How much orientation did you get as a new grad Lvn?

vintagemother, BSN, CNA, LVN, RN · Apr 17, 2014

I haven't worked in a true SNF as a new grad. One place was an ALF... Non medical. I received about 3 wks full time.

I didn't stay there long so was still a new grad for my next job at an inpatient psych, LTC. Here I get 4-5 days to orient on each shift.

My best friend works in a SNF. I know there's a new lady there who was put alone on her first night.

The good news is you probably know how to do 90-95% of the work because of what you learned on school. A longer orientation benefits you because you learn how the residents like things done, and how the facility operates.

As a new grad, the most challenging thing is speed (ie passing meds , documenting and charting in the limited time allowed), in my opinion. The other big challenge is learning who each patient is ( if you have wrist bands this isn't as much of a Problem) If your boss understands you may need to stay after (and work overtime) to complete your charting and paperwork, then you will probably be ok.

I'm looking forward to seeing what other new grads have to say about this issue!

SWM2009 · Apr 17, 2014

I got 3 weeks of orientation, 1 week on AM shift then 2 weeks on PM shift, the shift I was hired for. I still felt like I needed more orientation when I hit the floor alone. I can't even imagine having just a day or two of orientation.

SquishyRN, BSN, RN · Apr 17, 2014

The good news is you probably know how to do 90-95% of the work because of what you learned on school.

Nope. Not at all. More like the opposite. 90-95% of what you do was never taught in school. The number one skill in LTC is time management. In school you pass meds to about 2-5 patients? In LTC 20+ in the same amount of time. In school you don't really learn to chart. The charting taught in school is superfluous compared to what you'll need in LTC. In LTC you do targeted daily charting. And Medicare charting has its own rules as well. In school you're not taught how to do discharges, admissions, handle family, etc. School does not prepare you for real world nursing. Especially in LTC.

As a new grad LVN at a SNF I had 1 day of paperwork/general tour and 2 days on the floor before I was on my own. I had 45 patients on the station that I wasn’t oriented on. I had zero health care experience before this. I didn’t know any of the patients. I was still passing AM meds at noon. I cried at the end of my first day. I almost cried almost everyday. I dreaded going to work for at least the first 6 months. I was only per diem, but I hated hearing the phone ring. My first thought whenever I'd hear the phone ring was "What did I do now?" I'd be called in almost every other shift I worked to do a late entry to fix my charting. I messed up A LOT. My biggest mistake happened 1 month into being on my own. A patient fell and I told the RN supervisor. I asked what am I supposed to do and she said, “Don’t worry about it,” so I just continued my med pass after helping the patient back in her bed. The supervisor assumed I knew what I was supposed to do. She assumed I knew I was to call the MD, chart, and do an incident report. I didn’t know I was supposed to do any of that. I thought reporting to the supervisor was what I was supposed to do and they would take care of it. That’s all we had to do in school after all. As students, we aren’t responsible for the patient at the end of the day. If a patient fell, we told the nurse and they took care of it. But as students we never actually learned what the nurse did. All the paperwork that had to be done. All the monitoring that had to ensue. So, no, 90-95% of the work is not learned in school. I got me and the supervisor suspended for 2 weeks because of that. I’m lucky I didn’t get fired.

With only 3 days orientation, I “survived” my first year. But nursing shouldn’t be about “surviving.” But in today’s employment climate, you take what you can get. Definitely try to get more days, but if you absolutely can’t, good luck to you.

Here are some old threads that may be helpful:

Here I wrote a step by step of my work day in LTC: https://allnurses.com/lpn-lvn-corner/new-grad-first-810713.html

Here’s an article by TheCommuter for LTC charting: https://allnurses.com/geriatric-nurses-ltc/ltc-charting-beginners-899111.html

Here I wrote LTC charting examples: https://allnurses.com/lpn-lvn-corner/how-read-document-889303.html

TheCommuter wrote how to carry out an order: https://allnurses.com/geriatric-nurses-ltc/ltc-617067.html

Thread about other new grad experiences in LTC: https://allnurses.com/lpn-lvn-corner/what-school-does-884574.html

And just some general advice:

* Do not get overwhelmed by worrying about getting your med pass done on time. You are new. You WILL be slow. Focus more on getting the right med to the right patient. Do not cut corners to speed up your med pass. I’ve seen plenty of new grads get flustered because they’re late, make a serious med error, and then get fired. Don’t be one of those.

* Do not be afraid to ask “stupid” questions. Assume that people assume you know what you’re doing. Make it clear that you don’t. VERY clear. That was the mistake I made with the patient fall. I should’ve asked what to do specifically. Like step by step specifically. Do not accept a vague answer like I did. Assume everything is your responsibility. Because in LTC, it is.

OrganizedChaos, LVN · Apr 17, 2014

It varied, between a couple days to 2 weeks. My LTC experience sounds the same as the PPs & I also had no prior healthcare experience.

My first job out of nursing school was in LTC. I got maybe a week of orientation but I was so not ready to handle a whole hall all to myself. I always tried my best. But apparently it wasn't good enough to the DON, who verbally attacked me in front of a family member. Later that same day she fired me.

The last LTC job I worked I could tell from the get go they didn't like me/want me there. Orientation was scant & even though I had some nursing experience, I still wasn't 100% on how to do things at that facility. I was constantly called into the ADON/DONs office. The finally the DON fired me...over the phone.

But don't let my experiences affect you. If you have great coworkers & an understanding boss it will make things easier. Good luck!

mandaq4 · Apr 17, 2014

I couldn't agree with you more about learning everything on the floor vs school.. Thank you for your post! Kinda put me at ease.. We are a rehab/transitional care averaging 180 admissions and discharges a month so I will never really know the patients for very long.. I'll do my best tonight, med pass isn't my issue, I was lucky enough to get plenty of med pass experience in school I was at a snf majority of my reparations. Documentation is what is gonna get me.. I will review your links and I'm sure they will help. Thank you!

Fiona59 · Apr 17, 2014

Fresh new grad, got 3 buddied days on the floor and then I was on my own. Orientation is about learning the unit routines and paperwork knot developing your skills. You should be familiar with catheter insertion, basic wound care and med passes for LTC.

When I moved to Active Treatment it was 3 days and 2 evenings to learn the unit routines.

LTCNS, LPN · Apr 18, 2014

Fresh grad with my license in my hand for one day. Was hired on the spot at a LTC and got 1/2 day orientation because someone had to go home and I had to fill in the rest of the shift. After that I was completely on my own because the home was so short staffed they had no choice but to throw me to the wolves. It was sink or swim but I pushed through and ended up staying at that facility for one year. That was in 1996.

NurseQT · Apr 18, 2014

My first job as a CNA was in a hospital I was orientation for 4 weeks, I was paired up with a preceptor the entire time and was more than comfortable to be on my own when my orientation period ended. When I got my first nursing position I was again on orientation for about 3 weeks. Next job I had at least two weeks. My last job, I had 3 shifts and no general orientation. I told them that I was not ready to be on my own and I was told "tough". After a year there were still things I didn't know how to do. An orientation of only a few days is not right and only setting the nurse up for failure. I think a nurse should be given a week in each hall as well as some time of just computer training. A nurse should be able to work the hall with little to assistance before they come off orientation. And that nurse should never be counted as an available nurse for the shift while they are on orientation.

TheCommuter, BSN, RN · Apr 18, 2014

I'm just curious to see how much orientation everyone got before they started alone as an LVN..

I was a new grad LVN in 2006. I received one 8-hour shift of orientation in LTC/SNF before being cut loose to work by myself.

andreasmom02 · Apr 18, 2014

I was a new grad LVN in 2006. I received one 8-hour shift of orientation in LTC/SNF before being cut loose to work by myself.

Ditto, My first LPN job was in a LTC facility. I got 8 hours of training from a "foul mouthed LPN", who showed up for work in street clothes to supposedly "train me". I'd later heard she was fired for stealing narcotics from the place. I lasted four shifts in that nightmare facility before quitting. I hope things go better for you...

eeffoc_emmig · Apr 18, 2014

3 days. With a nurse that took way too many and too long smoke breaks. I spent more time sitting and waiting for her to get back on the floor.