LTC, SKILLED almost impossible to get things done

9livesRN, BSN, RN · Nov 11, 2011

- then you have to make sure the CPM' are all on, and they are measured right, and not hurting the patients

- turn around and check blood sugars at least 4 people ac and hs, some times as high as 10 diabetics.

- change all iv tubing, o2 tubings, feeding pump tubs and bags

- call the pharmacy (often off site) and fight with them because your patient is in pain and they need to hurry up and rush that pill, since it's not on your narc emergency kit.

- get to dressing changes just find out the nurse before you used the last supply and did not arrange for more for you,( no wonder I hide some supplies, I order a little extra and hide, so I can do my treatments)

- then you have to complete your incident reports, because of falls, or a bruise noted, or what not. And you better do it right, or the report comes right back to you

- then you have to care plan everything,

- draw labs, since lab only comes for schedule routine labs...

- also care for a dying patient, call family, arrange everything...

The interesting thing is that this often happen all together on the same shift.

Having SNF experience made the hospital life a breeze!

My heart goes to you!

Share your thoughts!

Dazglue, ADN, BSN, MSN, RN · Nov 11, 2011

You just described my daily work routine...except ours is actually inside a hospital, and we STILL have the same issues..

9livesRN, BSN, RN · Nov 11, 2011

I used to worry if I wasn't able to find a vitamin, or if I could not get treatment consent signed, because the patient was not alert, I used to think the incoming shift would be mad, today I don't really care, they will get it done, nursing is 24h...

NurseLoveJoy88, ASN, RN · Nov 12, 2011

OP LTC is alot. I'm sorry but there have been many of day when a resident may not have gotten their artificial tears or a vitamin. In LTC there is too much to do in so little time. Have to do what you can and anything else may have to be passed on.

JenniferSews · Nov 12, 2011

You get used to it. You learn to manage your time REALLY WELL and while you will still have bad days I find I can still get it done 90% of the time even on those bad days. It takes an extreme amount of organization and some preparation, as well as a good report or at least some pointed questions. Then if the off going nurse doesn't know I read the chart. That takes a bit of time, especially if 5 of the 15 are new, but it's worth it. A good hospital H&P will give you a good idea what to expect.

I give my vitamins, eye drops, breathing treatments, dietary supplements, do my wound dressings and still manage to catch and treat COCs and deal with family. Not to mention track down lost laundry, catch the dropped appointment, get a patient to dialysis last minute because transport wasn't scheduled even though they said it was, discharge someone at the last minute and admit someone else, then make a meal myself since we all know the kitchen isn't going to do a damn thing if they forgot to send a tray out. Don't get caught in the kitchen though, because then there will be hell to pay!

Oh and lets not forget that not only is pharmacy not on site, you're lucky to get your meds within 48 hours so you must plan ahead and if that doesn't work call and get an order to hold a med you won't be getting for at least 24 hours. And no doctors on site mean you must be the front line and eyes and ears of a doc who will sometimes refuse to return calls because all nurses are stupid and leave you to try and pull from whatever prn orders you already have to keep a patient stable.

Then try not just 5 tube feedings, but teaching 5 people to manage their own tube feedings so they can go home with them in a couple of days. Teach that scared elderly person how to give themselves a bolus feeding every three hours (meaning you are in there every 3 hours for at least 15 minutes) and make them feel not just like they have the basic idea but like they are truly comfortable and know what to do if their tube gets clogged, etc. Every 3 hours for 5 people?! But if you don't, how can you live with yourself knowing some 90 year old went home lost and confused and not knowing how to feed themselves. Because you know a lot of the time they think they CAN swallow if they just tried it, so their tube feeding needs to be as easy to manage as cooking a tv dinner. Otherwise they will be back in the ER with asp PNA and you will be the one everyone is pointing at.

Plus the new diabetics, those going home on Coumadin for the first time, and trying to convince family that Grandma really can't take care of herself by teaching them how to care for her and thus showing them she really CAN'T do it.

I keep my fall risks close and engaged in some activity whenever possible, even if that just means me talking. There are no sitters and you absolutely cannot give Ativan or even a pain pill just because they are trying to stand up and walk 1,000 times every hour or smacking the crap out of every caregiver. And don't even THINK about restraints, we are a restraint free facility. Why isn't your family member in bed? It's called "rehab," they are here to get stronger and go home, that won't happen if they lay around in bed!

But all that took a good 18 months to master, and for the six months I thought I was going to have a nervous breakdown. I would like to think all my hard work will someday be applicable in a hospital setting, but in my city SNF experience counts as nothing at all. If you think this is nothing, or that hospital nursing is "just like this" then you should walk a mile in my shoes.

sweetsleep28 · Nov 12, 2011

You have just described every single shift I work at my current job. Tonight in a span of about 30 minutes I broke up a literal fist fight between a demented man and a LOL, managed to cover myself in Jevity tube feed because in my rush I opened the can then tried to shake it. All with everyone yelling for PRN pain meds and trying to help the CNAs pass dinner trays. I feel your pain!

passionflower, BSN, MSN, RN · Nov 12, 2011

And that's why I left skilled nursing facility.

AZMOMO2 · Nov 12, 2011

Same here!

Zen123 · Nov 12, 2011

Just my rant for the night. This job sucks. And hell was created just for those big wigs who don't care. Somehow someone is making dollars over our aching bodies. My feet and legs hurt from standing. No time for breaks..someone is waiting for their meds and there's three admissions..somehow somewhere someone is making the dollars. And like I said there's a vip section in hell for just them kind. Thanks..feeling better already!*wine:throcomp:

DixieRedHead, ASN, RN · Nov 12, 2011

Don't forget PICC line care. Measure this, measure that, flush, hang, flush, measure, look, document. So much time.

TXNurse77 · Nov 12, 2011

I work LTC - Nights.. and this is the ONLY way I will work in a LTC. Yes, I have 60 residents but I only interact with 15 of them (but check on all) and that includes 5 g-tubes (1 bolus, 1 flush only, and 3 pumps), 1 BS at 12a and 1 at 3a, then 11 meds at 5:45a which are all Synthroid. What I chart - MCR (only have 3), G-tubes, ABT, Hospice and anything out of the norm.

I do not like working nights but I'm willing to make this sacrifice to maintain some sanity until I finish my RN. Otherwise, I rather work in retail or a restaurant if I had to work days or evenings in LTC.