Need some encouraging words as new grad in LTC

mag_new · Oct 5, 2009

Sorry to hear your situation.

The worst thing I fear about going to nursing home right after nursing school, is that after a couple of years, chances are one is stuck with nursing home forever. Of course there are exceptions. But it will be extremely difficult to transform from nursing home to the hospital.

So, after 3 years, your classmate who start their career from the hospitals, they can choose to work in the hospital, or in the nursing home, and they enjoy the opportunity as well as the compensation and the skill set that their hospital experiences bring to them. While one that starts from LTC, is probably burned out and still work in the LTC, with no other choices.

I would really feel bad if I were in the later situation. So here I'm, after 3 months of graduation, no hospital offer yet, but still pass all LTCs in my job search.

luvmyguys · Oct 5, 2009

although I have heard all the things that you have listed above-about difficulty transferring out to a hospital, etc. I have been told by my facility that I do get experience that I can use later in hospitals. I have many residents who are med/surg pts with IVs, wound vacs, etc. that aren't ready to go home-but hospitals don't want to keep them. So, I am not afraid of what I am not learning-at least not right now.

As far as compensation goes-I am making 3 dollars more than those friends of mine who are in hospitals in my area, I feel that my responsibilities are greater right now than theirs-I didn't get their orientation. But-I am working-I don't regret taking this job-just want some advice from those who have been in my shoes. Thanks.

stephanienicole87 · Oct 5, 2009

I am a new grad too. Well about 6 months. I took a position in LTC because I am a LPN right now and there are slim to none chances of getting a LPN job in the hospitals around here, esspecially without experience. While it is not where I want to be at least it gives me income to go on for my RN and I do get some good experience. I know how you feel. It took me about 3 months before that feeling started going away. It is ashame the way they just throw us out there so soon in LTC. Just try to think about the experience ur getting. I feel confident with g-tubes, trachs and I know ALOT more about medications than I did before. I don't want to get trapped in LTC and I know I won't let that happen to myself. I don't know if your a LPN or RN and where you are located but LPNs here can still get a job in clinics fairly easy (although the pay is about 5 a hour less) and RNs even new grads can still get hired in hopitals fairly easy. My suggestion is just to take your time and double check, If your not sure about something ask (even if you have to make someone mad), Don't follow bad examples (which I see alot of), and learn on your own outside of work. Good luck to you in your new nursing career.

luvmyguys · Oct 5, 2009

Hey beach bum! I am a new grad RN! In my area-Ohio-new grad rn jobs a hard to come by! Especially for not having any previous health care experience. I graduated in June 2009 and have been on the search since december of 08 sending out applications all across the country.

So, I started looking into LTC and calling/emailing facilities in my area. I went in and toured this facility. Its very nice, I like it a lot. I NEED this job-me and my family. There is nothing else here for me to turn to. I don't want leave and give up....I guess I didn't know what to expect bc I had assumed that when I graduated that there would be hospital jobs for me:eek:. But, there aren't. At least not right now.

I can't afford to not work at this point. I am trying to learn what I don't know~if that makes any sense. I guess I didn't expect LTC care to be this crazy....seems far more crazy than any clinical I was EVER in in school.

kittykatty · Oct 5, 2009

I took this from another link because she has the best advice for you to use. Hang in there!!

TonydeMom says----

Re: Help? Need cheatt sheet while doing precepting in nursing home

1. Come to work early

2. Before you clock in get a resident census sheet

3. Do rounds. Look at every resident on the census sheet. Make sure they are stable.

4. Find out who is a full code who is a no code. Mark it down on the census sheet. If someone is not breathing you have no time to hunt down a chart and figure this out.

5. Know where the suction machine with tubing attached ready to go, ambu bag and CPR boards are located. An emergency is no time to be looking for these items.

6. Know what residents need to get their blood sugar tested and at what time. If the order reads 30 minutes before meals. Know what time the meal is served and mark this down.

7. Know what residents recieve enteral feedings. Always a good idea to have the tube feeding formula at the bedside so it can be adminstered if an alarm goes off indicating the bag is empty.

8. Know what time the residents tube feeding pumps will be turned on and off.

9. Know what residents recieve their medications before meals, and after meals.

This will save you alot of time and should get your day off to a good start.

After you clock in:

1. Get report on the residents. Do walking rounds. Do narcotic count.

2. Give report to the nursing assistants

3. Start your med pass.

4. Do treatments when the meal carts are put away

5. Do weekly progress notes

6. Do the daily charting

Hope this helps.

lweatherby · Oct 5, 2009

OMG!!! I am in the exact same situation!!! With one small difference..... I am working in a pediatric LTC facility. However, I got the same short (six day) orientation and am on my own! Everything moves so quickly, no one had or took the time to tell me about the paperwork, paperwork, paperwork!!!! So...... in between the horrendous med passes, I have to struggle to find monthly summaries, log lab work, decide when to call the physician's, track down protocols.......etc, etc. I don't feel like I am using ANY nursing process or assessment skills. I barely have time to get my meds and feedings going...... I would LOVE the chance to do a complete assessment. My orientation consisted of helping the nurse do med pass. The training I received there was just .... bad. Most of the nurses take short cuts that in my opinion jeopardize the safety of the patient. I REFUSE to take those short cuts and because of that I am much slower at med passes. In addition, 90% of the residents have g-tubes and most of the nurses "push" everything and do not take the time to flush with the appropriate amount of water. This is a hydration issue and I refuse to take that short cut as well...... again really slowing down the med pass. I feel like everyone thinks I am an idiot because it takes me so long to do med pass. I too have trouble sleeping at night because I am constantly worrying about what I did or did not do.

I have decided to give myself 6 months to get to a level of comfort that allows me to feel I am really providing thorough nursing care. If that doesn't happen.... I MUST move on. I can't continue to be so stressed and worried all of the time. I really want to work there a care for these precious kids...... but I don't want to do it in the half-ass way I am doing it now!!!!!! I'm starting to think that in order to get everything done, you HAVE to take short cuts and I can't do that.

I feel your pain and I wish you peace!! :smokin:

ChineseRN · Oct 6, 2009

Hi,

I was in somewhat a similar situation as you 5 months ago. It took me half a year of hardwork searching, basically flaunting my resume and cover letter to all the hospitals in NY. :uhoh3: After harassing the nurse recruiters through phone/email/fax, and getting the same answers, I started looking for nursing home jobs/LTC. I was so grateful when one decided to hire me.

I would say orientation was also bearable, trying to absorb every little detail possible, which is impossible. Med pass scares the hell out of me because sometimes the residents would make a long line and I feel my stomach turning trying to get vitals, contraindications, etc. :eek: Getting the whole picture on a pt is so hard. I really disliked the paperwork because I felt the system was so outdated and I have been trained to chart everything on the computer. :typing

One thing I did enjoy was calling the doctors for abnormal lab results, because after awhile you can kind of predict what new orders there would be. When the doctors do come for their monthly/weekly renewals, they are very friendly and some really don't mind answering my questions.

I felt really left out at times, because everyone had so much time to socialize. Not that I care about socializing and making friends during work, but I also felt like a chicken trying to do everything I aimed to do within my shift.

I also felt so pressured to delegate to the CNA's. It got a little better over time.

OK ENOUGH RAMBLING:

The result of my LTC experience, I didn't quit until I made sure I had another job. I went on 2 interviews during my orientation, and when I was certain I had a job in the hospital, I gave them 3 weeks notice. I thanked them a million times for hiring me during the hard economic times. Surprisingly, most of the people there were so supportive. They encouraged me to go to the hospital to learn more.

What I'm trying to say is, don't lose your heart for wanting to be a good nurse. If you don't feel that LTC is giving you great experience, you should start looking elsewhere. Your facility sounds like you can gain a lot of experience, and learning from the elderly is a gem. :heartbeat

My preceptor, whom I call my "mother," told me one of the smartest nurses is a nursing home nurse and I agree. There is so much involved. Whereever you end up, I feel that you will be a great nurse because you care. Hang in there. Whatever path you choose to take, as long as you keep learning, you will be a great nurse.

P.S. I made a master sheet during orientation. I made my preceptor check off some things for me. On the master sheet, I had the pt's names, and columns of "crush med, PEG tube, Fingerstick, Other" I just check off whatever my pt has, and during med pass, I can refer to the sheet, and it really helps. GOOD LUCK! :w00t:

mag_new · Oct 6, 2009

It's great that LTC work well for the above two. A lot to learn, and, seems not difficult to transfer to a hospital job?

I might rethink my decision. I graduated in June 2009, still no job yet. I'm in NJ. I'm thinking either start looking in LTC, or move to Texas to find a hospital job, heard it is easier to get a hospital job there. But moving out of state is really a pain, and I don't think I like the climate there.

BoopetteRN · Oct 6, 2009

I am the in-service director at a large nursing home, when full we have 304 beds, it is really like 4 different nursing homes. I have all the new nurses and CNAs for 2 days than they go to the floor. I shutter when the nurses go for orientation on the floor. We have been working with agency nurses for quite a while and the thought that an agency nurse would train a new grad nurse just makes me sick. The last nurse we hired had the same problem, and I was unaware of it becuase I do not know the schudules. After 2 days the nurse came to talke to me, I was so upset, I actually worked double shifts to make sure she had the proper orientation. The med cart is an important part of our job, but also the paperwork is sometimes overwhelming. Having it explained in detailed and putting a rhyme to the reason it has to be done helps the new nurse understand the importance of it. The other thing that is difficult is supervising the CNAs, making sure they are doing what they are suppose to do. PMs is one of the worst shifts to work when you are a new grad and have to get used to doing a med pass, answer the phone, interact with visitors, and resident tend to feelo worse at night. Residents tend to fall more on pms because they all want to go to bed at the same time and you have to intervene and find out why they fell and come up with solutions to prevent it from happening again. At first you are overwhelmed, but as time goes on, you will be comfortable with the route, or should I say the shift, because one thing for sure, long term care nursing is neve boring, residents come up with some pretty interesting situation. I wish you the best of luck

Reigen · Oct 6, 2009

I can certainly understand your postion, in fact I will post what I wrote for a graduating class "speech" for them, and I hope these words encourage and inspire you as well :

You made it! You survived nursing school--All should be well, right? Once you’re out of school and the reality of your chosen profession hits you, it can be quite

overwhelming, no matter how thorough your schooling was.

So what can you do to survive (or better yet thrive) during your first year out there? Here are some tips to get you started:

Be patient with yourself. You’re just starting out. Take time to learn and gain experience. Most seasoned nurses agree it takes a good year to become somewhat comfortable and two years to be able to handle most situations. Go

easy on yourself and think about how far you’ve already come. Even the most competent nurse once started out exactly where you are now.

Focus on the positive. While it’s human nature to dwell on the negative, if you focus on the positive, that will become your reality. At the end of each day, reflect on what you learned and on at least one good thing you did for someone. Write it down, look at it, and fall asleep with that thought in mind.

Keep a positive journal of the times you made a difference or helped someone, including any nice things people say about you. Review it often.

Help others. It’s never too soon to lend a helping hand to a coworker. You might even learn something in the process. Show your willingness to help, and others will do the same for you. Be sure to extend yourself to students and other new grads who follow you. Treat others as you wish to be treated.

Align yourself with positive, competent people.

Experienced and friendly people are all around. Buddy up with those after whom you’d like to model yourself. A person doesn’t have to have the same title as you for you to learn something from him or her. Many RNs have told me

they learned everything they know from an experienced LPN.

Show some initiative. Don’t wait for someone to tell you to do a procedure. Seek out opportunities to get the experience you need. If certain procedures aren’t done with any frequency on your unit, talk to your preceptor, unit educator, or nurse manager about getting that experience elsewhere. If a certain procedure is going to be done on your unit, see if you can participate (or at least observe). Show your willingness to learn.

Build good relationships. Don’t wait for others to come up to you. Introduce yourself to coworkers on all three shifts, to physicians, and to others. Have lunch with someone you don’t know, and get to know him or her better. Learn others’ names, and use them. Say good morning and good night to everyone. Become part of the team.

Keep learning. Use your drug reference guide, the Internet, policy and procedure manuals, and other resources. Ask questions, observe experienced people, and ask more questions. Remember — you have to do something

for the first time only once. Then it starts to be old hat. Do your homework at the end of each day, and look up things that are new to you. Remember — this is phase two of your education.

Join professional associations. Become a member of your state nurses association and specialty association. These affiliations help you stay on the cutting edge, provide sources of support and help, offer educational programs,

and give you a forum to share ideas, and so on. Don’t stay isolated within your department and your facility.

Become part of the greater whole, and develop close ties with your colleagues on state and national levels.

Track your progress. We all have a tendency to look at where we are now and where we still want to go. We lose sight of the progress we’ve already made and keep making.

Consider starting a log. Record your accomplishments periodically, including any new procedures you do. Start with what you’ve already done, including getting through school ready to take the boards, and keep adding to it.

Review it on a regular basis to see how far you’ve really come.

Manage your stress. Stress is not something to be tolerated; it should be managed. Everyone has stress in his or her life. As caregivers, we’re particularly

susceptible. Make time to socialize, engage in leisure activities and hobbies, exercise, meditate, and so on.

That way, you’ll have more to give your patients, your family, and yourself.

Stay focused, and keep moving forward. With the passage of time, you’ll become more confident and comfortable in your new profession. You can do it!

How do I know that? Because I was once right where you are now. Who knows?

Maybe someday you’ll be giving advice to new grads or writing a career advice column for nurses. I’ve come a long way since I got out of school almost 22 years ago, and you will, too. Hang in there. It’s definitely worth

it. You can do it. I know you can!

lvnlrn · Oct 16, 2009

Can you talk with your supervisor about getting more orientation? I know it may be a hassle for them, but not nearly as much of a hassle as starting over with another new nurse after you quit!

I work in a LTC also, but I had to ask them to take me off orientation (two and a half weeks). Talk with your supervisor, and hopefully (s)he'll understand and work something out for you.

Good luck!