Orientation at LTC/Subacute Rehab facility

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Hello everyone,

I am new to LTC but I have many years of experience dealing with the geriatric population. I recently interviewed for a staff RN position at Subacute Rehab. I was wondering how is the orientation process in longterm care? The interviewer didn't give me a direct answer when I asked. She only mentioned one week would be spent in the classroom. I would appreciate it if someone could give me details of what goes on during orientation. Is one week spent in the classroom, then the remainder on the floor five days a week?? Any help will be appreciated. Thank you in advance.

Specializes in Geriatrics, WCC.

Classroom orientation is two days. There is about a month of floor orientation, as I have four separate units that each nurse is oriented to. Seasoned nurses it ends up being about a month. New grads usually longer... 6-7 weeks. BUT... each nurse is an individual and learn and different speeds. I like to make sure they are able to work on their own before taking them off orientation. So, when my staffing coor. thinks they are nearing the end of it, I not only ask them how comfortable they are feeling but, also ask the nurses they have been workng with how they did. That way I know if they need extra time.

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I got into nursing to make a difference in the patient's life. I entered into this profession late in life. I graduated Feb 2011, took the boards (passed) right before Memorial Day weekend (celebrted by going to Joplin for a week, removing debris from neighborhoods), and got my first nursing job at a Skilled Nursing and Rehab (also LTC) end of August. Four weeks later I was in the DON's office handing her my badge. Since I was quitting I told her point blank how I felt about the so-called "training" (me passing meds while the nurse I was following sat at the desk doing the paper work and gossping/talking so we could leave on time) and that I was put in the postion of being the only RN (not under training??) in the facility at night and there were IVs to start/flush/dressing changes etc and I hadn't been exposed to where even the supplies were (the LPN said, I don't deal with IVs and not helpful but I needed her keys to get into the med room on her floor to try and find the supplies). I told her the training was inadequate and I cared about my license even tho they didn't and I wasn't about to lose my license on my first nursing job. The facility director came in while I was speaking with the DON and I told her too. I was honest (since I wasn't going to stay), even made suggestions on how training could be improved in the ideal situation (they are always hiring new nurses since they can't keep them) so training is always several nurses at a time. Long story, they talked me into staying, I got better training with the paperwork because of what I said I felt like I was lacking, I even asked to follow the wound nurse one shift to get an idea of wound care and wound vacs since we had several patients on wound vacs and there is no wound nurse at nights. (not really the shift I applied for but got assigned night nights)

I am still there, basically bidding my time getting more experience to move on. (I have not increased any spending and been saving my money like mad) The place is trouble and hopefully we can pass state inspection this go around (had too many tags in Oct, on the revisit early Dec, even more tags so now no Medicare payments). Nurses are bailing (too many threats of being written up for small things, the fourth is dismissal) so they are out finding other jobs and also in case we get shut down. Making the situation even worse for those nurses remaining. I had over 24 hours overtime in one week. Couple of other nures had more. The other night I had 58 patients by myself for half the night. I figure when I get a second write-up (none so far but many were given this week) that would be when I give two-week notice. I am hoping to find another job where I can be a nurse instead of a pill pusher (there is no way to get meds out to 28 patients in the two-hour window with the double signing of nurses to all narcs and insulins) so everyday I know my license is on the line. And management agrees that it can't be done in the two-hour window but do the best you can is the answer, but you know as well as I, that will not be the answer when it gets down to my license.

Good luck in your traing, hope it goes well. I wish it wasn't so hard for a new nurse to find a position but my community has several nursing schools locally and tons of new nurses.

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Specializes in Geriatrics, WCC.

It is difficult to pass out meds in a two hour window. that is why many facilities are going to a more open approach. Meds are scheduled for AM, noon, PM, HS. THis allows more flexibility.

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Good to know, will pass this to the DON. Any research or doucmentation I can print and take with me? Thanks and love this idea. If each nurse starts at the same end of the hall at the start of med pass then there will be the the correct timiong between meds. :) We all start at the same end of the hall and start our way down...

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Specializes in Geriatrics, WCC.

Send me a PM with your email and I can email you a sample one.

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I got 3 days on the floor with a floor nurse. No such thing as "classroom time" unless, by that you mean the orientation day in with staff development watching videos about the company and filling out paperwork.

Took me a month to get a routine down. I can get meds passed to 28 people in 2 and 1/2 hours as long as I don't have any interruptions, or falls, or stop to chitchat and lord knows there is NO TIME for that!!

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Specializes in Oncology,Orthopeadics,LTC.

Each facility is different. If the facility is actually run by a hosptial you will receive a more structured orientation. It also depends on the position you will be taking. Many facilities do not give an Administrative Nurse the same orientation a floor nurse receives. I do not necessarily agree with that approach as all nurses should learn the facility policies and practices. Although it is the facilities responsiblity to provide an appropriate orientation for all staff, I find that so many nurses fail to take any responsibility for their education and want the facility to spoon feed them everything. I have seen so many nurses that feel that because they did not sit in a classroom while someone spoon fed them every policy and practice that they did not receive an appropriate orientation. There are just somethings you cannot learn until you do them. So I encourage you to take charge of your orientation process. Openly communicate with the Staff Development Coordinator, your preceptior and Nursing Supervisors, give them feed back on your orientation so that they can provide you with a better experiance. And never, NEVER sit back and pass up an opportunity to learn how to do things in your facility. Best of Luck

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I was told that I would have 2 weeks orientation and then, if I was not comfortable, I could ask for more.

I had one day in a classroom to fill out paperwork and watch videos. Then had 2 shifts training. On my 3rd and 4th day, they

were so understaffed, they put me out on my own. Before I worked another shift, I called the staff manager and insisted on more orientation since I still had not done a new admission or learned how they like their paperwork done. I had a total of 6 days of shadowing a nurse before I was let loose on my own. I am still struggling with the paperwork and my time management and the worst part is, they now have a policy that they will write you up if you get overtime. And the on-coming nurses do not want to do any work that you have completed. I just want to stick it out as long as I can for the experience and then find something else.

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