New grad in LTC - frustrated

IdrilRN, BSN, RN · Aug 6, 2011

You are lucky to get the ten days! It's frustrating to learn the in and out's of a job. I think LTC is a lot harder then people make it out to be. I recently got two days, but I've been in LTC for many years and passing meds and doing treatments is passing meds and doing treatments, for me anyway.

When you go on your own you will develope your own routine and and before you know it you will be a awesome.

I always tried to make sure my residents with anti psychotics and/or anti anxity meds were done first and then people with cronic pain medications. Of course if you have blood sugars and insulin they are important too. I only learned that after working for a while and going from the start of the med book to then end of it. As far as treatments go the stage 4 and threes were the most important. Then I would work on putting the creams or ointments on people.

I always checked who was coming in for 3-11 as some nurses would have a fit if something like a minor dressing didn't get done, and they would be more then willing to assist. AFter all we are there 24 hours a day.

Now I am on 11-7, my important stuff might be an IV on another unit at midnight and disconecting someones IV at midnight. but the killer med pass in the morning.

One thing that helped me at the beginning many years ago was to look meds and and conditions up when I was at home. Unless I needed to know right then and there. But I got it eventually and love to work in LTC.

Good luck to you and hang in there. To thank yous and when the residents say the funniest things make my day.

Hospice Nurse LPN, BSN, RN · Aug 6, 2011

Three days really seems to be the norm, even for new grads. That's exactly what I had at my first LTC job, but I was trained on 7-3 and was hired for 3-11. The one saving grace was that a CNA was assigned to go w/ me for med passes for the first week. She was able to id the residents until I learned them. You're right, the pics in the MAR are usually the ones that were taken on admit....sometimes many years ago. Plus no arm bands.

You'll get better and faster at your med passes. Like anything, it just takes practice. Good luck!

pixie120 · Aug 6, 2011

Thank you all for the insight and encouragement. I feel a lot more comfortable with the 10 day orientation. Going to talk to my DON and supervisors if I need more time

YOur DON is your best friend, IF you allow her to help you. DO NOT LISTEN TO BAD ADVICE from floor nurses, and DO NOT CHANGE YOUR PRACTICE from best practice by a reasonable and prudent nurse. I got yelled at for 7 years as a CNA and then for the first 2 years as an LPN and THEN as a LPN/manager, and NOW as an RN/DNS, so....morale of the story? I have been ignoring them for 20 years, and still have 3 licenses that are not encumbered, nor have I had to go to drug rehab or any of that other crap that THOSE nurses have had to do cuz they are NOT being professional, period. CNA's can and will gladly tell you which patient's are which, and will literally line them up at your med cart if you ask them.

CareteamRN70 · Aug 6, 2011

I was given 7 days of Orientation at the second job I took (my first job gave me 1 day following a medcart then that night I was by myself with 60 pts).

There are not what I would call short cuts but prioritization skills you can develop (or learn from good nurses) that will help you ten fold. Some examples I learned from some experienced nurses:

We have a 1 hour before and after med window. When I started I passed my 4AM meds at 4AM, my 5AM's at 5AM, my 6 AM's at 6AM....it never occured to me to pass my AM med pass at 5AM and cover all 3 passes within the facility defined window. This did take some reserach on my part to make sure that I was not passing any medications that may be contraindicated in a same pass time frame.

I learned which pt's in my hall took a bit longer to pass too..either they woke up slowly, wanted to talk, or my more alert ones that wanted me to asses them every pass to see if they were needing any of their PRN's (Got one every AM that wants imodium, mylanta, milk of mag, a suppository, 2 tylenol, a neb tx, and insist that the previous shift did not change her 30 minute to do dressings for cellulitis and wants them done now - even tho the dressings are c/d/i and are dated and initialed by previous shift nurse) I tend to pass her meds first just as she is waking up as she often wants to go back to sleep..otherwise I am doing an hour of assesing to document that she had a BM my shift, regular not loose, Dressings are c/d/i and dated properly, O2SATS are 99% on RA with no labored breathing, 2 tylenol given for pain with a mylanta chaser.

One wonderful OCD nurse I work with taught me to lay out all my blood sugar supplies out before the med pass. She always has them neatly lined up on top her cart 1 lancet, one accucheck stick, one alcohol swab per pt..all on top one another..she even goes as far as to write inmarker on the swab the pts name..I used to just fill my pockets with lancets, swabs etc....I just don't wash my hands 16 times and check the faucet 16 more times afterword.

As for pt names..at first it is daunting, use the advice given of asking aides at first, but what I did was every morning once I verified a pt I used their name several times ie "Good morning Mrs pt" "I'll be back in 15 minutes Mrs Pt" etc after a week or two you will be amazed that you can remember over 127 pt names like they are family..(because in a way they do become that).

Right after report make yourself an action plan even if it is just a scribbled page of quick notes..I need to do this this and this..and if at all possible try to alot yourself 20-30 minutes for "Ah sh*t" moments...that fall that happens 10 minutes before your your relief shows up, the one time your pt that wants all her prns actually does need them because she has loose stools, hypoactive bowel sounds, and has O2SATS below 85%, or my favorite time killer...when a visiting MD from the wound team leaves three pages of orders...then hides them in the chart no where near the orders section..and you find them one hour before shift end.

Last note, good CNA's are angels sent from heavan to protect us time challanged nurses..I never finish a shift without thanking my CNA's for their contribution to the shift.

SunshineAnytime · Aug 6, 2011

This is great advice! Thank you so much for taking the time to write. I'll be back on the floor Monday and these priority skills will hopefully help

Forever Sunshine, ASN, RN · Aug 8, 2011

Wow I guess I was spoiled. Nobody ever told me I was slow.

I'm still slow sometimes. You get quicker as you keep doing the same med-pass. If I'm on my usual hallway I can whip out the 4:30 meds in 2 1/2 hours and help feed. It used to take me all shift to do the med pass. Now its only a fraction of my shift.

Give yourself a good year to a year and a half. To feel fully comfortable at your job. Ignore those who say you are slow. Take your sweet time.

LTCangel, ADN, BSN, LPN · Aug 8, 2011

I agree with Forever Sunshine, slow and steady is the name of the game until you get your routine down- esp those large 9 and 9 medpasses! I just made it through my first 90 days at a LTC facility after 14 years at a hospital. My first job was LTC so I kinda knew what to expect but I still consider myself to be "slow", but I am slowly picking up my pace. I'd rather be slow and accurate then speedy and sloppy. You will get a routine, you will learn your residents. They become kinda like your children because after a while you know them so well that you can pick up on little things that alert you that something is going on with them. Your CNAs can be your best friends or your worst enemies. Treat them well and they will always want to come to you when they notice something is off cuz you can't be everywhere all the time. Once you are able to get faster you will find you have time to give that extra TLC that the residents deserve and sometimes yearn for, especially the ones who don't have family or friends who visit often. Geriatrics is a special calling and those who come to love it are special people in my book! This world we live in now doesn't always appreciate our seniors the way they did in the past and we see so many who have been dropped off to just wait to die. I hate that. Other cultures cherish their elders, but many Americans don't. LTC today is a place where you can become very proficient in the skills you learned in Nursing School because we do a lot more in house than we used to such as IV therapy, and of course trachs, g-tubes, foleys, strait caths and the list goes on. Just try to relax and it will all come together and 6 months from now you will be giving advice to the newbies who will be in the shoes you are in now!