New LPN in LTC and I am drowning - page 2

I feel so ashamed hearing numbers like 30 and 50 per nurse - I have between 18 - 22 patients, am going into my 1st month on the job and I am drowning. Is this not the career path for me? I worked so hard to try to find a job... Read More

  1. 2
    Quote from JZ_RN
    The problem is the unrealistic and unsafe amount of patients that you are assigned to.
    I strongly agree with JZ_RN.

    About 5 years ago I took a night RN position in LTC. I had always done ER & OB and was pretty efficient, but in my 'old age' I wanted to try something slower pace. I found very quickly that LTC was not slower pace.

    Med pass was overwhelming. 40 pts/nurse. The nurses who knew the residents well had a huge advantage. Trying to identify residents by their photographs in the med-cardex was a joke since hardly of them looked like their picture and they were all over the place when i needed to pass meds....dining room, etc and many didnt know their name.

    I got very frustrated with other nurses advising me to take unsafe shortcuts and I gave up when I found a bunch of pre-filled insulin syringes on the insulin cart. (pre-filled by another nurse, who apparently thought this was quicker than properly doing the sliding scales that were ordered.) I reported that as part of my resignation letter, but my understanding was that this was not so unusual there.

    I hated every minute of my LTC experience.

    If a resident was really lucky, they got 10 minutes of nursing care per day. BTW, how much is Medicare paying for that 10 minutes? $300/day?

    Because of this experience, when my mother was in a rehab for 2 weeks before she died, I stayed with her every minute so she would not be neglected/abused. I know some, or even most are not like I experienced, but I was so traumatized!
    Not_A_Hat_Person and JZ_RN like this.

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  2. 0
    Oh dear I feel so bad for you! I am LTC too and a pretty new nurse. I understand how frustrating it all is. I more often than not cannot get done in time either now. I have been put in a permanant hall that is a mix of LTC and rehab making it a great big zoo!
    Speed really does come with time. There are just to many new things to learn in a very chaotic environment. You need to give yourself time to become familiar with everything. It is not you. it is the nature of the job.

    One of the things I learned real quick was to prioritize in order that I can "hand over the cart" at the right time and then finish all my own work after the night shift nurse takes responsibility for the hall. You do not need the extra stress of having coworkers angry at you for making them start late and getting them behind.You also can work faster on the other stuff once another nurse is in charge of the hall.

    For example if "crap hits the fan" and someone falls for example. I will ONLY do the absolute most essential things required at the time it happens. In our facility we must call "Dr rehab" to room whatever" so the RN super comes to "assess" the patient.Help get them off the floor, vitals, call family, call or fax the "FYI to Dr and save the rest for later. I keep my vital sheet with me on the med cart and the patient stays in the hall with me so I can keep getting my vitals as I do med pass. If they have a skin tear etc again bare minimum. cleanse apply bacitracin cover with clean dry dressing. Worry about the paper work part later.
    Do not try to do treatments while getting meds out. if you must stay late to finish all your own work, again better to finish treatments after you handed off the cart and the next nurse is responsible for the hall. They don't need you to be done with treatments for them to get started with all their own work.
    It takes a little time to learn your residents too but I have also learned to use my census sheet to make slash at each persons name after giving their meds. That helps me ensure I do not miss anyone and can more safely "jump" to the ones that I need to take care of first to avoid problems with later. For example if I know a patient takes seroquel or ativan routinely I make sure they are at the top of the list on who gets meds first. it is less likely they will become behavioral and wind up on the floor or something. As unfair as it sounds I also am quick to jump to the "trouble makers" that are more demanding right after any on psych meds of any kind. it also prevents problems interrupting the med pass. You know like taking off and needing chased down in a temper tantrum because you didn't drop what you were doing and get them what they want first. Little tricks like this will become more and more apparent to you as you learn your residents.

    Where is your RN super while you are drowning by the way? In our facility the RN super is suppose to help the LPN if crap is hitting the fan. For example, a fall they should be calling the family Dr etc for you so you can get back to med pass as quickly as possible. I can see our RN super getting in an awful lot of trouble for not helping a brand new LPN that has only worked as a nurse for less than a month!
  3. 0
    Thanks again all - I appreciate the support. I am really glad I am not alone in this. As sad as it sounds that this seems to be the norm, I at least feel now that I am doing the best that I can and that takes some of the pressure off.
    Yes - my CNA's are terrific - they do the turning of patients and do vitals - there are some meds that require (based on the MAR) to have BP and pulse or just pulse done before I can give them - I have a seperate pulse ox that takes pulse but sometimes it doesnt always pick up on certain patients so I have to use the BP machine. My supervisor has helped me - she has done one med pass with me to try to help show me how to prioritize - she normally does all the admissions and she has been doing all the paperwork for me (except charting) so I can stay on the floor and get used to assessing my residents and get used to their meds. However she has 3 other halls that she is in charge of - 4 total - with 3 out of 4 of those halls having new nurses in training (I am the only new newbie - the other 2 are RN's who have experience but are new to the facility) and they have sometimes double the amount of patients I have to pass meds on plus she has to help with getting meds checked in when the pharmacy comes. She rarely leaves more than an hour before I do to make sure I am only left with charting to do. Honestly in this situation I am not sure how she could do better - but I dont know because I am just starting my 4th week. Couldnt she get in trouble for not helping the other 2 new RN's too? I am thankful I am not afraid to ask questions - I have even asked the girls (the 2 new RN's) what they do to help them go faster - one of them pulls 6-7 of the residents meds for the 2nd med pass before she goes to dinner, writes on a clear cup and puts them in her drawer then never goes offsite for dinner. I am not going to do that. One leaves the top part of the cart unloocked so she doesnt have to keep reaching for her keys to unlock it and keeps the cart turned towards the wall so residents wont get into it - I am not going to do that either - if state were there for either of those things I would get in trouble. I am up now because I am just sick to my tummy about going in today - I am trying not to think about it - but I feel like all the joy is being sucked out of what I thought nursing was - I know part of it has got to be my atttude and perspective on things - which I am trying to adjust - I just simply feel overwhelmed. My supervisor was in the middle of doiing a new admission when the fall occured - she couldnt come and assess the patient - she came later - but I couldnt bring him out on to the hall with me for the first hour I monitored his vitals every 15 min. because he was so scared he had fallen. I did stay down towards that end of the hall and finsh my med pass down there, but the residents that were up at the 1st of the hall got irritated with me even tho I explaiined the situation to them. I dont know what else to do - I really really dont. The whole situation is just dishearteniing to me. I love my residents and its not their fault - I just always felt nursing was what I was led to do - its whats been in my heart to do - and now it just makes me sad. And after working so hard to get here to be a new nurse I am disappointed that I dont have a better attitude about things and that I am constantly feeling sad. I guess I should try harder to count my blessings and just be glad I have a job.

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