Help! is this Normal/legal?

[LegginMF]

Hi guys I have had my license since July. I was working home health but was bored to death. I got a job at an assisted living facility. I was reading other post for assisted living and think something is wrong. So if anybody can answer some of the following questions I would greatly appreciate it.

My job description/ duties.

I work in the Alzeheimers/ Dementia ward. (basically the charge nurse)I have three seperate halls. I have a total of 52 residents. We have only 1 (one) LVN per shift for all three halls and two RA's (residential assistants) per hall, No RN. But have Ph#'s to call for questions. All doors are locked and alarmed. My residents range in ADL's from a gentle reminder to needing to be dressed and fed.

MY job duties:

I pass all of the meds to all 52 residents according to the MAR. They all take tons of meds. If I don't get any interruptions I will finish 8 a.m's about 11:30 (but I am constantly having to stop to answer the phone, speak with family etc..)

I do all of the BP's, BS's and Pulses and insulin of those who need them.

I answer the phone and make calls to the family when the residents want to speak with them.

I do all of the initial assessments and put together the charts for new residents.

I call orders for refills on meds, talk to the D.R.s and families.

Keep track of who is in or out of the facility, who they are with and why.

I monitor and pass meds for daycare and respites and give the family a report when they pick them up.

If a door alarm goes off I am to stop what I am doing and see where and why it went off.

I have to sign for all meds and equipment being delivered

We use focus charting, so I usually only have to do notes in 10 or 15 charts a day.

I have to coordinate care with VNA/hospice/family/M.D..

I do all of the wound care.

If somebody calls off then I have to find a replacement for their shift.

Not mention all of the general paperwork that would keep a normal person busy for hours.

I understand that these are all in my scope of practice but isn't one person being responsible for 52 pt's (plus any extras for daycare and respite) a little crazy? Can they have this pt load because they are called an assisted living instead of a SNF? I see some of the others doing assisted living only have 6 pt's!

Oh by the way this is in California.

[CaPsychLVN, LPN, LVN]

I, too, have 50 patients in a SNF. I give out 262 meds in "2 hours" (really 3.5 if I don't have interruptions). Some of the meds are in cards and others (vitamins & aspirin/tylenol) are in bulk. I take B/P with a manual cuff on about 20 patients. I do finger sticks and insulin, charting, weekly charting, med re-ordering, phone calls, etc.

I, too, as a fairly new nurse (May graduate) didn't realize that this was not normal. In fact my DON just criticized me for not knowing by face all 99 residents (2 halls, one which I work less). Perhaps, I'm not a bad nurse. I love some of my residents and it is so hard to be so torn between time with them and getting everything done.

Any suggestions appreciated.

[HotmaleSPN]

I got one of those cool electronic wrist BP cuffs from CVS drug store, it is a great time saver, because everyone is always using our electric cuffs, and there is just no time to do a manual on 60 patients. ANd it fits right in your pocket, highly recommended.

[LegginMF]

Last Sunday I got a call from one of the courts to come over oh and please run! When I got there I was told the resident had just slumped over into her dinner plate. She was non-responsive, cyanotic, not breathing and no palpable radial or carotid pulse. I was freaking out because I couldn't remember if she was full code or DNR. Thank God as we moved her to the floor she started breathing again on her own. Pink is such a beautiful color! I got in trouble because I don't have everybodies resussitation status memorized. We are up to 56 full time residents and about 15 daycare/respites. I made a list and walk around reading and repeating. Perspnally I think the easiest and safest way is to have a little red ribbon on their shirt for DNR that way you know at a glance what their status is. But was told no because it interferes with privacy and this is where they live. So back to my list I go. Jody (by the way I am job hunting, scared of losing my license).