New grad nursing home charge nurse.. help?!

himilayaneyes · Aug 7, 2010

there are some things that take nurses a long time to learn, especially a new nurse. i would brush up on the signs and symptoms of a stroke/heart attack/respiratory distress/hyperglycemia/hypoglycemia. a snf has a lower acuity level than a hospital. however, i wouldn't suggest risking your license. i would suggest that you continue to look for work elsewhere while you work at this nursing home, a staff position. you may also want to take a pocket guide for nurses to work with you. good luck to you.

Flying ICU RN · Aug 7, 2010

First, allow me to correct you. Despite what you see with all of the other alphabet trailing silliness out there, your clinical title is (RN), and then to be followed by whatever alphabet soup you care to trail. When you get your ARNP or DNP, please drop both the undergrad and masters degree from the alphabet soup, it is inferred! Picture for example Dr. Jane Doe AS, BS, MD.

My apologies for the brief rant, now to the questions at hand....

You were hired into this position out of necessity and desperation, which must also be indicative of a particular shortage in your specific geographic location. That having been said, you must also have given them cause to hire you during the interview, (confidence).

1. Do not fear emergencies, you apply the same standard of care regardless of diagnosis, (i.e. ABC's).

2. Learn to recognize respiratory distress, S&S of stroke, and the appropriate interventions.

3. Your biggest challenge will be personnel management, so learn to "Lead by Example" rather than preaching and or micromanagement. Rely on and treat the LPN's and CNA's as valuable resources and they will deliver.

4. Stay in the position at least 1 year before job hopping.

Good Luck!

Flames9_RN, BSN, RN, EMT-B · Aug 7, 2010

Is it an ideal situation?? Prob Not. You will soon find out, that no one cares more about ur RN License than YOU! Simple as that!! The group home/hospital most likely does not, ur just a # that can be replaced. Throw away all that $$$ you spent on education if you loose your license.

If you have a great staff and ur willing to learn and treat them well, they will probably work hard for you and help you out a lot. Some of the best nurses I have come across are LPN's-----I just say that because on these forums, some give them a bad rap, not sure why!! You work hard for them and they will prob work hard for you!! But if ya sit at the desk and sit on ur butt, they will prob throw you under the bus!!

guest2210 · Aug 7, 2010

the rn supervisors i've worked with have been fabulous. they knew they could count on me to help them if warranted. their main function was staffing-making sure they had it and finding coverage when they didn't. the lpns and cnas will be tremendous resources for you. they know the patients and their history. an old adage that i lived by- when in doubt, send them out. if doing assignments is a part of your duties, check with the other charge nurses to see what personalities work well together. you don't want to upset the apple cart by doing a bunch of changes right off the bat. changes can and should happen, but ease into them. you don't want to alienate the staff that has been there for any length of time. good luck... :smokin:

landesmummy · Aug 7, 2010

All I can say is good luck. I was the only RN at nights for 110 pts...heart attacks, breathing difficulties, unresponsive pts, fisty cuffs between pts, belligerent pts. If you have a crash cart, make sure it is fully stocked, if not, be prepared to cal 911 & SBAR when you call the MD.

handyrn · Aug 8, 2010

I have been in the nursing home business for many years. Nursing home nurses get a lot of guff, which has really bothered me. It seems like you are not as respected as a hospital or clinical nurse. However, if you are in a small facility like I have always been, you will learn TONS! It's a great place to get some on the job education. Resources are not as readily available to you as they are in a hospital.

Here are some roles that a nursing home nurse plays (in my experience):

1. Nutritionist. State laws vary, but most of the time the consulting nutritionist visits once a month and visits the dietary staff to consult on menus. If your patient has gout you have to know the proper diet for them. If you have a diabetic you have to be able to know their diet, etc.

2. Podiatrist. Podiatry consults are paid by medicare every 60 days. In between times you get to be the one to treat toenails. FUN!

3. Physical Therapist. Knowing ROM limitations and how to encourage your patients to be as fully functional as possible is important.

4. EMT-In an emergency, it's you until those paramedics arrive.

I could go on, but you get the picture. It is so rewarding to be a nursing home nurse! And such an education.

landesmummy · Aug 8, 2010

I forgot to mention, get to know your staff and work with them. And don't forget to say thank you for a job well done. The CNAs & some of the LVNs never got to hear a thank you and by doing so, showed me so much, with supplies, & with procedures. I learnt so much from some of them, they were amazing. Others, well lets just say, I wouldn't have them look after a cockroach...

TonyaM73, ASN, RN · Aug 8, 2010

The biggest thing I can stress is: If you do not have your own patient load #1 Ask your LPNs if you can follow them around to get a feel for how things are done. Tell them that it would help you out if you could help them out. #2 Tell the CNAs the same thing. #3 Use a lean management style: keep your staff on the floor!! Go to supply and get them the things that they need. Make the phone calls to help keep them with their patients rather than having them run around like chickens trying to get everything done. It will take a while, but in the mean time you are gaining their trust and experience for yourself. That way in any situation you can pitch in and help out. If one of your nurses gets sick and has to go home, you can pick up where she left off until you get someone else in. Try to be proficent in everyone's jobs so that you can find ways to improve situations for everyone. DO NOT CHANGE THINGS FOR A WHILE until you have gained their trust and have a good understaning of how things are done and why.

I started of as a floor nurse in a LTC/Rehab for 4 months, then they moved me to evening supervisor and I have been in that position for about 6 months for a 180 bed facility with 7 LPNs and 18-20 CNAs. I have gained a lot trust because I am pro-active. I go around to all of the wings and find out if everyone is okay and what they need. If we are having multiple admissions to the rehab side, I put all of the orders into the computer and when that is done ask which patients have not been assessed yet so that they can keep up with the other 15-25 patients that they have. If all of that is done, I ask what wound care they have left and if they are behind. Just jump in head first and learn and in the mean time you are gaining trust and help everyone out. Do not be afraid to put someone on the bed pan or clean them up. Some of your best resources are your CNAs. Good luck to you.

Bairkr · Aug 8, 2010

Thank you for all the information! It is very helpful, I guess I just needed to hear that is has been done and I'm not going to crash and burn.

iamnomad · Aug 10, 2010

when I read your post, and saw 2 LPN's as two of the staffs you are supervising, I actually knows exactly what to advice: Seek their help. Especially if they are experienced. I'm a new grad when I started working in a long term care facility. I was hired a charge nurse. And in my experience, LPN's actually know more than I do even though I got more education. Its because they have more experience. And seriously, if I can confer an honorary degree, I'll confer a BSN to them.

Bairkr · Aug 10, 2010

I completely agree with you about the LPNs. They have been there for 20+ years and are going to be a great asset! When I found out they had so much experience I felt a little better about the whole situation. They are very knowledgable.