what's it like working at a LTC facility ?

xtxrn, ASN, RN · Sep 2, 2011

Different facilities have different sorts of patients- not all have Medicare, not all have locked Alzheimers units....BUT, you will likely have 12-20 residents to give meds to, do treatments on, chart on (Medicare especially, but anything out of the ordinary). You will supervise the CNAs assigned to your patients. It's busy, but you get your own routine (and it may take some time to feel like you're on top of things- that's normal :)).

The residents can be wonderful- and it's easy to get attached. It can be really hard when they die- as many will over the course of the year. It's ok to feel lousy and even cry. Families can be really great- or some can be a pain- but most all want the same thing- care for their loved one.

HUGE things to remember- hydration is massively important. Skin checks are critical (most places have a schedule). Weight loss is a big issue. These are things that the state (and a lot of lawyers) focus on. The state health department will be in every year for a "full book" survey, where they go through everything. They also come when there has been a complaint. Your biggest ally with that is good documentation and following policy at the facility.

Don't be afraid to call a doc- do what you have to do to take care of the resident. :) And chart everything - give meds correctly (do NOT sign them out before you give them - if you get plucked from the earth by giant monkeys, you don't want to have meds charted as given that weren't.....Do not set them up ahead of time- ever. Don't sign them out ALL at the end of the shift- monkeys may come back :) Always do things according to policy- not "because that's how we've always done it"....if you get called out on something, and were following policy, that's one less thing to worry about. :)

Plan on feeling overwhelmed or a little lost - it's part of being new anywhere

Enjoy your new job :clown:

lvloverRN · Sep 2, 2011

thank you so much xtxrn that helps...what do you mean by "if you get plucked from the earth by giant monkeys" ?

xtxrn, ASN, RN · Sep 2, 2011

If something unexpected happens :)

PchezRN · Sep 2, 2011

I work in a skilled nursing facility where the nurse/pt ratio is 24:1. I think xtxrn said it beautifully and I could not have said it better! I do agree with the fact that it will feel a bit overwhelming at first, but you have to give yourself time to adapt to the facility, policies & procedures, docs and how they work, your management, STNA/CNA's, admission/discharges, and all the paperwork inbetween. How much orientation are they going to provide you with? My facility gives 3 days new grad or not (which I think is a crock). It is a lot to soak in at first, but you WILL develop your own "routine" and way of doing things, which will in turn make the job much more manageable. Best advice I can give is to be a team player from day one...and make sure you have your STNA/CNA's on your side...cause they can make your life a living h*ll if they want to. Just go in with an open mind, willingness to learn, and a go-getter attitude and you should be fine. Once you have gotten around a year of experience under your belt, it will be much easier to find a job in a hospital setting. Good luck to you!

lvloverRN · Sep 2, 2011

If something unexpected happens :)

oh thank you =) english is my 2nd language ... appreciate it.

lvloverRN · Sep 2, 2011

I work in a skilled nursing facility where the nurse/pt ratio is 24:1. I think xtxrn said it beautifully and I could not have said it better! I do agree with the fact that it will feel a bit overwhelming at first, but you have to give yourself time to adapt to the facility, policies & procedures, docs and how they work, your management, STNA/CNA's, admission/discharges, and all the paperwork inbetween. How much orientation are they going to provide you with? My facility gives 3 days new grad or not (which I think is a crock). It is a lot to soak in at first, but you WILL develop your own "routine" and way of doing things, which will in turn make the job much more manageable. Best advice I can give is to be a team player from day one...and make sure you have your STNA/CNA's on your side...cause they can make your life a living h*ll if they want to. Just go in with an open mind, willingness to learn, and a go-getter attitude and you should be fine. Once you have gotten around a year of experience under your belt, it will be much easier to find a job in a hospital setting. Good luck to you!

oh wow... i have a 3day orientation next week and will be with a preceptor for 2weeks..i hope to be able to grasp everything during those times.... and just go as you said w/ a positive attitude.. thanks a lot..really appreciate it!!

PchezRN · Sep 2, 2011

Well I would imagine that the 3 day orientation probably consists of new-hire paperwork, videos you'll need to watch, learning about the facility, paperwork, etc, but the 2 weeks with a preceptor will be where you are actually passing meds, doing tx's, putting orders in, and learning more about there computer system and paperwork. Sounds like it will be a good amount of orientation for you. We hired a new grad who got 3 days orientation/preceptor all together and she quit in her first month. I don't think it is fair to give a new grad 3 days and throw them to the wolves...IMO anyways.

lvloverRN · Sep 2, 2011

Well I would imagine that the 3 day orientation probably consists of new-hire paperwork, videos you'll need to watch, learning about the facility, paperwork, etc, but the 2 weeks with a preceptor will be where you are actually passing meds, doing tx's, putting orders in, and learning more about there computer system and paperwork. Sounds like it will be a good amount of orientation for you. We hired a new grad who got 3 days orientation/preceptor all together and she quit in her first month. I don't think it is fair to give a new grad 3 days and throw them to the wolves...IMO anyways.

ok great...atleast its something to be thankful for .. i just want to be prepared as much as i can...

may i ask what i should keep handy w/ me besides the usual stethoscops, a good pen and a pair of scissors?

how about working 2nd shift? anything special about a 3-11 shift i shld look out for?

thanks again.

Hospice Nurse LPN, BSN, RN · Sep 2, 2011

xtxrn always gives such good, thoughtful answers. :redbeathe

nola1202 · Sep 2, 2011

be prepared to be promised a lot of support and orientation, then be thrown to the wolves. Don't take it personally, it happens to all of us. Just know there are a lot of people who know what it's like who will stop and help you. good luck, better to go in with your eyes open. :)

PchezRN · Sep 2, 2011

Things I always carry with me are a stethoscope, tape, tiny bottle of hand sanitizer, black sharpie marker, yellow highlighter(for d/c meds), couple good pens, scissors, and a pen light(falls=neuro checks). I also have what I like to call my "nurses brains" which is a sheet I made out on the computer with all 24 rooms(# of pt's I have anyways), to help keep me organized throughout the day. I write down any pertinent data on it, plus anything I know i'll need to remember for charting purposes.