New Grad w/ 1st LTC job

lwndrgn · Nov 30, 2010

Congratulations...I graduated in August too from another program and have been working ever since. Just believe in yourself and training and you will do fine. Ask a lot of questions and write down the answers, so you won't have to ask the same questions over and over. Customer service is a big in nursing the nicer you are to co-workers and family the more help you get...lol

TheCommuter, BSN, RN · Dec 4, 2010

I'm also in the DFW area.

Most of the LTC facilities in the area will give you no more than three days of training before they cut you loose to work on your own. Make the most of those three days, and really focus on learning how to complete the paperwork. Don't get caught in the trap of following another nurse around as he/she works the medication cart, because that will be a wasted day.

Ask about incident reports, Medicare documentation, grievance forms, charting by exception, weekly/monthly summaries, and other types of paperwork that you will need to learn how to complete. Good luck to you!

skittleslvn · Dec 4, 2010

As a new nurse (3 weeks old), Make sure you ask about Admissions and Discharges. You may have started and I wish you well. This is for other new nurses.

blessedmomma247 · Dec 6, 2010

As the other posters have said, ask questions, learn the paperwork. Try not to feel overwhelmed, you will find your own system and it will take time. Always trust your gut instinct.

Here are some tips:

Remember to give Prilosec and Synthroid seperatly from other meds , on an empty stomach and a full glass of water. Prilosec can be opened or left whole, mixed with a small amount of applesauce. I seen too many nurses give the 7am meds and 8am meds together. :uhoh3: Also, remember you cannot crush or break in half KCL (Potassium Chloride). If you have a resident who takes their meds crushed, just let the tab sit in applesauce, water or juice so it can dissolve. Tylenol Arthritis is NOT crushable. I am trying to think of other common meds that are not crushable but drawing a blank. Tylenol, Miralax and Senna will be your best friend. Also know your insulins. Remember to date a bottle when you open it. The same with eye drops.

Get organized!! Get a routine and stick with it. Where I work, we have are mars on computers. However, we can print out the med and tx sheets, which I do. 1) In case the computers go down, I have my sheets to go by. 2) I make my " to do list" from my tx sheets .

I usually start my med pass by first giving all my breathing tx's, checking vitals, accuchecks and assessments. A few clients do get their meds then bc they have that preference. That usually takes about 20mins and then I start my actual med pass. Now, it was pounded and pounded in my head that you have an hour before and an hour after to give the med. In a perfect world, that will work. But, as you will soon learn, that is not how it really is. It is humanly impossible to pass the 8am meds and be completed by 9am. In our facility, we follow these med times:

AM meds: 7am-11am

NOON meds: 12pm-2pm

PM meds: 3pm-7pm

HS meds: 7pm-11pm

NOC meds: 12am- 6am

Now, if you have a pt who is getting ABT's QID (that would be 8am, 12pm, 4pm, and 8pm), then you WOULD NOT give the med at 11am and then turn around and give it at noon. Just pay close attention to the med, how its supposed to be given, ect...

Mrs. Smith is an 89yr old who loves to sleep in. She will not be up for breakfast until 10:30. Now I am not going to wake her up at 7am to give her a Prilosec. She will get her med at 10:45am, with the other "AM" meds given at 1pm. (Multivitamin, ASA and calcium) . This is a careplan we have in place for her. It took several months for the unit manager to find out why the nursing staff was getting beat up every morning. One day her daughter came in and said her mother was not a morning person and literally would beat the crap out you if you tried to wake her. Once itwas in a careplan for her to be up at 10:30, her "behaviors" disappeared.

Remember the clients you have are grandparants, a father, a mother, a brother and a sister. At first, you may not feel like you do not have the time to sit with an upset resident. Make the time. Get them a cup of coffee or a cup of ice cream while they are sitting in the lobby waiting to go to bed after supper or for the next activity to start. Sometimes making a simple phone call for a resident, or even holding their hand, makes a world of difference.

Congrads on your new job!!

TheCommuter, BSN, RN · Dec 6, 2010

I am trying to think of other common meds that are not crushable but drawing a blank.

Any medication that ends in XL, XR, ER, SR, etc., is to not be crushed. These are extended release drugs such as Toprol XL, Seroquel XR, Depakote ER, Rhythmol SR, Procardia XL, and so forth. They are intended to be long-acting.

Never crush MS Contin, which is extended-release morphine sulfate.

JubilleeStar17 · Dec 15, 2010

thanks everyone... today is my last day...

Kingocal · Dec 22, 2010

I would have given anything to have had my instructors holding my hand