Tips from experience LTC nurses

Specialties Geriatric


Hello all. I have been a nurse for almost 21 years, in a variety of settings ( pacu, OR, L&D, ER, corrections, M/S and management). 

I am picking up shifts with a local agency in my town and will be going to a LTC setting for the first time ever. I have worked in a corrections infirmary as the only nurse on NOC, with 12 patients to give meds to and no CNA so I don't anticipate that LTC will be much different in regards to meds/vitals management, but again, I am on here because I don't know..

The facility that I am going to appears to get high ratings and is staffed ( supposedly) with a 1:15 ratio on each unit, and 2 CNAs and a bath aide one each unit.

Any tips for this old gal to help make my shift a bit more manageable?

Thanks in advance!





Specializes in retired LTC.

Sounds like a 'Medicare skliled nsg' unit as versus a general LTC/NH unit.

Regardless, your responsibilities will primarily be med pass, treatments, documentation per CMS guidelines (and they've just added new requirements). Admissions & discharges come & go quite freq, so they're all yours to fit in. Hopefully, the 'crises' (falls, low bl sugars, seizures, etc) are minimum, but they're all yours. Chart orders are yours, but this may vary dep if a UM helps to do 'desk'.

Then there's keeping everything running smoothly as Therapy wants the pts, and doctors are rounding, or pts are outbldg for appts, families wanting your 'immed' attn., etc.

You will be BUSY like you've prob never been before!

Prioritorize first - like meds & tx. And emerg as they come up.

Delegate if you can - but remember those ancillary staff have their assigned tasks too that MUST be completed too.

DO NOT POSTPONE - like don't 'wait til later' to catch a urine spec. something else is bound to come up and then you still have that urine  tto

Try to jump ahead if poss - sounds like a lot of time mgt. IT is. But that's how you'll manage.

Families will always take a top priority - they'll be in the front office otherwise! Always, always, always, keep them in the loop! Even if the pt f*rts funny, let them know. Being serious though,

Stay on good terms with others - Therapy can be your best friend or foe. Same for SW & Act Dir. But the regular nurse who precedes you can be your best-est ally!

With CNA staff - remember to compliment them in public. Critique in private. Always investigate their concerns (in a time approp fashion) - they know those pts BEST. And get back to them re the issue.

When in doubt, always err on the safe side. And ask when you're needing an answer. Alert the DON if you think something's really hinkey. And PMP notification for problems also, not just when you need med orders.

***** Words of advice common to all nurses - 1) have your own , and 2) always be SUPER careful re narcotic count. Very easy for things to slip up in LTC.

Good luck.

Oh, and welcome to our LTC world. We need experienced sensible staff  for our seniors. They deserve it.

Specializes in Transitional Nursing.

Just know that much of what they ask you to do is for payment purposes and not for the wellbeing of the patient.  Sometimes you have to prioritize and the patients you are asked to assess and document on aren't the ones who need your attention.  I've made peace with that and I will leave them until the end of my shift sometimes so I can focus on my sicker folks. 


Pay close attention to new admissions and anyone recently sent from the hospital.  They are often not stable and are liable to go back out within the day. 

Find other seasoned nurses who you can trust and they will tell you the things I can't put in writing. ?

Specializes in retired LTC.
2 hours ago, Straight No Chaser said:

Find other seasoned nurses who you can trust and they will tell you the things I can't put in writing. ?

I'm nodding here, just after I snorted up my tea!

Specializes in Transitional Nursing.
43 minutes ago, amoLucia said:

I'm nodding here, just after I snorted up my tea!

At least you have clear sinuses now ?

Thanks for the responses. I just wanted to update and ask a few more questions to know if what I experienced was normal..

1- I showed up for a 4 hr orientation ( prior to working my actual 8 hrs to follow), spent time following a nurse, getting a high level overview of the point and click system, layout of the unit, giving meds and then, boom. On my own after getting a covid test ( after 4 hours on the unit , sigh).

2-No intro to others on the floor so I didn't really know who was who, I didn't even know who my CNA was. CNAs do not even put vitals in ..

3- No report given, so I surmised health hx by the meds taken.

4- 80 % of residents looked the same- scary during med pass..

5- Residents wandering hall, and approaching me at the med cart while I was trying to pull meds for patients I didn't know, and couldn't distinguish from photos to ask me for coffee.

6- Going to give meds to find residents no in their rooms. Put their meds back in locked cart and continued with next on the hall.

7-Call bell ringing off the hook and no one answering it except me, I answered for fear of someone really needing help.

Is this normal or was it just a crappy unit??

Walked in praying I didn't kill anyone. Walked out praying I didn't kill anyone.  

Unfortunately some of that is par for the course. As you get to know your patients identification will be easier. In the meantime grab a CNA.  I find I have to take charge of introductions, when I work a new floor I introduce myself to the CNAs and ask them to let me know who might need meds first or any other concerns. Where I have worked CNAs typically don't take vitals, they are mostly tasked with ADL care and charting. 4 hours orientation and on your own for a shift is fast to hit the floor. I wonder if that's a staffing red flag that they need help that badly. Don't get me wrong- I have always been put on the floor fairly fast after getting oriented. However I reread your post and see you are agency - typically agency nurses don't get shadow shifts and are just expected to start/fill in/hit the ground running. When I worked a temp agency assignment I came in 15 minutes early to sign some papers and then worked my shift.  Agency nurses who rotate through facilities and shifts typically show up and start in my experience. I find it helpful to have a running list of questions as I go and then there are the questions I always ask: How do I reach the doctor, how do I reach the oncall doctor, Where do labs come in and where do I report them, How do I access the E-kit for meds, Where is the supply room/Do I need a code or key, Where is the crash cart, How do I do an overhead page on your phones, and fire drill process. Also handy: keep the address of the facility and phone number on your report sheet in case you need to call 911. As for not getting report, that's kind of weird and might be a micro issue with that nurse his or herself, you should be told how they take their medications/behavior issues that may arise/other major recent events. However many long term patients have extensive histories, so I would not expect to hear about every diagnosis in report. I think diabetics, mobility issues (ie recent fracture), actively dying and seizure disorders are major things you need to be told off the bat, I wonder if anyone else has ideas about what else is up there for notifying a new nurse to the unit. Not that all diagnoses aren't important - But I don't expect to hear hypertension for every patient during report. Many computer systems have a way you can look up diagnoses as wel so you can aways confirm if needed.


Specializes in retired LTC.

MJLPN727 - a nurse after my own heart!  Very, VERY  approp questions/info to question when new to the floor.

Specializes in Nursing Home.

Hi, I am an LTC charge nurse with 8 years experience. I have been a staff nurse most of this time aside from a short stent as MDS coordinating in LTC. LTC Nursing is different. It’s remote. Your biggest nursing skill used in LTC is clinical judgement in my opinion. Med pass, and Medicare and routine Facilty becomes repetitive. Entering physicians orders, etc. but your judgement will be crucial. You won’t have access to fancy monitors or medical equipment. Just text book judgment regarding issues before you notify the MD. You’ll do great. I love LTC

Specializes in Emergency Nursing, Pediatrics.

1:15?? That's a cakewalk!!

On 3/3/2021 at 3:11 PM, amoLucia said:

Families will always take a top priority - they'll be in the front office otherwise! Always, always, always, keep them in the loop! Even if the pt f*rts funny, let them know. Being serious though,

Usually tasks will take priority, the I.V.s, the wounds. The phone will go unanswered if there is an emergency. 

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