Give me some tips for LTC- up to 40 pts at a time!

SunnyAndrsn · Jul 27, 2009

Give me your best tips, nurses!
I start a RN job in LTC in one week, and I will orientate on all 3 shifts. I had, at the most 3 in clinicals, and since this is my first job, give me an idea of what my day will be like, and how to organize what I need to do. I am told med passes for up to 24 on days, and care for up to 40 on midnights. It sounds extremely overwhelming with just a 10 day orientation.
I appreciate your advise!
Heather

1. Staple two report sheets back to back, one for the current shifts report, and you can also put your treatments, who needs VS, blood sugar checks, and times of medications. Use the second sheet for your report.

2. Take 10 min. to go through the treatment books to make sure you don't miss a treatment, and then to stock your cart before you head on down your wing.

3. Carry scissors, a sharpie, nail clippers, skin prep wipes, and alcohol wipes in your pocket.

4. Consider carrying the treatment book with you as you go through your med pass. Check the treatments as you go...

5. Do your skin checks, alarm checks (pressure pad or tab alarm), check for proper cushions, wanderguard placement, etc as you do your med pass. A good once over on each pt. will save lots of time and running.

6. Delegate, delegate, delegate.

7. Don't let your CNA's walk all over you because your new--some will try, some won't. Fair warning!

8. Keep a box of gloves and kleenax on your cart.

9. Keep a BP cuff and your stethescope with your cart.

10. Check your cart for stock meds, syringes, and needed treatments before you start.

11. Take detailed notes on your clean report sheet to chart from.

I'm a big B***h when it comes to room order, making sure pts. nails are clean and clipped, and that all pts. (including women) are shaved. These things are the things that visitors seem to notice the most, and leave a lasting impression.

Good luck to you! Your orientation is about the same length as mine, I think I might have been a day or two shorter--it took a few months to feel comfortable with the routine, and a few more to feel confident.

TheCommuter, BSN, RN · Jul 28, 2009

Moved to the LTC forum. Good luck to you!

LockportRN · Jul 28, 2009

First, take a deep breathe! When I went from working in the hospital with 4 patients then went to LTC with 50 patients, I couldn't breathe. I did not know where to start or how in the world I could do it. What I didn't realize is that in the hospital, it was total patient care. The aides really only were transporters and filled stock. The nurses did everything else for the patient. In LTC, you have CNA's. It was the wonderful CNA's that I worked with that got me through.

ON the first day, I arrived at work. Got report and completed the CNA assignment sheet, which included telling them which residents I needed full vitals on, which needed only temps/BP's etc. Who I would need specimens from (you'll know from your report) etc.

Then I called the CNA's over and told them what I would need and gave them a 'mini-report' which they expressed gratitude and surprise (apparently this was not done by any nurse prior).

Generally, the CNA's do a quick round to check that all residents have alarms in place and are safe and to see to any immediate needs, then they stock their carts, and answer call lights. So I told them that when they did their first rounds that I would go with them. At first, they were very suspiscious of me thinking that I either did not trust them or that I wanted to 'catch them doing something wrong and get them in trouble'. I explained that I did not know any of these residents and that by watching them interact I could better know who was Alert and Oriented and who wasn't so if I ran into a confused resident that normally is not, I would know that there was a medical issue that would need immediate attention. The same goes, if I came across a resident in my rounds that was telling me something that seemed rational but knowing that they have dementia or a brain injury and are not reliable historians, I would definitely treat them in a different manner. Once they understood this, they were more than willing to open up and offer me info.

Another plus of doing the first rounds with the CNA's is that you get to see the residents bodies without having to disturb their sleep, wake up the roommate, cause sleep deprivation and disorientation and possibly a fall. I used this time also to complete my treatments, often helping the CNA's giving care so all of our jobs went much more quickly with much less distress to the residents. You just want to ensure that u have all the equipment that you'll need with u and work fast as there are so many patients to see. But if you work with the CNA's they'll work with you.

Another plus of this system is that you will come across residents once they are awake and do a quick assessment of them (no not like in nursing school when u only had 2 patients at a time, but don't worry and trust yourself. You will get really good at this, just think when you walk in and introduce yourself, do they answer back? HOH? Can they speak? Do they appear in resp distress? If you shcke their hand or touch their arm for BP is their skin warm and dry with good turgor? Dry? Moist? Diaphoretic? See what I mean, just use your senses, take your report sheet (see first post) and write down what u see.

Also, esp on the noc shift, you'll often come across those that c/o headache or generalized pain or inability to sleep. Often they request Tylenol or a sleeper. Sleepers are really frowned upon in LTC (they cause falls) but often a snack or a simple Tylenol usually helps. If you are smart enought to check with them at this time and address it now, it will save your feet, and your CNA's feet as well as help to keep the other residents from being wakened by the call lights that seem to always go on the minute you leave the room just to ask for the aforementioned intervention!

I also made sure that I knew where the policy books were as well as the nusing journals that showed any procedure that I may have to do that I was not quite 100% confident in, I could quickly look it up to refresh myself, prior to going to complete the procedure. This really helped, esp on nocs if the other nurse in the facility called off leaving me alone and fairly inexperienced.

In my situation, the ADON, gave me her home phone number to use if I needed to which I rarely did but she would call me every morning before she came in to work to see how 'we' did that noc. She was awesome!

Like the first poster wrote, you have to get your own routine down, once you do, things will go smoother. As for knowing everything (which I thought was mandatory when I started) you never will. As long as you know where to find the answers, where you can go or who to ask, you'll be fine! I wish you luck and please post back so we can track your progress!

locolorenzo22, BSN, RN · Jul 28, 2009

Personally, after I get report, I check and see who I need 8PM sugars on...take those as I see them, take 15 minutes to see who has major treatments vs creams or changing o2 tubing, etc....and then I'll start at one end and go to the other...now there are times where someone has to jump ahead due to needing pain meds, or scheduled nebs, or PD, or a antibiotic....but it depends.. I work 12hrs at night, with a max of 22 patients...but as the RN, I'm charge for everyone if there is only another LPN with me.

just take a breath and realize it may take a lot of time to learn how to do things...

make SURE to learn what to fill out/do in case of falls or needing to send someone to the ER, and make sure that you learn the charting system and how to do admissions! good luck!

4treasures · Jul 28, 2009

Thank you for your ideas, I am taking them down, and I will definatly try them!

Heather