New Grad RN in LTC Needs Advice Please!!

  1. Hi All,
    I am a new Grad RN recently hired in a LTC/SNF/Rehab with a 25 patient load needing medications, treatments, etc. My question is how on earth can one person pass meds (in typical marge quantities, most crushed in applesauce, several narcotics and G-tubes, etc.) and finish in 3 hours or even 4 hours??? I did basic math and this leaves 3-5 minutes per client start to finish! Yikes.

    This was my only job prospect for the moment, and I do think I am getting some decent experience with clinical skills, handling patients with varying degrees of acuity, etc. as well as daily verbal and telephone orders, lab requests, etc. Whew! I am freaking out on medication administration alone never mind adding in the occasional health crisis or patient crash. On occasion they bring down a certified medication LNA but I am worried about when they DON'T- what then? I'll be passing 8am meds at 12:30? That's crazy.

    I know of at least one serious med error recently which resulted in a patient being hospitalized, I'm afraid that's going to be ME!

    Any thoughts? I appreciate any feedback, thank you!
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    About Cashboy's Mom

    Joined: Jun '07; Posts: 20; Likes: 6
    RN; from US


  3. by   nyteshade
    Sorry, but that is life in LTC. The best you can do is wait it out in this job market...
  4. by   SuesquatchRN
    4 hours = 240 minutes or almost 10 per patient.

    25 in 4 hours is a light load.
  5. by   Muffy5
    I also am relatively new and working in a sub-acute/LTC facility. Unfortunately, that is the reality. Try not to get discouraged! My work place doesn't even schedule specific times for most meds (unless time-sensitive), that way as long as we give it on our shift, it is on time. Terrible, I know, but that's the way it is. You will get great experience though and you will be so good at time management. I was told by the person training me, if you can work here, you can work anywhere! I believe him too. Good luck and congrats on getting a job.
  6. by   montinurse
    I've actually come to enjoy my workload (30 pts). My facility has now given two nurses, or 1 QMA to the unit, sometimes for a whole shift. It honestly works wonders for everyone's moral, including the residents. I have more time to chat while I'm giving meds or treatments, and actual time to DO the treatments and charting. Good attitudes from the nurses and aides are what these people deserve! I tried med/surg, it's a way different kind of busy. I found myself longing for my LTC workload. SO-here I am, back in LTC
  7. by   Cashboy's Mom
    thanks for the replies, and I should have clarified- according to my training materials they expect the AM med pass to be completed by 9:30, which after taking off time to get report, count the cart and give report to aides, leaves 2 hours and 15 minutes- which leaves 5.4 minutes per patient....doesn't sound right! Once you add in any type of (expected interruptions), requests from staff, patients and their family, it's impossible. I guess I'll find out if it's OK as I go along though....

    I can see how timeliness is not really an issue with many of these meds but it is with cardiacs and antihypertensives....
  8. by   Cashboy's Mom
    can I ask you all too, about signing off on treatments done by the aides? Is this standard procedure? It's hard to tell being new, what's what- what's OK, or what's just something bogus being done in my facility: for example my MNA pulls a set of meds, crushes them and then I'm the one to administer-well how do I know what is even in the mix, or if it even should be crushed?
  9. by   SuesquatchRN
    I don't have CMAs and I don't give what I didn't pour unless it's someone I've worked with a loooong time and trust implicitly.
  10. by   Ms.RN
    Are you working day shift? You have one hour before and after scheduled time. I think its better to give the right medication then giving medication on time. If I were you I will personally pull out all the medications and give it to the patient and not rely on NA. Also you get used to giving medication and get to know what you are giving and why. You can ask nurses aides to take blood pressure and pulse rate of patients who needs blood pressure medication which saves alot of time. NA can apply creams but those requires dressing changes nurses have to do it. Try to change dressing changes before NA dress them and sit them up in a chair.
    Last edit by Ms.RN on Mar 31, '10
  11. by   ndragonfly
    I have worked in LTC for several years now. In fact where I have worked for the past almost year is LTC and rehab to home. My resident load is usually 18-24...depending. Many of them are crushed meds, most have wound care (hip, total knee, etc.) one of the halls I frequent has 3 g-tubes You gain speed as you gain experience. Eventually you learn the residents and how they like things, what their daily activities are and what works best. When I first started out in LTC like you I felt overwhelmed & even incompetent at times...I thought there is no way I can do all this in 8 hours, it just isn't possible! But everyday I got a little better at it...except for the occasional days from hell when everything goes wrong & someone falls or dies and shakes your entire day apart, but evetually you learn to handle that too. You will do fine, just take it one step at a time & remember you can only do what you can do. You may stay late the first couple weeks but it will soon become like second nature. Good luck!
  12. by   ndragonfly
    Quote from SuesquatchRN
    I don't have CMAs and I don't give what I didn't pour unless it's someone I've worked with a loooong time and trust implicitly.
    I won't even do that! I'm just too nervous to give a med I didn't pull!!! But I know plenty of nurses who do....
  13. by   Tsatalstrana
    please give yourself one month and believe me you'll become very proficient at it. LPN for 4 years in LTC....congrats on getting a job
  14. by   mlisk589
    So happy I found this thread! I am in a similar position, start my job on Monday on a Short-stay/rehab unit. 50 beds on the unit, and they divide it between 2 or 3 nurses. I'm not sure about number of nursing assistants. From what they have told me, it sounds like getting all the charting done is going to be the most difficult part until I get used to it. I'm nervous but very grateful to have a job! Good luck to you!

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