I hate being a LPN in LTC. The horror! - page 3

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... Read More

  1. by   indigonurse
    Hi. Dont let the bad information given to you by others spoil your long term care experience. There is only one way to do things and that is the right way. As far as the med issue is concerned. If a resident is out of medication, the correct thing to call the pharmacy and reorder it. Then you must call the MD and notify the MD. Record that in the nurses notes. There is also an emergency medical supply that might have the medication in it. I am not sure what you meant by combining meds. Legally the time frame for medications in LTC is you have up to one hour before and one hour after the time to administer it. With the exception of insulin. Legally you cant sign a med that wasnt given. You can sign it, circle it and write on the back of the med sheet it wasnt available and write in the nurses notes that you called the pharmacy and MD. Sometimes the MD will allow you to give it once it arrives.

    Remember it is always better to risk getting fired from a job than it is to loose your nursing license. If the work load is unreasonable and it prevents you from legally performing your job you might want to pass it up for something that you can do in a safe manner.
  2. by   lisaannjamRN
    This is such a coincidence! I just had 2 days feeling exactly as you so perfectly described!! I am at my 1st job as an LPN. I graduated August 27, 2009. I just had orientation last Wed., Thurs., I was with an LPN a 1/2 day and by Sunday, I was left totally alone on the med cart. I got through the med pass and treatments for 29 residents. I was exhausted and terrified, but I got through it. I can't believe I was alone. It seemed as if I was being tested to see how I would handle myself. I felt everything that you wrote. And as far as borrowing meds...that happens where I work as well. I actually wrote on the MAR med not available-ordered from Pharmacy and that it was not given. I think the thing that I absolutely want to cry about is that I see the looks on the faces of the residents when they see me coming with the cart. I have to give as many meds as I can while they are dining for breakfast and lunch in their dining room. I am the "pill girl". I miss the hospital. I wish I had known LTC would have been my only option as an LPN. I am so sad. Thank you for your post. It truly gave me great comfort tonight!! Good luck with things. I am sure you will figure out what is going to work for you. I guess time will help?
  3. by   89**11
    Okay you guys are scaring me. I am a new nurse and finished my pre employment info today for a LTC facility. It is one of the much nicer ones in town I believe orientation is coming soon they are suppose to let me know either this week or the next. I am excited to work as a LPN. I have worked at a hospital as a unit secretary and I was definitely thrown under the bus and have witness other nurses thrown to the wolves. I will let you all know how it goes wish me luck. I hope that things will get better, it is hard to get a job as a new grad unless you had prior experice in the medical feild. May god bless us all.
  4. by   lisaannjamRN
    Hi Williamsa! So sorry...didn't mean to scare you with my thread. I do sincerely wish you the best of luck. You are so right about it being difficult to get a job as a new grad. I too, got a job in a beautiful place. I also want to let you know when I went in today, I keep plugging along doing my best. In the afternoon, when I was just on the verge of tears, my Administrator called me in her office to tell me what an awesome job I am doing, and how much my co-workers and more importantly, the residents love me. I had to hold back the tears. And I could feel my eyes welling up. I thought of my insructors in school telling us how tough the first year of nursing would be. They told us they cried themselves. I do feel that I am truly caring and loving the residents even in the very short time I have been at my job. I have to remind myself...this is going to be tough. But it will get easier and it will be rewarding. I am absolutely exhausted, but I wanted to let you know I wish you luck, and hang in there in the beginning. It's tough but we can get there. Best of luck.
  5. by   lisaannjamRN

    Just read your post. Thank you!!! You are so right. I am thinking back to PCU during clinical at the hospital and remember RNs having days just as the one your described. You are right again in that this is just a tough field. Thanks for the perspective! Hope you have a great day. Best wishes.
  6. by   rapkeygurl
    do hang in there, I remember when I got out of nursing school was scared to death to call a doc I was just 19 years old. I have worked a lot of different areas of nursing, ob, med/surg, wound care, ortho, oncology, chemical dependancy each time was new and scary at first but so glad for each experience and the education I learned but ultimately I love LTC- I go to work for the residents. the paper work can be horrible. sometimes I just hate to ask nurses to document because I remember working and having 2 incidents, transfers and and admission and family yelling at you all in the same shift and the upper management yelling at me did they not teach you how to chart in nursing school. That just made me furious and I went out an bought a book on charting for charge nurses. Went to a few seminars. If your state has training like here in texas go to your state website and see when and where you can go for some education on what the surveyors are looking for. Those seem to help me the best. I usually start out new nurses passing meds also. Because if you become a charge nurse you have to, at least in tx, chart effectiveness of PRN meds, maalox, mom, PAIN MEDS even if the med aide passes them. Initial doses usually have to be signed by nurse. Ask to look at policy and procedure manuals. See if they have like I made up for our nurses JOB DUTY LIST per shift. It kind of explains what they are to do per shift We also do a general orientation for all staff and meet all department heads have topics they cover. There is so much to learn but dont forget to ask for what you need to get your job done. Stock your med cart when you come in-if the previous shift has not done that. keep that PDR handy. Heck honey when I have to on occasion pass out meds I take 2 hours getting my morning meds out. Mainly because I make sure they take them and not just set them down by the bed. ( that is one of those big no-no's I am with Sue just start with meds. Ask for a job description and job responsibility lists. I always say no question is bad just the one you forgot to ask. I think to one of the things we older nurses do is forget to put things simply. Dont forget they did not teach you job specific duties in nursing school. You where taught basic procedures. Wish you the best in your career!!
  7. by   rapkeygurl
    oh and one more thing- you have the experience of a CNA-- wish all my nurses did and understood how hard that job is. I started out as a shower aide that is back breaking/foot blistering work!! I really do appreciate nurse aides I teach them in our facility. See I think your already a step ahead girl friend!!
  8. by   hotnurse84
    LTC can be very demanding, hard, sad, grueling, and laborsome......but somehow i always end up back there.... It is very rewarding. i"ve worked off and on in LTC for about 8 yrs and right now i work home health. i do like it however, i kinda miss my residents and don"t get as much satisfaction outof HH. I'll probally go back to LTC soon. I just need a little vacation every now and then to de stress
    However, being a new nurse and just being thrown in there like that is extra stressful. I was only 19 when i was thrown in there and i was scared!!!! i still lived at home with mommmy and daddy for goodness sake and now i was in charge of about25 people and their lives!!! well i got over it pretty quick.
    You learn a lot in LTC. Now i learn nothing in my current job. i feel like a CNA who can give pills. so maybe if you loved being a CNA you might like Home Health...hehe
    I'd love to know if the the person who wrote this stuck with it or quit??
  9. by   Katie5
    Quote from birdietiel
    I am going through the same thing. I was thrown on the med cart. I have seen other nurses combining meds for 4 and 8, and other things that shouldn't be done. I am always out late because I do things by the book. Half the time the med isn't there. We even run out of narcotics for the residents, and have to use the emergency box. One time even that was out. There is a huge lack of communication at my ltc facility. There is no team work. People gossip all the time about each other. I don't get wrapped up in it. I don't feel very liked at my job because I'm new. I haven't learned all the forms yet either. I am learning them as I go. I'm stuck at the place I am, because there are no hospital jobs available here. Hopefully you can apply somewhere else. Good luck to you, and hang in there.
    Get outta my mind!
  10. by   lisaannjamRN
    There is such wonderful support here. Thank you all so much. I hate to know that others are going through the same stress and difficulties that I am, but isn't it also nice to know we are not alone. This is a common experience. I got through my first week, being trained on the Assisted Living and the Memory Care floors. I am going to be the charge nurse for the Memory Care floor this coming Sunday. My Administrator came down for report on a few residents, and I took that opportunity to ask her the many questions I had. She asked me what my comfort level was (regarding being the charge nurse on Sunday). And I was honest with her. I told her as long as I knew she or another nurse on Assisted Living was there to answer questions for me, as they know these residents, I think I'd be okay. I realized she is there to help me. I just have to ask for the help. Each day gets a bit less scarier, and I do fall in "love" with the residents a little more. I realize that I have the love and the clinical skills that they need. I imagine it will get easier as I get to KNOW the residents a little more. I am currently starting Excelsior for my R.N., but I need the experience and am bound and determined to get through this.
  11. by   MauraRN
    Leeann, I too did 3 yrs in LTC/sub-acute care while doing Excelsior. I have great assessment skills because of LTC. We are just thrown out on the unit to figure it all out, no hospital-like precepting. So practice your assessment skills, get comfy with wet-dry dressings, tube feeds, IV meds, subq insulins and heparins and you will be much more comfy doing the EC CPNE. Get familiar with care plans too. LTC care plans are usually junk in LTC, but look at them anyway and figure out how they SHOULD be done. Work on your documentation skills and consider LTC as paid clinical rotations, it will help you stick it out until you are done with EC. It is such a shame that those of us who love that elder population just can't stay in that industry, it is going to get worse with the 50billion in medicare cuts coming soon. And hope that when you get your RN there will be jobs available again. The cycle of no nursing jobs now should start to be on the upswing in 2 yrs or so. Hang in there.
  12. by   lisaannjamRN

    Thanks so much for the encouragement. I got through my first day as charge nurse, and I am happy to say I made it through. I will look at this experience as "paid clinicals" until I have completed Excelsior. And I will give those residents all the love and care that I possibly can in the interim. I do have a question for you, if you don't mind, as you worked in LTC. Did your LTC facililty expect you to work as an aide? And I mean actually work as an aide. If they are short on aides, and they are not certified in the Assisted Living or Memory units, they call LPNs and ask them to cover their shifts. The LPNs do get paid at their LPN rate, but I was wondering is this a "normal" practice. Also, when I work on the Memory Care floor, I am expected to give my early morning meds, shower and dress 3 people and get them to breakfast. In the afternoon, I am to "toilet" 3 or 4 residents and either help with making beds and replacing towels in the rooms, or help clean the tables off after lunch. My first day was rough. I did my meds, and got my first resident showered and dressed and I heard a resident screaming, he had fallen. Of course, I immediately went to him. In between helping the aides, I had meds, assessments, calls to the MD, dressing changes, speaking with families, incident report, 24-hr report, my shift report and nursing notes. I have to say they have 2 aides on for 15 dementia residents. These aides must shower, serve food, clean up, do activities, toilet...all of it. So, I dont' believe the aides are lazy, just overwhelmed and need and expect help from the nurse on duty. When I am on the Assisted Living floor, it is mostly meds and treatments for 30 residents. Thanks so much for reading this (if you have time...lol lol). Is an LPN working as an aide normal??? Thank you!!! God bless!!!
  13. by   Plagueis
    I'm still at the same workplace. It's still stressful, but as there's no other place to work, I have to stick with it, as I have a daughter to support, as well.

    I haven't had to do any recaps/changeovers yet. However, whenever I've had a fall or had to send someone to the hospital, it puts me far behind on my med passes, so I end up clocking out late (I work 3 to 11 shift). I had to help with both of those situations regarding the paperwork, as I was never shown how to fill out an incident report before. I still don't know how to do some basic things, such as the procedure for when a doctor writes an order for a lab, how to program and hang a continuous tube feeding, or how to program an IV machine. I'm told that if these situations occur to just ask for help. I'm just trying to stick it out. I'm better at passing meds, I think, but I still get behind if something unusual occurs (i.e. a fall), even though I don't take breaks.