Out of practice new rn starting first job - advice?

[Oswin]

Ok, so I graduated from nursing school in December of 2011, and had to take some time off. I'd been applying for nursing jobs since august 2012 with no luck, but I was just offered a job at a nursing home on nights. I know nursing homes tend to have kind of a bad rap, and I'm really kind of freaking out about the idea, but I'm scared that if I turn it down I'll never get a job as a nurse, so I'm going to take it...

However, I have NO idea what to expect at a nursing home job; I've never worked in one, and we didn't do any clinicals in long term care. I've been reading through ltc threads on here to try to get an idea, but they mostly just have made me panic more, lol.

So here's what the manager told me in the interview... it's a 5 star nursing home. They have 120 beds total, but 20 are "shelter", so they're pretty much independent, and they only have 96 filled right now. When I asked about acuity she said "we sometimes have residents with IVs", and there's one hallway that's dementia, with 12 beds. On nights they keep 2 nurses (rn or lpn) and 5 cnas. And their orientation is 2 weeks on days, and then 2 shifts on nights, which seems really short to me, but I'll try it and see where I'm at before asking for more.

I worked as a tech for 4 years which taught me a lot of organization and time management, but as a nursing student I never had more than 8 patients at a time. Obviously a nursing home is different from a hospital, but the idea of being responsible for close to 50 people is seriously freaking me out...

I'm going through my old nclex study books to try and brush up on things before I start, but does anyone have any advice(In general or on specific things I should brush up on before I start)? Can anyone give me a basic idea of what a shift might be like in this type of facility?

Thanks...

[gagezoie]

Its not horrible. Your lucky to get that much orientation, I got 3 days as a new grad and am the only nurse on shift. Usually 65 residents. Not sure how your facility does SNF but we only have to chart at night that we checked on them (no vitals). The only others we chart on are people on ATB or falls or new admits. It sucks during stomach/resp outbreaks we have to chart all symptomatic res. Med pass is minimal, tx are also minimal. Good aids make all the difference, help and praise when needed/able. Good luck and remember there are no stupid questions!

[Oswin]

3 days! That sounds terrifying.

Thanks for the reassurance. What does ATB mean? :-/

[Lev, MSN, RN, NP]

3 days! That sounds terrifying.

Thanks for the reassurance. What does ATB mean? :-/

I think ATB is antibiotics.

[gagezoie]

Oop sorry ATB at our place means antibiotics. There will be lots of acronyms used don't feel bad about asking what they mean.

[Nurse_]

It's not so bad.

I know nursing homes gets a lot of bad reputation but it's a good starting point until you find something better. You'll learn how to juggle 30+ patients, which is totally good for your time management skills when you move on to an acute hospital.

[sunmaidliz]

LTC is different than acute care because you don't monitor your patients as closely. No head to toe assessment for each patient. I worked the day shift when I did LTC and my day went like this.

Get on unit, get report, which consisted of going over the list and seeing who had any immediate concerns, such as so and so has a UTI and on ABT, so and so is going to the doctor today, so and so was fussy and yelling all night. Even though I couldn't start passing meds until 8 am, I would immediately go to my cart and begin to prep it. I would get applesauce, extra cans of house nutrition, wipe down the cart, and seperate the pharmacy packs according to the med pass. Then I would begin my pass. For me, the pass took about 3 hours, only because I was slow and we had a paper MAR. During the pass is when you would eyeball the resident and see anything that seems out of sorts. Make sure you write it down. Always have a notebook with you to note stuff because you will ALWAYS be interrupted.

After the med pass, take a small break. A lot of my coworkers smoked and I envied them because they got to escape the unit. Go to the bathroom. After your break, take blood sugars and give insulin.

Then make yourself a list of all the things to do for your shift. Call doctors with labs, process orders, document the residents with changes in condition that were noted in report, write weekly reports for the residents indicated. How much documenting you need to do changes by day. Then deal with comes up, like admits or discharge (you'll usually know who will be discharged), any new problems or orders, give the PRN pain meds when asked, sending a res out to the ER if something arises that isn't in the scope of the LTC. And then to all the treatment orders, which is bandage changes on decubes, zinc oxide on excoriations. It's a lot of work and a lot of juggling. Time management and organization, as well as prioritization is the key in LTC nursing, which is valuble in any nursing spectrum.

That's day shift. I only worked nights while oriented and that was twice and never worked nights again. But usually it's the same except you have a midnight pass and a 6 am pass as well as blood sugars. Nights usually do a lot of the paper work housekeeping that are too busy for days. And the thing about nights is that you wont have admin breathing down your neck.

Keep in mind who gets pills crushed and who gets them whole. Get a notebook and make a list. Get your favorite pen and a highlighter. But get your system down fast. They are expecting you to do your job better than the LVN because you are an RN. At least that's what i was told by my DON on my ltc job.