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| No. 10 | 
Sep 06, 2009, 05:08 PM
 Re: I hate being a LPN in LTC. The horror! Originally Posted by Plagueis  As far as not having the med available to give, I've been told that writing "med not available" is considered a med error, and that a facility could be cited for that, not to mention the nurse getting written up. Nurses I know who work in other LTCFs tell me that their employers have a similar "rule." Hence, the borrowing. I don't see how it all falls on the nurse, especially if the pharmacy fails to deliver a med in a timely fashion.
I would borrow the meds, personally, and replace those of the borrowed resident when the borrowing resident's meds come in.
The facility can be cited for not having meds available. Of course, rather than figure out the system breakdown that is causing the need to borrow meds they'll just borrow, but don't get yourself written up. You don't borrow and the surveyor cites them because of your MAR entries you'll see how high your butt bounces when it hits the pavement. No one will charge you with insurance fraud.
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Sep 09, 2009, 07:01 PM
Re: I hate being a LPN in LTC. The horror! Originally Posted by Plagueis I'm a LPN, and I'm conflicted about whether to leave the LTCF I work at, even though I'm still on "orientation." I loved working in LTC as a CNA, but ever since I've been on orientation as a LPN, I hate it!
Although I'm still supposed to be on orientation, I've been on the med cart by myself a few times without warning, as there is usually a call out. I was told that I should be able to "figure things out" myself, as I'm a LPN (though a recent grad!). The other times, the LPN I was supposed to be with would take breaks away from the facility, leaving me panicked. I still don't have a clue about 90 percent of the paperwork/forms that I'm supposed to fill out as a LPN, because it has never been explained to me; I've been thrown on the cart to "improve my speed." My requests to learn more paperwork have been ignored. I feel overwhelmed and stresed out.
In addition, I've been told about some of the "interesting" habits that I've read about on this site, which I'm told is nursing-home gospel, such as:
combining meds from different times into one pass ("you won't get done, otherwise")
borrowing meds ("everybody does it; you can get in trouble if you don't give the med")
no supervisor, except on dayshift ("there are hardly any emergencies on 3-11 or 11-7")
signing that a med was given, when it wasn't even available, and couldn't be borrowed ("you can't write 'not available'")
I know there's more to list, but based on my experience, I seriously long for the days when I was a CNA. I wanted to be a nurse, but after this, I need to get away to another place where I have a better breaking-in period. I don't think I can last another day at this place, and I'm scared for my license, to be honest. I want to quit, but some of my friends think I should just tolerate the madness because I make more money. I can always work as a CNA until something better comes along, but I am still struggling with what to do. Any ideas, thoughts, or other horror stories would be appreciated. I apologize for the length. I'm an LPN also, I tried LTC because the money is good but the facilities are a mess in the inner city and nearby suburbs. In LTC, it's all about billing it seems, and throwing pills at people really fast - not about health care. I don't want to be too negative because I know some really like it but it's not for me. I've tried but it didn't work out.
The facility where I worked had a large population of Filipino nurses and the language issues are difficult not only for the patients but for the other staff as well. The culture there is very interesting, they've very honestly shared that they don't allow their elderly to go to places like that. I get the feeling that they don't really respect the patients that are there or the families of the patients. This was my only real experienc with a facility that was straight LTC. I've worked part-time at facilities that had sub-acute care and assisted living and the culture was definitely different.
I'm trying to find my way back to ambulatory care or school nursing with a part-time weekend job in supportive living or assisted living. I like to see a positive result through good care and education, that's a rarity in LTC.
So, hang for a minute or use your CNA to hold you while you find your niche. The job market for LPNs is really limited these days so it's tough. I'm still trying to find my spot too.
| | No. 12 |
Sep 19, 2009, 04:07 PM
Re: I hate being a LPN in LTC. The horror! Originally Posted by Plagueis I'm a LPN, and I'm conflicted about whether to leave the LTCF I work at, even though I'm still on "orientation." I loved working in LTC as a CNA, but ever since I've been on orientation as a LPN, I hate it!
Although I'm still supposed to be on orientation, I've been on the med cart by myself a few times without warning, as there is usually a call out. I was told that I should be able to "figure things out" myself, as I'm a LPN (though a recent grad!). The other times, the LPN I was supposed to be with would take breaks away from the facility, leaving me panicked. I still don't have a clue about 90 percent of the paperwork/forms that I'm supposed to fill out as a LPN, because it has never been explained to me; I've been thrown on the cart to "improve my speed." My requests to learn more paperwork have been ignored. I feel overwhelmed and stresed out.
In addition, I've been told about some of the "interesting" habits that I've read about on this site, which I'm told is nursing-home gospel, such as:
combining meds from different times into one pass ("you won't get done, otherwise")
borrowing meds ("everybody does it; you can get in trouble if you don't give the med")
no supervisor, except on dayshift ("there are hardly any emergencies on 3-11 or 11-7")
signing that a med was given, when it wasn't even available, and couldn't be borrowed ("you can't write 'not available'")
I know there's more to list, but based on my experience, I seriously long for the days when I was a CNA. I wanted to be a nurse, but after this, I need to get away to another place where I have a better breaking-in period. I don't think I can last another day at this place, and I'm scared for my license, to be honest. I want to quit, but some of my friends think I should just tolerate the madness because I make more money. I can always work as a CNA until something better comes along, but I am still struggling with what to do. Any ideas, thoughts, or other horror stories would be appreciated. I apologize for the length.
Ugh, I had the exact same orientation. I was thrown on the cart by myself with my preceptor taking his cigarette breaks and saying "Oh, just tell me if you have trouble." Even worse he told me not to give the vitamins and OTC meds and to just concentrate on the big ones when I was orientating on days (I am a night nurse). I couldn't believe it. Our orientation is two weeks but is not concrete. If we ask for more time we get it. The night I come in and plan to ask for more time they throw me on our lock down unit by myself. I had no idea until 15 minutes later when I realized the regular nurse was not coming. I called my supervisor about it and she said "Sometimes you have to learn as you go." I was pretty ****** about that but slightly agreed with her and went for it. Luckily, that night went smooth. The paperwork is the worst. I had no real formal training of what needs to be filled out when orientating on days. Luckily for me when I was orientating on nights I had a FANTASTIC nurse training me. She showed me a lot and what paper work that needed to be done. Unfortunately, when it came to learn physician monthly orders I was already by myself on the floor so I had to "learn by doing" and would repeatedly be getting in trouble with my supervisor for not doing it right.
I've seen meds being combined, but I've only seen this on one unit which is 100% vent/trach patients. And they combined the 10pm and the 12am meds. So it slightly made sense not wanting to wake up vent patients for one 12am pill. Obviously, this is not condoned, I see this is as a use your own discretion sort of thing. With borrowing meds the facility can get cited for writing unavailable and it's considered a med error at my facility. Although that still doesn't stop me from writing unavailable. I view borrowing as another use your own discretion. The only thing I would never borrow are narcs (duh) or antibiotics. That's when I call the supervisor and see if I can get it from her and if not call the doctor and bother them.
Finally, OMG there should always be at least one supervisor every shift! No emergencies 3-11 or 11-7! Ha! That's when a majority of our accidents/incidents happen. If we didn't have a supervisor during those times we'd all be up sh*t's creek!
I am a new nurse and started my LTC just over two months ago. Just very recently I have finally gotten into the groove of things. Try and stick it out. I'm in the same boat as you and on my bad nights I go home feeling miserable and really questioning is this for me. But the next night I come in and a resident says something that really makes me feel this is worth all the crap. Don't worry you're gonna come into your own. Find a good nurse to lean on, they'll make all the difference. Someone you know you won't get crap for when asking questions and what may you feel is a "dumb" question. And if all is still going crappy, move to a different facility.
All the luck for you =)
| | No. 13 |
Sep 19, 2009, 05:03 PM
Updated
Sep 19, 2009 at 05:10 PM by porcelina
Re: I hate being a LPN in LTC. The horror!
Sorry to hear that you are having such a miserable time with your LTC job. WELCOME TO LTC! I have worked as a registered nurse at 4 LTC facilities and it's the same at every single one. My first evening of orientation I was placed on the med cart by the LPN who was training me, and sent on my merry way down a hall not even knowing ANY of the residents. Talk about a nightmare. It got easier as time passed, but that med pass was one from hell. As the RN I was required to work both the medicare hall and another hall. The LPN who worked with me got the much easier 3rd hall, but was required to do all the treatments on my hall 2 only because of all the extra work I had to do as the RN.
I have worked in facilities where the RN doesn't do the med passes, but at the majority of places I have done the med passes on 2 halls. Yes, it's a nightmare. We do borrow from other residents, not supposed to, but do it. Usually someone hasn't pulled a sticker on a card. I would call pharmacy and get that resolved immediately.
LTC isn't for everyone, but sometimes that is where the jobs are and you have to go where the jobs are. I am currently working LTC at a facility that has low census and 2 nurses working in 2 separate locations in the building. At least I am not alone as I was for many years at another LTC facility where I had 75 residents to myself on the night shift. It wasn't a good thing.
I wish the best for you. It does get better with time.
| | No. 14 |
Sep 19, 2009, 08:48 PM
Re: I hate being a LPN in LTC. The horror! Originally Posted by rennyren314 I've seen meds being combined, but I've only seen this on one unit which is 100% vent/trach patients. And they combined the 10pm and the 12am meds. So it slightly made sense not wanting to wake up vent patients for one 12am pill. Obviously, this is not condoned, I see this is as a use your own discretion sort of thing. With borrowing meds the facility can get cited for writing unavailable and it's considered a med error at my facility. Although that still doesn't stop me from writing unavailable. I view borrowing as another use your own discretion. The only thing I would never borrow are narcs (duh) or antibiotics. That's when I call the supervisor and see if I can get it from her and if not call the doctor and bother them.
Finally, OMG there should always be at least one supervisor every shift! No emergencies 3-11 or 11-7! Ha! That's when a majority of our accidents/incidents happen. If we didn't have a supervisor during those times we'd all be up sh*t's creek!
As far as writing "med not available," I found out that my facility can be cited if a nurse writes that. The alternative is to call the pharmacy to request a delivery ASAP, call the MD to ask that the med be held, and write out an incident report. The other choice is to borrow. What gets me is that after a certain time of the day, the pharmacy won't deliver until the next day, and it doesn't deliver on holidays!
We are also our own supervisor on the 3-11 and 11-7 shifts. If an emergency happens (i.e. fall or death), we have to stop the med pass and deal with it. We also are responsible for admissions, taking off orders, treatments, answering the phone, making appointments (we also apparently don't need unit clerks) and dealing with family members. Also, we are expected to do recaps/changeovers during our shift, too, near the end of the month!  I know that LTC is hectic, but how on earth do any of you nurses who do work in this area get all of this done in one shift without serious overtime?
| | No. 16 |
Sep 20, 2009, 07:39 AM
Re: I hate being a LPN in LTC. The horror! Originally Posted by Plagueis As far as writing "med not available," I found out that my facility can be cited if a nurse writes that. The alternative is to call the pharmacy to request a delivery ASAP, call the MD to ask that the med be held, and write out an incident report. The other choice is to borrow. What gets me is that after a certain time of the day, the pharmacy won't deliver until the next day, and it doesn't deliver on holidays!
We are also our own supervisor on the 3-11 and 11-7 shifts. If an emergency happens (i.e. fall or death), we have to stop the med pass and deal with it. We also are responsible for admissions, taking off orders, treatments, answering the phone, making appointments (we also apparently don't need unit clerks) and dealing with family members. Also, we are expected to do recaps/changeovers during our shift, too, near the end of the month! I know that LTC is hectic, but how on earth do any of you nurses who do work in this area get all of this done in one shift without serious overtime? It may not get done, which is why I left LTC, you're still held accountable even though overtime is not acceptable. And even though, facilities are staffed for 24 hours, leaving something for the next shift is also unacceptable. It's very wierd. | | No. 17 |
Sep 20, 2009, 11:05 AM
Re: I hate being a LPN in LTC. The horror! Originally Posted by Plagueis As far as writing "med not available," I found out that my facility can be cited if a nurse writes that. The alternative is to call the pharmacy to request a delivery ASAP, call the MD to ask that the med be held, and write out an incident report. The other choice is to borrow. What gets me is that after a certain time of the day, the pharmacy won't deliver until the next day, and it doesn't deliver on holidays!
We are also our own supervisor on the 3-11 and 11-7 shifts. If an emergency happens (i.e. fall or death), we have to stop the med pass and deal with it. We also are responsible for admissions, taking off orders, treatments, answering the phone, making appointments (we also apparently don't need unit clerks) and dealing with family members. Also, we are expected to do recaps/changeovers during our shift, too, near the end of the month! I know that LTC is hectic, but how on earth do any of you nurses who do work in this area get all of this done in one shift without serious overtime?
Wow, this place is really burning you out. Don't take that. There is far too much going on for one person to handle. I'd say to leave. You have a license to protect and there is too much going on over that is jeopardizing that daily. It does come naturally after a couple weeks and you get a routine. But it is rough. Changeover is coming up for us and we already started writing out the new resident care plan. Pace yourself. Some day's you're definitely going to be there an hour after your shift. It's gonna be fine. But something really seems off about the facility you're at.
| | No. 18 |
Sep 21, 2009, 01:50 AM
Re: I hate being a LPN in LTC. The horror!
I may be getting my first LTC position shortly. Glad I came upon the issue of meds not being available. So let me get this right. If a med is not available and you can't write "med not available or N/A" and you don't want to borrow, and you are 11 to 7 and no pharmacy exists to call for request.. exactly what do you write for the med miss officially to keep things straight and right for yourself and the facility?
| | No. 19 |
Sep 21, 2009, 09:40 PM
Re: I hate being a LPN in LTC. The horror! Originally Posted by newtress I may be getting my first LTC position shortly. Glad I came upon the issue of meds not being available. So let me get this right. If a med is not available and you can't write "med not available or N/A" and you don't want to borrow, and you are 11 to 7 and no pharmacy exists to call for request.. exactly what do you write for the med miss officially to keep things straight and right for yourself and the facility?
According to my facility, one is supposed to call the doctor to request that the med be held for that dose, call the pharmacy (even though it's closed) to request delivery of the med ASAP, and fill out an incident report. You would have to check to see what your facility's policy is concerning meds that aren't available. FYI, I have yet to see a nurse actually do this. It's less work to borrow. Plus, I'm sure the State wouldn't like to see numerous incident reports about meds not being available.
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