To all you seasoned LTC nurses: can you share with us new nurses to this specialty, little facts, tidbits, and helpful info to make our transition safer and better? Anything, even if you think it's "common nursing sense", please share it!!! Regarding meds, labs, treatments, routines, dealing with doctors or family, literally anything. This could be an amazing guide for us :)
Get to work with enough time, to make rounds on all your patients before you start your shift. I used to like to make them going from room to room, with the nurse I was relieving. It's not uncommon to find a patient on the floor, a PEG or IV that has been pulled out, or even a deceased patient. You don't want to be halfway through your shift, before you find out that any of these things have occurred.
Never give anything that you didn't draw up or prepare yourself. That includes pills, saline flushes, ointments, whatever. It was common for nurses to pass on a saline syringe to me, saying they didn't use it as a flush, and didn't want to throw it out. Don't use it.
Always count your narcotics with the nurse you are relieving. And make sure the count is correct before that nurse leaves. I've come across nurses who wanted to leave or were running behind. They would try to give me the keys and tell me to count on my own, or say not to worry, the count was correct. Don't fall for it.
If you have any questions on how a medication is to be given or stored, don't be afraid to ask for help. Your drug book and Pharmacy are also great resources, because sometimes even the other nurses don't know how to give/use a newer/unfamiliar medication.
The same goes for any equipment that you are unfamiliar with. Ask for help. In the early days, I used to be hesitant to ask, not wanting to look "stupid". But if you apply something to your patient incorrectly, you can cause injury or give them ineffective treatment. Then you really look stupid. LOL
Document well on your patients, especially anything related to their problem/diagnosis. You don't want to be making rounds with the next nurse, only to find that your trach patient has died since you last checked on him. Then when the supervisor comes to look in the chart, you documented nothing about his respirations, oxygen therapy, last suctioning or breathing treatment. This actually happened to a nurse I was relieving.
Make a conscious effort to get along with ALL of your co-workers. You WILL need them at some point or another. You don't have to like them, but try to always maintain a professional relationship.
Remember that this LTC nursing home is the residents' home. We are working in their home, they are not living in our workplace!. The whole way of thinking about this is now centered on a neighborhood environment for these folks, and it is only going to become more that way as the boomers age. Its a great place to come for your job if you love the elderly/chronically ill.
Before you call a doctor, make sure you have current vital signs and lab work handy. I always liked to have the chart right in front of me, in case I'm asked something about meds, diet, last dialysis treatment, DNR status, etc.
You should know exactly what is going on with the patient, and be aware of any major changes that have taken place (like decreased level of consciousness, no urine output, increased residuals, etc.) before you call. That way you can give an accurate report. Chances are, you will be asked something you don't know the answer to anyway. That always happened. But at the very least, you should know the basics.
And keep in mind that many doctors like to talk down to nurses or yell at them for calling (especially on night shift). But don't take it personal. It's better to be safe than sorry. As long as you know you did the right thing by informing them, that's what matters. And of course, remember to document that the doctor was informed, and be sure to re-read any new telephone orders that were given.
I work 7a to 7p on the weekends. The first thing I do after handover is go through the treatment record and write down all my treatments for the day. Then I check the treatment cart to make sure it's stocked.
I learned to check my medcart to make sure I have enough OTCs such as Tylenol, colace, B12 etc and other supplies before starting my first medpass of the day.
I then make a list of any supplies we need from central supply and give it to the charge nurse.
If you're lucky enough to work with the same residents every shift then write down who gets crushed meds and who gets whole, accucheck times, and who needs BPs done.
never take shortcuts, you will get burned everytime!
yes, i agree with this. but how do you get everything done with 30 patients (2 1/2 hr med pass + 1 1/2 hr med pass plus wound tx + disimpact pts, plus documenting (medicare and weekly note), plus doc calls, new admit, supervising cna's, taking care of all problems because it's pm 8 hr shift, and because there is no don~nobody higher up to ask?). how?
piel-"read your policy books & try to always be doing things the way state regulations would have you. fun advice huh? don't forget to document when you've updated the md or family on anything." as a new charge rn, i asked if i could read the policy books so i would know what i needed. they looked at me like i was crazy! like i should already know what they said. hello, new grad here, do you want me to learn correctly???? obviously not. then, when i "did not know/realize" i was supposed to fill out x report for x problem, i was told, "well it's in the book". hello, did i ever get to read the book during my 12 days of orientation? no. and nor did i get to even peek in those books during my next several weeks on my own, trying to just survive my med passes, tx's and documentation?
Specializes in Hem/Onc, LTC, AL, Homecare, Mgmt, Psych.
when i first started as charge nurse in ltc i asked for extra time to just come in and read thru the policy books. they (mgmt) gave me several hours to come and go through the books, plus i looked thru them whenever i had a spare moment or a new situation occur. did you even ask for the extra time during training to review policies? sometimes you gotta put your foot down.
piel-"read your policy books & try to always be doing things the way state regulations would have you. fun advice huh? don't forget to document when you've updated the md or family on anything." as a new charge rn, i asked if i could read the policy books so i would know what i needed. they looked at me like i was crazy! like i should already know what they said. hello, new grad here, do you want me to learn correctly???? obviously not. then, when i "did not know/realize" i was supposed to fill out x report for x problem, i was told, "well it's in the book". hello, did i ever get to read the book during my 12 days of orientation? no. and nor did i get to even peek in those books during my next several weeks on my own, trying to just survive my med passes, tx's and documentation?
A very important thing to do is to note on your census sheet or your 'brain' the code status of your residents. There is nothing worse than wasting time waiting for someone to go to the desk and look up the code status of your resident if something goes down.
Specializes in LTC, ER, ICU, Psych, Med-surg...etc....
Wash your hands...document medications as they are given and vital signs as they are done so you don't forget and there are holes and messes in documentation, don't be afraid to say "I don't know, but I will find out" then find out! Don't be afraid to say "I'm not comfortable with that", and talk to your nurse manager. Any Nurse Manager worth their salt will take the time to help you and make sure you feel good about what you are doing. Learn about your residents. Not just what their diagnoses are and what treatments they get, but "who" they are and what they like. This will go a long way in helping you deal with them and their families because they are your "patient" but they are a person and someones loved one. Know their care plan- what the team is doing to help them and what your goals and responsibilities are in their care. Don't be afraid to laugh and cry with your residents- don't be afraid to love them.
pielęgniarka- Yep, sure did. I really think they thought that because I have my bachelor's degree that I should already know their P&P, although I was new grad with zero prior health experience.
It's sooooo frustrating. makes one feel sooo stupid!
"What every nurse in LTC should know..." 
EmmyBee
165 Posts
I have a few:
Get to work with enough time, to make rounds on all your patients before you start your shift. I used to like to make them going from room to room, with the nurse I was relieving. It's not uncommon to find a patient on the floor, a PEG or IV that has been pulled out, or even a deceased patient. You don't want to be halfway through your shift, before you find out that any of these things have occurred.
Never give anything that you didn't draw up or prepare yourself. That includes pills, saline flushes, ointments, whatever. It was common for nurses to pass on a saline syringe to me, saying they didn't use it as a flush, and didn't want to throw it out. Don't use it.
Always count your narcotics with the nurse you are relieving. And make sure the count is correct before that nurse leaves. I've come across nurses who wanted to leave or were running behind. They would try to give me the keys and tell me to count on my own, or say not to worry, the count was correct. Don't fall for it.
If you have any questions on how a medication is to be given or stored, don't be afraid to ask for help. Your drug book and Pharmacy are also great resources, because sometimes even the other nurses don't know how to give/use a newer/unfamiliar medication.
The same goes for any equipment that you are unfamiliar with. Ask for help. In the early days, I used to be hesitant to ask, not wanting to look "stupid". But if you apply something to your patient incorrectly, you can cause injury or give them ineffective treatment. Then you really look stupid. LOL
Document well on your patients, especially anything related to their problem/diagnosis. You don't want to be making rounds with the next nurse, only to find that your trach patient has died since you last checked on him. Then when the supervisor comes to look in the chart, you documented nothing about his respirations, oxygen therapy, last suctioning or breathing treatment. This actually happened to a nurse I was relieving.
Make a conscious effort to get along with ALL of your co-workers. You WILL need them at some point or another. You don't have to like them, but try to always maintain a professional relationship.