Urgent Is this dangerous for my license?

jazyjaz112 · May 24, 2014

Congrats on getting you first job! I'm a recent grad as well (passed boards and I'm finishing up my BA this summer). But I have an interview with a skilled facility next week.

I actually hesitated about applying to this kind place because I had heard the stories of nurses getting crazy patient loads. But times were getting hard and I just needed a job! Hopefully I get a decent orientation so I'll feel safe enough to handle my patients on my own. But if you need more time to be oriented/ have questions, you have to let it be known.

Alex Egan, LPN, EMT-B · May 24, 2014

Firstly, the ratios are actually pretty good. Provided your actually staffed at the levels they say then I don't find 24 residents to be excessive for you, and 12 per CNA is not awful.

Secondly, five days is a little short for orientation, but mostly if you are not confident in your preceptor you should speak with management about switching. You do have to be careful about shortcuts, some are good. Others only cause trouble. It's on you to figure out which is what.

Thirdly, exactly how do you think your license is in danger? Exactly what would the board charge you with? I recommend you review the disciplinary actions your BON hands out. You will find that 90% of actions are about diversion, addiction, DUI, and falsifying records.

I use my phone, to type, I work at night, and I'm a bad speller. Pick any reason you want for my misspellings

jadelpn, LPN, EMT-B · May 24, 2014

"Shortcuts" may or may not be to your benefit. There are shortcuts and there is dangerous practice. Use this time to get to know who is who as far as the residents, a HUGE benefit is to write down and observe how each resident takes their pills (crushed, whole, in something). Know that you need to give medication correctly, do NOT stick a bunch of meds in cups and go find residents, I can't imagine what other shortcuts there could be.

If you are doing treatments, just be mindful of doing them so that they are correct and clean.

A lot of assessments (and some are done weekly) are done on a day shift, so if you are going to be on an "off" shift, then this is not something that you need to add to your "to do" list, unless of course you have to assess for change of condition. It is important to know if any of the residents are a full code.

If the RN that is training you is English speaking, then I would imagine that the staff who is ESL has a basic understanding of the language. What I found most helpful is to also do a translate application, so that I could basically say "hello" and "I am Nurse Jade" and "could you help me" or "patient needs help". Just the basics so that I could direct and there is no miscommunication. OH, and that I really had little experience with their language, however, I knew JUST a tad! HAHAHA!! You will find that people who are speaking the same language will in fact communicate with each other in their native language. That's ok--I really even learned a few little joking "I will not take it personal, but I can't understand you--is this a good story?" VERY light and humor. Then "patient needs help" and "room 233".

Do what you can, the first months are the hardest. You will find your groove. Best wishes!

tyvin, BSN, RN · May 24, 2014

IT is very rare to find a LTC/SNF facility that will train longer than 4 or 7 days. The SNF I worked at told me I would train for 5 days and then there were a bunch of staff call outs and on my 3rd day of training. I had half unit with 18 patients, all skilled beds that culminated in 3 hips, 2 double knees, 1 open heart, and the rest were diabetics, tube feeders, pressure ulcers, etc... It was a nightmare! I learned real quick that either you will sink or swim. I can't remember how I did it, but I put together a bunch of cheat sheets and went at it.

I didn't find my groove as they say so I put in my notice. The stress was just too much. What got me was that management really didn't care. The end result was all they cared about. I understand the political bull and results they had to produce, but at what cost?They turned their heads at questionable practices by some of my colleagues. That wasn't nursing; that was a butcher shop. It got to the point I dreaded going to work. When that happens, it's time to get out.

It just wasn't my thing. Some people like the high stress, heavy load work; to me it's too crazy. Good luck to you!

TheCommuter, BSN, RN · May 24, 2014

SNFs/nursing homes in my area train new grads for a maximum of three days, then management will laugh or roll their eyes if you request more days. Training/orientation is a time to learn the policies, procedures, paperwork, norms and routines of your new workplace so you can develop a workflow of your own. It is not an extended clinical practicum time where you get to learn what you didn't learn in nursing school.

Your license is not at risk. The "losing my license" mantra is severely blown out of proportion. In the US, the overwhelming majority of nurses have action taken against their nursing licensure for issues such as impairment, drug diversion, stealing controlled substances, or other issues somewhat interconnected to addiction and/or substance abuse. And statistically, most licensure sanctions are enacted against hospital nurses, not ones who work in SNF or areas outside hospitals.

24 residents is an excellent patient load in SNFs. Slow down, take a deep breath, learn all you can in those five training days, and tell yourself that you can do this.

Bushmanz · May 24, 2014

Thank you everyone for the words of encouragement. I've decided to stick with it. Today was in improvement from yesterday and I'm off tomorrow so I can unwind and catch up on sleep. Hopefully I'll be comfortable enough by the end of my orientation.

TheCommuter, BSN, RN · May 25, 2014

Thank you everyone for the words of encouragement. I've decided to stick with it. Today was in improvement from yesterday and I'm off tomorrow so I can unwind and catch up on sleep. Hopefully I'll be comfortable enough by the end of my orientation.

Good luck to you! You can do this.

Junebug903, LPN · May 27, 2014

When I was a new grad LPN, I had 3 days of orientation. At least half of the time, the nurse just gave me the keys and hung out at the desk. I was working 3-11 in LTC with some SNF patients. 30 patients all together. Besides learning where things are, there is learning a routine that works best for your time management and getting to know your patients. Be extra kind and offer help, even though you may be behind or struggling. It's hard to be the new person. I lost some weight when I was a new nurse, because I didn't have time to take a break and eat. I would have to do my med passes back to back, pretty much. That was a long time ago. It gets better every day. Hang in there and don't doubt yourself.

xoemmylouox, ASN, RN · May 27, 2014

5 days is great for LTC training, but I wouldn't count on getting all 5. 24 residents per Nurse is a decent ratio (of course it's not, but considering some other LTC it's not the worst I've heard of). It will seem very overwhelming at first. I think all Nurses experience this once you get out there and get working. You will find ways to save time, just always make sure to CYA and document well. Also you need to have malpractice insurance because things happen even to the best of us. Good luck.

Malenurse13 · Jun 10, 2014

That is pretty typical of what I have seen except for the 5 days of training, max orientation I have received (4 places) is 3 days. One was 1 day because the nurse training me / one I was replacing quit. Just make sure you have your DON / ADON number and don't be afraid to call.

First place I worked I was 1 of 2 nurses, other nurse was on other hall, but was not useful. In this situation you learn fast. You will make mistakes. And remember "when in doubt SEND THEM OUT". LOL

And that is all LTC

*Urgent* Is this dangerous for my license?

Urgent Is this dangerous for my license?