No specific training, total disorganization - is this normal?

[JustAdmitToObs]

Recently started my first nursing job in a LTC (3 shifts off orientation) and while I don't dislike it, I'm weirded out by the total lack of support or supervision for new hires.

I had four orientation days in which I was paired with a nurse but there was no kind of structure to the training, let alone anything on paper that was geared to getting new hires familiar with the specifics of how things are done. I was shown how to log in to the charting software, but that was it. What I find equally strange is that the nurse managers haven't once checked in on my training or transition to working alone.

The lack of communication and organization on the nursing side of thing astounds me. There is no hand off report between shifts, just written summaries that tend to just carry over info from the previous shifts. The nursing desk is just a deposit of papers. I have no way to tell if an x-ray order form or an abnormal lab result has been faxed and taken care of, or ignored and left for me to be responsible for. Sticky notes would pretty much solve the problem but I have yet to see this simple form of communication utilized.

If I weren't running around managing med admin for every minute of my 8 hour (never under 9 hour) shift, I wouldn't have a problem having to do some investigation on the administrative side of things. But after I get the major morning meds done, I spend the rest of the day tracking down residents for various treatments and nutritional shakes that seem to be staggered every half hour.

I just need to know.....is this normal? Even if it is, just knowing it is will allow me to pick my jaw up off the floor and get on with figuring out how to do my job.

[caliotter3]

Yes, that is very normal.

[VivaLasViejas, ASN, RN]

I'm afraid it is.

[Blackcat99]

Welcome to the wonderful world of LTC nursing. Yes, it is very normal for LTC.

[JustAdmitToObs]

Instead of being relieved, I'm just confused and concerned. It's such a drastic detour from the risk management efforts that operate within hospitals. But I don't see any reason why LTC would not be just as concerned with liability.

[VivaLasViejas, ASN, RN]

Oh, they are concerned with liability.....but when something goes wrong, they'll throw the nurse(s) under the bus. That is why you should carry malpractice insurance at all times, wherever you work. It doesn't mean you're not a careful and conscientious nurse, because you are---it's to protect you in case something goes sideways and you get blamed for it. And with the working conditions in many LTCs, it would be foolish not to carry insurance.

This is not meant to scare you. LTC can be very rewarding despite staffing problems, overgrowth of management and lack of mentorship. You will learn FAST how to improvise, how to optimize your time, even how to handle your CNAs. And at the end of the day, you'll have the satisfaction of knowing that you did the very best you could, even though you wish you could do more.

[kbrn2002, ADN, RN]

Sad but true, yes that's pretty normal. It helps if you and other nurses consistently work the same unit to have some kind of short-hand communication between shifts. For example, if this pile of papers is here, it needs to be addressed and if the pile of papers is here we are waiting for MD responses, and put the pile over there if it just needs to signed off and filed. Simple labeled manila folders works for us.

[TheCommuter, BSN, RN]

I'm sure there are nursing homes and LTC facilities that provide new hire orientations with meticulous structure and superb organization. However, in my personal experience the lack of organization is par for the course.

I've worked in several nursing homes. The new hire orientations are generally short (a couple of days) and consist of following another nurse around as he/she pushes the medication cart. During this period I'm trying to learn as much as I can about the important paperwork, the locations of crucial things, and the overall routine of the floor.

[nursielou72]

All of this is normal except for the shift report part. I've worked in 3 LT/Skilled facilities and gave/got report at all of them. Maybe you could get that started.

[SitcomNurse, BSN, MSN, EdD, RN]

I am grateful to : The Commuter : for giving some kudos to LTC. It is a sad state though that provides no support, no linear system to ensure the proper care and education for the LTC population.

In my orientation practices, there is structure, specific pairing and skills checklists. You are entering a SKILLED NURSING FACILITY. You will use those skills, or you will not make it out of orientation.

When I started this position, I was left a laundry list of things by my redecessor of what had to be covered. Although she had an ad-hoc approach, she covered EVERYTHING that could be taught. Our approach was different, but our goal was the same, Educate the new employees to ensure their competence. Then test. remediate, then test, Sepearte Workforce Training from Education. Provide opportunities for both.

Thats how it gets done where I am. Feel free to come to NY, and join me in a place where Education matters. A. Lot.

[Sixtyseven]

My LTC facility has recently hired a few new RN grads. After a few weeks, these girls have been set forth as supervisors and/or unit managers. It's pretty scary and I wish them the best. This has been the MO of this facility since I started working there. It's sink or swim and too bad if you don't keep your head above water! And there is always another new hire to take your place. As for report, we used cover every resident, but the newest DON doesn't want using time for that, so it is just summarized on paper.

[casi, ASN, RN]

This actually seems a little scary to me. I'm used to management leaving nurses to their own once they are "trained", but the lack of organization and the four days of training for a new nurse seem pretty scary.