Need some advise about orientation

[missy--kay]

I need some advise! I recently graduated from an ADN program, but since I have not taken the NCLEX, I have been hired at an LTC as an LPN. (got that license last summer) I am very excited about the job. I live in an area that jobs are VERY hard to come by. I wanted to work nights, and I got that, too. All sounds great, right? Well, I was there for 4 days last week to orient on the med carts during the day and to meet the residents. There are 4 halls, so I basically spent a day on each hall. The State has been hounding this facility nonstop and they were there all 4 days I was there, which was nerve wracking. I thought that working nights, I would be able to avoid state, until I was told yesterday when I called about my schedule that they also showed up at 0315 and stayed the entire day. Lovely. I was also told that I will only have 2 nights of orientation then left on my own!! AHHH! I do not feel comfortable about this! This is my very first nursing job, and I do not feel that 2 days of night orientation is adequate, especially when the State will surely be making an appearance. They already know that I am not feeling okay about that and the scheduler just said " I will discuss this with the DON". What do I do after my 2 days if they are still wanting me to take this on by myself?? Initially, I was going to have 5 nights of orientation, not sure what happened to that plan...

Any advise would be appreciated!!!!

[iLeyN]

I totally understand!!! I'm about 95% similar to your situation... I got goosebumps when the first post I opened here today is this one!!! I still look like I'm running around the unit like a chicken without a head :grn: , but it really does get better everyday. Let me share you my mantra everytime I get nervous or overwhelmed... :hdvwl: I hope it helps...

"Be confident in yourself... just do the best that you can and just handle things one at a time, but don't forget to prioritize..."

Look at the brighter side...

If I was the DON :chair:, I'd actually choose you to be with the surveyors. Why? Simply because you're a new grad, working as an LVN with the knowledge of an RN (huh!) and I'm definitely sure that every procedure you'll be doing that night will be "by the book" - and that's what the surveyors are looking for... right? No shortcuts, whatsoever... I personally am still having a hard time adapting to that... but that's a different story...

Believe in yourself... you'll do fine. We'll pray for a full dose of confidence and presence of mind towards your unit! Good Luck & have fun!!! :w00t:

[+one]

I also had a few days of orientation (5 days) before I started to work by myself, I did every shift (7-3, 3-11, 11-7) shifts differ, as for my LTC facility, mornings were a little med pass, few labs to follow up and relays to the doctor to get an order, afternoons were a bit busier compared to mornings, after you get your side and know the census, you check your 24 hour report for things to follow up, you do admissions, basically it consumes a bit of your time for that, sometimes the doctor makes rounds and you still have to carry out orders, and 2 med passes plus charting, nights are mostly quiet, no admissions, a few med pass at midnight and morning med pass, my area was in the skilled nursing area so I do a lot of monitoring especially those who are unstable and would be necessary to be sent out later if things get a bit out of the normal. I suggest you know the protocols of sending out the individuals in your facility. also, if you are doing shadowing for 2 days, ask the nurse/preceptor what her routines are, make a list so you can review them later, introduce yourself to the CNA's, tell them to call you if they notice something unusual to the resident they are assigned to.

I know you will do fine, it's just a matter of getting used to the routine,

as for the state I agree with the previous poster of doing everything by the book,

G tube medications? you should know which meds can be crushed.

Always lock your cart, sign after you give the medication, make sure the resident has swallowed the pill. Keep your cart clean, do handwashing after every resident.

Build your routine and you will be fine.

[neutrophil]

I am so happy that I was a med aide, before being a nurse. I used to medicate up to 110 people with the same P.O. Meds that nurses do. I mean, roxanol, ms contin, coumadin, you know all the good stuff. But we could pre pour, or their is not way that you could pass that amount of meds, in the time allotted.

So I became a nurse. Not too much difference except a license that you can loose. When I oriented, the nurse that oriented me, knew that I was a med tech before. So she had me pass all her meds, that I could do with my eyes closed, while she charted and chatted. So when I was off orientation, I had no idea of the charting, and the state came. We passed survey. I needed to learn all of the protocol and charting from experience and thoughtful nurses. Complaining, I have learned from others, doesn't help much. At the end of the day. I found that the harder it is to learn, the better nurse you become. But it is hard as you are finding out. Good luck.

[SuesquatchRN, BSN, RN]

I'd run away from that place. You SHOULD be orienting on days AS A GN, NOT AN LPN. And they have to be really messed up for state to be showing up in the middle of the night!

[CT Pixie, BSN, RN]

I'd run away from that place. You SHOULD be orienting on days AS A GN, NOT AN LPN. And they have to be really messed up for state to be showing up in the middle of the night!

She/he is not being orientated as a GN because she/he was not hired as a GN but was hired as an LPN. (a GN cannot take a floor by themselves, they work under a State licensed nurse). OP stated that the LPN license was obtained last summer. I have to agree with Bubbie, that place must be pretty messed up if the State is showing up on 3rd shift. I've never seen the State Surveyors come in before 7am or stay after 6 or so (thats not to say it hasn't happened, just saying I have never personally seen or heard of it in any of the facilities i've worked or any facility my friends worked..with the exception of one, and that place got shut down pronto by the State)

That being said, I don't feel that 6 shifts of orientation (as a GN, LPN or RN) is sufficient especially for a person that this is their FIRST nursing job and its been almost a year since getting their license. I was hired and received 6 wks of orientation for my very first job as an LPN in a LTC facilty. I felt good enough to take the floor by myself after 3 wks but my preceptor was always close at hand if I needed help or had a question.

Only thing I can offer is this, go back to the DON directly and voice your concerns. let the DON know you are not comfortable with being put on the floor alone after 6 shifts and only 2 being the shift you are to be working. But in all honesty you probably won't feel any more comfortable if you get that extra 3 shifts of orientation. And usually the State only stays a week (read 5 days) so if they have been there 4 already, they probably won't be hanging around much longer.

wish you the best. It will get easier as the shifts pass. i don't blame you for not wanting the State hanging around when you have so little orientation to that shift and as a new nurse

[SuesquatchRN, BSN, RN]

Oh, I know how she was hired, Pixie. I just think it's cheap and bogus and a way to save on orienting a new nurse, period. I wonder when she passes NCLEX-RN are thye going to keep her on NOCS as an LPN and expect her to take the duties of the supervising RN with all of the responsibility at the LPN salary?

Bogus.

[CT Pixie, BSN, RN]

They may try Bub! If our girl is smart she'll put her foot down and demand her due RN pay.

[Leelee2]

I really think that you are in a bad situation. Is state there for yearly visit?? Or for a visit regarding a complaint??

Seems they have been there a while...What is the facilities track record of how they have done on previous surveys?? I would definately be checking that out, that info is available to anyone. By looking at past surveys you can kinda tell what type of facility you are in. Medicare has it's own site to check this for long term care. As for your current situation.

If you do not feel adequately trained in those two days, it is your responsibility to contact the DON, and explain that you feel you need more training. Failure to do that on your part, puts you and those residents at a safety risk!! Our new nurses get at least 10 shift training on their new units, that does not include other orientation.

If the nurse feels uncomfortable yet, the facility should provide more training. If they Really care about their residents and about retaining staff, they will provide you with what you need to be successful in this position.

Also, once you pass your state boards, and have your RN license, they need to bump up your pay!!

Good luck to you, and let us know how it goes!

[CapeCodMermaid, RN]

In Massachusetts, the DPH is mandated to be in a skilled facility on an off shift. They have to do this in at least 10% of the facilities, so just because they are there in the middle of the night doesn't necessarily mean the place is horrible. We had them in the building for a solid week and ended up with a great survey. Orientation is different from place to place. Most places around here give 3 days. I worked in a place once that had a 5 day orientation for experienced nurses but a 6 week one for new grads. We try to tailor our orientation to fit the person. I've been doing this for years and years so I wouldn't need as long as a newish person.