So im a new Grad LPN as of July 17th. And now reality as hit I started My new job this monday and now asking myself ***..
In school they teach you everything you need to know to get started to being a great nurse. Many clinical hours spent in the hospitals doing skills and mastering them. My problem with this is LPNs no longer really work in Acute settings. Most LPNs do either home care or LTC no there is a huge difference in Acute and LTC and thats where my problem begins.
In school clinicals for our med pass we may be given up to 5pts...But we did not have to chart just sign off on the meds, we did not have to call doctors, we did not have to get labs or consults. In LTC the LPNs role is so much more then what we do in school. Yea they teach charting but omg what about everything else. I know there is a limit on what they can and can not teach but they want us to be great nurses and part of that is getting a job and being able to feel confident you can adequately perform.
Yes I can assess and treat and yes I can pass med and sign my book but there is so much more and I see it time and again in these threads how New Grads are overwhelmed because after 2days orientation they are on their own.
Does anyone not see an issue with this, yea you can ask questions but you are responsible and there is just so much room for error in the situation of LTC with a new GRAD on their on 20plus pts and no idea how to even start anything but a med pass..
Give me the med pass im good but im just so baffled at the pluses of the job. I feel like LPN programs should let you experience the hospitals and peds and ob but some time should be spent in the field we are to work. Let us get behind the desk with a nurse to see the paper work come in to get that early am report count the carts and the shifts end.
Im lucky enough my job is willing to train me a 3-4wks because the DON really believes in me and I know I will do great I graduated top of my class and Im just the kind of person to get what needs to be done done but for all those who have 2days orientation and are crying right now its just not fair. Some say you get use to it but dont you think things will be so much better if you were more prepared maybe nurses would not be cutting corners, or so grouchy.
I feel nursing programs, and new grad orientations should really adjust according to the times (sorry for this extremely long thread just wanted some thoughts on this because it has been bugging me)
I feel your pain! I am also a LPN working in LTC and feeling overwhelmed, scared, and inadequate. I graduated with honors from a condensed one year program. I thought I would love nursing and was going to make a huge difference in the lives of others. Truth be told I feel rushed to get in and out of the patients rooms to get to the next in the hopes of getting all my work done. The program did not prepare me for the "real world" of nursing. The snickers I hear from the CNA's and fellow Nurses is really disheartening, but I will continue to ask questions, stupid or not! Hold your head high and just get through it, with experience comes confidence and with each day we gain more experience. :)
Thanks everyone to your feedback to my little rant... well this is week two ot orientation and so far so great ive been blessed with 4wks of training and im gonna def take advantage my side is tough 20+ pts with 7diabetics and some who came from a psych facility sheesh its a lot to handle but I took a breathe and trying to just get a routine watch the nurse training me do everything wrong lol and stay positive....no nursing school can not prepare you for LTC and thats the sad thing u have to just be a quick learner and not have to many panic attacks ive started going in 30min early just to get organized hopefully it will get better I will keep u guys updated :)
In my ADN program, the nursing instructors seem to blatantly ignore the difficulties found outside of acute care. I'm an LPN, and my instructors will not even acknowledge working environments of most LTC nurses. I don't know what to do or say about this. No one seems to understand. I don't know if they can understand. The world is such a different place from school.
I recently graduated and got my license. I start my new job in 4 days, starting with 3 days of orientation. I'm planning on having a boat-load of questions to make sure I'm as prepared as possible when I get on the floor. It's a LTC facility, and it looks like I'll be looking at a minimum of 25 residents. I know I can do all the skills, and we actually had a few clinicals at two different LTC facilities during school. However, we were only assigned 2-3 residents as students. I did have the opportunity to follow around several of the nurses there, and one of them had some really good advice on how to keep track of what you still need to do for the day. I'm planning on following some of her ideas, which should help out a lot.
You're absolutely right that school doesn't prepare us for the workload that is common at LTC facilities. That is one of my anxieties about starting this new job.
One of the things that may help is if people leave advice on how to deal with the workload. The nurse who gave me advice kept a piece of paper with her at all times (I plan on using a notebook and shredding used pages at the end of the day.) She used the front to take notes of things she saw needed done during her 9am med pass (this included who needed finger sticks, who had an oddly timed med due, who needed wound changes, etc.). She used the back to jot notes on her interactions with patients. If one had a complaint, she'd write the time, patient, and a quick reminder of what the complaint was. If one refused a med, she'd note that. If she did wound care etc, she'd note that. Once she had the time to sit down and write her nurses' notes or chart, she would refer back to that page to ensure she didn't miss anything. It's not meant as a write-everything-that-happens-down, it's merely a quick reminder to herself of what happened so that nothing would be missed, and her notes were insanely thorough at the end of the day. I know this is a simple thing, but I've noticed a lot of nurses try the "I'll remember this" method, and eventually something is going to get missed, especially as a new nurse. An experienced nurse who knows all the patients well may not need something like this, but it's a good idea for new nurses or nurses starting a new job.
So, anyone else have any tried and true methods to help things along as a new nurse? Are there any questions that are often overlooked that need to be addressed during orientation? Hopefully my post helps someone somewhere, and I look forward to hearing what others have to say!
I am an new grad LPN working in LTC also. I was at the top of my nursing class and worked full-time as a CNA during nursing school. I knew how the LTC monster kinda worked before I went to school, but nursing school didn't prepare me for the craziness of LTC nursing. My orientation was 5 DAYS!!!! And during those 5 days, I was basically given the keys and forced to either sink or swim. Talk about SCARY!! From what I learned is that nursing school gives you the basics, and from the basics you can learn you own tricks and methods to increase your speed and organization.
What I've learned to help me get though my shifts are STAY ORGANIZED!! Get all your flushes and make sure your cart is stocked before you hit the floor. Know where everything is on your cart. Not being prepared kills so much of your already precious time. Keep a notepad near by so you can jot times, B.S., vitals, etc for your shift and keep them where you can find them. And don't be afraid to ask someone for help if something is unfamiliar or you are struggling.
So anyone else have any tried and true methods to help things along as a new nurse? Are there any questions that are often overlooked that need to be addressed during orientation? Hopefully my post helps someone somewhere, and I look forward to hearing what others have to say![/quote']
Some of the most basic and fundamental things relevant to your work day are frequently overlooked during orientation. Particularly paperwork. And oh boy is there a lot of paperwork in LTC. The seasoned nurses take for granted that they can do these things with their eyes closed, so it doesn't come to mind that you don't know how to do these things. I've noticed that new grads pay all their attention to the nuances of med pass bc that's all the exposure they received in school. I don't think they are scared to ask, they just don't know enough to ask about anything else.
Here's a list of things off the top of my head that I think are fundamental to know and ask about during orientation as a new grad that are often overlooked:
* How to take a doctor's order and carry it out.
* How to order labs / diagnostic imaging.
* How to chart. There are specific things that should be included in your charting depending on what you're charting about.
* The steps you take after a change in condition.
* The steps you take after a fall. Including filling out an incident report.
* The steps you take after a death.
* How to do an admission, if relevant to your facility. In some places only the RN admits.
And this is never overlooked, but I think it is the most important thing to get out of orientation so I'll just say it again, learn the nuances and preferences of your residents! The biggest time saver in LTC is when you know your residents and can anticipate and plan accordingly.
Good luck!
Edit: Oh, I just remembered another thing to ask about: how to do a discharge / transfer.
Wow, thank you so much, SquishyLVN! I wrote down everything you suggested so I can address it during my very short orientation. I hadn't thought of most of those, but they are all something I would be unsure of how to do properly!
Whatdidigetmyselfin2, thank you for the advice! I'll be sure to make sure my cart is fully stocked, and that I know where everything is. You're right, that could be a potentially huge time saver!
Any other advice out there? We new nurses are soaking it all in. :) And a huge thank you to all you wonderful experienced nurses who are so giving and helpful with advice and knowledge. Nothing can beat experience, and unfortunately there were no chapters in our textbooks on calling in labs.
I thought nurses were not allowed to order labs and diagnostic imaging. I thought nurses were not allowed to order anything at all. What does it mean to steps you take after a change in condition.
I thought nurses were not allowed to order labs and diagnostic imaging. I thought nurses were not allowed to order anything at all. What does it mean to steps you take after a change in condition.
After receiving the MD order, you write the interim or telephone order, then you "order" or call the imaging company or lab to come do it. You're right the nurse never says "oops, belly ache without a bm in 5days let's get a KUB" and then has it done. We call doctor next, and receive orders. Then ordering as in calling the MD/NP/PA order to the diagnosic contractor we do. It can be confusing. In clinicals on site everything was a luxury.
I thought nurses were not allowed to order labs and diagnostic imaging. I thought nurses were not allowed to order anything at all. What does it mean to steps you take after a change in condition.
I am a unit supervisor; we do the ordering of labs and diagnostics after speaking to the physician; sometimes that's just a matter if contacting the outside laboratory or diagnostic center; not an issue.
As far as a change in condition; you have to assess, contact the doctor, responsible party, as well as write an incident report (if applicable).
As far as school preparation: unless you have instructors who worked in LTC, you may feel that those instructors are out of touch; however, you still have to hone your own nursing practice that transcends and remains regardless what area you work in. I learned that the first semester in nursing school as a PN student; and was able to add to it as a RN student; I have worked in a rehab hospital, LTC, hospital, extended facility, and in home care; I have been able to apply my nursing knowledge CONSISTENTLY for the past 8 years I have been a nurse.
When I was in clinical in PN school, we tooth a cart and performed ALL of the meds, treatment, assessments, wrote noted on the changes, etc; this was about 8 years ago; when I got my first position, it took me bout 6 months to be comfortable, I'm not sure how PN education has differed these days...in my RN program, we got 3-4 patients MAX, was with charge, did EVERYTHING...so sometimes it's dependent on the school; but the curve IS (I repeat IS) attainable...you have to put one foot in front of the other...and come on AN and seek out the "experts" who will help throughout the transition; also, don't forget to seek out the educator and ADVOCATE for yourself; if you need more help, have questions-seek out what you NEED in order to be successful, DON'T back down from anyone's personality either.
SQUISHYRN thanks a ton!! And you are so right since starting my job ice had to send someone to the hospital, do an incident report for a fall, order labs, dc meds, get psych consults plus tons more and if u do not ask the right person u may do something so wrong and u will get In trouble because they say u should have known.....Just 2days ago I was on the cart 7residents were missing at least one of their meds so I could not give it and we are not allowed to borrow so I didnt knoe what to do besides call and fax new orders to the pharmacy but as far as documenting on the MAR I was lost 1 nurse said just put u faxed it and called pharmacy med not given one nurse said sign it and leave a note saying last dose was given and re ordered well the next day still lost I went to my Supervisors and DON and they said u have to call the pharmacy and tell them to delivery it STAT as per the DON because documenting not given because of the pharmacy would be a med error my head spun because the seasoned nurses not all but some have their way of doing things and not always the right way so they orientate u and some things I know flat out is wrong but the paperwork I would not know what is wrong or not ugh its so much
I thought nurses were not allowed to order labs and diagnostic imaging. I thought nurses were not allowed to order anything at all. What does it mean to steps you take after a change in condition.
Also, per facility, there are standing orders or protocols that you can write your orders based off of depending on the situation. And with a change of condition, there is certain paperwork that has to be done: SBAR, incident report (if applicable), notifying of the patient's family, MD and post-review that has to be done.
tmjemorris1
1 Post
I feel your pain! I am also a LPN working in LTC and feeling overwhelmed, scared, and inadequate. I graduated with honors from a condensed one year program. I thought I would love nursing and was going to make a huge difference in the lives of others. Truth be told I feel rushed to get in and out of the patients rooms to get to the next in the hopes of getting all my work done. The program did not prepare me for the "real world" of nursing. The snickers I hear from the CNA's and fellow Nurses is really disheartening, but I will continue to ask questions, stupid or not! Hold your head high and just get through it, with experience comes confidence and with each day we gain more experience. :)