LPN needs advice/tips PLEASE =)

LeChien, BSN, RN · Mar 15, 2016

My advice is to stay where you are. Most LTC facilities are understaffed which creates tons of unnecessary pressure on you.

Did you ask what the patient to nurse ratio is? Is there a med tech to help pass pills? Call out procedures?

My experience with LTC and call outs is that I would have to stay if my relief didn't show, until the DON could make it in or find a replacement, after working a 12hr shift.

Others may have had positive experiences, but I have worked in 3 LTC facilities and they are just bad news. Just my two cents.

TheCommuter, BSN, RN · Mar 16, 2016

I worked in LTC for six years, mostly as a means to an end. LTC nursing was hard, thankless, and disrespected by the rest of the healthcare community (e.g. paramedics, physicians, many acute care hospital nurses).

My advice is to go with the flow and get a feel for the person(s) who will be training you. Some welcome your questions whereas others want you to keep the hell quiet. Therefore, get a sense of the vibe the trainer is giving off before proceeding.

Good luck to you!

blessedmomma247 · Mar 16, 2016

I have been an LTC nurse since 2009 and before that I was an CNA for 8 years. I will say it takes a special person to work in LTC. As mentioned above, you will have a lot to deal with. I have worked other shifts in the past but I prefer the night shift and have worked it for years. Not everyone can do nights. It takes a toll on your body. You need a good support system...your family needs to understand to sleep during the day. You need to be strong and be able to work independently. In most cases, you are the only nurse with two aides. At my current job, when we are full, I will have 55 residents, with 20 of those on the rehab/sub-acute unit and 35 on the long term stay unit. To make my life easier I have came up with the following (this can be used on all 3 shifts):

** You must have a solid routine. I created a time line and I stick to it. ( for example...I do all my vital signs at 1 am. I complete my charting by 2am and prep my meds by 3am and start my med pass at 4 am....) I think its perfectly ok to become a tad OCD with this. I have created my own cheat sheet and its my lifesaver.

**Expect the unexpected and go with it. I have a resident who think he and his wife own the building we are in. He will come out during the night and want to know whats going on and demand to see what I am working on. I have a clip board of random papers for him. I have another resident who sees birds all the time and I have chased them out of her room many times. Same thing with spiders.

** When in doubt, send them out. Make sure you are following the patient's current POLST form and family wishes. DNR does not mean do not treat.

**You will be short staff. You will have call ins. Know you policy and procedures on call ins. And remember..chocolate goes a long way.

Ask your trainer questions. There is no such thing as dumb questions. Ask your supervisor for more training if you feel you need it.

Feel free to ask me any questions!! Good Luck!

littlespitfire · May 5, 2016

1. Keep that enthusiasm! If you think it'll suck, it will. It can ALWAYS get worse.

2. Don't get your CNAs mad at you... Trust me. I've seen how much help they give the nurses who bark orders and treat them like crap and refuse to answer lights. Your CNAs will make your shift great or awful. Love them. Help them. They know those residents better than you do.

3. Don't hate on other shifts. Each shift has its challenges.

4. Be flexible. I pick up part shifts or come in early if my day nurses have a family thing or or an emergency. So if I'm stuck, since I help out, they help me. If you don't offer to help your coworkers, they won't offer to help you. I'll even go to another unit and help if someone's declining and the nurse needs extra hands. We all have portable phones, my aides can page if they need me.

5. Food goes a long way. We have cake night where someone brings in a cake, and we line up all the med carts and bleach wipe everything and audit. I like to bring in "everybody doesn't suck pizza" every so often. 4 hot n readys can boost morale like you wouldn't believe... We have one nurse who brings in large coffee for everyone, one who will buy Taco Bell, another who's a magician with a crock pot... Even a bag of chips to munch while charting is fabulous. Nothing's worse than a hangry nurse.

6. Stay humble. There will always be something you don't know.

7. Be friends with your crash cart... Go through it on your down time so you know that baby inside and out. Learn how to hook up the suction. Look at your blood draw and Iv start kits.

8. Ask other nurses if you can come help with procedures. Does it necessarily take 2 people to straight cath? No. But you'll see much more anatomical differences.

9. Always make sure you check your meds. Sign date and check off important stuff on Iv bags. I like to check next to pt name, Iv solution, drug added and underline flow rate. That way I can guarantee I checked it, pharmacy makes mistakes. Check drug cards... If pharm fills a 200mg metoprolol order with a card of 50's, giving one isn't going to help anyone. I highlight in pink any different dosing.

10. We also have a "when in doubt, ship em out" unwritten rule. I'd rather be in sh!t for sending a patient when doc doesn't page back, than be in trouble for someone dying because something got missed. If you're paging a doc after hours, it's something major and probably life threatening anyway.

11. Ask your nurses what docs like to hear when you call them for things like positive ua's, abnormal labs, decline in condition. Always have recent MANUAL vitals. Keep the chart infront of you. Don't be afraid to carry it to the cart of you need to be there and you're waiting for a page back. Ask what labs they like to order. I have one who always wants a cbc with diff, so when he says just cbc we know what he wants.

12. Be nice to ems. We had the same crew that came to our facility... They work the same nights I do. I got the one grumpy guy to laugh and now he's not so tense and angry when he rolls in our doors. Sometimes we even share our food if they're dropping off instead of picking up.

13. Write detailed communications to docs with a clear intention. One doc complains about the facility he goes to where the nurses just write pt needs to be seen for x. He would rather see "pt has increased edema, weight increased by x in 2 days, lung sounds are x, no diuretics ordered. Vitals xyz. Please advise, thanks!"

14. Ask for help. Ask for input and opinions. Someone may have an off the wall tip from way back in the day. Or spot something you don't. And that's ok.

15. Every human body has an anomaly, it's just a matter of whether or not it's been found or is problematic. A surgeon told me that.

16. Don't be afraid of chest compressions. If you're starting them, your patient has no vital signs. They're dead. Dead people cant feel pain. You're going to break some ribs if you do it right. That ones courtesy of a paramedic when I was in nursing school.

17. "Textbook" presentations are for nursing school and tv. You'll see off the wall symptoms that in a roundabout way all correlate.

18... This ones a biggie. Know you can vent. You can lose your mind. Cry. Know who's safe to do that with. Any nurse who says she's never cried at work is either a freak of nature or lying. We see death. We sit with patients waiting for that last breath. We get screamed at by families. We see horrible dynamics play out in front of us. Our job can be as heartbreaking and soul crushing as it can be joyous. Joke. It's ok.

19. Doctors have bad days. They have families. They have days they're not on call. They have emergencies in their personal lives. They're human. Even the ones that forget that last bit.

20. Let your trainer train you, but also offer to help. Jump in with both feet and know you'll be ok. You'll probably be on the fringes until the regular staff can be confident in you. It's ok. They don't hate you, they want to know you can hold your own. If you help your trainer, she will help you back. And other nurses will trust you because she does. Or even better, see if you can train with a few different people!

Thats long... And that's all I've got :) you'll do fine! Always cover your a**, chin up buttercup, shake it off, keep on trucking... And all those other platitudes.

lpn92211 · May 6, 2016

1. Keep that enthusiasm! If you think it'll suck, it will. It can ALWAYS get worse.
2. Don't get your CNAs mad at you... Trust me. I've seen how much help they give the nurses who bark orders and treat them like crap and refuse to answer lights. Your CNAs will make your shift great or awful. Love them. Help them. They know those residents better than you do.
3. Don't hate on other shifts. Each shift has its challenges.
4. Be flexible. I pick up part shifts or come in early if my day nurses have a family thing or or an emergency. So if I'm stuck, since I help out, they help me. If you don't offer to help your coworkers, they won't offer to help you. I'll even go to another unit and help if someone's declining and the nurse needs extra hands. We all have portable phones, my aides can page if they need me.
5. Food goes a long way. We have cake night where someone brings in a cake, and we line up all the med carts and bleach wipe everything and audit. I like to bring in "everybody doesn't suck pizza" every so often. 4 hot n readys can boost morale like you wouldn't believe... We have one nurse who brings in large coffee for everyone, one who will buy Taco Bell, another who's a magician with a crock pot... Even a bag of chips to munch while charting is fabulous. Nothing's worse than a hangry nurse.
6. Stay humble. There will always be something you don't know.
7. Be friends with your crash cart... Go through it on your down time so you know that baby inside and out. Learn how to hook up the suction. Look at your blood draw and Iv start kits.
8. Ask other nurses if you can come help with procedures. Does it necessarily take 2 people to straight cath? No. But you'll see much more anatomical differences.
9. Always make sure you check your meds. Sign date and check off important stuff on Iv bags. I like to check next to pt name, Iv solution, drug added and underline flow rate. That way I can guarantee I checked it, pharmacy makes mistakes. Check drug cards... If pharm fills a 200mg metoprolol order with a card of 50's, giving one isn't going to help anyone. I highlight in pink any different dosing.
10. We also have a "when in doubt, ship em out" unwritten rule. I'd rather be in sh!t for sending a patient when doc doesn't page back, than be in trouble for someone dying because something got missed. If you're paging a doc after hours, it's something major and probably life threatening anyway.
11. Ask your nurses what docs like to hear when you call them for things like positive ua's, abnormal labs, decline in condition. Always have recent MANUAL vitals. Keep the chart infront of you. Don't be afraid to carry it to the cart of you need to be there and you're waiting for a page back. Ask what labs they like to order. I have one who always wants a cbc with diff, so when he says just cbc we know what he wants.
12. Be nice to ems. We had the same crew that came to our facility... They work the same nights I do. I got the one grumpy guy to laugh and now he's not so tense and angry when he rolls in our doors. Sometimes we even share our food if they're dropping off instead of picking up.
13. Write detailed communications to docs with a clear intention. One doc complains about the facility he goes to where the nurses just write pt needs to be seen for x. He would rather see "pt has increased edema, weight increased by x in 2 days, lung sounds are x, no diuretics ordered. Vitals xyz. Please advise, thanks!"
14. Ask for help. Ask for input and opinions. Someone may have an off the wall tip from way back in the day. Or spot something you don't. And that's ok.
15. Every human body has an anomaly, it's just a matter of whether or not it's been found or is problematic. A surgeon told me that.
16. Don't be afraid of chest compressions. If you're starting them, your patient has no vital signs. They're dead. Dead people cant feel pain. You're going to break some ribs if you do it right. That ones courtesy of a paramedic when I was in nursing school.
17. "Textbook" presentations are for nursing school and tv. You'll see off the wall symptoms that in a roundabout way all correlate.
18... This ones a biggie. Know you can vent. You can lose your mind. Cry. Know who's safe to do that with. Any nurse who says she's never cried at work is either a freak of nature or lying. We see death. We sit with patients waiting for that last breath. We get screamed at by families. We see horrible dynamics play out in front of us. Our job can be as heartbreaking and soul crushing as it can be joyous. Joke. It's ok.
19. Doctors have bad days. They have families. They have days they're not on call. They have emergencies in their personal lives. They're human. Even the ones that forget that last bit.
20. Let your trainer train you, but also offer to help. Jump in with both feet and know you'll be ok. You'll probably be on the fringes until the regular staff can be confident in you. It's ok. They don't hate you, they want to know you can hold your own. If you help your trainer, she will help you back. And other nurses will trust you because she does. Or even better, see if you can train with a few different people!
Thats long... And that's all I've got :) you'll do fine! Always cover your a**, chin up buttercup, shake it off, keep on trucking... And all those other platitudes.

Thank you so much!!!! I am a month in a doing well. I love my patients and my co-workers. I have smoothed out my routine for med passes and treatments and I am not shy about asking questions. Your tips/advice are wonderful. =)