New LPN in LTC and I am drowning

  1. 1
    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 - and I cannot even manage (on average) 20 patients. I work 2nd shift - I get my cart organized, label which patients on my hall get FSBS and skin treatments, and I finally thought I had it - I was able to start charting at 7pm one night last week. But then there was a new admit. Then a fall. I spent at least 45 min. getting the fall situation under control and montoring the patient, then I have another patient yelling at me (yelling - literally - NURSE! NURSE!) which upsets the other dementia/alzheimers patients on the floor - so one or two of them start screeching too - in the middle of all that I have a CNA come tell me one of the alzheimers patients took their clip alarm off their shirt and threw it across the room under a bed (we are out of bed alarms - hense the fall with another patient) - and while I am monitoring the fall patient I have another patient telling me he is in pain and will wait outside for me - I told him thats fine, I will be out in a few minutes, I had to monitor a resident that had fallen.

    He gets upset with me - starts badmouthing me as he wheels away because I dont drop everything and give him his pain med - so after I am done sorting out fall risk person I have to go sort things out with irritated pain med person - then man with alzheimers keeps trying to slide out of bed and by then it is about 830 and i havent started my 2nd med pass. A new patient doesnt trust our facility and requests that I bring in each of the packets of meds that I am giving her because she doesnt believe that I am giving her the right thing - so that takes 20 minutes because she is new and I have to go to the other side of the building to receive her meds from the pharmacy drop off that happened at 7 as well.

    I dont want to compromise patient saftey - but I am not getting off my 2nd med pass until after midnighte - the 3rd shift nurse has been there over an hour and its time for him/her to pass meds and I still have the cart because I dont want to compromise a patients saftey because of other issues I had to deal with earliier in the evening.

    I am learning a lot. I LOVE my residents, but I dont know how to improve on my med passes. I am even multi taskiing and doing more than one thing while I am passing out meds (vital signs, assesments skin preps) while I am in the room with one patient - and I am not staying and talking to them for any amount of time at all. I leave every nite at the earliest midnight - on Friday I didnt getoff work until 230. And I still missed stuff - or I feel I did anyway. I just dont know how to get it all done and not compromise the patient saftey. People keep telling me I will get into a routine - when? Things are always going toc ome up. Its never gong to be smooth - so I need to adjust. Any advice/support is appreciated. Im drowning.
    Last edit by Joe V on Jul 8, '12 : Reason: spacing
    KrystelMychelle likes this.
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  3. 12 Comments so far...

  4. 1
    I think you are doing an amazing job. I can not believe how you did with that many patients and that many things happened.. I only have 4 and sometimes 5 and I feel like drowning if something happens that requires extra time or attention. I learn that there are good and bad days in nursing and what I do is after a bad day, I will think about it, ask myself "What could I do to be better" and learn from it. (Of course I still feel like a horrible nurse but think about it: there is nothing I can do or go back to do.)
    KrystelMychelle likes this.
  5. 0
    Quote from lifeisgood2012
    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 - and I cannot even manage (on average) 20 patients. I work 2nd shift - I get my cart organized, label which patients on my hall get FSBS and skin treatments, and I finally thought I had it - I was able to start charting at 7pm one night last week. But then there was a new admit. Then a fall. I spent at least 45 min. getting the fall situation under control and montoring the patient, then I have another patient yelling at me (yelling - literally - NURSE! NURSE!) which upsets the other dementia/alzheimers patients on the floor - so one or two of them start screeching too - in the middle of all that I have a CNA come tell me one of the alzheimers patients took their clip alarm off their shirt and threw it across the room under a bed (we are out of bed alarms - hense the fall with another patient) - and while I am monitoring the fall patient I have another patient telling me he is in pain and will wait outside for me - I told him thats fine, I will be out in a few minutes, I had to monitor a resident that had fallen. He gets upset with me - starts badmouthing me as he wheels away because I dont drop everything and give him his pain med - so after I am done sorting out fall risk person I have to go sort things out with irritated pain med person - then man with alzheimers keeps trying to slide out of bed and by then it is about 830 and i havent started my 2nd med pass. A new patient doesnt trust our facility and requests that I bring in each of the packets of meds that I am giving her because she doesnt believe that I am giving her the right thing - so that takes 20 minutes because she is new and I have to go to the other side of the building to receive her meds from the pharmacy drop off that happened at 7 as well. I dont want to compromise patient saftey - but I am not getting off my 2nd med pass until after midnighte - the 3rd shift nurse has been there over an hour and its time for him/her to pass meds and I still have the cart because I dont want to compromise a patients saftey because of other issues I had to deal with earliier in the evening. I am learning a lot. I LOVE my residents, but I dont know how to improve on my med passes. I am even multi taskiing and doing more than one thing while I am passing out meds (vital signs, assesments skin preps) while I am in the room with one patient - and I am not staying and talking to them for any amount of time at all. I leave every nite at the earliest midnight - on Friday I didnt getoff work until 230. And I still missed stuff - or I feel I did anyway. I just dont know how to get it all done and not compromise the patient saftey. People keep telling me I will get into a routine - when? Things are always going toc ome up. Its never gong to be smooth - so I need to adjust. Any advice/support is appreciated. Im drowning.
    I am a new nurse as well (in my 3rd month) and on average I am responsible for 25 patients so I understand! If your facility uses bingo cards, see if you can mark the cards in the top corner so you know which ones to automatically pull at what time (Write "6 am" for example). And then take some extra time whenever you have down time to sort the meds for your shift towards the front so you can pull them quicker when it's time. Of course you will check with the MAR to ensure there were no new orders since the last time you were there. This all works better if you work the same floor and shift everyday.*
  6. 0
    When I first started LCT it was very normal to stay an hour late. By about my three month mark it was much more manageable. You learn how to speed up, with out hurting rts. Of course a death, a fall, an admission ect will throw everything off. I remember being so excited the first night I got out on time.

    I think in time you will find you grove. Best of luck
  7. 0
    I think it sounds like you are doing a wonderful job. At my facility, I typically manage care for 25-30 patients. I am going on my 3rd month in LTC now and I can say that 30 patients can still be a lot to juggle. However, my facllity has a med aid passing the majority of meds unless our census drops. If you are passing all of your own meds and doing all of the treatments, you are doing great for your first month I think. However, since I don't know how your facility is run I would suggest you ask your DON/fellow nurses for feedback. Ask for their input on how they pass meds more efficiently/manage their time. My coworkers have given me some of the best advice.
  8. 1
    You've been there for a month. Cut yourself some slack. You will get faster as you get your routine down.That said....alarms don't prevent falls. They make noise and irritate the residents. Don't make a habit of writing on the cards of meds. In some states it's against the regs.As for the woman who wanta to see all her meds, get an order for her to self-administer if she's capable. It'll save you and your co-workers time and aggrevation.
    LTCangel likes this.
  9. 2
    You will get better, but believe me when I say that the problem is NOT you. The problem is the unrealistic and unsafe amount of patients that you are assigned to. Do not feel bad.
  10. 0
    I feel like I have walked in your shoes a few miles. The more experienced nurses will tell you it will come to you in time. I know this seems impossible but it is true. One day before you realize it things will fall into place. This happened to me while I worked over Christmas. Holidays. Those two days were the best days I had since becoming an LPN the Aug. of that year. You will learn little tricks that will help your med pass happen quicker and then those tricks will click into order and things will smooth out. This all seems impossible but I say again I feel like I have walked in your shoes and wandered down that path. Best of luck to you!!!
  11. 0
    Thanks you all. I just feel like my confidence is shot. I know it will get better - I just get so concerned about putting a resident in danger. Most of the nurses there are seasoned and get very frustrated with how long it takes me - I know we all have to start somewhere - but they dont remember that. My license is on the line and I would rather take longer now and get my routine down and frustrate someone than put my residents at risk of an error. I can take a little mouthy-ness here and there from impatient people - I cannot take losing my license. Most of the time I do ok, most of the residents seem to get along with me and most of the time I have a fairly good attitude and want to jump in and learn how to do new things. All of those are positives. And I just need to hold on to those during this time. I am simply overwhelmed which is apparently normal for anyone in LTC no matter how long they have been there. I have learned a lot in 3 weeks too. I am proud of myself for not walking away. I truly hope it gets better. Thanks again.
  12. 0
    I just want to chime in - sounds like you're doing ok. The learning curve is steep.

    Do your CNAs not do vitals?

    I worked LTAC starting out - my typical shift went Pain meds. Assessments (including skin) Check MARS sign off vitals Pull meds. HS Meds. Wound Care. Pain meds. lunch and potty break. Turning. Charting. Turning. Pain meds. Pull AM meds. AM meds. Charting. Breakfast. Go home.

    Psych is much easier, in terms of the work load. Most days.


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