preparing to work in the nursing home

Neener_RNBSN · Apr 3, 2012

Well I think first and foremost I'd say try not to become overwhelmed. LTC is different than acute care. You will have dozens of patients to keep track of with various conditions. In the beginning it will seem impossible, but I promise it does get better. Time management is key. Use a single sheet of paper to jot down any significant info. I use the left side of my paper for the med pass: I cross off the room numbers as I give the meds. I also have a section for any documentation I must complete that shift so I know whose vitals to grab or what specific assessments to make; my right side is a big "to do" list, i.e. call 14B's doc about PT/INR. The bottom center of the page I use to make a list of any wound care/Txs I must do on my shift. The trick is so have a single paper with all the info you need right in front of you in a clear and organized way. Having so many patients makes this imperative. Know that you must trust your gut, because nurses run the show in nursing homes. But be patient with yourself! New nurses need time to learn. Take care during your med pass to prevent errors. Take your time with documentation and remember it is a legal record! Be respectful to your CNAs but never let them take advantage of you (and believe me, they will try!). Immediately report suspected abuse or neglect to your supervisor. Don't ever tolerate CNAs who leave residents saturated or poorly cared for. When you get overwhelmed (and you will), remember that you are only human and can only do so much in the time you are allotted. Do the most important things first. Work as a team, offer to help your fellow nurses so that they'll help you when the time comes.Don't let hasty doctors try to rush you off the phone. When taking verbal telephone orders, make sure you verify by repeating the correct drug, dose, time, duration, etc. Most importantly, love your residents. The majority are so deeply appreciative of what we do. Have fun with them, sing and dance for them, joke around, whatever. But never ever degrade them by treating them like infants. Cognitively impaired residents deserve just as much dignity and respect as any other human being. Working in a nursing home is incredibly challenging, frustrating, and at times demoralizing. But it can also be tremendously rewarding. I started in a nsg home as a new grad and have learned a wealth of information since. I am a stronger and more independent nurse because of it. I've been charge nurse on a 28 bed unit since I was 22 years old. On my shift, I'm the only RN in the building and am responsible for any staffing or nursing care issues that crop up. I don't think I would have gotten all that supervisory experience as a staff nurse in a hospital!

I truly wish you good luck. If you would like to further discuss this, message me. It's terrifying in the beginning, but you can do it! After all, you're a nurse.

shatikaz · Apr 3, 2012

Thank you so much for your reply and sharing some great advice. I'm definitely going to implement your suggestions.

CoffeeRTC, BSN, RN · Apr 3, 2012

Great advice by the above poster!

One more thing to add...your assessments are going to be different than those you did on your hospital pts. Head to toes don't really happen but you will be more focused on the primary problem. Your assessment will start with what you see and hear. I will run down the hall and eyeball everyone at the start of the shift. When you pass meds or do treatments you will do a little more.

Don't get upset if all you have time to do is pass meds and do the treatments and have little time to interact with the residents. Alot of times, you will only have that time. That's okay...you need to concentrate on the tasks. On the other hand, don't get too focused on the tasks that you forget to look at the resident/ whole picture.

Take a few minutes each shift or when you feel stressed to breath!

Merlyn · Apr 3, 2012

I worked in LTC for years and years. The one thing I have found is to listen to the CNAs in regard to the patient. If they say a patient doesn't look right. Run down to the patient and assess. The CNAs are the ones that see the patient for 8 Hrs. They know when the pt. is sick and when they are well far better than anybody. Try keeping your skills up. You tend to loose them if you don't use them everyday. Don't be too hard on them or yourself. Call all of the patients by their names Not Honey or Sweetie, or Baby. If you have time, listen to them. They are all walking History books. When I started in LTC on the night shift in 1972 I had a patient that was 95 years old. She use to tell me stories of her life and that of her family Her father fought for the South in the Civil War or as she called it, "The War for Southern Independence." He had been at Antietam, the bloodiest battle in American history. He had nightmares about the battle once in a while throughout his life. Her grandfather was in the Revolution. She said that her Grandfather couldn't stand Washington. He said that the General thought he was God come back again. Her Grandfather was 104 when he died. Her father was 99 when he passed. My patient went home when she was 105.

So there is a lot to learn from old people. Good Luck!

RNBearColumbus, BSN · Apr 3, 2012

I've been a LTC nurse for nearly 7 years now, and the most important thing I learned was :

5% of your patients will need 75% of your time. Most of your long term patients will just need you to give them their meds, and maybe change a bandage. It's OK to just do that and move on. Don't feel guilty about not being able to spend "quality time" or do complete head to toe assessments on each and every patient. You will need to prioritize care to be able to spend time with that 5% of your patients who will need more from you.

Good luck! I hope you like working in LTC as much as I do. I've found it very rewarding, and plan on making LTC my career focus.

NursingisAnArtform · Apr 10, 2012

Hi! I am also unfamiliar with the nursing home territory as you put it :). Hearing from an experienced ER nurse saying its "easy" does not particularly give me much ease. I know anything new will be both scary and exciting. Also it will take time to get use to. Let's keep in touch and progress together! I start orientation tomorrow. I am excited and level 1 panicked cos I pray all these horror stories on these posts under this topic ... Are just that... Horror stories. Lol. Let's keep it positive! K.I.P!

Merlyn · Apr 10, 2012

Hi! I am also unfamiliar with the nursing home territory as you put it :). Hearing from an experienced ER nurse saying its "easy" does not particularly give me much ease. I know anything new will be both scary and exciting. Also it will take time to get use to. Let's keep in touch and progress together! I start orientation tomorrow. I am excited and level 1 panicked cos I pray all these horror stories on these posts under this topic ... Are just that... Horror stories. Lol. Let's keep it positive! K.I.P!

Nursing home work is NOT easy. It is hard work. I've work nursing home for nearly 25 years. No spot in Nursing is easy.