Starting LTC Tonight! In need of some encouragement and tips.

Mandylpn · Aug 1, 2005

Do you think 3 days is enough orientation? I would surely ask for more if it is not. my advice: don't forget to take the time to use the bathroom, take a break for dinner - no matter what, and eat something, wear comfortable scrubs - that breathe (you will probably get hot with all the running you will do) whoops, you worked in med/surg, well you know what I mean! Good shoes help. chocolate. Good luck!!! let us know how you like it!

lovingtheunloved, ASN, RN · Aug 1, 2005

i'm not a nurse, just a lowly CNA, but I love LTC. It's got it's drama, but from what I see posted here all the time, so does everywhere else. Crap will happen that throws a kink in your routine, that you can't control. Like a RN I work with says, "Roll with the punches." That attitude will serve you well.

live4today, RN · Aug 1, 2005

lovingtheunloved.....you are not just a "lowly cna". cnas are a very valuable asset to patient care...and to the nurses as well. i know...i used to be one before becoming a nurse. :icon_hug: and...the work is hard on both sides of the coin.......just more responsibility on the nurse's end of things. :specs:

estrogen.......i wish you well on your new job! ltc's aren't for me, but many nurses love working in ltcs. there is drama wherever you go to work, so just give it the best of yourself...taking care to "take care of yourself" along the way. :specs:

Hyogo_no_Nagi · Aug 1, 2005

Yay! Another LTC buddy.

I've been working at an LTC facility for about three months now, and I've fallen in love with it. Sure, it has its drawbacks, but so does everything else. I love the chance to see the same residents day after day and develp a relationship with them.

Some things I would do is be sure to make a cheat sheet with who's a diabetic, who gets crushed meds, who takes it whole in pudding, who just takes it whole. And be sure to ask if there are any residents who you absolutely *must* get meds into them before the are put in bed (or they won't take them). Also, make sure the person orienting you gives you a clear picture of their vital signs policy (under which criteria per-shift vital signs are expected. I got busted for not having them done when I didn't realize they needed to be done.

Also, be prepared for even the most lucid of residents to go south on you eventually. I had a resident who was sharp as a tack for me for three months, and then completely freaked me out with massive bouts of confusion, anxiety and sobbing. You might ask who is a major sundowner and who is prone to anxiety attacks, etc.

It is especialy true for LTC: your aides are your new best friends. Take them seriously when they say a resident is "acting funny" or "not themselves."

And don't be afraid to call your supervisor of you're not sure what should be done in a certain situation. That's what they are there for. I have never been sorry for asking for help, or just advice.

Lastly, I would put everyone else's negative opinion of LTC out of your mind. What matters is your experience, not theirs.

Ganbare yo! (go for it!)

dekatn · Aug 1, 2005

Get to know your CNA's, they are worth their weight in gold when it comes to the residents. They can help you not only identify who is who, but can most of the time tell you how they will take their meds, their likes and dislikes. Learn what your duties are first, get your own system planned out, make sure you know where your contact phone number list is just in case you run into something you aren't sure of, ask about fire, disaster drills and escape routes, get to know your med cart really well, it will be your shadow. Know where to get extra supplies, meds, crash cart, O2 tanks and supplies. If I am comfortable with my surroundings and know where to find what I need, the rest of it kinda falls into place. That way if there is an emergency you don't feel as stressed. Oh yeah, know if you have a back up generator in case the power goes off. Make notes while in orientation of everything, then you can make your own general list. Where to find extra forms, how to do incident report in case of falls or what not. We are only human and can only do so much at one time. If you have an incident and it causes you to get behind on your med pass, don't stress, it can't be helped, tomorrow will be better. Just take it one day at a time and ask as you go, six months from now you will still have a question about something that comes up. Just be yourself, take one step at a time and enjoy. The MARS we use have pt. dx, allergies, M.D. name and phone number and whether or not that pt. is a code. To me that was a big help, I like to know these things at the git go. Another thing you can do is get a blank copy of your report sheet and take notes about the pt. as report is given, keep the paper with you during med pass and add notes to it as you go. This helped me tremendously. I always kept this paper in a safe place away from prying eyes d/t hippa, but it saved me a lot of time in the long run. After you get used to your residents you will no longer need it. I think I have rambled on enough for the time being, but if I think of anything else I will let you know. Or you can pm me anytime. Good Luck and Congratulations I hope you enjoy LTC as much as I do.

DusktilDawn · Aug 1, 2005

Good luck and all the best with your new job.

FROGGYLEGS, LPN · Aug 2, 2005

I left the hospital setting several years ago for LTC mostly because it is much closer to home.

As someone else said, you will get the opportunity to really get to know the residents. This makes it a lot easier to tell when something is going on with them.

I'd suggest you find out what the policies on transferring to the hospital are; which ambulance to call for an emergency and which ambulances do your routine transports. Find out which hospital the facility usually uses if no preference has already been made in the chart.

Know where your crash cart and oxygen are kept. You probably want to check that crash cart to make sure it isn't just a skeleton when you need it.

Find a copy of the standing orders. You'll most likely run into multiple requests for Tylenol, laxatives, and antacids that aren't on the MAR.

Find out the policies for incident follow-ups. Here we have to chart with full VS q shift x 72 hours. Fill out the report and notify the MD and family.

Fall follow ups seem to vary a lot at the places I've worked. Find out what constitutes a fall (sounds silly eh?). Usually you have to do another fall risk screen and the regular incident package, but there are usually specific guidelines on falls and fall prevention.

I have made it a habit to go to each room to check on the resident right after receiving report just to make sure that all of the residents are still there, still alive, not in distress, and not on the floor. I have a lot of residents and a long med pass so if I don't check on them first it will be a while until I reach their room for med pass. I have come across some very bad things at the start of my shift by doing that, but it is always much better to find it early on.

I also carry my own BP cuff and stethoscope and have just recently added a thermometer because it seems like if you rely on the facility's they will have disappeared at the moment you really need them. You may want to keep a folder with a few of the forms you use the most as well. They will also do vanishing acts at the worst time. The last time I forgot my stethoscope I had a lady that had a very sudden change in condition that needed a speedy assessment and a call to the doctor while I had to run all over the building to find a stethoscope. :uhoh3:

Best wishes for your new job.

dekatn · Aug 2, 2005

Hi

Just wondering how your first night went. Write back and let us know, if there is anything else we can do to help, we'll try.

nurseT · Aug 2, 2005

HI, I WORKED LONG TERM CARE FOR A LONG TIME. I LOVED IT AND YOU WILL TOO. FIRST OFF, YOU'LL DISCOVER YOU WILL WORK HARDER IN LTC THAN HOSPITAL DUE TO THE NURSE - PT RATIO. AT THE START OF YOUR SHIFT,FIND OUT WHO YOUR CNA IS, GET A ROOM LIST OF THE UNIT YOU WILL BE WORKING. FIND OUT WHO YOUR DIABETICS ARE AND WRITE IT NEXT TO THEIR NAMES. FIND OUT WHO HAS ANYTHING DUE LIKE PREPS FOR TESTS OR BLOOD DRAWS, TUBE FEEDS ETC. FIND OUT WHO HAS OPEN AREAS THAT GET DRESSING CHANGES. ASK IF ANYBODY ON YOUR UNIT GETS A MED THAT IS DUE ON AN OFF TIME OTHER THAN MEDPASS. ASK WHAT THE BASIC EVENING SCHEDULE IS RE: MEAL TIMES, MEDPASS TIMES, SO YOU'LL KNOW WHEN TO TRY TO GET YOUR TREATMENTS IN. I'M ASSUMING YOU ARE 2ND SHIFT SINCE YOU SAID " TONIGHT". THIS WILL HELP YOU STAY ORGANIZED ENOUGH TO MAKE SURE YOU GET ALL YOUR TASKS DONE. THEN YOU'LL NEED TO FIND OUT WHO NEEDS ASSESSMENTS AND CHARTING RE: MDS. PLUS YOU'LL NEED TO CHART ON THE PATIENTS YOU TREATED OR SPOKE TO THAT HAS BEARING ON THEIR CARE. YOU WILL FALL RIGHT IN AFTER ABOUT 3 WEEKS. CUT YOURSELF SOME SLACK. YOU WILL LOVE THE ELDERLY, AND THEY WILL LOVE YOU TOO.:balloons:

Tonight will be my first night at a new job. I'm comming from a med-surg floor in a hospital to LTC. This LTC facility is very conveniently located for me (five min. from my house, five min. from my daughter's school, two minutes from my son's daycare, nextdoor to the YMCA where we like to hang out) so I reeeeeeally want this job to work out for the long run... I'm also hoping (hoping!!) for some stress reduction, comming from a very stressfull med-surg job with very bad and ruthless management.
I read so many negative things about LTC here. Isn't there something to look forward to? In the wake of my first night there, I would really appreciate a few positive words, maybe some tips and tricks of the trade. They're giving me only three days of orientation, unless I request more, so I'd appreciate some tips on what to pay special attention to at this time, what questions to ask the nurse that will orient me. And if you really don't have anything positive to say, go ahead and let it out too... At least I can try to learn something from it...
I'll appreciate any input or support. :)

mattsmom81 · Aug 3, 2005

Just wanted to wish you good luck in your new venture! :)

estrogen · Aug 3, 2005

Thanks everyone! :) It was a very interesting first night and I wanted to let you all think, that I'm gonna be just fine there. The pace and workload seemded manageable. I'm a fast worker and I'm used to the stress at a med surg floor, so I thik it'll be okay.

The encounter with the other nurses was ...well... shall we say, iteresting. :lol2: One, that later went home, was one of those people who (eventhough she was a LPN for about two years just like me) has been everywhere, done everything (twice!) and the first sentences that came out of here mouth were to assure me, that she's the best, the smartest and the most knowledgable person that ever walked the earth and - of course - she's the boss of everything. (She had a couple resident's confirming it to her in my presence). She was tying to convince me, that LPNs cannot administer Benzo's IM (not true) and if I didn't give in to her, she would have probably ended up in a full blown battle with me. She also proceeded to sign off on some eye dropps, assuring me that she allready gave them and when we later went into this perfectly lucid gentleman's room, he ask for his eye dropps stating that she didn't bring them to him yet. How dumb was that from her?... It was kinda fun to watch her squirm. ....Ah well, what can I say. Most likely basically a sweet person, just one of those wise a$$es and CEO's Of The Universe. At least she was funny, chatty and friendly.

The other nurse, that oriented me the rest of the night was very, VERY sweet, but she was kinda overwhelmed. She was one of those people spinning their wheels and kind of running around in cicles, so everything took her a long time and she didn't have much time to answer my questions like what to do in case of falls or other emergencies. I think the first one would be better at that, so I hope that she is back tonight.

I'll let you guys know...