New to LTC. Any tips for me?

Kimberleighsue · Feb 9, 2006

congrats!! but only 4 days orientation:eek: i am getting 4-6 weeks and longer if i need. i am at my first job as well and responsible for 15:nurse:

doddlebuggin · Feb 9, 2006

1)make sure your diabetics get their hs snacks

2)trust your instincts if you think some ones going bad they are

3) if they are not a dnr and are going bad get them out of there quickly

4)learn from your cnas they do more 1:1 with the residents and they notice changes quickly

5)pace your self find some thing about a resident that will put them in your memory and so that wont be just that little old lady with grey hair and glasses(that describes most of them)

good luck I love working at ltc facility and I adore my residents,only problemis sometimes I get my heart broke cause I meet them so late in lifebut all in all its worth it.... :nurse: :nurse:

signet123 · Feb 9, 2006

You definitely need more orientation time. I was almost exactly in the same position you are six months ago. It was very overwhelming trying to learn all the patients and their habits. How they take their meds, what treatments they have ect.. A few things I did do that were invaluable were. Get a resident roster. Next to each residents name I wrote how they take their meds. crushed, whole,w/ice cream.ect.. Then I made several copies in case I lost it. I left a copy in the top drawer of med cart and carry extras in my zipper folder. Another thing I did was come in early one day and look through the treatment book for my hall. I copied down all the treatments and made sure I knew exactly what they were. This saves alot of time during the shift. You still have to go through the book and check everyday when initialing. Some treatments change as wounds heal and new ones are added, but the majority are the same. I then went to my computer and printed a worksheet. This has all the info I need for the shift on one paper. Accuchecks,treatments, Skin assessments, tube feed i+o, MOM's, medicare charting(we have to chart on something different every day). I use half the back for taking notes at 3pm report and the other half for writing down what occurs on my shift. At the end of the night when I'm charting I just look at this paper. I keep these papers so I can look at them later. This helps mr figure out ways to do things better next time. This really has helped me alot.

CoffeeRTC, BSN, RN · Feb 9, 2006

Read thru this forum....lots of great advice,issues,etc:)

Ask if more orientation is possible if you need it.

Read over your job description just to be familiar with it.

Treat CNAs with respect....they will help you sooooooo much

Always ask questions or know where to look for the answers.

Keep a roster like the above poster described. Also add the top few DX to it and maybe code status.

Sounds stupid, but always get to work on time and even a little early. Trust me, sometimes this needs said:rolleyes:

Realize that even though you have a plan or schedule, sometimes it hits the fan.....just figure out what you need to do to get back on track.

Learn from the other nurses routines...ask them what works for them.

Try to keep the med pass sacred. Its easy to get side tracked and thats when errors happen.

Dont get into a rut. Treatments and med do change, so do resident conditions.

Assess using your eyes, ears and hands. Listen to your resident and their family....they can tell you soooooo much.

This my routine (26 res). If I'm early enough, I check the assignments and staffing book, make the vital list down and then check my treatment book so I'm prepaired for any out of the ordinary tx. Get report, give report to the CNAs as needed, set up my cart (sometimes clean it...grrr) Check labs or any pending calls to docs. Eyeball all the residents and get going.....I start out with the residents already up in lobby or multi area since most of them will be staying up. I do my diabetics at the top of the pass, so they get done before dinner. Then I head down the hall and get the residents who are in thier rooms and will prob stay there. I leave the tube feeders for last.....takes more time. Be aware of meds that need to be given at specific times. This sytem works for my facility. Itry to do treatments when residents are in bed or try to time them when cnas are around to help or if they just did care (say for a coccyx dressing) Saves me time and we get to work together.

nurse_clown · Feb 9, 2006

the cnas at this place have been known to be defiant. any assistance is appreciated. thanks in advance. :)

i've been working at a ltc home for a little over a year. about cna defiance: i work in ontario and we have personal support workers. i've heard some places around here have problems with their psw's. the place that i work at, the psw's are pretty good. i've worked hard to prove myself and they trust me. i think working on a "trust" level with them is important because their "duty" is to report to you. you can't do your job effectively without them unless you plan on doing all the cares yourself. i help them as much as i can but i also let them know that i know that they can handle their assignments and if they can't, i'm there for them. i empty garbages and linen bags when they are busy. i give snacks and help feed residents during meals when my meds are done. i answer call bells to give me a rest from the huge amounts of paperwork i have. if a resident is giving them a hard time, i support the psw regardless. i know and trust that the psw's are there for the same reasons i am: the residents. i wont engage in conflicts but i'm always open to discussion and make time for it but in the end, my decision is final. i don't allow the psw's or rpn's question me but at the same time, i don't allow managment to question "us" either. i always assume that i have to work just as hard - if not harder then the psw's because in the broad scheme of things we're all on the frontlines together and i'm supposed to be the "leader." i take that position seriously. i have never taken the attitude that i am better than them. but since i'm getting paid the "big bucks"....

let me explain the "big bucks" thing. i didn't understand that at first but my charge nurse (and mentor) in acute care educated me on that. this also applied to the rpn's that we work with too. "yes, you'll be giving out meds, testing blood sugars, documenting, charting, ordering labs, getting specimens, and overseeing the psw's and rpn's. but you also have to show that you are a leader to your team. all true leaders work harder than the team. you not only have to do your job but every now and then you have to step in and take over for someone else when they are busy." it went something like that but i got the point. since then, i know i work my butt off.

at the place i work at, i'm the youngest person on the team. there are a couple of psw's that are younger than me but the majority of my coworkers are older. for respect sake, i watch the tone i use with them. just because they get paid less than me, i can't consider them any less worthy than me. after all, they've been in the business longer than me and have info and a tremendous amount of skill and experience. but mind you, i've been stuck doing the night shift by myself three times because they couldn't find a psw to help me. so, i totally appreciate and respect the job they do. i've heard that some of the registered staff dismiss their observations and slam doors on their face and act as if they aren't there. not cool! i wouldn't want it done to me.

i think i'm getting long winded here. i can also appreciate that there are those that don't agree with me. i end up arguing with my registered coworkers over "attitudes". but i can only focus on my shift and ensure that things are running smoothly to make "my" job easier for me. but that's just my experience and my advice. :nurse:

GooeyRN, ADN, BSN, CNA, LPN, RN · Feb 9, 2006

I think you should get more orientation especially if you are a new nurse or new to LTC. Its not easy! I agree about making a list of who takes their meds whole, whole in food, crushed, crushed in water/juice/applesauce/pudding/ice cream/etc. Some will only take their meds if they are in their preferred food/drink. It's very time comsuming (and costly) to get someones meds ready and then have them refuse them because you crushed them and put them into applesauce instead of ice cream. Im serious, some feel such a loss of control that they try to control everything they possibly can. Let the CNA's know that you respect then and very much appreciate them. Help them with whatever you can. Don't be afraid to dig into a huge code brown to help them out. They will respect you more and not give you as much of a problem. But don't let them take advantage of a nurse that helps them! Try to feed atleast one patient at dinner time or atleast help set up a few trays if you can. And most of all, BREATHE! It's very stressful but don't be afraid to stop, think and breathe if you are overwhelmed! Good luck!

BigB · Feb 9, 2006

4 days as a new grad !!.. that is not enough time. I got 3 weeks.

CapeCodMermaid, RN · Feb 10, 2006

congrats!! but only 4 days orientation:eek: i am getting 4-6 weeks and longer if i need. i am at my first job as well and responsible for 15:nurse:

i've worked in 5 different ltcs and a hospital and never received 4-6 weeks of orientation....consider yourself extremely lucky.

drwatson · Feb 13, 2006

33 patient's? 4 days orientation? they should give you more orientation; and they will, only if you tell them you need it to do a professional job. it takes a while to learn your 33 patient's, and new ones coming in all the time. they will give you more orientation if you let them know 4 days of orientation is unacceptable. good luck!

**Elektra6, ASN, BSN, RN** · Feb 13, 2006

I agree about making and keeping a list of how each resident takes their meds. It is a HUGE timesaver. Also the card in their MAR is not always updated. (I try to fix this) I am a new grad in LTC and I float, but I've been working now for 2 1/2 months and I remember about 100 residents! I was lucky in that I had over a month's orientation on day shift. I now work day and evening shift and am comfortable with both.

Maybe you can ask for some orientation on day shift as well. I feel that 3-11 can be a little isolating. It's also great to be able to talk with dietary, PT, activities and social workers whenever you want. Also, most doctors come in during the day. Just my 2 cents.

I also agree with the poster who makes a list of her treatments. I found this a big help. It also helps you organize your time better in that you can ask your CNAs to let you know when they change/lie down a resident. It's easier than trying to make a resident get out of their chair for you to change a sacral wound!

Respect your CNAs and work hard. You will do fine!

Best of luck

-Deb

GLORIAmunchkin72 · Feb 13, 2006

You are getting 4 days? You are one of the lucky ones.

You will have to prioritize. If something does not get done when things get very hectic let it be something that would have very minor consequences. Good luck.

Hello, everyone. I was hired onto my very first nursing job today and start tomorrow. I was hired onto the 3 pm to 11 pm shift at a nursing home with 66 beds, and I'll be responsible for giving meds and treatments to 33 of these patients. I asked the D.O.N. about training, and was told that I had 4 days to train before working alone.
Does anyone have any tips, pointers, or advice for me? This facility has no vents or IVs. There are a handful of diabetics, meaning I'll be doing some fingersticks. Basically I'll pass meds, perform treatments, and chart for the 33 geriatric clients. I'll also be in charge of the CNAs and ensure that they're doing their tasks. The CNAs at this place have been known to be defiant. Any assistance is appreciated. Thanks in advance. :)