What should new LTC nurse know??

ricksy · Jul 16, 2013

I hired in for my first job as an LTC charge nurse. I had no idea the charting was different. I didn't know what MDS nurse was and what MDS charting was. Ask your facility to give you all the information that they have on the two, because mine did not...had to figure it out on my own. Specifically ask them what they want and need. Specifically ask them about what is required by you as far as what do YOU do before giving pain medications. If you had clinical instructors like mine, you quickly learned to take BP and Resp before pain meds. When I told my facility....they said it was not required. The last thing I would tell you is to make the CNA's your friends...go slow with them at first....help them, and get to know them. You will figure out very quickly who is worth their salt and who stink! After a while, you will figure out who you need to push and who gets it! Enjoy your job and your patients...it is a whole new world. Good Luck!

scrublifenurse10, LPN · Jul 16, 2013

I hired in for my first job as an LTC charge nurse. I had no idea the charting was different. I didn't know what MDS nurse was and what MDS charting was. Ask your facility to give you all the information that they have on the two because mine did not...had to figure it out on my own. Specifically ask them what they want and need. Specifically ask them about what is required by you as far as what do YOU do before giving pain medications. If you had clinical instructors like mine, you quickly learned to take BP and Resp before pain meds. When I told my facility....they said it was not required. The last thing I would tell you is to make the CNA's your friends...go slow with them at first....help them, and get to know them. You will figure out very quickly who is worth their salt and who stink! After a while, you will figure out who you need to push and who gets it! Enjoy your job and your patients...it is a whole new world. Good Luck![/quote']
Thanks for such good advice! One of my biggest concerns has been being "in charge" of CNAs...really appreciate your advice on this!

DonMcAllister · Jul 17, 2013

I think setting expectations would be the main thing. I worked in LTC as a supervisor, and the main thing we all want to know is what is required of us new nurses. Many facilities don't do this and many new nurses don't think to ask it until problems arise. Like riscky said, get specific. Wishing you the best!

scrublifenurse10, LPN · Jul 20, 2013

Any other ideas to help me out on my new LTC LPN job?

jmaraRN22 · Jul 21, 2013

Show respect and appreciation to your nursing assistants and they will do the same in return. Go with the flow. The first few months will be the most difficult to get into your groove, but with time it truly does get better. Good luck to you!

fairyluv · Jul 22, 2013

I have a cheat sheet with me as I do my med pass, I write down all my CBG's and how much insulin they got, I write down all my PRN's and what time I gave them (incase I didn't have the time right them to go searching thru the narc book to find there page) and I write down my routine narc's and what time I give them. I also tell my CNA's if I am not at my cart and someone is asking for something to write it down on my note pad, i jot down little bits of info..ex: res. n/v medicated with zofran 8:40 pm. When I finally get a chance to sit down and do my charting, i will pull out my little cheat sheet and go off of that, and I also use to make the notes in the 24 hr report book. that one little cheat sheet can go a long way.

JBMmom, MSN, NP · Jul 22, 2013

I don't have a lot of advice as I'm still fairly new myself. The most important thing for me is my report sheet. By the end of the night it looks ridiculous, but I've got everything written down- all blood sugars, all PRNs given, all scheduled treatments, etc. I put a check box next to each one and when I'm done charting, or completed the task, I check it off so I know I did everything. I'm slower than most of the other nurses (okay, maybe slower than all the other nurses), but I'm okay with that as long as I know I've done a thorough job. Good luck.

Rose2013 · Jul 28, 2013

Getting along with the CNAs is HUGE. You have to work together as a team. My facility has a print out with each resident's name & code status. When I was new I would write down how they took their meds (whole/thin liquids, crushed/honey liquids etc..) & also any information I received during report. Getting my time management down in the beginning was really difficult but you will get there. Make sure you know before you start your shift what will be happening that day (which treatments need to be done, who is going out for an appointment, are you getting any admissions etc..)

chrisrn24 · Jul 28, 2013

I map out everything I need when I get on - vitals, blood sugars, o2 sats, etc and on my report sheet make underscores like this: o2 ____

By the end of the shift all my underscores must be filled in and I periodically add them as the shift goes on.

Cluster care whenever possible to move the quickest. If you are going into a persons room to give them their pills, and you need a set of vitals grab them right then, don't anticipate coming back because oftentimes you may get caught up in something.

Let your aides know what is up with the residents. Appointments, infections, behavior issues, pressure sores. They are the ones who see the residents all the time and are usually the ones who say "chrisrn24 come look at this red spot on your resident."

AngelRN27 · Jul 28, 2013

Everything mentioned thus far is very good advice. I understood your post differently and thought that maybe you were asking what type of nursing skills or assessment data might you need to be comfortable with in LTC. Here are some main ideas:

1. Be aware of your residents' "baseline" mental status. Geri's tend to become confused or agitated (more so than adults) secondary to physiological needs or changes, despite whether or not they may be able to TELL you what is wrong (i.e. UTI, high/low glucose levels, voiding needs, etc.)

2. Know your s/sx of common Geri issues; some examples include UTI, GI bleed, and fecal impaction. Also be sure that you pay attention to any temp above 99. Remember that Geri's don't respond to infection or inflammatory processes as well as we do. A low grade temp might be the only sign you get. Assess further just in case. Don't be a just a "med passer" and give everyone tylenol! (also, I don't really recall this one being "in the books," but I've noticed that our older folks tend to become tachypneic much quicker during a fever/low grade)

3. Always check your lines and tubes! Keeping things running correctly can prevent complications and confused or demented residents cannot always tell you that something feels funny!

Skills you'll get comfortable with pretty quickly along the way, if you aren't already: PEG care, foley care/insertion/straight caths, wound care/dressing, and TONS of patience!

Hope this helps!