New grad in LTC nursing- need advice please!!

mom2boyz · May 30, 2014

I don't have any advice, but will be watching this thread. I, just like you am a new graduate with a new job in LTC. I have one more day of orientation. It is a lot to learn!

amoLucia · May 30, 2014

To OP & mom - couple of suggestions/recommendations.

First, become VERY, VERY knowledgeable of the location and contents of your crash-cart, IV box, backup Ebox (or pyxis), suction equipment, and oxygen setups (esp the green tanks with the regulators). Also your IV pumps and the enteral ones.

I'm talking to get on a first-name basis with all the equip!!! When you need them in an emergency, you won't have time to fumble around. You need to be able to use them on the drop of a dime and when you just look at the equip as you walk by, you can tell if something is amiss. Most places have a q shift checkoff observation of the equip. Check it out.

Secondly, your paperwork/documentation will now become short, sweet & brief!! Not like the old nursing school kind of "3 pharts and 2 burps after eating a half piece of toast". (I qualify this entry if your pt does have an obstructive bowel issue that you need to monitor.) Your charting must be factual, detailed - the NECESSARY stuff, not the fluffy stuff. And do it just as soon as you can - not saving it for later (because we all know what happens later!!!).

Thirdly, do whatever you can as it comes up, Again not waiting til later. Try to be ahead of the situation.

Keep a cheat sheet and record all those things you want to check out. I usually recommend NOT keeping your cheat sheets because of HIPAA, but for a day or so, you'll need to review your notes to make sure you've followed up/checked out leftover stuff. Then dispose of those sheets.

Get to know what the LPNs and CNAs can and cannot do per policy/rules/job descriptions. Don't put them in an awkward position and then things get missed or done wrong. Also respect your CNAs - they will be your biggest asset to knowing your pt. Help them if you can even if it's just lending a pair of hands for a minute or two.

Just know that not everything will be achievable by day 4 or 5. Just work on it and priortorize where you can. There's more things I can think of but enough for this post.

But now for my most absolute, critical direction - PLEASE make sure your NARCOTIC COUNT is correct. No shortcuts. And do it as you're supposed to. Once you accept the keys, it's all yours. Staff freq get into sloppy habits but please,do it right.

And finally, make sure you have malpractice insurance. Just as a disclaimer: I don't work for any insurance companies, nor do I have any investments in any companies. Just my advice.

Allsmiles11 · Jun 2, 2014

Thank you for a lot of helpful advice!!!! I had one day alone and I'm still not quite in a routine- my bed time med pass took FOREVER but I am so happy nothing crazy happened. Just have to hope I can learn to better prioritize. So much for one nurse to do it's a little much to handle :wacky:

sallyrnrrt, ADN, RN · Jun 2, 2014

ammo lucia, thankyou for helping these two new nurses.........As a prior Don of several LTCs i hired a lot of new grads.........it can be overwhelming, take a deep breath, try to stay on task, being esp. nice to the difficult patient, will nake your life easier (smiles) we need you, this can be very rewarding nursing experience..... :laugh:

ParrotHead_RN · Jun 2, 2014

I have been working in LTC for almost 5 years now.

My advice for you:

-Make it a point to learn where everything is. That, for me, was the most frustrating part was trying to locate everything you need without bothering someone. In spare time, i would always walk around the supply rooms and look it over

-In my facility, we have "assignment sheets" It has the resident's name on the front and their essential information on the back (ADLS, alarms, dentures, glasses, etc) THIS WAS VERY HELPFUL! I would study it in my free time, of course never taking it out of the facility d/t HIPPA. I would read each name and try to picture their face. If your facility doesn't have one, I suggest making a blank template at home and filling it in when you get to work, Make copies, and store it in your locker at work.

-Develop a good working relationship with the CNAS and do not be afraid of primary care/answering call lights. The CNAs will respect you and it will make your work time much more enjoyable.

-Attach yourself to a friendly, seasoned, nurse if you can. Always ask questions and never think that they are "stupid questions". No question is stupid. You will learn a lot from a good nurse.

-When you call an on-call MD for the first time, make sure you have all necessary information available (Vitals, what is the resident's baseline, are they a full code, etc)

When I first started I was petrified! I never thought I would learn everything that needed to be learned. I was overwhelmed. But now it is second nature! :) It takes time. Don't give up! Good luck!!

AnonymousLPN · Jun 2, 2014

Always keep a Sharpie marker on your person for things like dating bottles when opened. Never leave the Sharpie on the cart as it will disappear. It is amazing how much time you can lose looking for little things.

If your MARS are paper keep extra pens in your pockets. Again so much time looking for where did I put my %&$ pen?!?

I can't agree enough with the person who said to stay on good terms with your CNAs. Give them a hand when you can. They can make or break you.

kiszi, RN · Jun 2, 2014

There's some really awesome advice here. I want to second the comment about narcotics. I am a PIA about narc counts and very careful when pulling and charting them to make sure everything is accurate. Not something you wanna mess with.

Ditto on keeping a Sharpie in your pocket. I also keep a highlighter or two handy. I note things like blood sugars on my brain sheet and also "cross off" each pt with highlighter when I've done their meds. It makes it easy to see at a glance where I am in my med pass and who I need to come back to b/c they were in therapy or whatnot.

A good pair of bandage scissors is essential too, not just for bandages, but for all those little exelon and lidoderm patches.

BoyNamedSue · Jun 17, 2014

As a brand new nurse myself, it's somewhat awkward giving advice but one thing I can say is that doing the most difficult things first really has helped me out. An example would be like working with the most difficult or the highest needs patient first, so that when something comes up, you're not swamped with some unforeseen task. Don't wait till the last minute to reposition a patient who's an every 1 hour turn, who's also a 3:1, and completely incontinent. One word: a*splosion. True story, happened during med pass :bluecry1: .

HappyWife77, BSN, RN · Jun 17, 2014

Welcome to LTC! I hope you have a rewarding experience. Just know it takes about 3 months or so to get a routine down for your self, after 6 months you should be comfortable in the routine.

Everyday can be completely different from the others and sometimes we end up staying over to take care of things.

Show up about 10-15 minutes early everyday to make out your brain sheet and get settled in.

This is what works for me....I use one sheet for my entire shift. I write everything down and cross it off when I'm done. I note what meds need reordered as I'm doing med pass, reorder everyone's at the same time, once I've seen everyones supplies. I address all orders and faxes as soon as I see them (if possible) and do not let piles develop. When I have to make a trip to do something, I will try to do two or three things on one trip rather than make three separate trips. I also forgo small talk with other employees. Keep it moving, if someone does need to talk and I sense it is ok to keep moving, I tell them to walk and talk to me.

Every minute counts and it's important to develop good time management skills right out of the gate....so to speak. You will want to be getting done on time rather than staying over to finish charting everday.

Know the protocol for skin tears and falls. Get good at doing the paper work and computer task quickly accurately and thoroughly, and it will become second nature to you. Know the policy and procedure for sending someone out. Get comfortable with making phone calls to families asap. ( some places you must notify them for every new order and incident).That way it's no big deal, they get to know you, trust you.

Generally, as soon as iam aware of something that needs done besides the schedule meds and txs I do it then. There are always things that will need done, so try not to have things waiting to be done. Hope this all makes sense.

Best wishes and God bless!

misstrinad · Jun 17, 2014

In my facility we can save our cheat sheet as long as it doesn't leave the building. If you can do that make a good one and save it. On my assignment sheet when ppl don't have scheduled meds I color in their name box, if they have meds twice I put a slash through it when the first med is done. And when all their meds are done for the shift I color in the box. Then at a glance I know who still needs meds and who is done. I used to use different color pens on my sheet. Red for bs/insulin blue for tx. Now I don't need to do that. Do the easy residents first and get them done. Save less important tx for last, if you have to you can pass them on to the next shift. If there is something you didn't get done apologize, explain why, and gratefully ask the on coming nurse if she could do it, especially if your facility is a pita about overtime.

Remember that every day is not perfect, don't be scared to ask questions.you will make a mistake at some point and it WILL be ok, just own up and don't make the same mistake again. When faced with a situation are aren't sure about take a moment and stop and breath for 30 seconds and gather your thoughts for your first course of action.

Last weekend I had to do an im rocephrin w lido and hadn't done that in almost a year. I checked the bottle instructions, looked it up on my phone, then went to another unit to hunt down the supervisor and double checked with her before I gave it bc I wasn't 100% confident.

I also always keep a set of sticky notes to jot down stuff that I don't want lost on my assignment sheet writing. Ex: x needs more apap, check y order, z bm today? If I get floated to a unit with lots of diabetics I will put all their bs times and results on a sticky note so I don't miss anyone.

Hope something of that helps and good luck!