Guide to first job in LTC!

I am writing this as I see this questions asked quite frequently on this thread of the forum as well as the LTC specialties thread in on this forum. Maybe it'd be nice to see it stickied.

What to do

1. If you can if your facility allows buy a automatic blood pressure cuff/monitor (I recommend a omron wrist model). Trust me the convience of these is a borderline must! *If you hear the whole "You know there not accurate" comment just assure them that before you hold a medication you will varify the read with a manual reading (which you should do anyway). ***Also important learn the proper way to apply and work your automatic BP monitor.

2. Starting on you first day taking notes either on your smart phone or the old fashion pen and note pad. Some key notes to take:

-a shift flow what to do and what time to do it on all shifts!

- key stuff phone numbers, door codes policies anything med pass times ect.

- a list of your mistakes/stuff you need to improve on. Update this frequently! (you need to know where you need improvement)

3. Don't come in with your nose up in the air please! Don't alienate your self from the staff, women can be catty enough and walking in and acting like your know better than Nightingale herself wont make you any allies.

4. Watch your NARCS!!! and your keys! This also includes med counts, make sure there's two nurses doing them. A Unfortunate part of our business nurses who steal narcs and get there fix. Also if someone claims a narc is or was Dc'd make sure you see the order.

5. Make sure you cart is locked and MAR/TAR are not open in a way that violates HIPPA!

6. Wash your hands and use gloves when appropriate develope good habits.

7. Get comfortable shoes!

8. Work off of your census sheet my method:

I use a 4 color pen for convience,

one black check mark next to a Pt. name=first med pass done (9am or 5pm)

one blue check mark next to pt. name =second med pass done if needed (1pm or 9pm)

A red check mark some med not given yet/something still needed

A red X next to any empty rooms

A red R next to pt. name= meds refused

(the following four try to write before you start your med pass try to get the info in your report)

BS in black= first blood sugar (7:30am or 4:30pm)

BS in blue= second blood sugar (11:30 am or 8:30pm)

BP in black=a early blood pressure (9am,5pm)

BP in blue= a later Blood pressure (1pm,9pm)

Also try get the info on whether your pt. take there meds crushed or whole

either a C or W next to the pt. names to "designate" them

red NN=Nurse Note or charting needed basically anything needed a Lab, Treatment, orders needed to be "picked up" write in red when its taken care of a green check over to show yourself you did it.

LAX in red=lax list when laxative administered a green check mark over it

this looks like a lot of info easy way to remember black=early, blue=later red=important/different, green=done

Trust me all this keeps me organized I can look at my census sheet and exactly

9. Remember your three checks!

10. Double if not triple check your MARS and TARS to make sure you didnt miss anything either administered or document make sure you mark or date the med cards so you can go back and check whether you infact missed giving or missed documenting the med.

11. Learn how to chart! If I may suggest a book ''CHART SMART'' or ''MOSBYS SUREFIRE DOCUMENTATION''. Also learn from your coworkers learn short hand.

Some tricks

C/O = complaints of (no C/O pain)

S/Sx=signs and symptoms (no s/sx of distress/pain/ect.)

N/O=new order

V/S=vital signs

Safety Maintained

will continue to monitor

11. This is the most important suggestion and it so easy, but not always practiced

''PUT THE PATIENT FIRST''

"I don't want to get in trouble", "I don't want to lose my license", "I don't want to get in trouble", "I don't want the doctor to yell at me" all these have I putting yourself first and not the Pt. Now obviously don't do anything to endanger your Pt. and don't work out of your scope but your primary duties is to be a advocate and the safety and well being of your PT. is always paramount.

Good luck! You'll Rock its like anything once you get it you can do it in your sleep.