LTC Emergencies - Not prepared!

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I was just hired two weeks ago at a LTC facility and am just completing my orientation. Will be flying solo very soon and am very nervous. There is so much to remember, and so much to do. As a new graduate, I feel very unprepared to handle emergencies, such as "codes", etc. In fact, I've never even done one. I wouldn't even know what to do with the crash cart. This was NOT part of my orientation. It never even occurred to me, so overwhelmed I was with just the whole med pass thing. Does anyone have any advice, and/or experience in their job with these types of emergencies? How did you handle them? I'm terrified that everyone will be looking to me and I will be like a deer in the headlights. Please help me if you can! :eek:

Specializes in Med/Surg, Tele, Dialysis, Hospice.

If your facility doesn't have a good policy in place for knowing in an instant what a resident's code status is, then take it up with your DON immediately. Something like a bright pink sticker on the cover of the patien'ts chart if they are a full code, whatever, just a system where you know where to glance and in an instant know if you need to call a code or send them out or just call the family.

I just left a facility that had no clear system in place where a nurse or CNA could know a resident's code status at an instant's notice, and it is so imperative in LTC to have something like that in place. It could make the difference between life and death and whether or not the caregiver's license is in jeopardy. If a nurse doesn't call a code right away because she has to waste time trying to find out if the resident is a full code and the resident dies, don't think that the facility will accept any blame, they will simply say that the nurse's job is to know a resident's code status, even though he/she has dozens of patients to be accountable for and couldn't possibly know that without looking it up in most cases. Having something like a full code status sticker on the resident's chart could literally save their life. I tried to talk to our DON about it and she acted like I was incompetent if I needed something like that, but to me, it makes perfect sense. Hospitals have systems in place like this all the time!

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Specializes in Gerontology, Med surg, Home Health.

We use red dots on our charts to mean DNR. However when I asked one of the nurses who'd been there forever what the red dot meant, she thought for a minute and then yelled "It means they're Catholic!!". I always check the advanced directives section of the chart for a signed DNR. If there's not one there we start the code.

We don't have a code team but we have a crash cart with 02, suction, a back board and an ambu bag. We also have one AED for the facility. It's a reg. in Massachusetts.

If your staff development coordinator can't walk you through a code, ask her to call the local fire department. They'll come in a run a fake code. It's never fun and we never get used to it but you don't want to be in a situation where no one knows what to do.

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Specializes in LTC.
It is not right. You should have at least 12 weeks and longer if requested. They are going to try and get away with whatever they can. You have to let them know you are not ready and need more training. I shake my head in amazement, because I know, they know, you can't possibly be ready in a few weeks. Most aren't ready after 12 weeks, but are thrown in anyway. You are not the first and won't be the last. What you have to be is your own advocate. They will train you longer if you insist. You are not being unreasonable and they know it. Please talk to her today and let us know how it works out. I am sure she will accommodate you. If she does not, she just doesn't care. Peace!

I got 4 days as a new grad LVN.

We have to check our crash cart every night against a checklist. We just now got a backboard(which was accidentally taken by EMS during a past code). Our nasal cannulas are so old they are brown and sticky. At least we have a crash cart though!

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I got 2 days of orientation/training as a new grad. All the people I know who went into LTCs as new grads got days, not weeks of training. Where are all these places that are giving 8-12 weeks of training?

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Specializes in LTC.
croppyRN, I am also in the same boat as you. I am nearly done with my orientation and I am terrified to be pushed onto the floor. I am so focused on getting my routine and passing meds, let alone getting to know every residents faces. The paperwork is whats killing me the most. I barely know how to talk to the MD! How are things with you? Any updates? I hope things are well.
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Thank you Chin up. I had a feeling I wasn't ready for this, and that I would need to speak with my DON before going it on my own. I appreciate your advice. I'm so nervous and wonder if everyone feels this way, or if the extreme nervousness is proof that I won't be cut out for this type of nursing? I will never understand why the LTC places give so little orientation compared to the hospitals. I know it is just the way it is, but just because they have been doing it this way all along doesn't mean it is right.

At the facility I work at, I received 2 weeks orientation down each hall. It is overwhelming at first. And, I think we all probably felt nervous the first day on our own. Heck, I felt nervous the first few months, and I still get butterflies when I admit a person with complex diagnoses'. Nervousness definitely does not mean that you are not "cut out." You will make mistakes, and you will learn from them. It is all part of the process!! ;) Good luck! I love working in LTC.

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If your facility doesn't have a good policy in place for knowing in an instant what a resident's code status is, then take it up with your DON immediately. Something like a bright pink sticker on the cover of the patien'ts chart if they are a full code, whatever, just a system where you know where to glance and in an instant know if you need to call a code or send them out or just call the family.

I just left a facility that had no clear system in place where a nurse or CNA could know a resident's code status at an instant's notice, and it is so imperative in LTC to have something like that in place. It could make the difference between life and death and whether or not the caregiver's license is in jeopardy. If a nurse doesn't call a code right away because she has to waste time trying to find out if the resident is a full code and the resident dies, don't think that the facility will accept any blame, they will simply say that the nurse's job is to know a resident's code status, even though he/she has dozens of patients to be accountable for and couldn't possibly know that without looking it up in most cases. Having something like a full code status sticker on the resident's chart could literally save their life. I tried to talk to our DON about it and she acted like I was incompetent if I needed something like that, but to me, it makes perfect sense. Hospitals have systems in place like this all the time!

On report sheet, write allthat are fullcode> Most in LTC are DNR, so the full-codes would stand out (we used to have a coding system on our charts, however, wasn't kept up to date, so not helpful). In the event of a code, I always send an aide for the chart, and call911 from my cell, then I have patient, chart andphone all in same room, saves a lot of steps. I can call family from the room as well, while waiting for 911 or even callthe facility if Ineed oxygen tubing brought or something.

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Specializes in ltc,hospice.

Regarding the code status of a patient, ask someone to get the chart and bring it to you then you can actually see for yourself if there is a DNR in the chart. Things change, a new admission might not have a DNR, etc.. Labeling charts is important, but never assume. Even hospice patients can be full codes.

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Hi,

I think you need to make your concerns known and ask for more orientation time. :nurse: Good Luck!

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Specializes in LTC.
On report sheet, write allthat are fullcode> Most in LTC are DNR, so the full-codes would stand out (we used to have a coding system on our charts, however, wasn't kept up to date, so not helpful). In the event of a code, I always send an aide for the chart, and call911 from my cell, then I have patient, chart andphone all in same room, saves a lot of steps. I can call family from the room as well, while waiting for 911 or even callthe facility if Ineed oxygen tubing brought or something.

I'll be keeping my cellphone in my pocket for that very reason. Thats a very good idea. We keep their code status on their name bracelet.

I've never had a code yet. I keep a close eye on my full codes. Especially new admits.

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Specializes in LTC.

Where I work we do a code in the case of a witnessed arrest only. If we do not witness their taking the last breath we don't do CPR. The sheet the resident signs at time of admission also states this. Usually if they are full code and circling the the drain we send them out.

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