New grad taking on PRN assignment at nursing home on 3rd shift

fultzymom · Jul 26, 2007

Our night shift workers pass meds, order meds that need to be re-ordered, stock the carts (med et treatment), provide any treatments that might need it, do any assessments on skilled patients, patients with anything acute going on, monitor STNA's "rounds," finish up any new orders that might not be done from day shift (not usually a lot left unless they were slammed). You will stay busy.

Eaglegrad007 · Jul 26, 2007

THanks, I believe I can handle that. I like to stay busy so this might work out good for me.

suzanne4, RN · Jul 26, 2007

You are forgetting one key factor: You will be legally responsible for thirty to sixty patients during your shift. Have you actually started your orientation at the hospital?

Remember that your training does not prepare you to be on your own immediately when you graduate, that is why you usually see orientations of about six weeks in a hospital at the very least for a new grad. You will be lucky if you get 3 days at the LTC, not a good thing, at least in my opinion.

And I assume that your orientation at the hospital will be on days, so you will be doing that five days per week, plus picking up extra night shifts? Something is going to suffer.

Definitely do not think that starting a second job in a completely different area while you are on orientation is a good thing for you at all.

I would rethink this, or you may have issues that happen with the job that you have at a hospital.

Va rebelnurse · Jul 26, 2007

Please think long and hard about this before you make a decision. I previously worked at a LTC as an LPN while I was in school for my RN. My orientation at the facility consisted of about 2 days. I "watched" another nurse passing meds before I was turned loose on my own.

I won't generalize here but sometimes bad habits are born from the fact that you just don't have time to spend doing things the correct way. In the facility I worked in, it was more important that a job was done quickly rather than being done correctly. I don't know what shift you will be working, but especially stay away from night shift if you decide to do this. Night shifts in LTC are notorious for being short staffed- you very well might find yourself as the only nurse for 60 patients- and that's just plain scary. :uhoh3:

kcochrane · Jul 26, 2007

I work the night shift in LTC as a LPN. I'm lucky in that our floor has two LPN's - unless we are really short. Most other floors only have 1. I also started out on the day shift, so I was very familiar with procedures and policy. We got 6 weeks orientation and every per diem or prn nurses get training. Any shift starts out on days for a few weeks so the nurse manager can make sure they are making it. Check to see what kind of orientation you will get. Agency nurse get no orientation.

We are responsible for med pass, a small amt of treatments unless days got slammed, charting, vs and monitoring those on report and we also go on rounds with the CNA's.

It is easy for me since I'm used the the fast pace on days and since I have 2+ years under my belt. I also have some good supervisors that I can call if I have a problem or need to ask a question.

tinesia · Jul 26, 2007

Hey,

You know I am actually in the same position I recently graduated in May of this year and will start at a hospital on the 20th of august. I started working at a nursing home just to get the experience and yes you may have 30 to 60 patients at night. I myself will have about 50 patients to pass meds to and not only that these patients are on vents. Not to discourage you or anything because Im not sure what the quality of the place where you will be employed but remember this, No matter what everyone is doing around you or what you see, do what you were taught in school, the correct way. I tell ya, the things that I seen nurses do at this place makes me nervous just thinking about them, I am soooooooooooo grateful that I do know better

dream'n, BSN, RN · Jul 27, 2007

Not so sure this is a wise choice. Nights in a LTC can be tough for a new grad, you will have few resources at night to turn to for questions, etc. and you will probably be pretty much on your own. Also part-time can be a little more difficult since you aren't there on a more day to day basis to see the changes in your patients and get into a more familiar routine with their medications (which can change often) and treatments.

marycd · Jul 27, 2007

I suppose every facility is different. I work the 3rd shift 3x's a week. and in the past worked med-surg in hospotal. the 2 coulldn't be more different. I am the only licensed person on my floor , i supervise 2 to 3 CNA's They are the backbone of the unit. They know the residents. It took me 6 months to really know my residents and their regular behaviors, cuz i work so infreq. I also chart check, any orders done for the day i followup to see they were posted correctly. I order meds when they get low. Do assessments on those who have fallen ( which is alot on my Alz unit), F/u on UTI"S, URI"S, update careplans, Do Blood sugars, order supplies.

Eaglegrad007 · Jul 27, 2007

Hi Everyone,

I just wanted to update everybody about my LTC experience. I was given a short orientation of the unit mostly to get familiar with where everything was located on the unit. The supervisor was really nice. She was very helpful, she told me exactly what I needed to do and what was expected from 3rd shift as far as what to document. The system this nursing home used consisted of weekly skin assessment on patients on different days. I only had 4 patients that i needed to do a skin assessment on, I have 3 patients that needed weekly notes and one incident report because a patient got out of bed and needed assistance with getting back into bed. I took the patient vital signs and recorded them on the incident report and in the nurses notes. I also did an assessment on the patient stating subjective and objective information about what I observe and what the patient stated. I had 9 glucose checks and 3 people to give insulin too. I checked the insulin dose with the other nurse before administering it because I know this is what I was taught in nursing school. I also did chart checks and entered new orders into the MAR. I had done this before during my preceptorship in the hospital so I was familiar with chart checks and new orders forms. At about 530 I started my med pass and completed it by 645. I had to get help with my glucose checks because I should have been doing them as I was passing meds. I will do this next time for sure. I can see where that would have help me time wise. Around 700, I was ready to count my narcotics with the 1st shift nurse. I only gave 2 hydrocodone on the shift so the count was accurate. We counted the drugs together and the count was accurate. All in all my night was very busy. I had one tube feeding and the nurse helped me make sure I had done this correctly. I had administered tube feedings before during my clinical rotation my times so I just needed to be familiar with the pump mechanics which was pretty easy. Well, based upon my experience i don't know if I would recommend this to a new nurse unless they were really eager to learn and the facility was well staff. This facility was well staff last night. I am scheduled to work on Saturday on the same hall and I will be working with some of the same people. The CNAs were very good and very knowledgeable about each patient. Thanks for all the advice, it was really helpful and I was happy that I received so many responses that really help me get through this night.

gt4everpn, BSN, RN · Aug 21, 2007

this is truly strange to my let me state why:

i am a new grad, i work 1st and 3rd shifts on different days, i work per diem, in the day there are two nurses one for meds and another for treatments and is also the charge. in the night i am the only nurse, i have been working on nights for about 3 weeks, i work with 2 cna's on each unit who have worked on the units for years and know their residents. the supervisor usually comes up 1-2 times per shift and if i have any questions i can just call and she will come. at night i don't do much, some dressings, some meds, mostly paperwork, reordering meds, tube feedings etc.. one of the floors in the facility actually has two units, so when i needed someone to show me how to suction a trach i just called the nurse from the other unit which was on the same floor and the supervisor and they both helped me out, on top of all of this, i feel confident working the night shift and with my progress as a newbie overall, are you guys saying that this is dangerous???