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...
Estrogen..you'll do just fine! It's different than a hospital, has its good points and bad just as anywhere else.. Most of my problems come from unreasonable family members who promised her sister she would watch over the sister's husband .
Promise was made just before sister died, and "Virginia" is at the facility every single day..we sorta watch out for her..anyway, I am digressing...sorry)
Lots of the same "problems"--staffing, supplies what not. I really DO enjoy my job, and plan on staying for the next 10-15 years. I hope to be able to work at different positions over the years, and not only staff/charge nurse(one and same)
Oh, a sense of humor REALLY helps. I laugh every day at work. There are many people who aren't able to say that...
DON'T EVER SAY THAT AGAIN!!!!!! (yes, I am SHOUTING!!!!!)
Many years spent as a CNA, I never realized how important my position was and what a help I was to the nurses and patients.
My CNAs are my eyes and ears down that hall. The CNAs **know** the residents MUCH better than the nurses, and pick up on subtle differences in behavior. I can't tell you how many times a CNA has been the 1st to pick up on a UTI, or a stroke
**NEVER** discount your importance to the residents and the team.
Now go wash out your mouth, and answer that call light!
i work in LTC and am a new grad..never worked in healthcare before, but I love elderly people and of course was nervous when i started there in April. I have learned so much more about wound care and pressure ulcers than i ever did in clinicals. we have had several patients from my unit that have gone out to the hospital, without a thought of even a red spot and then they come back with 5 or 6 ulcers...pitiful i think. especially the last one, he gets himself up in his w/c turns and rolls all over the bed, but after 6 days in the hosp, he came back with 6 pressure ulcers, even on his ears where the o2 tubing had rubbed him raw.
i am currently in a small ltc facility, 154 beds, but we have 54 residents on my floor, and 2 day nurses and 1 night nurse. that was a big change for me coming from clinicals and the first few weeks, i was stressing bad, but now it is not bad at all....i enjoy the majority of my residents, except for the one that keeps trying to jump the fence and escape.
i work the weekend baylor position 7a-7p due to the fact that i also coach cheerleading and softball during the week, and go 4 days a week for my rn-bsn.
ltc is great as long as you are in a good facility.
I worked (and still work on occasion) at the same LTC facility for five years. There have been good times and some really bad times, but the bad times don't last forever (bad times for a variety of reasons, from tyrant family members to everyone on the hall being sick to horrible CNA's or nurses) We eventually got through all of them, and the few CNA's and nurses who have stuck with the place are worth their weight in gold. If your facility is anything like mine, you'll meet some good friends there, and I actually look forward to going to work so I can be with them.
You will relax more as time goes on and you become acquainted with the facility (well, there is one nurse I can't speak for where I work...but she is a real oddity...anyhow...)
Thanks everyone for all the great support! It's time to give those interested a little update.
Sooooooo, what was supposed to be three days of orientation turned into two. The third day the person who was supposed to orient me didn't show up and I was left all alone on the LTC floor of the building with 58 residents (on night shift) and 2 CNAs. ....Typical I gues, huh?
The good news is, that everything went fine and I actually really enjoyed the night. Nothing out of the ordinary happened that night, no falls, no unusual events (THANK GOD!!!). I managed to do the med passes and blood sugars in a fairly timely manner and I took good notes in the little orientation that I had during those two days, so with a little help from the three nurses on the other - subacute - part of the NH I think I pretty much figured out who was on allert charting and I managed to chart a blurt in the prog notes of about half of them (as advised by my colleagues from "the other side" I used my nursing judgement as best as I could to establish priority, because there was no way I'd be able to chart on approx. 15). The narc counts (my biggest fear, comming from a wonderfully pixys-computerized hospital) were also correct in the morning, so I feel like I did fine, concidering the circumstances. The only thing that I feel pretty lost at (and therefore left it to the next shift - God love them) is paperwork... you know, faxed labs, confirmed orders etc. I wish my orientation would have consisted more of showing me that, than following the LPN around during med passes... I am a sink or swim (usually I swim) and hands on type learner, so it worked well for me this way, but still, I'm thinking sheesh, God forbid something happened? What if I didn't know what to do in an emergency situation and didn't respond appropriately according to rules and regulations? I could jeopardize my licence... I will prepare a list of questions that I need to find an answer to and either I find some policy mannual there or I'll go and ask the DNS...
Sounds like you will be o.k., as for faxing labs, unless they are panic levels,then of course I would contact the M.D., but most of the time they won't do anything until the next day anyway. On PT and PTT if unable to contact M.D., use your nursing judgement re: holding coumadin d/t increased levels and moniter closely. I work days and it is our responsibility to fax and notify M.D. offfices re: labs, x-ray results, etc. Occasionally day shift will have to pass on to 3-11 if no new orders have been recieved before we leave, but most of the time days gets the new orders, we try to contact docs as early in the day as possible so that if we need to order meds, eg: antibiotics, we can contact our pharmacy to have them delivered that noc. If you do get new orders for meds, check your backup, if the med isn't there, it just isn't and will have to be started the next day. Like you said, just use your nursing judgement, which sounds intact, take care of the most important and pass the rest of it on to the next shift. That's why we are 24/7 we never close. It will get easier as time goes by, each day you will get a little faster and then some days, no matter how fast you are, you'll still have something left over. Just don't sweat the small stuff. As for charting, I guess we all have that thorn in our side. Most of the time it will all get done in a timely manner and then when something major happens it just doesn't, and the world keeps turning. We are not supposed to stay over to chart, but sometimes, it just can't be helped, we have to clear it with our DON in order to get paid, but she has always been understanding as long as we don't make a habit of it. I have had to make late entries at times. You sound like a good nurse with sound judgement, just hang in there, ask questions and enjoy. Keep us posted.
i too came from med surg into LTC and love it but in LTC you have to use your assessment skills because you dont have a doctor near by. I went into management and now i am tired of the management and am thinking about going into the hospital for the flexibilty. oh the life of nurses
...One impression (and a possible problem for me) that stands out for me is how much more.... how should I say.... relaxed, layed back, slower paced (as opposed to high strung d/t accuity) everything and everyone is in the LTC.
As one nurse put it, this NH home is "as ghetto as it getts" - which is fine with me, because I actually love to work with (and for) the financially and otherwise disadvantaged, and as I allways said to the people who were wondering how I could work where I worked (even the part of the hospital was the most ghetto - homeless guys, druggies with abcesses, cirrhosis and encephalitis d/t ETOH, detox... and I loved it) : I didn't become a nurse to be cute and prissy. I like to "get my hands dirty".
...So in this ghetto NH, there's quite a bit of mess (paperwork-wise, not patient-care-wise), and as I allready mentioned, the staff is waaaaay more relaxed than in a hospital. I've also noticed that meds are sometimes not given completely consistently (or at least not charted), VS and I&O's omitted, I've seen CNA's nodding off in the hallways between rounds, allthough they had their rounds done. Even the nurse that was supposed to orient me, instead of ie. explaining the above mentioned paperwork to me, took a good 40 minute nap with her head down on the nurses station desk. I'm not judging it, I understand that it is just a very different setting than in a hospital, where it would be absolutely unacceptable and anyone would have been immediately fired for such behavior. It was kind of shocking to me.
However, I have also observed, that the staff LOVES their residents and that this more layed back atmosphere is probably in a sense therapeutic for them. After all, it's their home.
So my two questions are: 1) Are you other LTC nurses familiar with this? Is it "normal" for all Ltc facilities?
2) How should I "go with the flow" and enjoy the relaxed environment (after all stress reduction is why I left the hospital) and still be the best nurse one can be and ensure that on my shift the residents are receiving the best possible care?
Oh, and please don't get me wrong, I'm not doubting that at times it can get very stressfull and bussy in a LTC too, especially concidering the notorious staffing issues...
You will do just fine. And your med/surg experience should be welcomed and come in very handy. I've done LTC for since 1988 as CNA and LPN, in addition to working in med/surg and homehealth. I really enjoy LTC!! You will fall in love with some of the "residents" (patients) . Don't let some nurses or EMTs call this "wasted nursing" as I have encountered. You will still use your skills!!! GOOD LUCK!
Thank you every day for your hard work.
joyflnoyz, LPN
356 Posts
Estrogen..you'll do just fine! It's different than a hospital, has its good points and bad just as anywhere else.. Most of my problems come from unreasonable family members who promised her sister she would watch over the sister's husband .
Promise was made just before sister died, and "Virginia" is at the facility every single day..we sorta watch out for her..anyway, I am digressing...sorry)
Lots of the same "problems"--staffing, supplies what not. I really DO enjoy my job, and plan on staying for the next 10-15 years. I hope to be able to work at different positions over the years, and not only staff/charge nurse(one and same)
Oh, a sense of humor REALLY helps. I laugh every day at work. There are many people who aren't able to say that...
LOOK for the humor!