LTC charge nurses

nursedawn67, LPN · Apr 17, 2002

Where do we start? :)

Aerolizing · Apr 18, 2002

I am new to ltc and man oh man, I could fill up all available space to talk of my concerns. I am getting ripped from family members every day. I am getting no support from administration when I have serious concerns for my patients from the care the stna's give to the lack of concern from the docs. I would love to stay to make a difference but I am already tired. I came from 10 years of acute care to what I thought would be a much more relaxing job. I was wrong. It is very hard to keep positive for my residents when I am getting hit from all sides.

JAVA666 · Apr 18, 2002

After 20 years in nursing with about 10 in LTC, I dread going back to it. However it seems that there may be no other " choice". I am an LPN and as the market for us gets smaller it seems that all that is left is LTC. Now don't get me wrong I do enjoy geriatric nursing, But Like you said, I really don't like all the BS, with docs, rules regs, families, etc. that all seem to take away from my ability to " do nursing" with and for my patients,. There are all these great missin statements and if they were even followed 1/2 of the time that would be good for all, but in my experience they aren't worth the time or paper they are written on. Burned out/ probably! giving up on nursing? might, I'm even looking into working as a cna to get back to some hands on care and not " paper work nursing", or nursing to keep labs and everything else with-in "norms", and not seeing the individual. i miss nursing as it was when i started out, things were more client oriented, now not all " advances" in nursing are bad, I'm not saying that, what I'm saying is there are so many state and federal and etc.,.. rules and regulations that I work out of fear of messing up, or having supervisors jump down my throat or having good supervisors burn out for the same reasons.

oh well , guess i just got going too much, ? theraputic ?

jones58 · Apr 25, 2002

I'm a charge nurse in a LTC/Rehab unit. We have 35-40 pts. Discharges and new admissions every week. On the 3-11 shift we have 1 RN and 1 LPN, and 3-4 aides. I have read others' posts about staffing and I wonder-how do they do it? Our pts. are always wanting something. Want to go to the BR, want to go to bed, want to get out out of bed, want a pain pill, want cough syrup, want mylanta, want a laxative, want something to stop diarrhea. Have chest pain that turns out to be indigestion because they insist on going to bed 20 seconds after they eat. They keep us hopping. 24-7. If not for our dedication and ability to laugh we would all go crazy. Hey maybe we already are crazy.

Fran-RN · Apr 25, 2002

I work as Charge nurse in 80 bed facility. Sometimes we work with only one nurse in buliding at night. There are three halls and the other 2 are staffed with QMAs. + we have 3 CNA for the building. The Skilled hall Usually has at least 2or3 IV ATB, vancomycin, gentamycin, etc scheduled, feeding tubes, Skilled charting for medicare payment, Our big Med Pass of the day is at 5am, so we get that + Accu- checks, insulins. the other day we had 19 Accuchecks. Even when there is another nurse in the bulilding , I still get called to her hall for a second opinion! The night nurse is also responsible to get all paperwork ready for MD appts, transfers, labs etc. ( we aren't as busy as the other shifts!) We also have to do staffing if anyone calls in, which they usually do. And any one who thinks these people sleep all night is &*%&*. whine, whine. At least I have a great crew to work with. I couldn't make it without them. One thing for sure I'm never bored.

Dakota · May 3, 2002

I passed my RN boards and waited about 5yrs to work . I have been working as an RN in a LTC facility for 2 yrs. I would love to enter the hospital setting but am too afraid that i don't know enough. Any Suggestions.

unmovableshortie · May 5, 2002

I just worked three years as teh night charge nurse in a 64 bed facility. Last month I started as teh day charge nurse in a 30 bed facility. Most days I am the only nurse on. That means pass the meds, supervise the LNA's, assess the residents, call the docs, call the families, etc, etc.. As I walk home at he end of the day I remember all the loose ends I forgot!! Then to remember who is private pay and doesn't get their meds from the facilities pharmacy!! On the days there are two nurses on I do careplanning and MDS's!! I'm feeling a little overwhelmed. Thirty patients are OK if NOTHING happens!! But have a fall, CHF, Pneumonia or UTI's and I feel like all hell has broken loose. We're not supposed to put in overtime, but somedays I just can't get out of there at 3:30PM. I have a stack of charts I need to document in and orders that need to be noted. Any suggestions?

KlareRN · May 5, 2002

Long term care is not going to get any easier- especially with medicaid/care cuts.

Fran- have you approached your DON about your med pass? Having a big 5AM med pass-what time is your breakfast? If it isnt until 8 or so- I would think the meds should come later-less GI upset closer to breakfast. Food consumption might be better; cutting down on weight loss. (good argument for change!) First shift could pass the meds-some even later in the day. One time doses can many times be changed to hs instead of AM without any adverse effect (get Drs. OK first). That helps to free up AM time for first shift.

In one facility I had 3rd shift pass all the orals to those that were on the 3rd shift get up list, those that got up early anyway, and do all the AM tube feed meds. First shift did the glucochecks and insulins. I am shocked at the number of facilities where 3rd shift does the finger stick and first gives the insulin- usually at least 2 hours apart. I would not give insulin to a res that had a BS check 2 hrs ago that I did not even do. And- if you are also giving the insulin- hopefully not rapid onset that early in the AM before breakfast. (great potential for someone to crash)

I have found laughter is sometimes the only thing that keeps us going!! Sometimes it is morbid-and only us nurses understand the humor in some situations.

Dakota-

If you have been the RN in a LTC- I think you have the skills to go to a hospital. Nurses in LTC must have excellent assessment skills because we do not have a doc at the backdoor to back us up. Our docs depend on our skills. To survive in LTC you also have to possess good organizational and supervisory skills. I hope you decide to stay in LTC though. We sure need the hands!

Hope some of this might help someone-

Klare