New grad, LTC job offer...advice?

[tiona]

I'm a new grad LVN in CA. My hope was to work in acute care but hospitals in my area are going to all RN staffing. My clinical experience was mostly med/surg. I accepted an offer from the best LTC facility in my area. It's clean, professionally run and the acuity level is relatively low. Unfortunately the ratio is 30:1 which is actually lower than some facilities in my area...state standard is 50:1.

I'm scared to death...I need words of encouragement and advice. Can a safe med pass really take place with 30 residents....not to mention tx, assessment and charting. Can I do this???

Thanks T

[renerian, BSN, RN]

Good job. I read the entire post groups and I hope things go well for you. Just don't let people dump more supervisor stuff on you to turf it off their desk. I say that as it happens alot. Take your time.

I always thought subacute would be good. I just think the ratios are awful and it is very saddening for the patient.

renerian

[sixes]

Thanks for your replies. I started work Weds and "they" say I'm doing very well. My preceptor told me that I'm the best nurse she's ever trained, new grad or not. Why then do I feel Sooo overwhelmed. I managed to do the med pass, and treatments for 33 people...not on time I might add. I haven't started charting yet and there are so many, many things that I don't know how to do. They want me to work evenings...only one other LVN in the building. Do you all find that evenings are slower paced. Fewer tx and meds?

There is a big issue about OT in this facility....meaning one is not allowed to work OT. So what should I do? Stay on my own time, or not get all of my work done. I suppose they could "write me up" either way... Suggestions?

It is not humanly possible to get everything done in 8 hours and I refuse to cut corners or otherwise fake it by signing out on something that I didn't actually do. I suppose it'll get easier as time goes on...do ya think?

I don't nknow what LVN stands for sorry in Ontario we have RN, LPN, & hca/PSW.

When I am on as a Supervisor I Have 157 residents & staff (evening shift) I also have 3 RNA's who do the med pass and 1 RPN from 1600-2000 who does treatments, vitals etc. I have 4 HCA per floor (3).

On Nights (3) floors I have 1 RPN & HCA on 3rd and 2 HCa on 2nd and 2 HCA on 1. On weekend days it's the same as evenings.

If we are short a RPN I have to do meds on that floor ( doesn't happen often)

I have recently been promoted to a temporary Charge Nurse stricktly days and every other weekend. I find this harder then when I supervise. I have only 57 residents on my floor but with the paper work, families, Doctor's and all the care plans etc. I find I don't even have time to change my mind never mind anything else. My DON believes this is because I spend too much time doing other people's work Ie toileting, feeding, Lifts& Transfers etc. I like the hands on. I especially like being in the dining room at meals and doing the treatments. I usually have to stay 1.5hours after my shift to do paper work and this weekend I went in on my own time to do care planning.

I'll eventually get organized and learn to prioritize but until then I guess I will feel constantly behind the 8 ball.

I get great reviews from my staff as well as the DON, for my enthusiasum and dedication.

I love my job and all the the staff a very dedicateted including management which is rare

You'll do fine. If you are feeling overwhelmed. Ask your supervisor for direction.

Good Luck

[tiona]

Canada must have some different policies. LVN stans for "licensed vocational nurse" which is the same as "licensed practical nurse." For some reason TX and CA call us LVN.

I like the nurse supercisor role because I get to communicate with physicians, personally assess the residents and do stat procedures, which utilizes my skills. I help out where ever I can. But paperwork is the biggest issue....I was highly trained to do assessment and careplan in my nursing program, so I'm happy to have an opportunity to keep my skills. As a new grad this is all very intimidating and the state is coming next week ..YIKES. My facility has a very low turn-over for nurses and not bad for CNA's. They treat everyone pretty well and right now they treat me like a queen. I'm having some difficulty directing the CNA's. Some try to manipulate me because I'm new. Not many. They are the hardest working people in LTC by far. I believe in mutual respect, but I also need to be strong enough to make sure they do their jobs adequately for the sake of the residents. It is very hard to be a new grad, a new employee and be handed so much responsibility. So far, so good. But, inside, I'm terrified! I'm using my nursing skills though, and gaining confidence. Too much too soon....?

[renerian, BSN, RN]

How are things going now? Just wanted to check on you.

renerian

[scarterlpn]

Of course you can do it ! I currently work at a LTC facility. The ratio is 34:1. When you do your med pass just take your time. Make a routine that fits you. I have worked 6 months as a LPN in LTC. I enjoy my job and working with my cna's. You can do it just believe in yourself. I know at first it is scary ! Things will fall into place and you'll learn more than you could ever imagine. Find someone to help you get into a routine and spend time with you until you feel comfortable about your med pass. Currently we only have 5 tx's and there split between shifts but if i have time i usually do them to help out the next shift. Help your fellow nurses and they will help you. Good luck !

[tiona]

Hi All,

Things are going well. I'm working full time, hoping for a permanent part time kind of schedule sometime soon. I'm learning a lot about every aspect of the LTC "business" as well as how to manage 33 residents. It sometimes feels very overwhelming, but I get a lot of positive feed back from everybody. I can't say that I actually enjoy the job yet, but I can say that the work environment is very good. The time that they are taking to mentor me is a great learning opportunity.

I spend a lot of mental energy even on my days off worrying about this-and-that, but I'm sure that will get better as I become more comfortable with my role. Right now, I'd just like 2 days in a row off!

Thanks for all the advice and support! I'll keep in touch.

[renerian, BSN, RN]

Good for you! I am glad to hear your hanging in there!

renerian

[Betty_SPN_KS, LPN]

I'm glad to find this thread. Tiona, I'm glad to hear it's going well for you. I am also a new grad (of an LPN program in Kansas) and also going to work in LTC. I'm going to work in 2 facilities. Fortunately, I have worked as a CNA in one of them so I already know the residents. But the other is all new to me, and after my orientation, I will be the only nurse in the building from 6 pm to 6 am.

[HisTreasure, BSN, RN]

I, too have been hired on a sub-acute floor of a LTC. I am working evenings. It is a 24 bed unit. I will be the only nurse on my unit with 3.5 CNAs. The charting is computerized, and the CNAs and nurses said there is some downtime. Many of the patients shouldn't be considered subacute, but they keep the beds full anyway with LTC patients (if that makes sense). I will get phlebotomy and IV certification which I look forward to. I am excited and scared. I feel ill prepared, and as I haven't been in healthcare prior to nursing school I really don't know what the reality of nursing will be like. I enjoy reading these posts, I am learning so much from each of your experiences.