New grad nursing home charge nurse.. help?!

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I am a new grad BSN RN and I was just hired as a charge nurse in a nursing home. This is my first job as an RN and I will be supervising 2 lpns and 6 cnas on a 60-bed unit. I took the job because it has taken me 3 months of searching to even get an interview and when they offered me the position how could I turn it down?! At first I was excited but now am scared. I believe I can do it but I'm most afraid of what emergencies I will run into most often and what skills I should brush up on, any ideas? Is it silly of me to think I will be able to sucessfully hold this position as a new graduate? Is it normal for a new grad to be hired into this position?

Specializes in Gerontology, Mental Health, Informatics.

You are the resource and the leader for the LPN's.

You need to know procedures & protocols for your facility as well as the laws that govern your license.

So get out of your own way and learn to be a nurse.

Listen and observe. Get to know the people you work with as well as the residents. For the residents, this is their final home. Respect that. Respect them.

Get to know the difference between a DNR and a Full Code.

Are you comfortable with death and dying?

Get to know the electronic charting, the paper charting, and how to speak with a doctor/NP on call.

Get to know what the routine is for each and every floor and every nurse.

That way you will know when a deviation occurs and be able to follow up before you are summoned or before a crisis occurs.

Skin tears happen.

Incident reports are common.

Ignorance is common.

A lot of the people who take care of the residents also have outside lives.

Some have chaotic lives.

Some have poverty and subsist on the leavings of the residents meals.

Some feel entitled to possessions of the residents they are charged with.

Get to know your people.

Not the persona they shine on you, but the person they become when they don't know you are on the other side of the door.

Walk into a resident's room after the caregiver has "completed" their care.

Observe.

What do you smell?

What do you see?

What does your gut tell you?

Safety first.

Does the resident have easy access to their call light?

Has the bed been lowered after the NAR has left the room?

Did the nurse pour meds into the dry mouth of a confused resident and then leave the room?

Are the resident's hands clean or sticky?

Is the TV or radio blaring?

Turn it down or off.

Talk one to one with the nurses and caregivers.

Show respect.

Be firm.

You are not there for anyone to like you; that would be a benefit of the job.

Don't indulge in gossip - you are there to set the example, whether or not you are aware of that dynamic.

You are a role model.

You are not their "friend".

It is a privilege to be a nurse in long term care.

You are often a confident.

An angel.

The only one who cares enough to give of your time and just listen.

Or the only one with the power and ability to intervene and assess.

Narcotic diversion is easy in nursing homes.

I have worked with nurses who had a special juice pitcher on their cart for them.

Alcohol included.

I have worked in large facilities.

The supervisor was well liked by all.

The supervisor had a major addition to narcotics and whole cards of narcotics would disappear during a shift.

Disappearing patches.

Morphine injections that aren't giving the dying resident any relief.

Because it has been diluted with water from the bathroom tap.

After the nurse self medicated in the bathroom.

Watch for this.

The signs are subtle.

Residents, for the most part, have little choice but to trust what the nurse puts in their mouths.

Med errors are common.

Neglect can be common.

Follow protocols and learn who your people are.

To what degree and what intervention is your call.

Your assessment.

Your choice.

The emergencies are few and far between - it depends on your people and your facility.

It is a slower pace.

It may grow on you.

Give it a chance.

Trust yourself.

You are a nurse.

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Specializes in Dialysis.
"I have several years experience as an LPN, frequently thrown into the position of leadership. I just graduated with my ADN. I have been offered a RN supervisor job near my home. During the interview I got the distinct impression they weren't concerned about my lack of "proficiency" in their paperwork (it is a rehab/subacute setting). They were more interested in my ability to take control of the facility once the administration goes home for the day (3-11 shift position). I gathered that the CNA's more or less run wild, and they need a strong personality to regain control. I am a new RN, but I have been a leader for a long time....this should be an interesting experiment! Any other words of wisdom Nurses?"

Words of wisdom from a DON

1) Leadership is about mentoring not controlling.

2) Praise in public -- criticize in private.

3) Do unto others as you would have them do unto you.

4) Always show respect. (and believe me you can reprimand someone with respect.)

5) Customer Service is the top of the list when administration is out of the building

6) Fear and intimidation are not useful tools for leadership. A title does not give you power, you must earn it.

7) Get a good leadership book (My favorites are by John Maxwell)

I hope that helps.

All of this, 100 times over!
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Specializes in Dialysis.
i have never done home health but as i understand it, you will be by yourself when you go to their house and only have a phone to call your supervisor for advice (i hope). anyway, i will pick ltc. you will learn tons of things and you have people that will come and help when you have emergencies.

I have much experience in both, and home health is NOT a good place for new grads. You have to have experience with a full range of diseases, processes, and management. School just gives you the basics. Nursing home, on the other hand is a great place to start for new grads. You learn so much, beside the before mentioned-time management and critical thinking skills are honed, as you don't have an MD in the facility to give direction. You also learn the other valuable things-the value of teamwork, and most of all, how to listen to and learn respect for the elderly.

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Specializes in kids.
I've read all your comments here, wow... I'm happy for Bairkr.

I have a question for experienced nurses out there: would you recommend a new grad RN a home health agency job or a nursing home job? I understand they are not ideal jobs for inexperienced new grads, but I was wondering which one of these poses less threat to having your license suspended?? Thank you,

I would discourage home health for the very reason, you are the ONLY person there. There is no one else to bounce things off of. You have not had a chance to develop/hone your assessment skills.

LTC can be a great training ground for other experiences or it can be the right place to start a career in LTC!

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This is ALL awesome advice!!!!! Thanks for posting! :)

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I am an new nurse and im about to start at a nurseing home that has MULTIPLE LPN's doing everything that only the nurses (RN's) should be doing. all of the nurses there are charge nurses in charge of the lpns and cna's and i will be the only one on night shift. it pays about 15k$ more a year then the hospital and is 3 min from where i live. I am scared to death that i am going to miss something because i need to spend more time learning before im thrown into a role where my judgement is critical for a patient. I am looking up data and learning as much as i can but i cant only remember so much if i do not see it often. it is very stressful

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