New grad, LTC job offer...advice?

  1. I'm a new grad LVN in CA. My hope was to work in acute care but hospitals in my area are going to all RN staffing. My clinical experience was mostly med/surg. I accepted an offer from the best LTC facility in my area. It's clean, professionally run and the acuity level is relatively low. Unfortunately the ratio is 30:1 which is actually lower than some facilities in my area...state standard is 50:1.

    I'm scared to death...I need words of encouragement and advice. Can a safe med pass really take place with 30 residents....not to mention tx, assessment and charting. Can I do this???

    Thanks T
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  2. 32 Comments

  3. by   gerinurse10
    Hi Tiona: Yes you can do a safe med pass for 30 residents. Take your time, you will finish it. Every day that goes by you will get faster. You will get to know the residents. Don't forget to ask questions if you don't know something. Rely on your charge nurse, director whoever can guide you. I've had med passes that took an average of 3 hours. Before I knew it it was already time for lunch meds. OHHH! Get your cart prepared juice, applesauce, cups, straws you know all the goodies. Hopefully your facility has pictures of all the residents so you can find them. Check their arm bands be very careful I've had residents say oh yes I'm Mr. X and he was really Mr. Y So just take your time and stay focused. Good Luck. You can do it!!
  4. by   KrisV27
    No, you cannot be safe with that many patients. I usually have about 30, and it is simply physically impossibly. They get their meds, but usually not at the correct times. Basically, we have to prioritize. Which is more important? Giving a resident her medication cocktail on time or keeping the dementia patient who took of her self-release belt and is walking down the hall stark naked from falling? Where is that CNA anyway? Or wait, what about Mr. Smith who has just disrobed, defecated in the activity room, and is smearing it all over himself, the dining table, and the oriented residents? Just do the best you can.
  5. by   CoffeeRTC
    Quote from Kristen B
    No, you cannot be safe with that many patients. I usually have about 30, and it is simply physically impossibly. They get their meds, but usually not at the correct times. Basically, we have to prioritize. Which is more important? Giving a resident her medication cocktail on time or keeping the dementia patient who took of her self-release belt and is walking down the hall stark naked from falling? Where is that CNA anyway? Or wait, what about Mr. Smith who has just disrobed, defecated in the activity room, and is smearing it all over himself, the dining table, and the oriented residents? Just do the best you can.
    Kristen...sounds like you are extremely frustrated. I've been where you are before..trust me, it does get better and there are better places out there. I normally have 26 pts and 1-1.5 Cna, the LPN has 22 pts and 1-1.5 cnas. We have a high number of demetia residents and have many situations like the ones you described. The biggest thing that has helped me is organization and priortizing care. Also helps to have good CNAs or at least ones that know you are the boss. We all do the best we can..that is all we can do For me that means starting the 5pm med pass at 3:30 so I can be done at 6pm or maybe skipping a body audit or passing it on to the next shift so I can do an incident report or pick someone up off the floor or stop a resident fight
    Bottom line LTC does have its rewards, but if you cant take or handle the rest of the stuff that goes along with it realize that LTC isn't for everyone.
  6. by   KrisV27
    At times, LTC is very rewarding to me. I am not frustrated for myself, but for all of the residents that must suffer because I only have two hands. I love working with the residents, but it is disheartening that I can't give them the time they really need.
  7. by   tiona
    Thanks for your replies. I started work Weds and "they" say I'm doing very well. My preceptor told me that I'm the best nurse she's ever trained, new grad or not. Why then do I feel Sooo overwhelmed. I managed to do the med pass, and treatments for 33 people...not on time I might add. I haven't started charting yet and there are so many, many things that I don't know how to do. They want me to work evenings...only one other LVN in the building. Do you all find that evenings are slower paced. Fewer tx and meds?

    There is a big issue about OT in this facility....meaning one is not allowed to work OT. So what should I do? Stay on my own time, or not get all of my work done. I suppose they could "write me up" either way... Suggestions?

    It is not humanly possible to get everything done in 8 hours and I refuse to cut corners or otherwise fake it by signing out on something that I didn't actually do. I suppose it'll get easier as time goes on...do ya think?
  8. by   northernnyLPN
    Tiona,

    I'm not sure meds can safely be passed with so many clients.
    I worked in LTC for 3 months new grad and well I hated it. I found it difficult to pass meds for 29 clients and get all the paperwork done and treatments. I left work every night after 12A. I was on the 3-11 shift. Like you I wanted acute care not LTC. It seems like in NY all the LPNs are in LTC. All I can say is do the best you can and if you feel you are unable to provide quality care talk to your nurse manager. At least you are not a float like I was can't remember how many times I got clients mixed up. Thank god I didn't make any major med errors. Good Luck to you and remember to ask for help.




    Ps thank you bunches Brian for fixing the problem with my account
  9. by   dekatn
    It helped me tremendously to have a "cheat sheet", the nurse that helped me with orientation gave me some great tips as I went along, eg; does a pt take meds whole, crushed, g-tube, whatever, if pt. takes meds better while still up or after they have been put to bed. (I also started on 3-11). I would get all my supplies together for afternoon accuchecks, insulin administration etc., I am big on lists, I had a list of pt. that had to take meds before meals, 6p and hs, how they took them, and even sometimes how to approach certain pt. that may have a hx. of refusing meds. It does take time, but it does get better, 3-11 to me was a tough shift to work, as pt. had meal, showers, and all had to be assisted with hs routines, with limited staff. It seemed like all the pt. wanted to go to bed or the bathroom at the same time!! Not to mention that staff had to have a break somewhere in between all the demands! We are fortunate to have some wonderful CNA's, they really care about the pt. It is impossible to get everything done sometimes, just make your priorties, I was often told by my DON, we are a 24/7 facility, we can't always get it all done in 8hr, that's when it's really important to have teamwork. I feel at times like I am "passing the buck", but sometimes it just can't be helped, and if you stop and think about it, there are times when the nurse before you will run into the same problem and you may have to pick up something that was left unfinished from 7-3 shift, it's not intentionable, it's just the nature of the beast!! Don't be too hard on yourself, do the best you can and you will be fine. You will get your own routine and it won't take as long as you think. If there is anything I can help you with, please feel free to contact me. Good luck and congratulations on your new position!
  10. by   CapeCodMermaid
    Yes, it's possible to safely administer meds to 30 residents. My first job after taking almost 10 years off to raise my kids was on a sub acute floor. There were 60 pts, 2 nurses for meds and treatments and a charge nurse who mostly transcribed the orders. It was hellish the first few weeks --I had 4 GTube patients, 4 IV's and one guy with end stage AIDS-- after all they NEVER told us it was like this in school, right?, but after a while I got my routine down, the patient's got their meds on time, their treatments done, and the charting done...and then guess what happened...some lame brain in administration thought the MDS nurse was over worked and wanted us to do MDS's as well!! That's when I left that job. Get organized,prioritized, and don't make yourself crazy about the med pass rules. Good luck.
  11. by   CHATSDALE
    30 pts is about average in our area but at the nh that i work at we have

    more but we do not have many bed bound pts that require turning q2 but that is not always a plus because they wander all over the place many are mental/emotional problems and sometimes getting them to take meds is difficult many will come up to the cart and get their meds

    but i have worked in a facility with stroke and decub pts that reqired a lot of care and cna s who would quit or call in at the drop of a hat. they work hard and usually can find an equilivant job easily when they want to drop out for a little while keep trying for acute care you will learn a lot more there and it will help you when you go back to school good luck
  12. by   tiona
    Thanks again for your replies. I'm concentrating hard on the med pass routine right now and trying to make a "cheat sheet" re: who can swallow, who needs their meds crushed etc. What a massive task! I still need to learn all about interfacility transfers, when to call 911, family members Docs etc. So much to do. Then of-course there are CNA assignments which is a challenge since I don't even know their names yet. I'm thinking that I'll go for continuity of care and let them tell me where they want to go until I learn more about the them and the residents. We'll see.

    I have a sneaky hunch that the DON is going to want to end my "orientation" as soon as possible. I've only been there 3 days and I think that I'll ask for at least a couple of more weeks to orient. What do you guys think is a reasonable time line to ask for. Remember I'm just out of school.....

    I just don't want a patient to aspirate meds or some other awful thing like that. To top it off, the state is expected to show up any minute for the anual review. Ugh! Tell me about what THAT is like!
  13. by   debRN0417
    Speaking as DON in LTC, you need to feel a certain level of comfort before your orientation is over...three days is not long enough. Now I'm not saying that you need to orient until you're completely comfortable, because that may take a few months...what I am saying is that you need to talk to your DON about an extended orientation. You should not be "pushed" along. Yes, we need staff on the floor, but I'd rather pay the extra money to orient you properly and have you feel comfortable, than for you to either make a mistake, or leave out of frustration because you were overwhelmed. Orientation is a crucial time for anyone, but especially someone who has never been in LTC and is new. Please discuss your concerns with your DON. Good luck!





    QUOTE=tiona]Thanks again for your replies. I'm concentrating hard on the med pass routine right now and trying to make a "cheat sheet" re: who can swallow, who needs their meds crushed etc. What a massive task! I still need to learn all about interfacility transfers, when to call 911, family members Docs etc. So much to do. Then of-course there are CNA assignments which is a challenge since I don't even know their names yet. I'm thinking that I'll go for continuity of care and let them tell me where they want to go until I learn more about the them and the residents. We'll see.

    I least ahave a sneaky hunch that the DON is going to want to end my "orientation" as soon as possible. I've only been there 3 days and I think that I'll ask for at couple of more weeks to orient. What do you guys think is a reasonable time line to ask for. Remember I'm just out of school.....

    I just don't want a patient to aspirate meds or some other awful thing like that. To top it off, the state is expected to show up any minute for the anual review. Ugh! Tell me about what THAT is like![/QUOTE]
  14. by   tiona
    Thanks for the advice Deb. My preceptor gave me the same advice. I think that I'm doing pretty well for a newby, but I really need to become very familiar with the residents and know "what to do if....this happens" ya know what I mean?

    I'll have a pow wow with the DON this week. Thanks

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