Uneasy about an rn job in a nursing home. No previous nursing experience

allnurses Guide · Dec 30, 2017

Any reason why you are not applying at acute care hospitals?

ClumsyOne, ADN, BSN, RN · Dec 30, 2017

Where I live BSN is required for hospital positions mostly (NYC), I did apply to some hospitals to no avail. And I think it is pretty hard in the big city (especially) for a new grad to land a hospital position, and I graduated a long time ago.

purplegal · Dec 30, 2017

Hmm, with LTC it's pretty hard to find a lengthy orientation period. I had 3 days of in class orientation which basically discussed charting. I was supposed to have 5 days of on the floor orientation but on day 3, I was the only nurse on an entire wing (although there was a supervisor in the building if I needed assistance). 19 months later, I am precepting new nurses, even though I am still learning new skills myself. The other day, my orientee and I both learned how to remove staples from surgical incisions. I think, if you pursue LTC, your success will depend on how receptive your coworkers are to teaching and answering questions. My coworkers are approachable and always willing to teach and brainstorm solutions to situations that come up. But it may not be that way everywhere.

ClumsyOne, ADN, BSN, RN · Dec 30, 2017

do you carry any reference notebook with you or something? What do you do if you are suddenly required to perform a procedure that you have no/vague idea of, and there is no other nurse around? Did it happen often when you started?

purplegal · Dec 31, 2017

do you carry any reference notebook with you or something? What do you do if you are suddenly required to perform a procedure that you have no/vague idea of, and there is no other nurse around? Did it happen often when you started?

We have a report sheet that we take notes on that we carry around. On there, I like to write major medications I don't want to miss, who needs vitals, blood sugars, who needs a skin check, certain procedures like wound care and bladder scanning, etc. I leave room so I can add the results of these items plus make note of anything unexpected that happened throughout the day (such as episode of chest pain, patient sent to hospital, etc). As far as procedures go, I work during shifts that another nurse is around. I wait to perform the procedure until someone's available. Very rarely will I attempt a procedure after looking it up alone. Most procedures can wait until someone more knowledgeable is available.

djh123 · Dec 31, 2017

I started at my LTC/rehab facility with no experience and only a handful of days of orientation, not much training, and ... I somehow made it work. It was kind of hard for a while, but I didn't have to pass meds then, so I had a bit more time to work on everything else.

moretonel · Dec 31, 2017

I too had only 5 days of orientation at a LTC facility after only receiving my LPN license two months earlier. I work nights and I am the only nurse on the floor (of course the night nurse supervisor there also). I was terrified, but the supervisor answered any questions I had. It's been six months now and I'm still learning, but gain more confident with each med pass, dressing change, IV administration, wound care, and emergencies. I had to fight to keep an airway open on a resident with a swollen tongue (while the EMTs were on the way), gave nitro to a resident clenching his chest in pain (while waiting for EMTs), immobilized a resident's arm who fell forward off their wheelchair and broke their shoulder, and kept a resident's head straight and kept the resident talking (while waiting for EMTs) after falling backwards hitting back of head blood seeping. The nurse supervisor was there to help, and I gained knowledge, experience, and confidence. When the time comes, you'll know what to do; and, as another poster has said, if you have supportive co-workers, you'll do well.

kbrn2002, ADN, RN · Dec 31, 2017

A good nursing home can be an excellent environment to learn and grow. Your time management skills will become stellar, your assessment skills will be spot on, your communication skills with a diverse population of residents, staff, providers and management will become second nature in a short amount of time. Sadly a short orientation is the norm in LTC but with supportive co-workers you can make it work.

A bad nursing home on the other hand is one of the deepest, darkest levels of hell. Poor management, way below adequate staffing resulting in very short tempered staff, lack of supplies, just poor all around nursing care. These places not only exist they are shockingly common and you might not know that you landed in the 9th circle of hell until you work there. Believe me, in places like that the DON will gladly lie through their teeth to get you in the door. Word to the wise, don't accept a job that requires you to sign a contract before starting just in case the facility is not one of the good ones.

Sunshine.nurse · Jan 7, 2018

I have worked for the past 6 years in skilled nursing. My advice is to go to CMS website and check the facility's star rating for "Quality Measures". The higher the stars, the better the nursing work environment from my observation. As far as your orientation period goes, your ADON/nurse educator is responsible for making sure you have been signed off on the bare bones skills check list BEFORE you hit the floor. This is usually completed by your preceptor. Not sure of what state you are in, but in general, here is what I do.

Please make sure you read the facility's nursing policies and procedures and Follow them. It will save your bacon in most cases. If a p & p is unclear, ask for supervisor clarification, even if that means asking the ADON/DON. Remember, there are no stupid questions.

Also, time management will be your biggest hurdle, especially during med pass. Just know you will develop a routine... first 30 days are the roughest..you will get through them. Getting in and out of the rooms without getting bogged down with ADL care will be a challenge. It always is...lol This is where developing a great working relationship with your fellow nurses and CNAs/techs can make or break you. They have to run interference for you and you have to learn to triage care needs. Run a 24 hour new order report that will give you a heads up on what has happened with your residents over the past 24 hours. This will help you not miss important labs/treatments. Also, review previous shifts' nursing notes. Also check for any lab results from the previous shifts for the last 24 hours. Was provider made aware? ( double check NN before report so you know) Those things will help you know what questions to ask during shift change. If the off going nurse says, "Mr. So-so is okay." This is NOT an ok report. Is resident AO x ___? What was his admitting diagnosis. Any med/treatment changes? ON antibiotics? Foley/suprapubic? Has the person voided this shift?Last BM? Shift vitals?(Vitals taken even for a long-term resident if on BP meds) Any behaviors? Falls? Any labs? Was family made aware? Any medications for this resident that have been reordered and pending pharm delivery? If out, did you notify doc and get ok to retime med order and family? Did you document that? You will know to call pharmacy to find out where med is if it isn't delivered. Prevents a delay in service error. This is why it is important to check the things I listed BEFORE shift report from off going nurse.

Also, remember to go actually lay eyes on the person, assess them, take BP and pulse. ASK who ever you are passing pills on if they need their PRN medications if they are AO x 2-3 BEFORE you start pulling their meds. Are they SOB, what's O2 sat? Will save you from those residents who "need just one more thing".

Oh, and one more thing... it is ALWAYS a good thing to have a second set eyes laid on a resident if something isn't quite right. Get your supervisor involved. Make sure to notify providers and family, then document everything. Keep your report sheets as reference for the week, but don't take them home. Hope this helps, í ½í¸œ

jodispamodi · Jan 8, 2018

Honestly I'd be careful about LTC, if you can get on the sub-acute or rehab unit thats better but the ltc and memory floors can be quite difficult depending on how they are staffed, and not the greatest for developing good habits. What about a doctors office or ambulatory setting. Best of luck