New Grad LPN offered a Nurse Supervisor position in Post Acute

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nursel56

7,078 Posts

Specializes in Peds/outpatient FP,derm,allergy/private duty.
Hello!

So I just recently got my license and this is going to be my first time ever working in the field of nursing, other than my clinicals. I accepted a full time position as a LPN Nurse Supervisor for a Post Acute wing in a LTC facility. I have been on the job for almost two weeks. Running the cart for both MAR and TAR is not a problem. I usually have 12 patients and can get it all done within my 8 hour shift...However, all the paperwork, computer work and constantly having to assess and supervise my aides is really taking a toll. I do have previous supervisor experience in hospitality but its nothing like this. I love all the patient care experience I am getting in Post Acute but I have found it extremely difficult to get to all the documenting, calling PO's, ordering labs, assessing new admins, and making sure my aides are doing their job.

I think I can do this but I have no previous experience with doing any of this paperwork, calling docs, labs, etc and as of yet, I have not received any training on how to do so. This place was supposed to give me orientation but my first day of orientation was with a nurse who had not worked in post acute for over a year, the second day was spent passing meds only, and every day since I have just been told to treat and pass meds...

Should I consider looking elsewhere, where I can actually go through an orientation process so I can learn how to do the things that are not being taught to me here or am I being unreasonable?

Sounds like they dumped quite a bit on your plate at once, but for less than 2 weeks in you sound like you have a handle on it more than most new grads who take jobs like that. It isn't uncommon to see posts here from new nurses put into situations they aren't prepared for - normally they start out with Heeellllllp! ! ! Sometimes it is obvious they are being dumped on and expected to pass meds on 50 residents right away. I don't think long orientations are the norm anyway.

You will probably pick up speed as you get used to the paperwork, as well as the phone calling. Feeling you have your med cart and the time constraints of that under control is important!

I would ask about how you feel about the place in general . .are they responsive to your questions and do you feel you can work in a team that's supportive or do you feel they'd be just as happy to toss you in the deep end and walk away? If there's a foundation there where constructive change can occurr I probably would stay longer and see how things shake out.

If delegating is just something you aren't really used to there is a chance - if they are surly and/or insubordinate that's another far more difficult thing to adapt to.

I guess the bottom line is that for me any new job takes several months to get used to get in the groove so it's best to try to hang on until that happens before you decide unless it is an obviously unsafe situation and they are trying to take advantage of you. Best wishes. :)

Trauma Columnist

traumaRUs, MSN, APRN

88 Articles; 21,249 Posts

Specializes in Nephrology, Cardiology, ER, ICU.

Lots of great advice for the original poster!

As everyone is saying: LPNs doing assessments varies tremendously from state to state and depends on the work setting.

It would probably be a good idea for the poster to read the nurse practice act for her state regarding the scope of practice for LPNs.

Midwest4me

1,007 Posts

Specializes in A myriad of specialties.
the op works in ltc. in my state, an lpn does the initial assessment in an ltc setting. reason being, after 5 pm there are no rn's in the building. just can't make the poor pt wait until the next day for an initial assessment. the scope of practice varies from state to state.

wow, hospice nurse, that's amazing that you have no rns in the building after 5pm! i'd say that company that owns your ltc needs to be educated on the need for at least one rn there.

i agree with traumarus--the op needs to read and know her nurse practice act and the scope of her practice. in any ltc i worked in, there was at least one (or two ) rns. we lpns practice under our own licences but must have a supervising rn.

op: i also recommend you ask for more training/orientation. as a new grad, you are indeed asking for help to ensure the best care for your patients--word it that way to your supervisor--how could he/she say 'no"? the patient load is not unreasonable for ltc. most ltcs in our state have patient loads of 25-45. it's normal not to get done with all your work in 8 hours. i know i (as well as many others)never did when i worked in ltc(and i spent many years in that area before leaving for greener fields). i do wish you the best and hope you get more orientation!

xtxrn, ASN, RN

4,267 Posts

wow, hospice nurse, that's amazing that you have no rns in the building after 5pm! i'd say that company that owns your ltc needs to be educated on the need for at least one rn there.

i agree with traumarus--the op needs to read and know her nurse practice act and the scope of her practice. in any ltc i worked in, there was at least one (or two ) rns. we lpns practice under our own licences but must have a supervising rn.

op: i also recommend you ask for more training/orientation. as a new grad, you are indeed asking for help to ensure the best care for your patients--word it that way to your supervisor--how could he/she say 'no"? the patient load is not unreasonable for ltc. most ltcs in our state have patient loads of 25-45. it's normal not to get done with all your work in 8 hours. i know i (as well as many others)never did when i worked in ltc(and i spent many years in that area before leaving for greener fields). i do wish you the best and hope you get more orientation!

that's extremely common. in all of the ltc/snf facilities i worked at in tx (or interviewed at), lvns were in charge after hours- unless they could get a 3-11 rn....but an rn on 11-7 was pretty much unheard of in smaller towns. in the one i worked at in a larger market, rns in the building wasn't consistent. they did have to have 8 hours/day on the weekends (state requirement)- and there was usually a part time rn who did that as the w/e supervisor. but they all had an rn on call for any emergency situation. that was very consistent. and if needed, whoever had call would go in if needed. but if someone was having enough trouble to call the on-call rn, the doc generally had to be notified- so the rn may get a call after the lvn talked to the doc and got orders; depended on the situation. :)

i had some limitations on being on call, but would go in for any iv problems. at another place, i had the "death beeper" and would go in to pronounce someone so the funeral home could be notified. :eek:

there are a lot of ways ltcs work- and the lvns i worked with - the vast majority of them- were outstanding. they knew those residents, and took pride in giving good care. same with a lot of cnas (of course there was turnover, but some had worked there for over 25 years).:nurse:

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nursel56

7,078 Posts

Specializes in Peds/outpatient FP,derm,allergy/private duty.
. . .I had some limitations on being on call, but would go in for any IV problems. At another place, I had the "death beeper" and would go in to pronounce someone so the funeral home could be notified. :eek:

Well dang - sort of a Grim Reaper Beeper - now why is my crazy mind offering up possible ringtones for your beeper?

Specializes in LTC, Psych, Hospice.
Well dang - sort of a Grim Reaper Beeper - now why is my crazy mind offering up possible ringtones for your beeper?

Queen's "Another one bites the dust" is stuck in my head now.

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nursel56

7,078 Posts

Specializes in Peds/outpatient FP,derm,allergy/private duty.
Queen's "Another one bites the dust" is stuck in my head now.
:lol2::lol2::lol2:
Specializes in Med/Surg, LTC/Geriatric.
Wow...I think you might be putting your license in jeopardy here. First, LPN's can't "assess". They can gather information, but assessments need to be done by an RN. New admits need to have quite a bit of paperwork done by an RN for Medicare reimbursement.

Second....it sounds like you've had little to no orientation/training. I would be out pounding the pavement looking for another job. I know they're not easy come by, but this doesn't sound safe.

WHOAAAA!!!! Better do your homework before posting such a claim.

I am not even going to comment any further than this because anything I say from here on in will not be nice.

Fellow LPN's care to comment?

Yes, that was a very broad and presumptuous statement to make. Doing your homework would mean to realize that scopes vary greatly from state to state, province to province, country to country.

I am also an LPN in Canada and do initial assessments in both LTC and acute care. As my mandate states that LPNs care for "stable patients with predictable outcomes", that is exactly what I do. The RN and I work as a team of 7-8 acute care patients (general and short stay surgery). I will take the 3-4 patients who are stable and have little IV medications. If I am ever unsure of something, I am grateful for the RN whom I can go to and ask for his/her assessment. But yes, I take the patient post op and do the entire assessment, VS, process orders, sign off on the MAR, give meds etc.

wannabenk

13 Posts

What is the difference between Assessing and data collection?

Seas

519 Posts

Specializes in Telemetry, OB, NICU.
Copy and pasted directly from the Alberta LPN competency profile :

A Licensed Practical Nurse will:

S-2-2 Demonstrate knowledge and ability to provide full health assessment of the

client including, but not limited to: (See Competency Band B)

 admission of client to clinic

 determine reason for visit

 prioritizing care

collect assessment data

 prepare client for physician examination

 collect and send specimens

 follow clinic protocol and routines

 document and report findings

If you would like to read the whole profile here it is:

http://www.clpna.com/Portals/0/Files/doc_AB_LPN_Competency_Profile_2nd Edition.pdf

I don't see where it says LPN assesses. It says they collect data which we already know.

There is nothing different.

CT Pixie, BSN, RN

3,723 Posts

I do admits on my unit. We have an RN in house acting in the supervisory position. I do the initial assessment, the skin assessment and all the other assessments that go along with a new admit. I chart it in our computerized charting under my name, however its refered to as data collection of assessment info (like that play with words they do?! ;). The RN follows behind, reviews my 'data collecting' assessement information and confirms it with something that reads like, I have reviewed and verified the information and her name and title.

So while I cannot 'assess' I can 'data collect'. What we do is collect the data needed for the initial and follow up assessments as well as the skin assessment and all the other assements :)

All the facilities in the area all work the same way. The LPN on the floor does the admit assessments but its called 'collect data' for assessments etc and the RN verifies the info.

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