Published Jun 28, 2009
Hi all. I have been out of school since December, 2008, passed boards in March, 2009. I finally landed a position as an RN and I am really excited to start and also a little nervous . I am a new grad RN BSN to start in a LTC facility on a 60 bed sub-acute unit. Will have 15 patients and will be working the 11 - 7 shift. Will start my first day of unit orientation on Monday. Just wanted some encouragement. Also what should I expect on this shift? Any time management advice would be greatly appreciated it. Thanks all :redpinkhe.
Congratulations on your new job! Make sure you are clear about the expectations for your position and your shift. You shouldn't be giving too many meds on 11-7 since people need their sleep and you shouldn't be doing too many treatments for the same reason. Make sure you do rounds on your patients...try to plan your shift when you arrive but know that lots of times the plans have to change.
If that facility is like the ones I've worked in, 11-7 is usually mostly paperwork, so again, be clear about the expectations. Your 6 am med pass will be busy...most likely blood glucose checks, synthroids, pain meds....take your time and do expect to be perfect or as quick as the people who have more experience.
Let us know how your first day goes.
Congratulations! I too am starting my first job as an RN in an assisted living facility. I am very nervous after reading some posts that suggest new RNs should not start out in this area. But then there are some positive posts. I'm starting out on the 3-11 p.m. shift but my orientation will be days. I'm told as soon as a day shift opens up, I can have it but who knows how long that'll take. How long is your orientation?
I was a little nervous also because I heard you should not work in LTC until you have experience, but with the economy the way it is, I am happy to have a position. I am going to try to do some prn work somewhere and take some ACLS classes. I start orientation on days also and then will spend a week on nights. I have 3 weeks total of orientation. Last week I had corporate orientation and then this week I will start my unit orientation on days and then next week on nights. Keep me posted on how things are going with you dekagirl and I will do the same.
Thanks for the advice CapeCodMermaid!!! Sigh! That's what I thought, I just hope that I will be able to develop my critical thinking and clinical skills and I will try to move to another shift as soon as possible.
Congratulations and welcome, there are lots of opportunity for learning during your shift which shouldnt be too hectic, take the opportunity to read the charts, and whatever you can find. After working a bit, visit during the day you will be shocked how different the pts look during the day hours. Ask questions, keep a note pad, etc.
There are numerous posts here on tips for the night shift, you can browse thru them.
there are more but this is a start.
If it seems difficult remember we all did it and you can do it too. Working the night shift is quite important- you set the stage for the day shift- your success is her success!!!
I too am a new graduate working in sub acute in a skilled nursing facility for approx 5 months now and love my job. There is alot to learn and I just take one day at a time. It is hard work but rewarding. When I saw a flash of blood inserting my first IV (and only so far) I was excited and glad I got the stick. Hang in there and if your as lucky as me in finding a supportive management team you will be fine.
Just tips and tricks I have learned over the years of being in the medical arena as an Administrator:
Have boundaries with staff, residents and family members. Remember you should not be rude but we should not be exposed to abuse as well. Read the following books: Everything I learned I learned in kindergarten and How to win friends and influence people. Really those books are very good with simple instruction.
Work your scheduled shift with no or very few sick days/call offs. This impacts our unit, the residents and ultimately care rendered. We have an important job as caregivers and must take it seriously. If work calls on your day off please answer the phone, if you cannot work just say no.
Keep you nursing skills up to date. Look for opportunities r/t nursing skills. I followed the phlebotomist in the early am to increase my blood drawing skills, on my own time.
If you are good on the computor take the time to print out "cheat sheets" to common issues and the paper work necessary to complete your nursing skills/assessments. An example would be I filled out a pain assessment for "John Doe" I had my mentor look over the assessment and what should be included. I used this as a template when I was learning. Same with Accident/Injury incidents. My mentor filled one out for me as a temp plate: a pretend resident who fell, hit head that is bleeding and was transfered out to hospital. This has been a life saver for me when I did have a resident fall with no injury. You never know and I continue to use this template for unforseen incidents (we do not have many).
In short treat this like school, ask questions from nurses/staff you feel are safe and compentant. Take the time to get acclimated to your unit.
Learn to laugh at your self and your enviroment. Humor goes along way.
Well, I have finished my first week on my own and my patients have survived and I have too. I sent one patient out that was not doing well. I am a little more confident in my skills as a nurse, but everything moves so fast, you must have excellent time management skills. The most annoying thing is trying to keep up on charting, since it is a skilled unit, I have to chart on everyone. As far as time management, I am still working on it- it is so hard to get . It seems as if I lose steam at about 6:30 am when I am trying to finish up my treatments and medication pass. I do love the patient population, even though I do get some young people in with knees and wound care. I love it so far. Dekagirl, how is it going with you?
Thanks everyone for their comments and advice, they have been very helpful. I love Allnurses!!!!
RNgrrl09, glad to hear things are working out so well for you. Do you have a routine down pat yet? I don't really, mainly because I haven't been shown everything there is to know yet. So far I've basically learned to do the med pass and chart on patients. I agree, time management is key. Since I've gotten to know the patients and their needs, I think I've gotten a little bit better, and just a little bit faster. Unfortunately, I haven't done treatments yet, or admitted a new patient (although I was shown the paperwork when someone was being admitted but it wasn't me who completed it. I think once I do it myself, I will be able to learn it better but the paperwork does seem overwhelming. Haven't even talked to doctors or labs or anyone else except the pharmacy. Beginning to wonder if I'm really getting the best orientation as I write this. The nurse training me always seems so frazzled and in a bad mood, although it's not directed at me. I'm still trying to have an open mind about things. Hopefully, now that I'm starting my regular shift tomorrow, instead of days, I'll learn more with the different nurses.
Really happy you're loving it! I hope I'm there someday soon. :)
RNgrrl09, glad to hear things are working out so well for you. Do you have a routine down pat yet? I don't really, mainly because I haven't been shown everything there is to know yet. So far I've basically learned to do the med pass and chart on patients. I agree, time management is key. Since I've gotten to know the patients and their needs, I think I've gotten a little bit better, and just a little bit faster. Unfortunately, I haven't done treatments yet, or admitted a new patient (although I was shown the paperwork when someone was being admitted but it wasn't me who completed it. I think once I do it myself, I will be able to learn it better but the paperwork does seem overwhelming. Haven't even talked to doctors or labs or anyone else except the pharmacy. Beginning to wonder if I'm really getting the best orientation as I write this. The nurse training me always seems so frazzled and in a bad mood, although it's not directed at me. I'm still trying to have an open mind about things. Hopefully, now that I'm starting my regular shift tomorrow, instead of days, I'll learn more with the different nurses.Really happy you're loving it! I hope I'm there someday soon. :)
Dekagirls. I do have a routine. I come in- get report and count narcs. I then do a quick once over of all of my patients- see how they are doing, check bed alarms, chair alarms, air mattresses and quick assessments- if a new patient then I do a head to toe. Check to see if I have any midnight meds or treatments on my new patients. Check to see if any of the lpns have any iv's that I may need to change or piccs that may need to be flushed or drsgs changed. Review how to progress with my day. Give out any 12 am meds and treatments. Do my 24 hour chart checks on everyone. Then chart on those patients that I can. I then do another check on my patients. Check glucometers and refrigerators. Get all my supplies for my 600 am med pass and treatments. Start my med pass at 0500 am and then give report and count narcs and then finish my charting. I have stayed until 1000 am when I have had to send patients out- and I have had a lot of help from the other nurses on the unit. The nurses on the floor are very supportive. I am usually out by 9:00 - 9:30 am, depending upon the census.
I have completed no new admits- although we were shown what paperwork needs to be completed in corporate orientation. I have not had to do that yet. I have talked to docs regarding the patients and some are great and some not. I hope everything gets a lot better when you start your shift. I know that when I oriented on days, I wondered how the nurses got everything done. They passed meds from the time they came in to the time they left. They were hunting patients down before they went to the dining room- parked outside and then hunting them down in PT. It is so busy.
The paper work is very frustrating- since there is so much of it. This is the end of the month and I am dreading changeover. We will be responsible for all MARS and TARS being complete and correct so that the dayshift nurses will be able to start the day at the beginning of the month. I don't know how I will fit this into my schedule. I never take a break as it is now and don't know how long this will take. Sigh!!! I just hope that I am doing everything ok- I asked my unit manager and she stated that she hasn't heard anyone speak ill of me. I just don't want to be doing all of this work and then find out that it was all wrong. I hate wasting time and prefer to do things correctly the first time- so that the correct things become a habit and I don't have to try to change bad habits.
I hope everything is going better for you. Let me know how your doing on your regular shift. Remember to just take your time and ask, ask, ask when you don't understand something. Don't be afraid to say no to something that is not your responsibility- you have enough that needs to be done and can only be completed by you. Wishing you well.
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