Starting out in LTC

Juwon · Jan 15, 2011

Hi, first off congrats on landing the position at the LTC facility. In my honest opinion, it shouldnt take u too long to catch on to the work in LTC. When my mother first started off her nursing career as a RN in LTC she was given a 3 day orientation period. After that she was stuck fending from anywhere to 38-62 patients on a skilled floor. In the beginning on her own she struggled minimally, mainly with the charting. The medication pass was easy. Make sure that when u r doing a med pass that u create yourself a cheat sheet for the patients. like room xxx bed 1(this and that med) bed 2(this and that med). Keep this for your record but monitor the doctor order. I believe you will do well. Remember if u have any questions, ask the DON if available or the more seasoned nurses. Good luck and best wishes to u!!!!

CT Pixie, BSN, RN · Jan 15, 2011

16 patients??? Ohhh I'd kill for 15..hell, I'd kill for 20. I am an LPN in LTC and I started at my facility the day after I found out I passed my NCLEX.

Anyway, keep a spare piece of paper handy..that way you can jot down which resident gets their meds whole, whole in apple sause or pudding, or crushed.

You can also get a small piece of paper to keep in a pocket..keep the list of your full codes in your pocket (I check my advance directives every day as they can change from one shift to the next). Nothing worse than finding someone down..and not knowing without running up the hall to check the chart or run to your laptop to check it there!

You can also jot down who has blood sugar checks, sliding scales with those checks and at what times.

We are a computerized facility which makes the chances of giving the wrong med at the wrong time nearly impossible as you have to "click" off a time frame and it brings up the pts and the meds scheduled for that chunk of time. If you are not computerized, be sure you check, double check and triple check the times the meds are to be given. Most places do the 3 shifts highlighted in different colors..but don't rely on that..people are human and make mistakes.

I got 6 weeks (full time hours) of orientation..but honestly, there are things that popped up after I was off orientation that I hadn't been told about, because they weren't an every day occurance. You just have to remember to ASK! You are brand new nurse in a facility that is unfamiliar to you..the best thing is ASK ASK ASK.

nicenrse · Jan 15, 2011

OMG Thank you BOTH soooooooo much!!!! I take your replies to heart and will definately use the tips mentioned....the cheat sheets for meds and codes are brilliant! I feel a little better already! Oh and of course I will ask whenever Im in doubt (just hope they don't get annoyed by it)!:hug:

tyvin, BSN, RN · Jan 15, 2011

When I got my first LTC job way back in the day the orientation was only suppose to be for 3 days; I got 2 and was flung out into the abyss. I did survive. Really can't remember too much in the beginning but I get occasional flash backs.

Seriously; keep your head low and take notes. Learn your patients meds especially the ones who are diabetic (don't want to miss those ones with a sliding scale). Get a clipboard, attach a pen to it (black no felt), have paper on it and keep it with you always.

Make sure you have a stethoscope and if possible your own BP monitor; include a thermometer in you pocket with a watch that has a second hand and you are ready for anything (almost). You will create your own work belt in time depending on the needs of your patients. Paper tape, small alcohol packets, hemostat, scissors, and small cc measuring tool are key for survival to be put in your pockets. Also pens, black ink pens everywhere!

Find out what your patients code status is and on your report sheet that you will create (remember the clipboard) have your patients name, code status, Dr.s name, Dx, allergies, menu, and the way they take their pills (crushed, crushed with pudding, crushed with ice-cream, crushed applesauce, crushed with cherries jubilee! (kidding), and know which meds you can crush and make sure you have a crusher on your cart along with thickener (some will have to have thickened liquids (menu/diet).

So when you are standing there looking at the person orienting look down at your clipboard with your patients/residents name in listing order and make sure you have their:

code status

diet/how to take liquids meds

Dr.s name and diagnosis

allergies

room number

Hmmmm I'm sure I'm missing something but I hope this helps. Good luck; with only 16, what could happen?

Oh another thing is make sure they have a current Mosby's nursing pharm book available (or similiar) or get one of those small ones that are for the pocket and look up any meds you do not know the amount, action etc... for.

You're going to be fine. :up:

CT Pixie, BSN, RN · Jan 15, 2011

OMG Thank you BOTH soooooooo much!!!! I take your replies to heart and will definitely use the tips mentioned....the cheat sheets for meds and codes are brilliant! I feel a little better already! Oh and of course I will ask whenever I'm in doubt (just hope they don't get annoyed by it)!:hug:

I'm almost 3 yrs into my facility and I still have to ask questions. I'd rather a new nurse (be them an RN or LPN) ask me questions over and over than not and possibly harm one of "my" grammy's or grampy's :)

About the med cheat sheet..be sure you're checking the MAR, b/c the med doses do change from time to time..I can pull my meds for a pt without even thinking about it (I remember watching in awe when I was in orientation when my preceptor just pulled all the meds by memory..thinking..gosh, I'll never be able to remember 34 pts meds for the 2 med passes..and next thing I knew..I was!)..anyway..I pull my meds from memory from the cart but I ALWAYS double check the doses etc..because they do change, meds are d/c'd, doses upped or lowered etc.

I won't lie, you ARE going to feel lost, overwhelmed and want to run screaming..thinking you can't do it..but you CAN do it. One step at a time. Try to get your own "schedule" once on your own..a certain way YOU do things..My co-worker (there are two wings to my floor) and I do things very differently when it comes to how we do things, how we set up our carts, which hall or residents we start with etc. There is really no "right" way. its whatever way is easist and safest for you and your residents.

Did I mention..ASK when in doubt :lol2:

Forever Sunshine, ASN, RN · Jan 15, 2011

Think of your first year as one unofficial orientation. I've been at my job for a year and I'm just starting to feel comfortable.

Don't do anything you don't know how to do. Ask if you don't know how to do something.

Before calling MDs, get everything together. The chart, the mars, the tars, a fresh set of vitals including pulse ox, and any assessment information you have gathered(since you will be doing that for LPNs, as we are not allowed to assess)

If you have to do a med pass, get your fingersticks out of the way first, and those that like their meds at a certain time. Then go in room order. Set up your cart first, vanilla and chocolate pudding, applesauce, water, juice, glucerna, insulin, syringes, alcohol pads, cups, tissues, b/p cuff, stethoscope. Limit trips to go find supplies as this sucks up time and you find your medpass is taking 4 hours to do(which sometimes it will because interruptions can be very frequent sometimes. Sign out your narcotics as you give them. Keep the ones you already used behind the pile so you lessen the chances of accidentally grabbing the wrong card. Put them away in the medroom if you do not need them for the 2nd medpass. Its less you are accountable for.

Bring snacks. Some shifts you won't have time to take a break. Stay hydrated too and wear comfortable shoes.

INLPN93 · Jan 15, 2011

First off, Congrats!!!

Now, my first piece of advice is to get the sheet used for report and make notes~ detailed notes on each res.

1. Crushed or whole in applesauce, or just whole meds

2. Diabetics needing Glucose monitoring AC et HS, tubes, and invasive treatments

3. Res who sun down or have cycles of behaviors

4. Who likes meds before they eat and who likes meds after, you wouldn't believe how much this matters to a res.

5. LAB DAY @ your facility, who is responsible for UAs, Blood work and other non-stat labs ordered when lab isn't coming~ this is important and it is usually a facility policy

6. Get a general low down on your doctors, who is nice and who isn't

7. Find out about the policy on falls and incidents, it is a huge issue in LTC: who to notify; of course MD and family but I work where you notify the DON and Administrator and have worked where you notify therapy and social services.

8. Know your CNA's because the majority are extremely awesome and have your back

9. Know your bed, chair & wheelchair alarm res and always check functioning at the beginning of your shift

10. Know your narcotic pain patches, make a check for placement

11. Don't give your cart keys to anyone, ever. Until you count off with that person.

I hope it goes well, I have been in LTC for 18 years.

LTC is what you make of it, do the best you can with what you have.

When you feel that you don't have enough Speak Up.

Don't be afraid to say something is wrong when it is.

Oh, and look for someone to be a shift buddy or at least someone to go to for any questions/problems you may have that has been there a while.

Good Luck!!! I hope you enjoy LTC!!! :) :)

LPNnowRN · Jan 15, 2011

I was hired in June 2010 as an LPN and I still learn new things about my LTC policies and procedures every shift--I have about 35 people on my wing, most of the diabetics, and some hefty wound care dressings.

1. Keep calm. Prioritize what you NEED to do first, and do that.

2. Realize you WILL NOT be as fast as the other nurses for a while. Cry on the way home if you have to and then figure out a better way for the next day. My preceptorship for my RN was sooo easy with just five patients--she kept asking me "Is this done? Is that done?" Time management will get highly developed!

3. You will survive. I am orienting a new grad now, and it is eerie how similar the comments are to what I was feeling not even a year ago: "I was just feeling good, but after yesterday I just can't do this!" You can. It just takes time.

4. Everything is hard until you learn to recognize all the residents.

Good luck! Enjoy your new job!

CareteamRN70 · Jan 15, 2011

My first Job which was not that long ago was in LTC on the night shift with 50+ patients. I was promised 5 days orientation got 3 instead and really dont count one of those because we were short staffed and I was put on a med cart and left on my own to sink or swim. In 4-5 days, with good nurses, you can learn enough to tread water. My new job gave me 3 weeks orientation which was comprised of classroom and floor orientation and I feel so much more comfortable but I know there will still be those times when I run into situations that stump me or were not covered in orientation...nature of the job I guess.

I screwed up tons during my first few weeks on my first job...didnt take orders correctly, found out I had neglected duties that were expected to be done by night shift because no one told me we do them, had to back off from some tricky IV orders beacause I had never mixed dry antibiotics that didnt come attatched to the 50cc bags of saline and didnt feel comfortable "hand mixing" or doing it as a push. But each week I learned more..every mistake I learned from and never forgot and was making progress. So thats the long answer..short answer is No, 5 days is not enough time but you "can" do it and make it work if you are open to learning as you go and see mistakes as just learning experiences. First night I sent a patient to the hospital I know I goofed most of the paperwork, didnt make all the calls I should have, probably had the on call Doc wondering if students were running the night shift (in my case not too far from the truth) but I got the pt out, and it turns out they were very very sick and I made the right call. That made all the panic and doubt I went through worthwhile. So as my ol MedSurg teacher used to shout at us "Go getcha that knowledge"

CapeCodMermaid, RN · Jan 15, 2011

Congratulations on your first job as a nurse! I've been a nurse for more years than I'd care to admit and I can still learn new things. I love having new grads work in my facility...y'all still have a lot of enthusiasm and are up to date on the latest in the profession.

I second what most of the other posters have said. If your facility doesn't have a resident roster you can use to keep notes, make your own. I'd be careful about bringing in a bp cuff since many places have policies about using company supplies since they have to be calibrated.

And, please, refrain from the grammy and grandpy names one of the other posters used. It is condescending and not at all dignified (unless the resident asks you specifically to call them that).

Good luck!

nicenrse · Jan 15, 2011

Wow!!! I don't know what I would do without this site!! The support, wisdom, and encouragment is great!!! I have my first day of orientation Friday! I will definately pay close attention, take notes, and ask ask ask!!! I will let you all know how it goes! thank you so much....I feel like it's gonna be a bumpy road in the beginning but it has been done before and I'm eager to learn as much as possible and give the best care possible....and in all honesty, I do think I will be one of those people that will cry in my car on my way home feeling overwhelmed while I figure out how to make the next day better!!