New Grad starting LTC Monday

  1. I am a new grad (BSN in case that matters in answering the questions below about what to expect) who will be starting in LTC on Monday. Nervous. I graduated in November, NCLEX in Jan and am afraid I've forgotten everything already. The place I will be starting has a behavioral wing, an Alzheimer's wing, a fast track rehab wing, an acute wing (everything but trach's and vents) and then standard assisted living, etc. I will be floating, which makes me nervous. I will get two days of orientation for each wing. I am also afraid that I will forget all of my medsurg stuff! I kept hearing that any experience is good experience, take ltc right out of school, and then another new grad told me that she was told that once you did ltc a hospital wouldn't look at you!? Ultimately, I want to do hospice, so I think it will be ok, but I find it frustrating. One nurse recruiter at a local, smaller hospital (150 beds) said she gets 300 RN applications a week. So, a steady job with benefits sounds good right now - and those pesky loans will be rearing their heads soon. Since we did mostly hospital clinicals, and our geri clinicals were with very high functioning patients, no geri psych, no trachs, no vents or IV's in the nursing home, etc it was basically medpass and vitals for our geri clinical - what advice would you give a new grad going into ltc? Things to watch for, do, be aware of, etc? Thanks!
    Last edit by jlynn2303 on Apr 15, '11
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    About jlynn2303

    Joined: May '09; Posts: 106; Likes: 54


  3. by   Forever Sunshine
    I wish we even had that. For geri-clinical the only med-pass education I got was from an LPN who was showing another student in my group how the med-cart is organized.

    I feel like my LTC experience will be useful in the future. I know people say that but .. LTC nurses have 25-30, sometimes 40, 50 patients. Who sometimes all need our attention at the same time. So time management and prioritizing, and assessment skills are very necessary to survive in LTC. We have many residents who were just admitted from a med-surg unit and still have g-tubes, foleys, drains, b/p issues, trachs we get from time to time, wounds(either ulcers or surgical wounds), wound vac, psych issues, colostomies, iv sites, etc

    I tell people I work in a nursing home and they think all the residents do are sleep and eat. Just the opposite,, they don't sleep, they are awake(and some not behaving) most of the day and part of the night lol.. and you have to beg and plead and pray for some of them to eat.
  4. by   SarahLeeRN
    I would maybe suggest asking for more than two days orientation on each unit. In my experience it takes a bit longer than that to get to know a unit. Did you ever work as an LPN? If you are brand, brand new, (even if you aren't!) I think it would be wise to get as much orientation as possible.
  5. by   taalyn_1
    I Wish u good Luck, patience and a willingness to love the job. LTC needs GOOD RNs who want to make a difference in the specialty. LTC gets such a bad rep most of the time. Don't be afraid to be an RN, theres more to LTC than passing meds. Ask for longer orientation if you feel you need it. Don't let the aides push you around but also dont alienate them, they can be a valuable asset or your worst nightmare. Your skills will come back to you, you didn't forget anything (keep a positive attitude! ). Good luck and enjoy the experience of doing what you worked so hard to do.
  6. by   Sonnalasean
    what state and city are you in?
  7. by   iceprincess492
    My best advice is just to be patient with yourself. It takes a long time to learn everything you need to know and an even longer time to become comfortable/confident in your job. Dont be afraid to ask questions...that is the best way to learn. Dont be afraid to let your co-workers know that you don't know everything...they will be more willing to teach you if you appear to want to learn. Prepare yourself to have bad days because you are going to have them. Just remember that everyday you are learning more and becoming a better nurse, this will make it easier to return after one of your bad days.

    Enjoy the residents that you will be meeting. They are all very fascinating in their own ways. Don't let people make you feel like a "lesser nurse" because you are in LTC, it is a very challenging and rewarding job. Also, don't believe everything you hear/read about LTC's because there are some very good ones and even the not so good ones probably have a lot of very compassionate and caring nurses/staff working there.

    I have been in LTC for the lst 15 years and although that was not my life plan at all I would not change a thing about it. I love my job and love all of the residents that I have an impact on and those that have had an impact on me. Good Luck!! Hope you like it as much as I have
  8. by   wyogypsy
    Welcome to LTC nursing! First of all, you will be way behind the other nurses as far as how long it takes you to pass meds, chart, etc. Don't beat yourself up over it - after all, the rest of us were way behind when we started - it is a learning process; and each week you will find yourself getting your meds and work done in a more timely manner. You also have to take into account that residents fall, get sick, get transferred to the hospital, and die. These have a direct affect on when you can get to the rest of your work. Don't feel so rushed that you ignore when a resident, family member, or CNA tell you that there is something wrong with a resident - they deserve the time you take to assess them properly.

    All jobs have ups and downs - the best part of LTC nursing is the wonderful residents - for many we are all that they have, we are their family. You will fall in love a hundred times over and your greatest thanks are from the residents that need you so badly. It may not be spoken, but when someone's eyes light up because they see you coming on shift, and they smile, you will know you are needed and appreciated!
  9. by   Nurses-Rule1987
    As a new RN working in a short stay soon to be transitional care unit, It is a very interesting job. I just started not too long ago and I really love it. I wouldnt change nothing about my option to start work there. I am very excited, willing to learn everything so I can make a difference in my patient's life. I appreciate the comments posted here.. I find comfort and fuel to become everything the Lord has created me to be as a nurse..

    thank you.
  10. by   MrsBradyMom
    I work LTC as an LPN. Here are the biggest pointers I can give you:

    1. Ask the off-going nurse how each resident takes their meds (whole, crushed, etc.) Keep your own cheat sheet.
    2. Stock your med cart before running off down the hall.
    3. Do NOT pre-pour meds.
    4. Do NOT sign narcs out at the end of your shift. Sign as you go.
    5. Organization is key. I make a To Do list at the beginning of every shift. I draw little lines for rountine things on each pt. such as VS, BS, fluid intake etc.
    6. Chocolate goes a long way with your CNA's
    7. Expect to stay late to complete charting.
    8. Expect the first month to be overwhelming. I cried every day & swore I was not cut out for it. This too shall pass.
    9. Stock your med cart for the next nurse.
    10. I keep a seperate piece of paper with items I want to chart on. I rarely have time to chart a NN as I go & I am always afraid I am going to forget something.

    Hope this helps & maybe others have items to share!
  11. by   croppyRN
    Great advice! I too am a brand new RN beginning at a LTC/rehab facility. I find these forums to be a great source of information, and certainly a good dose of reality. I appreciate your positive, valuable advice! Thank you so much!
  12. by   jlynn2303
    Sometimes I wonder, when listening to the conversations and ranking (Hospital vs ltc, ICU vs medsurg, rn vs lpn, bsn vs adn etc) - um, what about the patients? Another pet peeve that I am developing is this focus on 'customer service'. When I interviewed for the job I got I was not asked a single nursing related question. I was asked for a customer service example. I think that people should be treated well because they are human beings and therefore deserve to be treated with respect, NOT because they are giving me money (are 'customers') Does this mean if I am not at the receiving end of a financial transaction I should not treat them well? If we are only to treat people well because they are giving us money, there is a new level of hell. Why is it becoming defined as a primarily financial/business question? Grr.
  13. by   marthyellen
    Wow I am so impressed with the all the responses. There is some great advice here.
    As for customer service:as the saying goes."No one cares how much you know until they know how much you care."
    LTC is full of people who are stressed out. The families have lots of guilt and anger and take it out on the nurses and the CNAs. There are days when family members and residents will act stupid. You have to learn to deal with this without taking it personally. Good Luck. I hope you like LTC because we can use some RNs who want to be there