Start orientation at 1st nursing job tomorrow. PRN in LTC. Any advice?

Nurses General Nursing


I start orientation at my 1st position tomorrow in a local LTC facility (while I look for a FT job in a hospital). Even though I'm disappointed not to have a hospital job yet, I am starting to get excited for tomorrow! I'm also very nervous. I enjoyed my LTC clinical rotation in school, so hopefully I'll like this job. I have a combination of excitement, disappointment, and nervousness. Anyway, I'll be charge nurse over about 30 patients. I am looking for any advice you all can give. I want to do a great job, and I want to learn as much as I possibly can. Any suggestions would be appreciated! (What to do or what NOT to do). ;-)

Specializes in Hospice.

Congrats good luck. I don't do ltc so i have no advice except find a good mentor that you can go to for support.

Hi Irock:

Congratulations on your new job! I have worked in LTC for 25 yrs. I love it. I worked in LTC for awhile, then worked in a hospital for awhile. Then I went back to LTC because I really missed it. Most of the residents in LTC are elderly. My soft spot is with the elderly. You are asking for suggestions.

What to do: Be kind and courtious to everyone in the facility. It sounds like a no brainer, but after a few weeks or months there will be times that won't be easy.

The PSW's, front line workers, health care aides, whatever they are called in your facility are your eyes and ears. If they tell you that Mrs. XY has a bruise on her shoulder, check it out. That too sounds like a no brainer. One of our biggest problems where I work is when RN's and RPN's don't follow something up. Write it down somewhere if your are too busy at the time. If you can't get to it make sure you pass it along to the next shift. If you do assess the resident, document it.

When I ask the PSW's to do something, I thank them afterwards. We had a RN who always said thank you when I did something for her. It made me feel good. So I do likewise. I also thank the PSW's at the end of the shift. I learned that from another nurse as well. If you treat the PSW's with respect chances are good that they will respect you too. So many times I hear PSW's state that this RN or that RPN looks down on them. That won't be said of you, will it?!!

Learn from your mistakes. We all make them. I continue to make plenty. Admit them and carry on. Hard, hard to do sometimes. This is so true with med errors. In our facility we have a special form just for med errors. That means I am not the only one who makes them!

Try to be punctual. Avoid calling in sick unless absolutely necessary. Accept call-ins whenever you can.

If someone reports you to management, document everything about the situation that you can remember: date, time, who was there etc. I find it helped me to keep the documentation and also the meeting with management as objective as possible. It is tempting to be defensive. Try not to be. Sometimes I have said to management (especially if I had been involved with staff conflict)"There are 3 sides to every story: the other person's side, my side and what really happened." Right then I demonstrate that I realize management probablly hears some doozy stories from both sides.

Smile! Even when it is hard. Sometimes it will be very hard.

What not to do:

Avoid small gossip as much as you can. In the long run it could really pay off.

If a co-worker gives you a hard time try not to take it personally. Some of the staff that have worked at these facilities can be downright rude. If they lambaste you, no doubt you are not the first and you won't be the last.

I know this is very long winded and wordy. I hope that it does help you a little.

Great luck to you. Keep us all posted on how you are doing.


Congratulations on your first nursing job. My first bit of advice is don't panic. It can be overwhelming all that comes with being a charge nurse. Remember to breathe and take your time.

Then I agree with BigRed, always thank your aides and nurses you are overseeing. When you try to make the team run as smooth as possible, and give the respect deserved, you get the respect deserved and all is well. Respond to your aides and other nurses requests in a timely manner, not only will it develop trust, it keeps you in the knowing of what is going on with your patients.

Always document no matter what. Carry a notepad or something of the sort so you can make notes at any given moment, never leave it to memory.

Hope you have a great first day!

Specializes in acute care med/surg, LTC, orthopedics.

Best advice to you is....

.................. RUN AS FAST AS YOU HUMANLY CAN!

Hopefully your LTC experience turns out better than mine.

Specializes in Home health was tops, 2nd was L&D.

Big Red gave you great advice, use it.

Take many deep breaths, really listen to toher nurses, you will be able to tell the real mentor type from the ones thta would love to see you fall, stick with the mentors. Watch, listen , learn. Treat everyone how you want to be treated. I know this sounds like the 10 things I learned in Kindergarten! But really a job is a part of LIFE where you get paid to expand knowledge and skills to care for another. You have good knowledge and skills, You will continue learning every day you are alive. Just take it one day at a time and if needed one hr at a time. Make sure to TAKE your Breaks so you can step out out that world for a breather. Eat something fulfilling, read a magazine article or a few pages of a book...Specifically NOT NURSING, recharge and then go out and smile!!!

Give yourself plenty of time to learn the routines on all the floors. I think it's tough having your first job be PRN because (at least in my experience) the regular nurses have their own floors and you'll be bumped from floor to floor to cover days off and stuff like that.

I would see if you could get a couple days one each floor you might be working. I have oriented per diem nurses and they've felt great doing my assignment on my floor but of course when they start working alone they discover they're somewhere totally different in the facility and they get overwhelmed and discover that each floor might run a little differently with different mixes of patients.

Also, don't expect to be anywhere near fast at first. Expect the med pass to take forever and remember that accuracy and safety is the most important thing and speed will come over time. Good luck!

Specializes in Gerontology.

Ask questions if you are not sure. Ask if you can DO things, rather than WATCH someone else do them. There is nothing like hands on to help you learn things.

Don't say : Thats not how I was taught in school. Thats not how such-and-such a place does things.

Learn all you can. If you think of questions when at home, write them down and ask them the next day.

Ask, ask, ask! What happens if...? Who do I call if this happens...? There is so much that does not get covered in orientation that you need to know. Sometimes the person orientating you will not tell you something because it seems so routine to them they forget to tell you.

ie What happens if the power goes off? Answer (in my hospital) Generator kicks in right away. However, make sure important equipment is plugged into red outlets.

ie What happens if I can't deal with a situation in off hours? Answer (in my hospital) Manager-on-call can be accessed via switchboard. They are there to help you.

Specializes in Hospice / Psych / RNAC.

Chances are you're going to end up on a med cart at one time or another. Many places will train the charge on all carts before they start so if it happens (lol) you can do the med pass. Don't get too discouraged; it can be an overwhelming experience to say the least.

One very important thing is don't alienate the CNA's. They can make or break you. It's a tricky dance dealing with the CNA's at some places. Good luck.

I didn't have time to read everyone's response, but as a PRNer in a few places my biggest piece of advice is you need to be flexible. YOu might be working on a different unit or floor each time you work. Remember that the other nurses are there more than you and might not want to hear grumbling about certain things that they have to put up with more often than you.

Specializes in Med-Surg, Neuro, Nephrology, Pulmonology.

Thank you Irock for this post!! I am in the same situation, and I wasn't sure of how to tackle the situation. I am so happy that someone finally gave me a chance to prove my skills, but I am bummed bc my dream to to work in another area. Never the less I will give my all to the facility and patients......Good Luck to you!!

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