New RN grad, working in a ltc for first time.

cyc0sys · Oct 30, 2016

I'm currently working as an LPN in a LTC/Rehab. I far as I can tell, there are no differences, with the exception of IV push meds, if you're working the floor. LPNs here are IV certified and can hang bags for ABT and whatnot. However, I have worked in LTCs where the LPNs do the bedside care, med passes, etc while the RNs do the admits, orders, and administrative stuff. Most of our unit managers, care coordinators, chart reviewers, etc are RN but that seems to be more upper level administrative/ managerial and less entry level.

I'd try to stay on orientation as long as you can. Two weeks seems hardly enough to get a handle on all of the internal processes and paper work. Otherwise, your day will most likely consist of several hours of med passes, treatments, dealing with family members, and jumping through your ass to complete charting at the end of the shift.

I'd focus on trying to duplicate all of the tasks in the same manner as your trainer until you develop your own system. Have them complete the task first and then repeat it yourself with the next patient. I'd be careful with some of the shortcuts like presigning the MAR, copy-pasting routine assessments with no status change, or the old 'you're not supposed to do it this way but... you'll never get out on time, we don't have 'x' to do this right, etc...'.

Get on a first name basis with your CNAs. A good CNA can help you get squared away quickly when it comes to locating people, things, or if you need an extra set of hands. If the patient is in a w/c and needs fingers sticks/ coverage, I'll have the CNA wheel them to my cart before meals. They can also let you know if one of your patients' vitals are declining in case they start circling the drain and you have to send them out. I try to help them with patient care if I have the time. I also bring them food on occasion to maintain repport and an open dialogue. Some of the old CNA are the eyes and ears of the DON or ADON so keep that in mind.

Start plugging numbers into your phone. The Docs, the DON, pharmacy, facility maintenance and security are all good starting points. It may seem like a no brainer but if your away from the desk and need to contact someone your not running or sorting through papers to get someone on the phone.

They say speed comes with time but I have my doubts. You might be able to figure out where things are, how to prestock your cart, or how to short cut paper work but there is no substitution for spending time at the bedside with the patient doing a thorough assessment. Unfortunately, that seems to be the exact thing that is most often short cut. One trick I learned is to have the CNAs notify you right before a bed bath, shower, or dressing in the morning. It's easier to do an assessment at that time if the patient isn't a new admit and it's not priority.

Most of the RNs I got hired with have already quit due to the 1:30 patient ratio and the breakneck speed at which you have to operate. However, they came from med/surg hospital floors and not everyone is cut out for LTC no matter what the title (myself included). If I had to sum up LTC Nursing in a sentence it would be this- Never have so few, did so much, for so many with so little. Best of luck!

Jchitester · Oct 31, 2016

Thanks so much for the detailed comment! Very very helpful. Today was my first day of trainunh and it was very overwhelming I had a GREAT trainer! I asked lots of questions...but very confused about all the paperwork that needs to be filled out and when to do what and what to do when Lol. I know this will cone with time in just oberwhemled.