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 :)
Specializes in LTC, assisted living, med-surg, psych.
TWELVE DAYS of orientation in LTC?? Unheard of........as a brand-new grad with the ink on my license barely dry, I got exactly three, and I was basically on my own after the first two. You were most fortunate to receive that much orientation!
I use sticky notes to remind myself to go back and look at something. EVERYBODY criticizes my stickies yet...these same people are the ones Ive come behind countless times who have told me stuff in report yet NEVER charted it....they forgot.....wonder why?????
*dont make a habit of doing everybody elses work...if you do it will become expected and more will be added to you.
be a team player....dont let your coworkers sink if they are behind go help with what you can
learn to say no and mean it. dont be pressured into doing things you cant , like working extra shifts for people who want a day off...alllllllllll theeeeee timeeee!!!
be on time every time
be organized and not scattered..when you're scattered and all over the place the nurse coming in behind you will be thrown off and after enough of that you will be a target!
dont be buddy buddy with the aides......esp at work....Ive seen this soooo many times....when you get too friendly with the aides other aides get jealous and before you know it...the rumor mill is flowing...plus sometimes aides use this "friendship" to their advantage when they do something wrong...they think that because you are buds that they wont get in trouble...keep it strictly professional
stay out of the gossip circles if at all possible. if nothing else...just listen but dont put in your input because it will be overheard by someone and taken out of context completely...this is a recipe for disaster and bad blood between yourself and others
dont be texting and trying to do your meds or charting..nothing is more ANNOYING to watch
Dont forget to go PEE! take a breather once in a while.
stay informed of your policies and abide by them
know the meds you are giving...if you cant explain the basics of it you need to learn it
realize first thing that you are not a robot or supernurse...you cannot do it all and you cannot please everybody all the time...its impossible to do!
Michelle126, my CNA's are my eyes and ears. I have a CNA on my shift who's is very sharp and a very good worker. At times she gets mad at the previous shift's work when it does not live up to her standards. When she gets mad she will spout off and then go silent for a while out of anger. I just wait til she cools off. She is an excellent worker and cares about her patients. Just every so often she explodes. I figure its just her way of handling stress and disappointment, even if she yells at me, her RN. I dont always have the answers for her. but i listen, and she comes back to work the next day in a much better mood.
Several people said this already but: Your aides are your lifeline. They spend more time on a day by day basis with the residents and know them better than you ever will. I say this as a former CNA. Help them when they ask for it. Happy aides = a happy work environment. DO NOT ever say you did not go to school to help them turn and position someone and take them to the bathroom.
Chart, chart, chart. Keep lists. When in doubt, take VS. Make sure you have all your info on a resident when you call the doctor. CYA (cover your ass). Trust me, you need to watch out for yourself because a lot of the time other people are all too ok with letting you take the fall for their mistakes.
IDK if people will have a problem with me saying this but it's the truth. When I worked afternoons I had between 21-23 residents I was in charge of. All their meds, eye gtts, ointments, tx's, charting, etc. It is impossible to do everything the way the state wants it done. IDK why we have state survey because they should know if it takes 5 minutes to give 2 eye gtts and the person has 4 different gtts you do not have 20 minutes to give them. Plus you probably will have multiple people with multiple gtts. Just do your best.
Document, Document Document....like the other posters have said. I can't tell you how many times I have thought "ehh...not that big of a deal. I don't need to chart it" and have it come back and bite me in the backside. Also, notify the family of any changes, xrays and infections. Not just to cover your butt, but also it builds trust with the families.
Have a plan..If a change happens to a resident, such as weight loss, frequent falls...have a plan...notify MD. It is not enough to just chart it...but what are we going to do about it. Not everything is preventable, but you need to show interventions were tried
I tell all the new orienties: Listen to your CNA's, they are your back bone, they know these people better than we ever will. If they think something is wrong or different, believe them, look into it, they haven't failed me yet.
Thank them at the end of every shift, they don't hear that often enough.
I tell my new CNA's, you are working under my licence, I worked hard to get it. I want things done right, if you need help, CALL ME, I will help!
Be "the boss" when you have to be, be a coworker the rest of the time
Insist on a detailed report on all Pts you are going to be incharge of, hearing they're all ok just doesn't cut it.
Document the heck out of everything! (I even document when Doc's yell at me or refuse to treat)
Even if a Pt is DNH, contact family & ask if they want Pt sent out, never hurts & Doc's appreciate having knowledge of what family thinks on this particular problem
Ask Questions!! there are no stupid questions, only unasked ones.
I agree with forming a relationship with the CNAs. The other day I had a CNA tell me that my patient was sweating really bad. I went in to check his BS and it was 24! I'm so glad the CNA told me. I also make sure to let the CNAs know about any changes in care (fluid restrictions, NPO, if the residents can get up or not). I don't know what I would do without some of the wonderful CNAs we have!
TWELVE DAYS of orientation in LTC?? Unheard of........as a brand-new grad with the ink on my license barely dry, I got exactly three, and I was basically on my own after the first two. You were most fortunate to receive that much orientation!
Thanks, that makes me feel so much better for failing with "that much orientation".
"What every nurse in LTC should know..." 
VivaLasViejas, ASN, RN
22 Articles; 9,996 Posts
TWELVE DAYS of orientation in LTC?? Unheard of........as a brand-new grad with the ink on my license barely dry, I got exactly three, and I was basically on my own after the first two. You were most fortunate to receive that much orientation!