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

kdhnursern · Mar 14, 2020

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!

jeanbeth, MSN, DNP, RN · Mar 15, 2020

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!

kbrn2002, ADN, RN · Mar 17, 2020

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.

Dani_Mila, BSN, RN · May 7, 2020

First off, CONGRATS. Genesis is a good company. My facility used to be owned by Genesis and I was hired by them. 31 bed unit is not bad. Are you the only one on the floor? My unit requires 2 nurses as it has 56 beds. Honestly, if I were you, I would work for about 6 months to 1 year to get that experience and get out. I do not like LTC setting because of politics and most places are for profits, meaning more money and less care. I am trying to leave LTC, but it has been taking quite a while.

jennsrn · May 19, 2020

I am not an experienced LTC nurse, but I've started my nursing career in LTC in September, so I have about 9 months experience. It's a lot of work, and I'd be lying if I said I didn't go to the bathroom and cry on multiple occasions. The patient load is high, as well as the med pass, but as you get more and more used to it, it becomes repetitive. The facility I work at considers themselves as a "SNF", so we do get some rehab patients from the community, so I have had some experience with wound vacs, IVs, colostomies, catheters, trachs, wound care, etc, but caring for these individuals is tough when you have many others as well. Sometimes I rather go work in an acute care setting and take my 5 acute patients. You would be surprised on how many LTC residents are acutely ill. I'm looking to leave to possibly go to another LTC facility and/or subacute facility, because staffing is an issue, but that is usually how it is in LTC. One nurse to 20-40 patients. No wonder they have a high turnover rate. 9 months in, and I'm already burnt out.

You'll realize that many of the residents are on many common meds, like Lasix, Eliquis, Metoprolol, Coumadin, Synthroid, psych meds, Insulin, etc, so you get used to them (like to give metoprolol with a meal). If unsure about a medication, just look it up! I wouldn't be so worried about the meds.

Nessanikki · Aug 17, 2020

Hey Issak how did everything workout with your job when you began? I myself graduated 2 years ago and because of life circumstances/divorce/small kids it made more sense for me to stay in my previous career until I could organize my family. Now than I am about to apply and enter the nursing field am I looking for a bit of advice ?

Thanks so much

ComeTogether, LPN · Sep 19, 2020

You'll be OK.

Don't be afraid to ask for more orientation if you need it.

Don't worry about late meds, you can explain being late - you can't explain giving the wrong med/dose.

Don't pick up bad habits and use your judgement. Most nurses in LTC take shortcuts, I don't care what anyone says. BUT it takes a long time to learn what shortcuts are safe to take and what ones are dangerous. If your gut is telling you to do or not to do something, listen to it.

Don't be afraid to delegate to your CNAs and don't be afraid to ask them not to interrupt you. Don't be afraid to tell anyone to "please hold" while you are preparing meds.

You'll be OK.

Dani_Mila, BSN, RN · Nov 25, 2020

I am kind of confused as to why you opted LTC? You have a Bachelors. Try the hospitals or rehab hospitals for better experience