Night shift in LTC/Skilled Nursing

Specialties Geriatric

Published

Hello, I am a relatively new grad RN with several months experience in acute care as a RN and 2.5 years experience as a CNA in memory care prior to becoming an nurse. Long story short...I took a swing at hospital nursing and found that it wasnt a good fit for me and I wasn't very happy so now I'm looking for something different.

I've been offered a part-time night shift position in a local nursing facility that is minutes from my house and I am very much considering taking the offer. I am very nervous, though, about the high nurse:patient ratios (in this case approx 1:40-42) on night shift and about the fact that I've never worked nights before either. I am kind of hoping that my experience as a CNA will help me adjust a little to LTC nursing...but I'm just not sure...

I have a few questions for you guys who have loads more experience with this than I do:

1) What, typically, are nursing responsibilities when working night shift and how does your shift typically run?

2) Is this a normal nurse:patient ratio for a night shift and how do you handle these high ratios? I knew it would be much higher than it is on days and evenings but I don't know if this is "normal".

Any tips or advice would be much appreciated as well!

Specializes in retired LTC.
If you are the only RN, the lab will be asking you in the mornings to get the blood specimens from all of the patients who have PICC lines. Make sure you get plenty of sleep before you come to work. You may need a little benadryl 25mg when you get home to help you fall asleep. Good luck. Night shift is the best shift in LTC in my humble opinion.
Good point, Blackcat99. If OP is the only RN, she may also be called off her floor to assess/monitor any crises, particularly resident falls before they can get up.

Also, she may be responsible for any IV needs on other units depending on IV cert status of the other nurses, esp agency nurses who may or may not be permitted to do IVs per facility policy. Pyxis access is usually prohibited for agency and nurses without privileges yet (assuming they use pyxis).

Usually, an experienced nurse (someebody who knows who to call, who NOT to bother, when to call, etc) handles the callout phonecalls and staffing replacements, but this may fall to her also.

To OP - another BIG TIME piece of advice. Rely on your CNAs for advice. Respect them for their input and absolutely followup on their concerns/observations. I speak from experience when I say that I know of residents' lives that were saved because the CNAs gave me critical info FAST.

I've been working 30+ years, yet I always pick upsomething new. It's taken me all these many years to 'see the big picture' for my routines. It's always a learning process and one that changes as nec.

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Specializes in retired LTC.

To OP - don't know what State you work in, but you may also be required to pronounce pt expirations with the necessary Death Certificate completion.

Know your facility's P&P. But also be absolutely familiar with the protocol if you do computer entry vs paper.

Your own password with your RN license # is usually needed as well as facility ID#, other passwords, etc. Make sure you have reference resources immed avail at hand (not locked up in the Unit Mgr's office). Else you will be staying late in the morning to do the Certificate. There's no option as the funeral home and physician must work with the Certificate too. Nobody will care if your kids have to catch the school bus...

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Thanks for letting me know about the death certificate information. I'm not positive yet if I am responsible to this or not...I just got my handbook and am working my way through it. If I can't find it, I'll be sure to ask first thing Monday when i start. I'm very excited :) Thanks again so much for your responses :) They've really helped put my mind at ease!

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Specializes in retired LTC.

And if you still do paper entries, have lots of spare pens available (and yellow magic markers). Only a few facilities still use the red and green colors. Most use all black ink (even blue is frowned upon). I bring this up because in NJ the old Death Certificates HAD to be done in black --- I mean we didn't even THINK about using something NOT black. There were horror stories of undertakers not accepting the Death Certificate (in blue) and nurses being called back from home to re-do the Certificate in black.

Semper preparatis = always be prepared!

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I've had three nights of orientation a this point and so far...I think it's going as smooth as possible. What's hardest is getting to know the residents and match faces to names because they're mostly sleeping, but I know this will come in time.

I found out, though, that if I'm on a certain side of the building on my own my resident ratio will be 1:60 which is quite a bit more than I was originally told before accepting the position :cautious:

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Yes. Isn't it amazing how we are told one thing when being hired and then reality turns out to be something entirely different?

That seems to happen a lot in LTC. I wish you the best of luck.

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Specializes in retired LTC.

Yup, looks like they conveniently 'forgot' to mention it!

Many, many LTC units are 60-bed units. And they are typically staffed with only 1 nurse and 2-3 CNAs on 11-7. Being LTC, one BIG advantage is that the residents are usually chronically stable. Youl'l get to know their baseline status so determining when a significant change has occured becomes easier to distinguish. Also, a second advantage is that your census will usually be full/close to full. New admisssions with all the paperwork usualy go to the skilled/rehab unit. You'll most likely just get Readmissions. Thanks for small benes on a LTC unit!!!

Always listen to your CNAs as they know the residents best. They know the residents' normal and when they're abnormal. When they say something is WRONG, it usually is, so believe them and followup with a timely response. Thank them for the good call.

One last thing - and this is a personal thing. Keep your own copy of phone numbers for MDs, ERs, in-house ext #s, lab, dialysis, xray, etc. They around the unit somewhere, but I could never find them in a hurry when I needed them fast!

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Hi everyone! I'm new here, so I hope its not totally out of the norm to post on an old thread but it so perfectly fit my situation right now. I just graduated in May - Associate Degree. Passed RN boards May 28th. This weeks marks three weeks that I've been looking for a job. I have applied all over the place, but everyone wants experience. I'm at the point now where I just really need to work as soon as possible.

So, that being said - I'm a new grad, with absolutely no experience beyond nursing school. I interviewed this week for a night shift position in LTC - similar to OP. 60 bed facility, census currently 42. This facility is a little unique, in that one wing is a hospital with a few swing beds, a few inpatient beds and ED with 2 trauma rooms. The hospital sees very few patients - maybe 3-4 per shift in the ED, mostly "clinic" type patients with the occasional trauma patient. The position that Im pretty sure I got, is in the LTC wing. Because of the hospital, there is a doctor, xray and lab tech there 24 hours a day. I'm just wondering if I'm setting myself up for failure being that I have no real LTC experience, not even as a CNA.

I'm supposed to hear something on Thursday when my drug test comes back. BUT I'm also supposed to interview with our hospital's ICU on Thursday, but I think its a long-shot that I would get that, and even if, I'm really not sure if I'm ready for ICU. Basically I'm a scaredy-cat.

So OP - if you still post here - how did it end up working out?

To anyone else - thoughts?

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In today's economy, a new grad takes whatever job they are offered period. You go to work, you do the best you can and that is all you can do. So if you end up hating your job, you stay anyway at that job and you get your one year nurses experience.

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Specializes in dementia/LTC.

Ltc is a great place to start to get some experience under your belt. While nights probably isn't your first choice I've seen lots of nurses start on nights for 6-8 months and then a more desirable shift opened up and since they already had their foot in the door they were able to get a shift they really wanted.

I feel that any nursing position benefits from having some patient care experience, however not having that does not mean you won't be good at your job. Night shift would be a good way to get your feet wet since its far less busy than day shift. Don't be a afraid to request more training if you really don't feel ready to be on your own yet. You might get it you might not, depends on their policy. Try asking for a day or 2 of training with the CNAs, that might help you, but not if it's going to cut into the training they will offer working as a nurse.

Every new nurse is nervous about their first nursing position/ skills/competency. Honestly school gives you so much but the rest of it you learn on the job.

Best of luck!

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Specializes in HH, Peds, Rehab, Clinical.

We do LOTS of charting on NOC's in my facility. The weekly summaries are split equally as are all of the Med A charting. We also get everything ready as far as paperwork for any out-patient appointments, dialysis, etc. NOC RN's do all of the blood draws before we leave. Order meds, pharmacy comes at night so we put away all of those each night. All O2 tubings are changed out while residents sleep.

At my facility the above is true. However the 11-7 shift also has to do upkeep on all oxygen concentrators, clean out and maintain any resident refrigerators, and lets not forget end of month turnover on MARS and TARS. Chart checks really are the most important nightly paperwork you will do. That process catches the mistakes and oversights that may occur on other shifts. Patient orders can get pretty screwed up if thats not done right. You'll be fine. Some nights the boredom is worse than the work.
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I just started on the floor on night shift in ltc. It is the rehab floor. I am responsible for up to 30 patients. Knee surgeries, colostomy, hip surgery, etc. Since I've been there, there are only a few patients that are in need of there pain medication. Everyone else, usually sleeps thru the night. My body is having a hard time adjusting to the noc. I only have 2 CNAs on shift. It could be crazy if several patients needs to use the restroom at the same time!!

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