New nurse, 11p-7a float on LTC, Dementia and Skilled.

Moved to the Geriatric Nurses / LTC Nursing forum

LTC facilities usually do not provide much time for orientation...Ask for as much as you can get for each unit you will be working...Floating is very difficult when you are new, since LTC/Skilled nursing facilities have a much higher acuity than they used to and the patients who are there for acute problems usually turn over pretty quickly.You will most likely have a heavy load of patients/residents & when you float from unit to unit, it is hard to get a routine since there may be several new patients each time you work. Hopefully, your facility is small with not many discharges and admissions. Some common dementia meds are: Namenda, Aricept, Exelon (po & patch), and also Risperadol and Zyprexa is often prescribed for delusions and behaviors. Common meds for geriatrics are: synthroid (almost always given at 6am @ my facility), zocor & other statins, anti-hypertensive/cardiac agents such as: lisinopril, cardizem cd, coreg, beta-blockers (Lopressor, Toprol xl), norvasc. Some of these folks are on multiple anti-hypertensive meds and are at high risk for falls due to orthostatic hypotension or decreased heart rate. Diuretic use is also common (Lasix & Demadex), which also put the patient at high risk for falls due to the need to get up frequently to urinate. Antidepressants are also frequently used: celexa, zoloft, etc. Anti-diabetic agents (insulin & oral agents)..Get to know who your diabetics are & which ones are prone to hypoglycemic reactions..Find out where your Emergency Drug Kit (EDK) is located & where the glucagon is kept..Pain management medications are also common (Norco, oxycodone, fentanyl patches). Try to learn what is "baseline" for each patient so you will be able to recognize when they might be having a problem. Try to form a good working relationship with your co-workers..It is so much easier when you work as a team..Show the CNAs much respect and appreciation & they will be a wealth of resource in providing useful information & quality care. Good Luck to you:)

montecarlo64--Thank you so much for taking the time to reply! I am hoping that because I am on nights that the pace will be conducive to learning. I will be orienting on days so I do hope to see patients at their normal so I'll be able to compare. I also don't know what I'll have for ancillary staff but I will definitely treat them with the utmost respect! Some of the meds are familiar and some are not, thanks for listing them. I will try to keep you posted, thanks again

Congratulations and welcome to LTC!!!

Previous poster left you some very good info. I would add that you'll also be seeing lots of antibiotics, most frequently for UTIs, C-diff, wounds (these will usually be cultured and organism-sensitive ABTs as ordered) and for URIs. Flagyl, vanco, erythromycin, augmentin, amoxiclillin, zithro come to mind quickly. And there are others!!! As many of these may be IV or via GT, I recommend becoming very, very, VERY adept/skilled using pumps. I mean, get on a first name basis with pumps, if you understand me!!!! This is the time to do so as it may be difficult when you start to work more independently.

Likewise, get your hands on O2 concentrators, wall O2, green O2 tanks and setting up the regulators (if that's what you'll use at your place). And suction machines! In an emergency is NOT the time to be fumbling. They're no-brainers, but you just need to be comfortable with them, kinda like when you get a new car --- it takes you a while to get familiar with all the bells & whistles.

Know where your Crash Cart location and its contents - most LTC places don't have a lot of stuff in them because if your pt is THAT SICK, you're probably sending them out to Hosp. If you have an AED, where is it and who brings it??

Learn your telephone system ASAP. And...this is something personal that I do, have your own xerox list of phone numbers for Administration and /Dept heads, police/fire, DOCTORS, lab, xray, dialysis, PHARMACY, dept extensions, etc. You'll be floating, so initially, it may be hard to find each floor's phone lists. (Some places are better organized than others, so this may not be nec.)

Lastly for now, know where your facility's NSG policy & procedure, IV, pharmacy, and wound protocol books are. Refer to them as nec. All the other books will fall into place.

Again, welcome to LTC!!! It'll seem like a lot, but it does fall into place. Good luck.

amoLucia--Thank you, thank you! I am nervous/excited to start and I hope have a good orientation period. Being a new nurse can feel overwhelming and I just want to be as efficient as I can. I will take everything you've said and familiarize myself with the abx! I really appreciate the feedback...:)

amoLucia--Thank you, thank you! I am nervous/excited to start and I hope have a good orientation period. Being a new nurse can feel overwhelming and I just want to be as efficient as I can. I will take everything you've said and familiarize myself with the abx! I really appreciate the feedback...:)

Also you probably need to know about the PRNs, the most common PRN in my SNF unit is ativan, restoril, and morphine. With the antipsychotic, antidepressants, ect there are many scary side effects & will need to be monitored.

Make sure that you check for new orders daily, find out where all the paper work is, find out about post fall procedures, and for that matter know where the policy manual is located. Know who to call when something happens and where their numbers are. If you will be alone this will help.

The hardest thing will be getting to know where everything is, and getting to know your residents. If you happen to have any spare time read their charts. Use your aides, the will be your best help! For real, treat them with respect & show them that you aren't above them by helping them, turn, transfer, whatever you have time to help with. But make sure they know you are their supervisor because after all you are delegating to them under your license.

Good luck!