new grad, new job, nursing home orientation

Silverdragon102, BSN · Aug 31, 2011

Moved to the Geriatric Nurses and LTC Nursing forum

Congrats on getting a job

CrazyGoonRN · Aug 31, 2011

I am starting a position at a skilled Nursing home. I am a new grad with CNA experience. This is my first job as a RN. I will be starting orientation next week.
What are some things I should look for to make sure I am getting adequate trainning? what are some questions I should ask, or things I should look out for? Seeing I have never been in this position, I'm not sure what to look out for
Any advice from the experienced would be appreciated.
Thanks,
Bea

You definatly want to be trained by someone who has been trained to train. So hopefully they have someone who normally trains the new nurses. Are you working a cart? Believe me it can be overwhelming. Don't be afraid to ask questions and always check and re-check to make sure you are giving the meds to the right resident. Ask someone else who has been working there for a while to point out a resident to you so you can make sure they are the right person. Some are confused and if you ask them what their name is they may not tell you or they may say yes to any name you call them.

One thing I often missed in the beginning: Look at the entire MAR before drawing up insulin. The pt may have an accucheck w/ SS insulin to be adminstered and they may have 5 units of Regular insulin that is always given at lunch unless their BS is below 110. So you need to add the 2 up before drawing up the insulin. Also they may get Lantus every AM or PM so that would be a separate syringe and a separate order on the MAR.

Ask what time you should have all you accuchecks completed by. You may have a lot or none. For example I try to have all accuchecks and insulin adminstered no later than 7:30am. (It is scheduled at 7:30) Then I can start immediatly on the Med pass.

I am not sure how it will work at your facility but where I work the halls alternate between meds scheduled at 8am and 9am. Where I work we have 1 full hall and 1/2 of the next hall assigned to 1 nurse. So I always make sure I start passing meds on the 8am hall first so that I am not late. Then on to the 9am hall.

Ask if there is a place that you can get a list of the residents that are going to early morning therapy. If you know who will be leaving to go to PT or OT then you can give them their meds before they leave the floor so you won't have to hunt them down. Also where I work there is a standing order that residents who are scheduled for early morning therapy can get their meds up to 2 hours early instead of the normal 1 hour.

At the moment that is all I can think of. Good luck on your job!!!

CrazyGoonRN · Aug 31, 2011

One more thing: Know where to look to find the standing orders for your facility.

beatrice1 · Aug 31, 2011

Thanks, great advice... I'm so nervous cause I have never worked in a facility, just home care. Don't even know where to start. I'm sure I am going to be overwhelmed but I am looking forward to alot of learning. Just want to do a great job!

optimist · Aug 31, 2011

You're going to feel really overwhelmed for the first weeks/months.Nursing school does not teach you how to administer meds to 30 people in an hour,while performing neuro checks on the frequent faller Q15, responding to emergencies, hunting down missing meds, answering questions, etc. Just remember the skill of time manegment will come with time! Take deep breaths and dont give up. It takes a special kind of nurse to work LTC and I hope that once you get your routine down, you'll enjoy it. Congrats!

Oh and BTW, please dont be THAT type of nurse that thinks the initials behind your name means you're above putting someone on the toilet or fetching a glass of water.Its one thing to delegate, but be good to your CNAs they are invaluable in this type of setting.

beatrice1 · Aug 31, 2011

To optimist...

I will not be "that kind" of nurse... I am a CNA and sometimes wondered during Nursing school if I did the right thing becoming a Nurse because my passion is taking care of patients, getting to know them, giving them personal care... and in Nursing school all I saw Nurses do was give meds and do paperwork

I think I will find it difficult to delegate tasks to CNA's because I don't mind doing the work myself.

I think CNA deserve alot more respect than they get! They are the "real" caregivers :yeah:

dittosaur-bandaid · Sep 3, 2011

I am starting a position at a skilled Nursing home. I am a new grad with CNA experience. This is my first job as a RN. I will be starting orientation next week.

Congrats on your job, Bea! I had a nursing job waiting for me in LTC where I worked as a CNA as well. I am moving on to acute care, but I do not regret the 9 months I've spent there.

If you can spend at least one shift just following the nurse that is training you around, not doing anything (or much of anything) but just watching, try to do that. Don't think you'll be expected to take a med cart on your first or even second day. Maybe get vitals and run pills, but stick close to your nurse who will hopefully be experienced. Pay attention to their routine, ask questions about their routine. Half the battle in LTC is time management. Medpass rolls around and you feel like you are chasing the clock.

I was put on the floor alone after 6 days training with a nurse who'd only been out of school 8 months herself. Will you be on a floor with another nurse(s)? That can make a difference, too. It's nice to have a sounding board (I didn't!). Don't be afraid to call the DON, or any other manager, ask any passing by nurse a question. If you feel like you're drowning, ask for help.

Everyone else's advice has been great. My biggest piece would be to establish a routine. Vitals, any treatments that need to be done, what kind of paperwork you'll need to be doing, when to stop all that and start medpass, etc...Things can change and get chaotic at any moment but if you're working under some structure it can really help. Oh, and write everything down! I keep a spiral notebook on my person at all times. It's impossible to remember every PRN you gave, every question a family member asked you, or every time a resident sneezed sideways in one shift.

Good luck to you! :)