Most important things to know in LTC ????

Kittypower123, BSN, RN · Feb 1, 2012

There is so much to know! I'm still learning myself, but I can say that it is important to remember that normal in the elderly can be different than normal in younger people. Learn what is normal for each of your residents so that you can tell when something is "off." Also, sudden changes in behavior can often be an effect of an infection, such as a UTI, and/or pain.

As for organizing the day, I use a sheet that I developed with space for each hour of the day so I can note what must be done. I use only room number (not names) so if a family member walks up while I am consulting it, they don't see any names. I mark off each item as it is done and have a space for notes (like 103A needs more insulin) and a space to note any PRNs given (1630 - 107B - Norco) so I can be sure to include it on the 24 hr report for the next shift.

Finally, I am learning that each day is a new adventure. Some days, I am overwhelmed with everything that has to be done and constant interuptions from residents and family members (I'm getting much better at asking for help when I need it). These are the days that tend to make you question your career choice. Other days, things go smoothly, I have more time to spend with residents, and am able to help my teammates. These are the days when I thank God I am a nurse. And some days, a resident's face lights up when they see you and your heart just melts. Hang in there on the bad days, enjoy the good, and treasure the little moments that make it all worth it.

mazy · Feb 1, 2012

The first thing I do after report is I sit down with the MARs and TARs and go through and flag all of the "off-time' meds and blood sugars. That way I don't forget, in the heat of the moment, that Mrs. Jones needs her prilosec and coumadin at 1700 or Mr. Smith gets his Vicodin at 1600.

I've been doing this for years and it doesn't matter that I practically have these meds memorized, I do it every single time. Because things can get so crazy that all of that goes right out of my head. I don't want to be playing catch-up on PM meds at bed time.

Also, while I'm doing that I'm quickly reviewing all the meds and tx, to see if there have been any changes. I usually get most of that in report, but stuff does fall through the cracks or sometimes orders have been transcribed incorrectly and I don't want to end up in the sorry situation of calling the dr. at 10 at night to clarify an order for a med when I could have called during normal business hours.

It also gives me a quick snapshot view of what's been going on with the patients. I can see that Miss Smith has been started on Lisinopril, so now I know that she has some change going on with her b/p and I know I should be monitoring that; or Mr. Jones has started on a new sliding scale insulin and so there have been issues with his blood sugars that I need to be aware of.

I work 2nd shift so I have a little more flexibility with time before I hit the floor, depending on how crazy the day is; but I have done this when I worked the AM shift, just a little more quickly.

Vinniesguy · Feb 1, 2012

Great advice so far - here are some my own little tips:

- Never ask an aid/assistant nurse to do anything you're not prepared to do yourself

- If you have a moment lend the assistants a hand - do a shower or a feed - they'll respect you for it and will help you out when you need it

- Be firm with relatives - if they think you're a wuss they'll push you around and become more demanding

- Never ever let management push you you into doing something you're not comfortable with. A place I once worked at wanted me to fudge assessments in order to get more funding. I refused - I told them they could fudge it themselves - I worked hard for my license I'm not going to lose it over a few bucks

- And along the lines of what Mazy mentioned - be mindful of evening and weekend staff - make sure that there is enough dressings, drugs etc so nothing runs out

- Above all enjoy it! Aged care is so often over-looked because people thing it's un-cool and not exciting - maybe, but it's very rewarding and you have the chance to make someones last days happy and that someone still cares about them.

akita_mommy · Feb 2, 2012

Any sudden changes in behavior with a resident, GET A URINE! 95% of times it's a UTI. Also set the rules down early with nursing aides. If not, they will walk all over you. I had to learn the hard way :(TRUST NO ONE! I never understood this quote until I just finished my first year as a nurse. NURSES EAT THEIR YOUNG!

Long Term Care Columnist / Guide · Feb 2, 2012

Falls are another problem often associated with UTI. If you can't find an obvious reason for a fall---like a walker they don't remember to lock, or clutter on the floor, or a new BP med---grab a UA and see what happens. :specs:

pnurse68 · Feb 3, 2012

Hard to remember but we are often taking care of families psychsocial needs as much as residents! If you can empathize with the families and build strong relationships, your shift will run much smoother.

Nurse with your heart as well as your head and know when to listen to both.

Nurse's Aides and Unit Clerks are your best friends, cant live without them :)