Guide to first job in LTC!

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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.

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Thank you, so much! I just got hired at a LTC and will start this week after my fingerprinting check comes back. This is awesome and I'm so nervous! I just want to do the best job I can do for the patients in my care!

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Quick question. I've worked in Med/Surg for the last two months as a new grad, but due to low census their talking lay-offs...soooo I have an opportunity right now for a LTC position on days with 1:40/50 pt. ratio. I will be a charge with a med-aid, treatment nurse, and two CNA's. Does this sound doable for a new grad? I've never worked LTC before so I'm not sure myself. Thanks for your advice!!

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@Hopefull 1..DO NOT!

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This is so helpful! Thanks!

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This very much needed. Thank you so much @ KRODD

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Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

Thank you, Krodd! I'm in LVN school now so I will save a copy of these tips.

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Specializes in Psych, LTC/SNF, Rehab, Corrections.

1. If you work psych LTC (or a lockdown facility)...get comfortable 'running' shoes. The dementia pts (and similarly disordered) are always looking for a way out. I have two people who walk the halls all day long.

They remind me of the velociraptors from Jurassic Park. Systematically checking the doors for 'weakness'.

2. Get copies of all forms + paperwork and put it in a folder. When you need a copy? You'll probably have to search for one and it'll never be there.

I've learned that, if given a choice between making a few copies and using the original? A fair amt of my coworkers will choose the latter and you can't say, 'Oh, I didn't do that b/c I didn't have the forms...' You'll get dinged, regardless.

3. Get your own equipment. It's fine to share, but you DO need YOUR OWN:

- black pen

- black marker

- BP cuff

- steth

- thermometer

- WATCH

- O2 Sat monitor.

4. Carry a mini note pad. You'll have to learn procedure quick, fast and in a hurry. Phone numbers. Directions. Who to call. That's the most difficult thing: THE PAPERWORK.

Take notes.

Also, so many things happen during the course of the day...it helps to jot notes down as they occur. When you sit down, you'll be able to recall who you had to chart on, who you have to call and whatever else happened that day if you've written it down. Like, "Oh, yeah...Mr Jay had SOB today." Chart on that. Or, 'Oh, yeah...Ms Jenny fell again...what time was that? " Looks to notes. "Oh, right - 1145p."

I'm also the sticky note queen.

On a stack of papers, I'll slap a note on that says, 'This is Medchica's mess'.

It's a good identifier and keeps things orderly at the front desk.

5. Keep one 'dirty' pocket and one 'clean' pocket.

- The 'dirty' pocket? I keep my car keys, alcohol wipes, O2 Sat, sticky notes, notepad, marker, pen and LPN flip book/manual, etc....

- The 'clean' pocket? Gloves. Don't put anything in there BUT gloves. You never know when you'll have to assist or render aid or pick someone up or deal with some 'doo-doo'. Having gloves 'on hand', saves time.

- I keep my steth in my lower pants pocket. Someone's always falling or trying to die, so it makes sense that I'd keep something like on me at all times.

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