New Nurse RN in Rehab/LTC Setting Needs Advice

[RNjuice, ADN, RN]

Hi!

I'm an inexperienced RN working in a Rehabilitation / Long Term Care setting. I'm looking for advice from experienced nurses because I haven't been working as a nurse for a long time, I graduated years ago, and I only briefly worked as a nurse around the time I graduated.

I have already signed up for an RN refresher course and I'm trying to redevelop the skills I was taught in nursing school.

Is there anything anyone would be willing to share that could help me to provide the best care to my patients? I am responsible for roughly 15 patients at a time. My responsibilities include medication administration, assessment of new admissions, and handling emergent issues / changes in condition. Although LPN's typically work in the role I currently fill, my lack of experience, the facility's strong desire to hire RN's, and a staffing shortage have placed me into this role.

I find that the LPN's and Nurse Aide's are far more experienced and comfortable in their work than I am at this point, naturally, but everyone expects me to more capable because of those two letters: RN.

And to think I spent years thinking no one thought my license was valuable because I'm an ADN and not a BSN! It turns out that in this setting, people think it means something even without that Bachelor's Degree. A true shock after my very unsuccessful job search after graduation.

Anyway, any advice? (Besides "Don't work in Long Term Care" - I'm determined to give this job a minimum 6 months before I search for alternatives. I need experience and my old profession is being automated away so I can't go back to it.)

[Davey Do]

28 minutes ago, MikeTheNurse said:

any advice?

Hit the ground running and follow in the footsteps of the experienced, MikeTheNurse.

I got a position as the MN RN in a LTC facility after working in a few different areas of nursing for 10 years. I replaced an LPN as the so-called charge nurse on MNs after orienting and working on several day and evening shifts. I remember calling it "meat and potatoes nursing" in that there where a lot of basic nursing duties that I had to perform in a timely manner.

I chose to do as the experienced ones did, asked questions, outwardly gave appreciation and praise, and set my sights on quality and performance. (We all like attention and praise and what goes around, comes around.) It took some time, but once I got to know the routine and the residents, things flowed rather smoothly.

Good luck MikeTheNurse!

[CharleeFoxtrot, BSN, RN]

Too right DaveyDo! Don't be afraid to ask questions and watch how the experienced nurses work, what their workflow is like. Eyes and mind open! Keep yourself organized, see if anyone there uses a "brain sheet" or other form they use to keep track of important things.

[RNjuice, ADN, RN]

14 minutes ago, CharleeFoxtrot said:

Too right DaveyDo! Don't be afraid to ask questions and watch how the experienced nurses work, what their workflow is like. Eyes and mind open! Keep yourself organized, see if anyone there uses a "brain sheet" or other form they use to keep track of important things.

Thanks! I use my own "brain sheet" that I've come up with that keeps all of the information that I've determined over the course of the past 4 weeks that I need to know to get through a shift. It includes:

• Patient Appointment schedule
• AM Med Notes & checklist
• PM Med Notes & checklist
• Progress Notes checklist
• Nurse Aide Assignment & tasks
• Alerts - for things that need to be followed up on and notes
• Order Confirmation checklist
• Lab and Radiology Results requiring review

I do struggle with following what some of the more experienced nurses do, however. I've witnessed practices such as:

• Documenting medication administration done or expected to be done by Nurse Aides (often prescription creams, which is outside of their scope of practice in this state)
• Administering medications before their scheduled time (between 2 and 3 hours early) and documenting administration later within the administration window
• Lying to residents and resident family members to cover for mistakes

I want to follow in the foot steps of the experienced staff as you suggest, but I am deeply concerned about violating state / federal law and practicing or having others practice outside of their scope.

I suppose my next question should be: is this sort of experience normal, or have I found myself at a facility that is engaged in unusual questionable practices?

[Golden_RN, MSN]

I worked in LTC/rehab as a newer nurse and loved it. I learned a lot from the experienced LVNs. 15 residents sounds like a do-able patient load.

It's a very positive thing that you're recognizing others' bad habits. Just keep avoiding doing what you know is wrong.

After you get a good "brain" sheet and a good routine for your shift worked out, don't be afraid to jump in (when you can) to help reposition a resident, hand out a meal tray or 2, etc. It will help you learn from experienced CNAs and help build good relationships with them which is key.

Edited to add: Know your resources. Who do you call for help with the EMR? Are there other nurses in the building to consult with for clinical problems? If you work PMs or Nocs, when management isn't around, what are your resources for emergencies? It can be a little intimidating when you're new but the only RN in the building.

[RNjuice, ADN, RN]

Thanks for the tips, everyone.

I knew from the beginning that being a new nurse would be a serious challenge. It’s further complicated by the fact that I spent a number of years not working as a nurse after graduating, so my knowledge base and skills are very rusty.

One of the really scary parts is that the facility I work for is struggling to find nurses to staff it. The Director Nursing and the Administrator have both left and not yet been replaced, and there isn’t usually a unit supervisor working on my shift, so I feel very alone, especially when the wound treatment nurse is pulled to work a cart because of a call out and I have to do dressing changes in addition to my current responsibilities.

It’s overwhelming.

But what is the most stressful is the fact that I am inexperienced and out of practice. There is so much I don’t know, so many things I am not sure about how to handle.

I have signed up for an RN Refresher course to try and restore some of that knowledge. But it makes me wish mentorship was more feasible. An experienced nurse to help me deal with these experiences so I can begin to sharpen my skills and build a knowledge base. They gave me a 4 weeks training period, but most of that was spent shadowing someone on relatively routine days. Only the last week or so was spent with another nurse available to help answer questions and concerns as I worked independently.

For now, I just keep pushing forward. I made a commitment to myself to work here for a certain time frame no matter what to develop my skills. So I’ll keep going with it!