New grad RN in LTC/rehab, feeling conflicted

Specialties Geriatric

Published

Hello all. I graduated in December of last year and have been job hunting ever since. I finally got a job offer 3 weeks ago as an RN part-time in a LTC/rehab facility. I started training on nights and have had two weeks of orientation, I start on my own tomorrow. I will have 30 patients and on some nights I will be the only RN on the floor, but there will also be 2 lpns. I feel that being so inexperienced can be a dangerous position to be in and that I could lose my license if I miss something. The lpns are very proficient and know the ropes but I know that if a crisis happens, I ultimately have to do the assessments and take charge. I am nervous that I might miss something important due to inexperience, or make the wrong decision about something if an emergency happens. I am very conflicted because it seems like a pretty supportive environment but I do not want to risk my license by being put in a position of such responsibility being the only RN on some nights. Is this doable for a new grad? We also have some vent patients with respiratory therapists in the facility 24/7. It seems that many of the nurses have been there for years and that the turn-over is not high. Thanks in advance.

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Specializes in LTC, Correctional Nursing.

You will find that there are many LPNs out there that are just as knowlegeable (if not more) than an RN. Rely on those who have been there, that know what's going on. Don't be scared to get out there. You are going to make some mistakes. That's inevitable. Happens to all of us. ;-) But... the important thing is to learn from those mistakes. No matter what happens, you must present yourself as "confident". You are the leader and others will be looking up to you, but trust me when I say this... if you have some strong LPNs that have been there for a while and know the ropes, they will be more than willing to help you out. Give it some time and don't quit now. It's going to be tough but stick it out and take it one day at a time. It will take about 6 months for you to get in the swing of things and know what's going on. It's not hard to do, it just takes patience and a will to learn. You'll be fine, just push through and forget everything you learned in nursing school... it does not apply in the real world. You will figure that out as you go through your experiences. :-) Good luck!

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Specializes in hospice.

You're in a similar position to a new military officer straight out of college. His NCOs have been around forever and know their you-know-what, and he'd be a fool not to rely on them. As long as the appropriate roles are maintained, doing so in no way affects his leadership position, and can in fact make him a better leader. Knowing your limitations is an important component of being able to lead others and be effective in your own job. Giving due respect to those more experienced than you, especially when you outrank them, leads them to see you as a teammate in pursuit of common goals and not someone with an empty title (and the head to go with it).

My husband was a newly minted AF Butterbar many moons ago, and distinguished himself from the well-known and universally-disliked unit *insert synonym for donkey here* by showing active respect for the experience and wisdom of his NCOs and asking them for their input. You can do the same by leaning on your experienced LPNs. I'm pretty sure they want the best working environment possible too, so they are probably eager to help you do well. Good luck. :)

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Specializes in Pediatrics, Emergency, Trauma.
You will find that there are many LPNs out there that are just as knowlegeable (if not more) than an RN. Rely on those who have been there, that know what's going on. Don't be scared to get out there. You are going to make some mistakes. That's inevitable. Happens to all of us. ;-) But... the important thing is to learn from those mistakes. No matter what happens, you must present yourself as "confident". You are the leader and others will be looking up to you, but trust me when I say this... if you have some strong LPNs that have been there for a while and know the ropes, they will be more than willing to help you out. Give it some time and don't quit now. It's going to be tough but stick it out and take it one day at a time. It will take about 6 months for you to get in the swing of things and know what's going on. It's not hard to do, it just takes patience and a will to learn. You'll be fine, just push through and forget everything you learned in nursing school... it does not apply in the real world. You will figure that out as you go through your experiences. :-) Good luck!

This.

You have a great team in place; Learn to brush up on assessments; that will be key; also, as an RN, we are expected to be leaders due to our scope in practice; however being a good leader is listening to your team, especially in LTC.

As long as the place is well run with supportive staff then you will succeed.

Best wishes.

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Specializes in LTC, Correctional Nursing.

LadyFree28 is right... Teamwork is key in LTC... and as a tip, listen to your CNAs too. They spend way more time with the residents so they will know of some of the little things that maybe the nurses don't know that could clue you in to something big going on with your residents. For instance, a CNA comes to you and tells you that Ms. So-in-so isn't acting right, she's doing this or that and it's not normal for her... then you can go to your LPN and address it, investigate... that's happened with me before. Later, I found out that Ms. So-in-so had a UTI and that was the reason for her "acting strange." Listening is one of the biggest things that can help your floor run successfully. If your team trusts and respects you, then you have it whooped.

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Specializes in LTC.

It actually it sounds like you are in an awesome situation where you are going to learn a ton as a new grad. You've got a team that sounds very experienced with very good staffing levels. I know that in nursing school you keep hearing about about how LPNs can't assess and the RN is the boss and so forth... in LTC many time it's a little different. The RN will get slapped with the "Charge Nurse" title, but you all work as a team. A good LPN who's been around for awhile knows their stuff and in an emergency can walk you through what you need and can help you pick up on things you may miss.

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I also recently graduated from nursing school and I am conflicted between taking a job in a LTAC setting or geriatric psychiatry unit. What would nurses with more experience suggest?

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Specializes in LTC.

PN what are you interested in? Both are very different specialties. Head over to the psych board and the LTAC boards and read up on them a little.

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If you want hospital setting the LTAC will set you up to learn a LOT of skills... Just check out their staffing etc to be sure you won't be completely unsafe.... Near me, a lot if new grad ADN start in snf rehab... As soon as they get skills under their belt they are much more hire able up the food chain and generally leave in a year... Unless geriatrics is their love...

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Wow. In our LTC/Rehab unit there is one nurse on night shift for (max) 63 pts and the full time one is an LPN. So an RN (even if a new grad) PLUS 2 LPNs for half as many patients makes me feel that you are very fortunate, indeed.

I've been a day shift LPN on the same unit for 7 1/2 years, and I can tell you there is absolutely no distinction between LPN and RN in this setting, other than the pay. We all do the same job. The RNs don't look over my shoulder or supervise me in any way. It seems to me that having 2 LPNs plus the CNAs for only 30 patients....that would be a dream situation where I work. Lucky you!

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I wanted to thank everyone for your replies. So far it is going alright though I have my bad days that I go home and can't stop thinking about work, even on my days off. I have faith that it will get better with time. Thanks again to all of you.

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