tips about new grad working in SNF-LTC please!!!

[xiaobear007]

I am starting a job at a SNF with about 20 patient/1 nurse ratio, mostly sub-acute discharged from hospital for rehab. I read most of the post here and I understand that how time management is so important for this kind of position. Would anybody share with me some of your experience of the time management in regards to passing the meds, doing the treatment (mostly hanging IV, PICC line, G tube, would care, ostomy care, tube feeding, etc), and doing the report? What information do you think it is essential and needs to be passed on to the on coming shift and what is important to know from the shift? We do not have a format for doing the report so I am really lost sometimes.

Excuse me for asking so many basic questions. I am not so used to the ltc facility. I have had some health care experiences before but majorly in the hospital and they had more supportive system there. I have also been out of the bedside for a while ,so any tips to help me survive this new job would be appreciated! Also I was offered only about 2 weeks orientation. Do you guys think it is sufficient? I feel I may need more since there are so many paper work and protocol I did not know or needs to get used to.

Thank you all!

[Purpsfrog]

First of all, good luck! It's a ridiculously difficult environment. Yes, you are going to need to learn to manage your time. I only graduated a couple months ago and had 8 days of orientation before assuming an assignment. The first two weeks were hell, all I wanted to do was run at the end of the shift but I had to stay an extra hour to finish documentation. I'm now able to leave on time, mostly. I worked agency as a CNA and med aide in LTC for 13 years prior to this though, and it's helped immensely.

Get yourself organized right after getting report. Don't count on your cart being stocked. Gather IV antibiotics from the fridge. Look at what your charting requirements are for the night and be aware of them. Try to get a sense of who will require Medicare notes, who needs a skin check, etc. Catch up with the aides as soon as you can to tell them about urine/stool, vitals you need, etc. Cluster activities; e.g., when you go to deliver meds, flush PICC lines and change dressings. The rest is really trial and error; what works on 1 unit doesn't necesarily work on another. I worked on 3 different units last week, 1 skilled, 1 intermediate (still 2 PICCs, 3 tube feeds, 9 accuchecks), and 1 dementia.

Anything out of the ordinary needs to be passed on in report, such as change of status, hallucinations, fights between residents, vomiting, falls, new orders. Pass on info about PICCs and antibiotics, specimens that are needed, time of last PRN meds, blood glucoses, Foley changes, new or worsening wounds. Anything else that seems significant; nobody gets mad about getting too much info!

You will find your way but it's going to take time. I'm starting to get some respect but I'm still proving myself.

[ponymom]

And really make an effort to eat as healthy as you can, no smoking, don't rely on coffee or other caffeine, drink water all day instead. Take your break, you must eat to keep going. Get good sleep. Sounds 'yeah, yeah, yeah', but it really is the simplest advice that is the healthiest advice.

[JBMmom, MSN, NP]

Good luck. That's not a very long orientation but it seems standard, I'd probably ask if there's any way your facility would agree to an additional week, knowing you might not get it. Report will come to you pretty quickly. The nurse you get report from should hit the highlights of any changes in status, new orders or major resident issues that occurred on their shift. In your report you'll do the same, and only mention the most pertinent information from the previous shift- getting bogged down in too many details won't help either of you. As far as time management, that unfortunately, comes with time. You'll quickly learn to prioritize- meds are going to supercede treatments in when they are done, but everything will need to be done at some point. Charting can be done later (not that you want to stay late all the time), and fortunately you're not going to have every resident with a treatment/ IV/ ostomy, etc. While rehab gets many intense patients, you also get some very alert and oriented people that don't require much care. You'll learn a lot, good luck.