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HELP! Old new grad in LTC need advice ASAP From LTC nurses

Geriatric   (594 Views | 3 Replies)
by lyssak lyssak (New) New

645 Profile Views; 7 Posts

Hello all nurses,

Quick background, I graduated in May 2018 (BSN RN). Got pregnant (twice :0), passed boards January 2020. Now I have a one year old and 6 week old. I applied to work per diem/part time at a nursing home down the street from me (genesis healthcare). They said I am the first new grad they ever hired. It’s a 31 bed unit with a mixture of hospice, post acute rehab, LTC, and respite care for veterans.

So long story short I am so scared. I feel I have been out of school for so long that I have lost a lot of my skills. I have no previous healthcare experience (cna/Lpn). I have 3 days of computer training and a dementia class and then I orient on the unit for a few weeks. (So they say)

I start in a few weeks. Can someone please tell me I’ll be okay LOL

In all seriousness can someone who’s a pro in LTC can you give me a list of advice on what skills I should brush up on. Common meds? Any resources I should look over (books)? What to expect? I don’t want to start orienting and look like a clueless crazy person LOL 

Any knowledge will be greatly appreciated!

thank you 


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kdhnursern specializes in LTC, WCC, MDS Coordinator.

69 Posts; 2,930 Profile Views

You will do fine. In 1995, I graduated with my BSN, passed my boards, and went to work in a LTC facility. This was also my first healthcare job so I had no previous experience. I worked a combination of LTC, skilled, and Alzheimer's (locked unit back then). You will be trained to chart on the residents and they will teach you what to chart about. It's all on computer now and mostly "fill in the blanks". Your assessment skills will be what you'll need most. In LTC, you will have more time with the resident so you are the eyes and ears of the doctor. Being a charge nurse, there will be a "team" who will give all the cares to the residents. You are going to learn a lot in LTC. Some look down their noses at nurses who work in nursing homes but I found it to be quite an education. In my years, I worked LTC, dialysis, occupational health, and management. The LTC taught me the most. Enjoy your new career. You will do fine!

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jeanbeth has 6 years experience and specializes in Gerontology, Education.

44 Posts; 1,519 Profile Views

Without knowing what issues your patients will have I suggest you watch some youtubes about Foley insertion and straight cathing, IV monitoring, guaiac testing, and tube feeding. These all greeted me on my first day. Otherwise, just go to work with an idea as to how you will access quickly info on meds and treatments (an app?). No one expects you to know all.  Good luck!

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kbrn2002 has 25 years experience as a ADN, RN and specializes in Geriatrics, Dialysis.

3,073 Posts; 29,735 Profile Views

A 31 bed unit is pretty large even by LTC standards if you are the only nurse. It'll be doable, barely as long as you have good CNA's and management.  

Expect a massive med pass. There will be a mix of residents that take meds whole without any problem, some that take them whole in pudding/applesauce and some that are crushed. You may or may not have some tube feed residents that have meds administered via their tube. There's likely some respiratory treatments as well plus a bunch of eye drops. With the huge med pass time management is key.   Most will likely be perfectly compliant with taking meds, but don't be surprised if there are a few that are a bit more difficult. You'll get to know their routines and figure out the most efficient way to get the meds done pretty soon. 

Odds are there will be a decent amount of your residents of your residents that are insulin dependent diabetics.  Know who they are so you can have your blood sugar checks done before they eat.  Hopefully you aren't saddled with a bunch of carb count residents, scheduled and sliding scale insulin are no problem but those carb counts are a stinker.  Expect some residents to be daily weights as CHF is common in LTC, the CNA's generally have them done in the morning but you will likely be responsible for documenting them and following up as needed.

There's probably going to be several treatments. While those are generally not as time sensitive they'll still have to be fit into the shift somehow. 

Somehow between getting all this done there's also family members and visitors to deal with. Various therapy departments, MD appointments that require follow up, probably order entry unless you are lucky and a ton of other daily and change of condition assessments and charting to complete. 

Plus I am sure there's a lot of out of the daily routine things that will happen.  I know it sound like a lot, and it is.  A good brain sheet will be your best friend.  

While it's not the norm at all at least short term there's going to be a lot of new policies due to the corona virus, and the established staff is going to be adjusting to that as well so you will all be in the same boat with learning  those policies and procedures.

LTC in a good facility can be one of the most rewarding jobs there is. Hopefully you are going to be working in one of the good ones. 

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