Just hired at a Skilled Nursing/LTC Facility

Guest505077 · May 26, 2011

my advice is to keep your eyes open, find one or two experienced nurses that you admire, respect their practice,knowledge, professionalism - they can be a "role model" for you

*ask lots of questions- if you don't ask (especiallly being a new grad), you might give the wrong impression- there are no "stupid" questions-don't pretend to know something if you don't

good luck with your career :)

bubblymom373 · May 26, 2011

First congratulations on your job! How exciting for you!

One of the biggest challenges you will probably face is time management. My guess would be that you will have at least 25 residents in your care at a time. When orientating ask the nurse you are with if she uses a "cheat sheet" or "brain" to organize and keep track of things during her shift. You can then either use or adapt to make your own. Watch to see if she groups her cares,treatments, meds ,assessments etc so she isn't going in rooms multiple times. When passing meds make notes if certain medications are kept separately from the others and where they are stored.

optimist · May 26, 2011

Ive been in LTC for a long time both as an aide and a nurse: a few tips

*Learn to roll with the punches. It can be a brutal job some days both physically and mentally.Take one day at a time and dont take anything too personally

*build a relationship and treasure your aides. They are the backbone of LTC. They will tell you something is wrong with your pt long before you would have caught it. If you're good to them they will return the favor (just wait for the time you have to roll that 300lb man for an enema, you will need them)

*Its okay to cry-and you will. The first time a family berates you in front of everyone, the first time someone dies on you, the first time the MD tears you a new one. Go ahead and cry

*If you believe in prayer, then pray before every shift.

*There is NO SUCH THING as 'someone elses job'. You will do everything in LTC as a nurse. Dont be the nurse that spends more time looking for someone to do the little job (ice,water,remote,bedpan) than it would actually take to do it yourself.

Good luck and congrats!

arabstarRN · May 26, 2011

Thanks for the tips everyone! I am not the type to pass along the little things, just because "it isn't my job" and that attitude annoys me lol. I know many seasoned nurses are that way, I have seen in clinicals - the nurse will walk out of the room after the patient has asked for ice water and find an aide o tell them so and so wants ice water, when she PASSED by the nutrition room herself and could have just gotten it to the patient in half the time. I am the type to ask questions and clarify what I feel I am unsure of, even if I think I have the information right, I still clarify as I want to be the best I can be. I am big on learning new skills and love new training opportunities (I am a nerd in some respects I guess hahaha) so I look forward to the inservices that this company has to offer as well. Everyone seems really friendly and the inservice director said that they try to pair up the new RNs with the most receptive RNs so that they get the best experience and learn the most about the company. I have already been through a patient dying (during my first semester in nursing school... long story short, I saw the change in him from the previous day and the nurse just kept telling me he was just confused because of his illness... he was more than just confused and my instructor agreed with me because she had been helping with him the previous day too. He died later that day) and it was tough, but it drove me to want to understand how to be there for the family more.

Anyway, Thank you for the tips, I look forward to learning more from the experienced nurses on this forum as time goes on. I can't wait to start my career in June!!!!

Forever Sunshine, ASN, RN · May 26, 2011

Thanks for the tips everyone! I am not the type to pass along the little things, just because "it isn't my job" and that attitude annoys me lol. I know many seasoned nurses are that way, I have seen in clinicals - the nurse will walk out of the room after the patient has asked for ice water and find an aide o tell them so and so wants ice water, when she PASSED by the nutrition room herself and could have just gotten it to the patient in half the time. I am the type to ask questions and clarify what I feel I am unsure of, even if I think I have the information right, I still clarify as I want to be the best I can be. I am big on learning new skills and love new training opportunities (I am a nerd in some respects I guess hahaha) so I look forward to the inservices that this company has to offer as well. Everyone seems really friendly and the inservice director said that they try to pair up the new RNs with the most receptive RNs so that they get the best experience and learn the most about the company. I have already been through a patient dying (during my first semester in nursing school... long story short, I saw the change in him from the previous day and the nurse just kept telling me he was just confused because of his illness... he was more than just confused and my instructor agreed with me because she had been helping with him the previous day too. He died later that day) and it was tough, but it drove me to want to understand how to be there for the family more.
Anyway, Thank you for the tips, I look forward to learning more from the experienced nurses on this forum as time goes on. I can't wait to start my career in June!!!!

And theres nothing wrong with getting ice water, or putting someone on the toilet quick but like I've said before.. you as the nurse have to draw the line. If you are elbow deep in charting and its 10 minutes before the end of your shift and the CNAs are waiting around.. and a call light goes off.. even if its to turn the TV off.. have them answer.

Its your job to care for the patient too but don't become a pushover when it comes to the CNAs. Appreciate what they do and how much they love the residents but there will be times when you have to pass along the little things.

CapeCodMermaid, RN · May 26, 2011

Ive been in LTC for a long time both as an aide and a nurse: a few tips
*Learn to roll with the punches. It can be a brutal job some days both physically and mentally.Take one day at a time and dont take anything too personally
*build a relationship and treasure your aides. They are the backbone of LTC. They will tell you something is wrong with your pt long before you would have caught it. If you're good to them they will return the favor (just wait for the time you have to roll that 300lb man for an enema, you will need them)
*Its okay to cry-and you will. The first time a family berates you in front of everyone, the first time someone dies on you, the first time the MD tears you a new one. Go ahead and cry
*If you believe in prayer, then pray before every shift.
*There is NO SUCH THING as 'someone elses job'. You will do everything in LTC as a nurse. Dont be the nurse that spends more time looking for someone to do the little job (ice,water,remote,bedpan) than it would actually take to do it yourself.
Good luck and congrats!

Wonderful advice. Remember, you will not learn everything in a day or a week or even a month. One of the most difficult things to learn is how to prioritize. Every resident is important but you'll learn which residents are not so stable and those who need just that little extra attention to keep them from going back to the hospital.

It's a great place to make a difference in the lives of so many people. Keep us posted on your progress.

And, I'm SO glad you are excited about starting your career as an RN in LTC and didn't see it as a poor 2nd choice to working in the hospital.

Marie13 · May 27, 2011

Congratulations! I also work in a SNF/LTC so let me know if you have any questions :)

CapeCodMermaid, RN · May 27, 2011

We were all new once. This is the best place to come for advice.

NurseLoveJoy88, ASN, RN · May 27, 2011

:ancong!:

croppyRN · May 27, 2011

Congratulations! You are about to start an exciting new chapter in your life. I should know, because I just started myself! My advice to you is to be prepared to feel overwhelmed at first. I am still in that stage, but everyone at my facility assures me that it will get better, and I believe them, because it already is, albeit a little bit at a time! The hardest part, as some others have already told you, is Time Management! It is so easy to fall behind. Do Not compare yourself to the other nurses! They have been doing this for a long time, and they've got it down. You do not, and will not for a while. Just do the best that you possibly can, and know that you will slowly improve. Who knows, you may be one of those nurses who catches on really quickly and just sail right through this early part of the job! I like your attitude about not having a problem answering call lights, getting water, etc for your residents/patients. But as another nurse mentioned, there is a fine line to walk, too. You don't want the aids to take advantage of this, and believe me, some will. On the other hand, some will be very impressed with you, and very grateful that you are "that kind of nurse". I am already thinking about bringing in some kind of treat for the CNAs in my facility, because they work their tails off, and are (or don't seem to be) very appreciated for their hard work. As others have said, PAY ATTENTION when they tell you "something isn't right" with one of your residents. In the beginning, if you are like me, you will hardly have time to breath, so busy you will be passing meds, giving insulin, etc. If something happens out of the norm for a patient, it will throw off your whole day. Try really hard to roll with it. If you fight it, you will not win. Good luck to you. I'm in Michigan, too and am happy to have found a job! It is very hard work, but rewarding, too. :nurse:

arabstarRN · May 30, 2011

CroppyRN, where in MI are you located? I definitely want to be part of the team and understand that there is the fine line to walk so that the CNA's dont take advantage of me and my helpful attitude. I am fully expecting time management to be my biggest and slowest problem haha. I will definitely keep everyone posted on my progress, I start orientation middle of June. Thank you everyone for the advice/encouragement/tips!!!!

I don't view LTC/SNF as a 2nd choice, in face I loved my Geri rotation in college. I loved putting a smile on the residents faces and giving them some company/special attention. Some of them didn't have any family that came to visit, so they were happy to have someone to just spend 5 minutes talking to. Others only saw family once a week so they too were grateful for the students who treated them like people instead of a job!

I do have a question though, is there any equipment that I should buy that a LTC/SNF may not have but that would be helpful to my practice?