supervisory skills and good assessment skills. You will learn how to look for and spot the smallest changes in your residents this often will give you a leg up at the hospital. Good Luck and have confidence in your skills and you will do just fine.

ibmissy · Jan 13, 2005

Thanks for all the advice...BTW got my results today for the nclex. I passed. :balloons:

PBAJS · Jan 14, 2005

congratulations !!!

:balloons: :balloons: :balloons:

LPN1974, LPN · Jan 14, 2005

Congratulations on passing your exams.

Some of my advice is, Never be afraid to ask questions.

Take some notes. Alot of things they will tell you, you might not remember the next day. I'm sure you will be flooded with alot of information, so if you can write some things down.

When you transfer to the night shift, beforehand, find out what the facility's policy is for making arrangements in getting an ill resident to the hospital as far as transfer.

The LTC I worked in on the night shift, had a real problem with transfers.

The ambulance didn't always want to pick up the resident, because they would say it wasn't an emergency that would be paid for by medicaid/medicare. The ambulance crew who would come to evaluate would say that if the resident could walk and sit up in a wheelchair they did not need an ambulance. Well, that may be true in some cases, but if I had no other way to get them over there, what was I to do?

You have to be very specific about what you write in the Dr's order, in order to get the ambulance to pick them up.

So if they came out and judged that the resident wasn't ill enough to go in their ambulance, then the facility had to provide the transportation, and that is where I ran into alot of problems. The facility did NOT have anyone trained on the night shift to drive the facility van, therefore effectively leaving me at times with no way to get someone to the hospital.

I was very frustrated with this, many times. It's the main reason I quit that job.

I'm not trying to scare you.....just find out and make sure you will always have someone available to provide transportation if needed, and maybe what the medicare/medicaid guidelines are or the ambulance requirements.

If you're going to train on dayshift for 4 weeks, you will have enough time to ask questions and find out.

Sorry for going on so long......this was just one of my pet peeves while I worked there, and it caused me much frustration.

Midwest4me · Jan 14, 2005

First of all, CONGRATULATIONS on passing your boards!

Second: A) Although you are getting 4 wks of orientation on day shift, I would still recommend that you ask for orientation on swing and noc shifts--especially noc shift. Orient with an experienced nurse on noc for several days or at least a week, then have that nurse shadow you for one or two nocs if possible. I advise that since the majority of your "Baylor" is on noc shift--you need to have a real good idea of how to organize your time on that shift. Nocs is not as easy of a time as some will lead you to believe.

B) Not to scare you but.....Be prepared for NO breaks/lunches---or very short ones IF you get them---due to constant interruptions(phone calls, family visits and "absolutely MUST talk to the nurse now", questions from CNAs, needing to get up and answer call lights because you MAY feel like you hear them going off continually, etc....)

C) Take as many notes as you can during orientation---if you orient with more than one nurse, that's a big plus as you can then gleen what you like from each nurse's routine and thereby create the best routine for you.

D) Paste a smile on your face ALL THE TIME. LTCs are stressful places; staff need to APPEAR friendly as well as BE friendly to all visitors/family.

Best of luck to you--it will be a great learning experience.

purplesdk · Jan 14, 2005

Congradulations on passing your exams!!

I am an RN working in LTC and I love it! I started out working in a rural hospital and then switched to LTC (rural area) and I don't think I would ever go back to a hospital setting. There is a lot of work that goes on in LTC, but it is rewarding. Where I work, we have about 65-70 residents (including those in the locked unit). We have 2 nurses working the day shift, 2 or 3 med aids during the day, and 5 or 6 cna's during the day. At night we only have 1 nurse for the whole facility, a med aid until around 9 or 10 pm, and anywhere between 4 to 6 cna's (if we are lucky). I prefer night shift, because it is a little slower after 9 pm. (I am currently working part time day shift, and it is very busy). I drag on.

My advise is

1. be fair, but firm in your decisions (especially toward the cna's), it is not easy being in charge of cna's when you were once one and now you are "there boss". If you have disputes, talk to that particular cna about the problem, then go to the DON if a problem is not resolved. Make sure to be on good terms with the DON, you may need her help in the future, for whatever reason.

2. Do not be afraid to ASK QUESTIONS! I have worked at my facility for almost a year, and I still ask questions when I am not sure about something. (The only stupid question is the question that is not asked!) Where I work the orientation period is usually 3 days, but I insisted on a week on the day shift before I started working on the night shift. I also was able to orient on the night shift with another RN, and was able to work with her for several months before they changed it to only 1 nurse at night (hope they go back to 2 at night).

3. NEVER be afraid to call the ADON or DON at night if there is a problem with anything, or if you have a question that you need answered that can't wait till the following day. That is part of there job (to trouble-shoot).

Good luck, congradulations on the baby.

purplesdk