New Grad with no experience, starting in a LTC. HELP!!!

greenfiremajick · Jun 6, 2009

My situation:
-New grad RN, BSN in December 2008, 27 y/o male
-No hospital (CNA,LVN) experience
-Got a job in a LTC in California $30/hr
-DON expects "aggressiveness" out of me and said my ratio is 1:30 with CNA's and LVN's assistance.
-Don't know my shift yet, I start some time next week.
-I have been a server/bartender for about 5 years.
My Questions:
-I know I'm going to struggle for the first 2-3 months or so. I've been told everyone usually does. What are the top 3-5 tips/advice you can give based on my situation?
-What is the worst thing I can do? For example, "Don't ever, ever do....." And I know the obvious, don't kill anyone, any other scenarios will help. What is the best thing I can do? For example, " You should always, always do this........"
-How can I gain respect of CNA's, LVN's, peers, and staff? Some of the people here look older than me and have been there a long time. How does a young, new grad come in and give them orders while gaining respect?
-What does a normal, routine day consist of for an new grad RN? What does a catastrophic day consist of for a new grad RN?
-I loved being a server/bartender for 5 years. In the back of my mind I'm thinking 1:30 ratio may bring me back to my serving days. I understand that there is a lot more risk involved and more critical thinking required, but do you think my serving/bartending experience will help me care for my patients?
-What are the top 3-5 tips/advice while being oriented? What are the top 3-5 things that should consistently replay in my head as my shift goes on?
Thanks in advance for all the responses, tips, advice, and experience shared. I really appreciate it!!! I really want to develop into a great nurse. The beginning is very important. I finally get an opportunity to begin my career. I believe that putting in time/work off the floor will help you be better when your're on the floor. That's why I'm trying to get as much information now. Thanks again.
-J

I have no RN experience, but I do have management experience. One of the first things that came to mind was this statement you made: "How does a young, new grad come in and give them orders while gaining respect?" First of all, you do not "order" them around; you ask for their cooperation in an authoritative, yet respectful manner (I know you probably didn't really mean "order," but somewhere in the back of your head, that whole dictatorial management style is present and there is a notion that that is how you will operate.....If you can meet this and change your way of thinking, it will do you a world of good and will help you to gain the respect of your fellow coworkers.)

Congratulations and good luck!

ChickenJoyRN,BSN · Jun 6, 2009

I have no RN experience, but I do have management experience. One of the first things that came to mind was this statement you made: "How does a young, new grad come in and give them orders while gaining respect?" First of all, you do not "order" them around; you ask for their cooperation in an authoritative, yet respectful manner (I know you probably didn't really mean "order," but somewhere in the back of your head, that whole dictatorial management style is present and there is a notion that that is how you will operate.....If you can meet this and change your way of thinking, it will do you a world of good and will help you to gain the respect of your fellow coworkers.)
Congratulations and good luck!

Thanks. And your're right, I didn't mean it in that manner. I understand we all work as a team and I will do my best to act in an authoritative and respectful manner. Such a new grad(rookie) move!!! My apologies. Thanks again

**Elektra6, ASN, BSN, RN** · Jun 6, 2009

I was in your shoes a few years ago, some tips for you:

If you have the same patients all the time you learn their likes/dislikes, etc. Your med pass will flow nicely after that. Expect it to take you a lot of time at first.

Everyone has their own way of keeping organized. I typed a nice report sheet with the resident's names & bed #'s on it going down the page. They may already have this for you. When I got report, at first I wrote who needed meds crushed or could swallow whole or who was a diabetic. Also, who was sick, tube feed times, medicare charting, blood sugars, etc. I used this sheet to check off meds, vitals, blood sugars, it kept me organized. I always got vitals and checked on medicare patients and my sick patients first thing. Helps you to get a baseline on them. We had great CNA's but timely vitals was not their forte, they would get them at shift end so I always did my own.

With regard to supervising nursing assistants: be fair and consistent and never act too "good" to do anything. If a call bell rings and you are standing outside the door, go and answer it! It is less work than hunting the CNA down who is 99% likely to be busy helping another resident!

As a new nurse I bugged everyone who had a procedure, machine or med I wasn't familiar with to show me how to do it and let me try myself. Most nurses are glad to share their knowledge with you.

You already have the "customer service" aspect covered from your job so I'm sure you will do fine! Best of luck! :specs:

Freedom42 · Jun 6, 2009

My Questions:
-I know I'm going to struggle for the first 2-3 months or so. I've been told everyone usually does. What are the top 3-5 tips/advice you can give based on my situation?
-What is the worst thing I can do? For example, "Don't ever, ever do....." And I know the obvious, don't kill anyone, any other scenarios will help. What is the best thing I can do? For example, " You should always, always do this........"
-How can I gain respect of CNA's, LVN's, peers, and staff? Some of the people here look older than me and have been there a long time. How does a young, new grad come in and give them orders while gaining respect?
-What does a normal, routine day consist of for an new grad RN? What does a catastrophic day consist of for a new grad RN?
-I loved being a server/bartender for 5 years. In the back of my mind I'm thinking 1:30 ratio may bring me back to my serving days. I understand that there is a lot more risk involved and more critical thinking required, but do you think my serving/bartending experience will help me care for my patients?
-What are the top 3-5 tips/advice while being oriented? What are the top 3-5 things that should consistently replay in my head as my shift goes on?

I'm a December BSN grad. Just finished my first three months on the job. Perfect? No. But I believe I've gotten off to a good start. Some thoughts:

Rule No. 1: No matter how far behind you are, don't rush -- and don't let anyone rush you. It's too easy to make a mistake when you're trying to maintain a pace that is probably unrealistic anyway. Always, always safety first.

Recognize that the aides and LVNs have a lot to teach you, and thank them when they help you learn. Respect should be mutual. Acknowledging your own inexperience -- and respecting theirs -- is a first step toward earning it. Don't just delegate tasks. Offer to help them when they're taking on something you haven't done before. You'll lend a hand and learn at the same time. The CNA I work with most is a great instructor.

Ask for feedback constantly. My greatest ally at work is my nursing supervisor. We talk at least once per shift about what's gone right and what could go better. Don't wait for a formal review for management comments. Initiate the conversation yourself. Have that conversation with everyone on the team, not just your manager.

I don't have a typical day. My unit works at a very fast pace. I haven't had a catastrophic day (yet!) but I think that's because I recognize my inexperience. Ask for help as soon as you realize you're in over your head. Remember that saying "I don't know" or "I need help" is not a sign of weakness. You are instead demonstrating that you know what you don't know, recognize your limitations, and put patient safety before your own ego.

Finally, recognize what you have to offer: You're new, you've just been taught the latest standards and techniques, and you bring energy and enthusiasm to the unit. Not everyone wants to help a new grad. But among those who do, you'll remind them of why they are nurses, and they just might take that extra moment to give you the constructive feedback you need.

Will being a bartender help? I think so -- but that's because I think life experience of any kind helps you to be a better nurse. Some nurses struggle to talk casually with patients. Maybe your experience will make it easier for you to establish rapport.

Good luck, and congratulations on your new job.

amoss2345 · Jun 6, 2009

I am experiencing the exact same thing right now, I was a bartender for 12 years and am a new nurse in LTC. I would say that the number one thing you need to work on at first is to develop a system. Once you get your day organized in a way that works for you, things flow much better. Your CNAs are your eyes and ears. Treat them with respect and they will treat you with respect. My CNAs know that I never did their job and worked myself up into nursing, but they also know that I don't think that I am above giving them a hand if they need it. Do not demand things of others that you are not willing to do yourself....in general. On the same note, do not let them walk all over you just because you're new either.

You will find your serving/bartending skills coming in handy, I promise. I doubted this until the other day when I had to deal with a difficult family member....people skills developed in the service industry are of definite value. When your income depends on how well you deal with people, you tend to become creative, even in the most difficult circumstances...good luck to you:)

deleern · Jun 7, 2009

Right at the end of your shift analyze your Med pass. if the same thing keeps popping up, ask co workers, what they do. example, this little tiny blind resident was always up set with me, she had a ton of med and I always tryed to give them all in the door way of her room, i asked my co workers, she want just her tylenol, at her door way and then some just before she at Breakfast, and the rest after Breakfast. she was in that Nursing home for 25 years, and it was her way of controling her environment.

ChickenJoyRN,BSN · Jun 19, 2009

Thank you to all responders. I just finished my second day of orientation today and it was my first day on the floor shadowing an LVN. I have to say that I was overwhelmed....even though I was shadowing an LVN. I had the 7-3 shift. I asked a ton of questions during the morning med pass. I can see how easy it is to be distracted my residents and co workers. There are a lot of medications to know(generic names too). Some are similar but there are a wide variety. I took some of the advice and wrote down some of the residents' likes and dislikes. I wanted to be aggressive, so I requested to do the 1300 med pass. My trainer agreed and said she is going to let me do it all by myself while she charts MD orders in the nurses station. I was shocked because I was expecting her to shadow me. But I decided to go for it, but always kept in mind to slow down when flustered and always ask when in doubt. I've never block out simultaneously so much in my life. Its like I knew what had to be done but for some reason could not do it. She told me that it okay, I'm just starting and started shadowing me. At the end of our shift we stayed till 400-415 charting. I wanted to stay so that I can get the whole charting experience regardless if they where gonna pay me or not.

So at the end of the day, my biggest concern is knowing all the residents' face, name, room number, diagnosis, MD, and family. I feel that would be a big part in my development. I also learned that I need to have a system for med pass and brush up on drug names and purpose. Thanks again for all the advice and responses. Any others would still help a lot. Thanks all and wish me luck!!!

NewGoalRN · Jun 19, 2009

Good luck! You can do it. You want to learn and you are seeking advice. This shows that you take your job seriously and you really want to do well.

RNgrrl09 · Jun 20, 2009

Congratulations on your job J. I too am a BSN RN with no hospital experience, graduated in December, 2008 and passed boards in April. In my past life, I was an applications support analyst in an IT department of a law firm. I quit my job in March to concentrate on the NCLEX and to concentrate on finding a nursing position. I didn't think it would be this hard. Finally, I was offered a position in LTC on a subacute unit. I will be starting this Wednesday at corporate orientation for 3 days and then will start my orientation on the unit. I will be responsible for 20 patients with G-tubes, trachs, IV's and treatments (Is this doable?!? Is this a common patient to nurse ratio for this type of unit). I will be working the 11 - 7 shift and would appreciate any insight that others can provide as to what to expect. I'm pretty sure there cannot be too many treatments done at night- right? Anyway, any tips and encouragement would be much appreciated.

ChickenJoyRN,BSN · Jun 22, 2009

Okay, I need to vent. So during the middle of my 2nd day of orientation my DSD comes up to me and ask if I can come in tomorrow for a 3-11 and work on my own because someone called in sick. I said I am available, but do not feel comfortable being by myself yet. She said I will do fine and that I can go to the other nurse on the other wing if I have any questions. She even said she lives 5 minutes away and to call her if I need help and she would come over. I would be responsible for 34 residents. I did not feel right about this at all, but my DSD said I would be okay. So I decided to give it a shot since there will be another nurse on the other side.

So as all would expect I was swamped and overwhelmed. I was a turtle during my med pass and residents were complaining they were not getting the right amount of meds. I was not doing my FSBS before dinner and I was basically about 2 hours behind everything I needed to do. But in the middle of my shift, the other nurse comes to me and ask if I can either work the AM shift tomorrow or the Noc right after my shift. I was like ***???? Is that a joke? Please tell me you're joking. Unfortunately, he was not. Our DSD called him to ask me that question. When I asked the other nurse where is she, he said not in the area. I was like WOW?!?!?!? I've never been more set-up in my life. I was really put in a difficult position.

So I took the NOC shift and was going to be working 16hours straight. I figured that was the best choice since I was behind in my charting and everything else, I would be able to catch up during dead time. The moment I thought I was caught up, it was time for the 600 meds. Now I had pre-poured meds and still ended up swamped and behind. When the Day shift came they all felt sorry for me. I looked drained and stressed. They said it doesn't make sense to put a new grad with 2 days orientation by himself for a straight 16 hour shift. I totally agreed.

So these are my thoughts.

-Are all my days/shifts going to be like this in this LTC facility? That is a lose, lose situation. The nurses are stressed and the residents don't get the proper care.

-Most of the nurses say that they all went through that, but with about 1-2 weeks orientation/training, NOT 2 days orientation. I feel like was set up.

-I don't know what they expect from me, a new grad with no experience. Is my DSD to blame? Her whole deal just seem a little fishy. She said to call if I need help, but she was about 2 hours away during my shift.

-I am strongly considering to leave unless someone tells me this is the norm in a LTC facility and this is how new grads get introduced to the environment.

-I'm so stressed out and drained and just the thought of going back to work leave a nasty feeling in my stomach.

Any advice, comments, response, tips would help a lot. I was really looking forward to working here, but this experience has left a nasty taste in my mouth. Thanks for reading.

CoffeeRTC, BSN, RN · Jun 22, 2009

Never, ever agree to do that again. Ever. It is hard enough for an experienced nurse to start at a new facility and jump right in working without an orientation to that place. BTDT and have the t shirt.

If they are interested in keeping you, they will give you an orientation that is proper. Speak with the DON about this.

My advice to most of the above..ask questions, listen and write stuff down. Get to know your CNAs and when you have free time (lol) help them out. You get to see so much from that point of view. Don't worry about remembering every detail about the resident. You can alway look up who the doc is. Try to know why they are at the LTC..what is the main dx. Most of them will have 100 other dx's, but what is the biggy.

Ask the other nurses about the staffing proplems too. Will it always be like this or is it just a fluke?