New grad in LTC overwhelmed. Help!

[andreead]

Hi

I just accepted a PRN ( no fulltime available in my area) position in a LTC SNF that has long term floor, memory care and rehab. Rehab is like med aurg really. Lots of admissions and discharges everyday.

Well I started 2 days ago ( tommorow will be my third 12 hr shift) and I feel absolutely overwhelmed. So much to learn in so little time. I onky get 15 days of orientation and that is for all the floors - rehab, memory care and long term care.

I am learning a lot of time managememt for med passes, treatments etc.

Do you have any suggestions for me?

I am so worried for when I will be on my own.

[roser13, ASN, RN]

Suggestions: Continue to take in every bit of info on every shift. Dig in and do the work. Research every night what you didn't understand that day.

[mmc51264, BSN, MSN, RN]

See if you can get permanently assigned to the rehab. I did that for 10 months and got my current, dream job from it. You do learn great time management and appreciation for the older population. I would never go back, but I appreciate the time I spent there. Try to hang in there.

I got turned loose after 6 days of orientation because my preceptor called out. You CAN do this!!

[DenraSam]

Hi and welcome:)

I agree with the previous poster, try to get assigned to the rehab hall - you will tend to see more people with g-tubes, wound treatments, IV antibiotics and get exposed to more nursing procedures.

In the specialties section, look into the Geriatric Nursing section, there are many topics that address how to get along in this environment, and to get along well.

I started in a SNF a year ago and absolutely love it. The work can be overwhelming, so it's best to go in with a plan. I like to make sure I list all the residents who need medicare charting that shift. You'll need vitals and a focused assessment based on what the resident is admitted for, ie: infection, ortho, renal, CHF.

Then I list those who I need vitals for, those who need closer attention - these residents could have fallen recently and we need to watch for pain or further injury. They might have new onset edema, a cough, diarrhea, emesis event and so on. Know which resident has O2, and how many liters- you will check their O2 saturation to be sure all is well and their portable O2 tanks are full:) Know who has a foley catheter so you can monitor output, who has pressure ulcers so they can be shifted frequently to offload pressure.

I work evenings, so I like to know which residents I need for blood glucose checks/insulin injections before they go off to dinner. My facility likes to administer Coumadin right at dinner time, so I like to know who those folks and their latest INR are as well. I note those who are given nebulizer treatments, and the times. Find who is getting IV antibiotics, and the times of administration. You can try to find the oddly scheduled medication (doesn't fall into normal scheduled med passes). These things are sort of the framework of your shift - the things that are strictly scheduled - the rest of the stuff can be completed as you can get to it. As an evening nurse, it is easy for me to save dressing changes and skin treatments for when the resident is undressed and in bed.

My aides and I have found a nice working relationship. I ask that they wheel/walk the residents to me before dinner, for meds. I ask that they report skin problems or anything unusual to me right away, and appreciate this when they do! I try to help them as much as possible when there's a moment or two to help reposition/lift, answer a call light, toilet somebody, etc. You can learn so much from the aides when first starting out - everything from facility procedures to resident likes/dislikes and which residents or family members or staff need to be handled with care:)

When taking report, find out how the residents take their meds. How do they ambulate, or are they in a wheelchair. If they are continent, how many to assist to transfer to the toilet. Your aides will know alot of this, too. Don't ever be afraid to ask a question.

Try to cluster your care if you can, it will save time... and your feet. Getting vitals, a focused assessment, accucheck, med administration along with a dressing change all at the same time is a tremendous victory - you'll see! Oh, and try to be sure your cart is stocked with everything you might need at the beginning of your shift. Water, cups, applesauce, syringes, nutritional supplement drinks, gloves, tissue...

This is all I can think of right now. Best of luck to you - you can do this. You might not feel that way just now, but you can:)