New Nurse in LTC


Hey everyone,

I am a recent grad going into LTC. It a progressive Alzheimer's unit. I am seeking any advice you might have to help me be successful in my first attempt at nursing.

What types of nursing skills are needed the most?

I know time management, assessment skills and critical thinking are all a necessity.

How is your typical day? I will be working 7a-7p.

What information do I need to refresh on in order to be ahead of the game?

Any thing else you can think of to help me along my way is greatly appreciated...

Thank you so much!


173 Posts

Patience. That is a very important thing when working with the elderly. I have seen many nurses start to get angry because sometimes the residents ask the same question over and over again, it is part of their disease. You just have to be patient. You also have to treat them how you would want to be treated.


157 Posts

Specializes in Geriatrics, med/surg, LTC surveyor. Has 26 years experience.

Is it a locked unit? You need to make sure that the patients are always within eye sight. They are a very special group but can be very frustrating so don't be offended if they curse at you or try to hit you. They do well with routine. They are very easily constipated because of their medications so be sure to monitor their appetite and bowel sounds.


3 Posts

Yes, it is a locked unit. I completed a clinical rotation at this facility, so I am somewhat familiar with the patients as well as the unit. However I know a clinical rotation is not enough to prepare me for what I am about to experience. I am excited, the people on this unit are all special to me. Thanks for your advice. If you can think of anything else I should know, I am all ears!!


36 Posts

I too am a LPN in a "memory care" unit. I think the most help I recieved when I started came from the NARs. It takes a very special type of person to give cares to these people, because often they are very resistive to cares, eating (food that is), medication, and nearly everything you need to do for them. Just about the time you think you can't take it, one of the residents does something to crack you up. The NARs know a million little tricks to get them to cooperate. These people are the most vunerable residents. Remember even on the very worst day, you still get to go home. That's more than they'll have ever again. Believe me that is on their mind all the time. Good Luck!


157 Posts

Specializes in Geriatrics, med/surg, LTC surveyor. Has 26 years experience.

Most nurses that work on a locked unit love it. They can be frustrating but you will get to know them and they will learn to trust you. They can be so endearing. There is really nothing that you do for them that you wouldn't for anyone else but you get to spend more time with them. It is a slower pace. You will have to come up with little tricks to get them to take their medication. You will know them so well that you will know when something is wrong with them.

achot chavi

980 Posts

Specializes in acute care and geriatric. Has 20 years experience.

This is your chance to be imaginative when giving treatment in order to get cooperation.

Families are also a consideration. You need to be patient and helpful, you want to make an ally out of the families- so tread lightly. Try not to be judgmental, remember that the children might be concerned as the chances of them developing Alzheimers has jumped with their parents diagnosis.

Remember that Alzheimers is a progressive disease so don't be disappointed with the failures or lack of progress.

You will get familiar with the patients quirks, who gets sundown syndrome, who is afraid of baths etc.

No sudden changes or movements near them as that will startle them too much, everything in stages. For example before the meal we begin to prepare them by first finishing the activity, explaining that it will soon be supper, put on the bibs, pour drinks, etc

Youve got to give them a chance to get used to things slowly.

They could still be suicidal, depressed, easily exciteable etc.

We put in Snoezline Room- if you don;t have one, its worth investigating and try to have one= they really work!!!


31 Posts

Specializes in Geriatrics. Has 4 years experience.

You still need to be aware of other medical conditions they have. Cardiac, diabetes most common in LTC. I've seen CRF progressing to ESRD increasing.

These people can be very fustrating, but oh so special too.

People ask me how I can answer the same question over and over again. I just try to respond to the person asking the question as if it was the first time they were asking it.

I have two questions from the above responses. 1. What or who is NAR ? 2. What is a Snoezline Room?

Good luck! Give yourself time to adjust.


36 Posts

1. What or who is NAR That is what we call our nurses aides in my facility. I love the ones on our women's memory care unit. We work together to make the residents as comfortable and secure as we can. One word about families, some have accepted the diagnosis, some have not. Its hard to be careful with their feelings, but its worth it. They are in a lot of pain, missing the person that use to be. Let the MD. or NP. help them see the reality. Just try to be as supportive as you can.


61 Posts

Specializes in Geriatric/Psych.

Never stop asking 'why'. An increase in behavior could be a UTI, or pneumonia, or pain, etc. It may not just be a deterioration of their Alzheimers. Be creative with interventions. Your CNA'S are your eyes, ears and backbone; listen and respect them. Families can be difficult but become an important part of your work family.


31 Posts

Specializes in Geriatrics. Has 4 years experience.

Furwillfly is absolutely right about listening to your CNAs. I can't tell you how many times I have heard the CNA say something isn't right with so and so. Sure enough they are usually right. They have more interaction with the residents then the nurse is able to.

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