Interesting article about Nursing home & the number of people the LPN & CNA care for

When I worked the 3 to 11pm shift as a new grad, I cared for 30 residents. Although the first couple of weeks were overwhelming due to trying to do everything by the textbook, it certainly got easier as time passed.

Those numbers are typical for a nursing home. As Commuter said, it will get easier with time as you find your groove and what routine works for you.

This might sound selfish, but I take my breaks because I come first. I cannot reasonably expect to provide care to others if I haven't rejuvenated, eaten, used the restroom, and relaxed during break times. No one else is going to take care of me, so I might as well do the self-respecting task of taking my breaks.

Management, coworkers, patients, and their family members do not give a rat's crap whether you have taken your break because they're more concerned with their own interests. And you are correct that cutting corners is one of the only ways to get everything done by the end of most of our shifts.

Good luck to you. Nursing homes can pose serious uphill battles regarding staffing, patient loads, and so forth. However, there is light at the end of the tunnel.

Let me tell ya what I do on my 3-11 shift....starts off when I get in the door the day shift charge nurse starts handing off all of her unfinished CRAP to me to do....like calling in critical labs that came in that am and then they all have to add stupid stuff to the call list b/c I have to call our MD every night btw 7 and 8pm for any INCIDENT REPORTING such as falls etc....ok...so then I start my med pass for which I have 30 people one whole hall of pure skilled patients and then another section of another hall in the bldg for our "rehab" patients....not to mention when admissions come in on my shift or have come in sometime in the am and first shift didnt do the first thing on the admission ..whether its my patient or not I am the one expected to make sure its all done...I often work with 2 older nurses who were hired well after me....(ive been here 9 yrs) and they think that b/c they are older than me they dont have to do as much as me ....that includes pulling a double even though this past year I worked over every single month several times and I have an infant at home who doesnt go to daycare...now thats fun....plus they dont think they have to fill out their charting or do incident reports if needed and they dont think they are responsible for calling the md when something happens with THEIR pt.....so in the mix of it.....I finish my meds and try to do MY charts and my treatments and my skin sweeps plus try to keep the cna's in check on ALL THE HALLS....and take all the phone calls from families, pharmacies and what have you....and then I finally get to do my night time med pass while the other nurses go eat for an hour and read the paper ....never not one time offering to help me out with anything. ITs worse when we have to send a pt to the hospital b/c I always always always get stuck doing the paperwork and calling the md and family and dealing with ems. And on top of that my DON wants me to go into our med room and send back any d/c's or expired meds which is an 11-7 task. On my hall...I have almost all the diabetics and I have the dementia pts with wild behaviors who get unruly at times and I have alot of pts who are attracted to the floor for some reason and so .....I have to do incident reports alot without anyone helping me. I do have some good cna's though from time to time who will come help me with doing my treatments...they will hand me my supplies or hold a leg up or whatever I need ....and to top all the other stuff off....I usually go through our md's box and get his papers ready if he's coming in that next day b/c nobody else bothers to get his papers together. One night dec 26 2007...I ran a full code on a man by myself with just 2 cna's and had 2 other nurses in the place with me one of which was an RN and our former ADON neither of whom helped me. After about a year and a half of this crap, recently I have put my foot down with everybody including my boss....I dont send those 11-7 meds back anymore, I dont do anyone elses charting, incident reports, or admissions and when the families/pharmacy calls now...I page that nurse to come take the call. I have been so burned out from all that extra stress that I had to do something and what I chose to do keeps me licensed, keeps me safe, and forces my coworkers to pick up on their slack and if they so choose not to complete their work then it can only come back on them from now on and not me. Im faster with my med passes now, I am able to do my treatments and skin checks better and I have a minute or two that I get to spend with my patients that I didnt have before. My patients really like me and so do the family members that I deal with. They ask for me by name now and most of them know my work schedule now. I have also stopped picking up day shifts slack too....I nod and smile appropriately when they hand me off their BS....but as soon as they leave I go through it and put what needs to go in certain places where it belongs. Sometimes you gotta quit worrying about everybody else and take time to make your own path and routine that works for you and your patients. It took me almost 2 yrs.

What makes me deathly afraid of nursing homes is that I feel I have not gained enough assessment experience in order to recognize an emergency. In addition, being in charge is not appealing to me. I believe that there should be at least two nurses on all shifts in order to balance the responsibilities, but I noticed as a CNA that the evening and night tours usually had one LPN per floor and a "house" RN responsible for the entire building.

I strongly believe that the elderly deserve better than this. They should not have burned out nursing staff that are too wired to be thorough. These horrible ratios lead to neglect and patient abuse. I do not advocate for patient abuse at all, but I can see how these ingredients can lead to this. I do plan to try and obtain a per diem position in one just to see how I would navigate such a situation, but it scares me to death.

JoAnn,

Put ashesive tape over the thumb that's cracking. And at night before bed home and slather your hands in A&D ointment and put cotton gloves on.

{{{JoAnn}}}

You'll get it down. But yeah, take your potty and meal breaks. We're people, not automatons.

I fully agree....we are people too..not machines...yet mgmt in alot of ltc facilities expect machine like qualities and production. IN my case....my facility has a total of about 80 beds some of which are not supposed to be skilled....our rest home has full total care pts on it....the catch is this...those skilled pts are PRIVATE PAY...so they say....why should I pay 130/day for skilled when I can get it for 80/day? and thats exactly what happens. It takes an act of God to get those pts moved to the halls where they need to be....and then we have to hear families complain that moma didnt have a cna on the hall last night or bla bla bla......in my opinion you get what you pay for in this case....skilled halls will always be covered FIRST....anyhow....its always about a dollar. My DON is well....smart but heartless. She doesnt seem to care about the staff or our pts....she cares about the money and budgets. I cannot tell you how much money I have spent out of MY pocket buying spoons, applesauce, and cups to do my med pass with when they leave in the pm and dont get us supplies. No matter what the nurses say....it never gets handled. or....should I say handled correctly. Alot of times Ive asked myself why in the world I even stay here...but Ive been with these ppl for 9 long years and I can't imagine my life without my pts and their families...even the families that make my guts turn in knots when I see them coming in. When I was in nsg school I never cried about anything..not one time...I watched the rest of my class boo hoo over everything from tests to clinicals to boards....but my first 9 mos of on the job actual nurse work....I cried every single night when I would go home and think to myself...this is not what I went to school for...this isnt what I learned..but I was also pregnant @ the time and very hormonal. My DON made me work multiple double shifts when I was 9 mos pregnant and just said " Well...Im sorry but someone has to do it"...never once offered to get any help in the place..& expected me to be back the next day @ 3...yea right ....like I really did that one lol. She hires prn nurses who NEVER come in! Ive suggested that she do a protocol on prns.....put them on call 2 wks out of a month and rotate it btw 2 or 3 prns..if they dont come in...get rid of them. That was a no go too......we still dont have prns. I dont mind doing my part by any means but after being up for over 24 hours....thats not safe....I have went home @ 7 am with double vision, dry eyes, and hallucinations from no sleep and wondering if I gave everything I was supposed to. Drives me crazy. Aside from the bad ..I still do love nursing homes. I figure that my pts will outlast my mgmt...they have for 9 yrs haha. Another thing that was hard for me was transitioning from cna to nurse and being my former cohorts supervisor....they didnt want to listen to me...they expected me to do their work for them.....however...now that has somewhat improved. New nurses in ltc...stand your ground and learn all the policies and procedures that you can so that when other nurses or cnas try to run you to the ground you'll have the upperhand and the knowledge to back yourself up. Be good to yourself.....rejuvenate with a coke and a candy bar and get back to it. Organize time wisely. A little tip ....its worked for me....when I come in...after report is done...I get out all my charts and line them up.....for when I get a chance to actually do them...I hit them in 1 big shot. You never know when someone might fall or choke or get a skin tear and cause you 45 mins of paperwork misery. Hope my tip helps a little.
Ps....colored sticky notes are a wonderful creation! I use them all the time to remind me to go back to something or chart something else that is extra or new etc etc.