Help a new LTC nurse

JackdLPN · Jul 26, 2017

30 residents is too much for any nurse especially with no med aide. U should find another job which isn't hard to do at all.

Cactus Nurse · Aug 1, 2017

Ltc- so are just abou 95% of your pt PO? Go room by room, if your pt is in the dining room or bathroom whatever, pop the pills, label the cup and move on. Pass pills first. Take mental notes and only write a note if something happens or you do something. First med lass should be about 2 hours, then start with the harder, more time consuming tx or who ever is not in dining room or activities. If you see someone in their room and u know they will leave, get their tx out of the way first.

Skin checks, as your cna if they see any new redness. If they already have to in place, you've seen that part of their body and can work your way around the rest. Our common areas or injury are sacral and groin. Any other spots the cna would see or even you- let's say a bruise or abrasion on their arm or

quiltynurse56, LPN, LVN · Aug 1, 2017

Does the MAR have colored tabs you can use? If so, designate certain colors for certain times of the shift, then pull out the ones needed for each resident, pushing them back in when given.

Another thing is to create a cheat sheet to use with this, writing down who gets what med or tx when, along with designating crushed with applesauce or whatever your facilitiy uses as well as whole with applesauce.

These two ideas help you know what you need to give at what time. I usually go down a hall in order to give the meds. Sometimes have to find out where they are in the facility if not in their rooms. Meal time meds you take the cart to the dining room or just outside of it and administer meds at that time.

Around here it is not unusual to have 30+ residents.

Hope this helps.

**Elektra6, ASN, BSN, RN** · Aug 1, 2017

Make a sheet with residents name/room #. Depending on shift, write who needs BS checks, tx, who is a crush and who needs VS and Medicare charting. If you work 3-11, make a sweep when you get in to see and do as much as possible. Usually people are coming back from activities at 4 or so. Great time to check VS or a BS. If you have a lot of alert & oriented residents ask them when they go to bed and what time they want their meds. I used to run around after dinner and give pm meds to the early bedtime people first. I would save my night owls/talkers for last to spend more time with them. You can do treatments during your after dinner med pass. If it is a difficult tx, ask the CNA to get you when they are putting the resident in bed. Day shift you can just go up and down the hallway and find people at activities or dining room to give AM meds. Again, try to get their treatments done when they are getting up. You don't want to be needing to check a leg bandage when the person is away at an activity.

Take a deep breath and realize you WILL get it.

ComeTogether, LPN · Aug 11, 2017

Thanks everyone. I just feel so overwhelmed sometimes. I have pts who are supposed to get two passes of the same med (4x day meds) and I end up giving one late and the other early some of the time.

I don't want to take shortcuts but I literally have no choice, if I'm to medicate 30 pts, give nebs, blood sugars, insulin's, eye-drops, treatments and skin checks..... it pretty much works out to less than 10min a pt. with documenting and what not.

Now they have us parking our med carts during dinner and helping to pass trays. I am usually the first one to jump up and help with dinner or feed someone, but we literally don't have time to lose an hour off the floor. Dinner time is when I find a lot of these folks and am able to get them to take their crushed meds. Its just so silly!

Then I get floated to rehab where I have 15 folks I don't know who are all recovering from various surgeries or have had CVAs etc. I can handle that, no problem but they have us doing the admissions, too. The process is so long and archaic, hand writing all the meds.....it takes so long and I just want to scream.

I'm getting a little bit better but my one year as a nurse is about to come up and I"m not feeling "comfortable" as some say happens after your first year.

Thanks for listening.

Cactus Nurse · Aug 13, 2017

You're only a year in, don't stress. m almost at 2 years of being a LPN and I get overwhelmed still sometimes! It takes time to get your routine down. Do you always work the same cart? If so, then just little by little start remembering your tx and try to grab as much as you can and throw it on your cart. BS- maybe have a little chart and run around and check all the BS then go in order after that with med pass and when you get to a BS pt you already have their insulin ready.... Sometimes I do this and I like it, just get all my BS done at once then when I reach their room I can just walk in with their insulin

Remember use your CNA's, they are there to help. Tell them when thy are going to change pt A, to call you so you can do their sacral wound.

Have you been at this same facility for a year?? Maybe you can venture out to a E charting facility, paper charting is so old school, that's for the birds, you will love e-charting, remember you don't have to stay at that facility forever :)

Cream and sugar LPN · Aug 16, 2017

This sounds like my first facility job, heavy med pass, lots of diabetics and neb treatments and to top it off I would have to park my cart at meals as well just like you describe, stop my med pass and start serving trays and pouring coffee in the dining room. I was run down and never got to eat. Try small skilled nursing facilities that are part of assisted living. They are smaller, are more selective on who they admit and take pride in there facilities. It's a world of difference, trust me. Get your resume out there.

JennyLynne72 · Aug 17, 2017

I have been doing LTC for 18 years as an L.P.N. (Just passed my NCLEX B.S.N. R.N.) but I can tell with with certainty it never gets easier. But, that being said you can do it!! You have to make your own plan, it will not follow DPH standards but it's reality. I take all my supplies with me for my treatments and I start at the beginning and work my way to the end. I of course get the stragglers going up the hall randomly, but thats how I do it. If I don't get it done I pass it along that is all i can do and you too. Keep your head and remember why you do what you do!! Good luck