More than 30 residents to one LPN...?

Nurses LPN/LVN

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I'm a brand-new LPN. I graduated a little over a month ago, passed my NCLEX the next day, and got a job at an assisted-living (AL) facility 2 days after the exam.

I admit it, I feel a little overwhelmed. :nailbiting: I am the nurse for more than 30 residents-- actually, closer to 40 because there's a Memory Care unit at my facility where another LPN works only part-time. When she's not there, I am responsible for her unit.

For the most part, many of the residents are fairly independent. However, quite a few of them have severe mental-health issues (paranoid schizophrenia, for example), previous CVA, Alzheimers, issues with mobility, etc.

I feel like I am a little bit over my head right now. Whenever there is any kind of issue with a resident, minor or major (nosebleed, nails that need trimming, SOB, etc.), one of the PCAs comes to find me to deal with it right then and there...no matter what else is going on. Some things are a priority (SOB) whereas some things are not (nails that need a slight trim), yet I feel like everything gets piled on me. The RN I work with is usually busy with paperwork, phone calls, etc., so I am the go-to nurse. Yesterday I worked for 12 hours because I had to stay to finish reviewing all the February MARs, plus a resident had to go to the ER, and another somehow managed to poop all over her bathroom walls and floor at 7PM (no PCA in sight). I was on poop clean-up patrol.

I am not only responsible for patient care, but I also have to order and inventory all the meds, pre-fill all the insulin syringes, keep the med carts updated, work on the MAR each month, call back case workers and medical providers about resident needs...

I am supposed to be 9-5 (ha!). I work an hourly wage, but I am not paid more than 80 hours per 2-week pay period. If I work less than 80 hours per 2-week period, I get paid what I work. If I work more, I only get paid 80 hours. NO OVERTIME. These past 2 weeks, I worked 100 hours. I worked 20 extra hours that I will not get paid for-- NOT even counting the extra hours I come in on weekends when I am on-call.

Is this...normal? I knew being a nurse would be very busy. And perhaps I am just a jittery new nurse. But I worked as a PCA/clinic assistant for years before nursing school, and I don't recall "burdening" the nurse with every single trifle. Am I crazy? Am I just going through a transition? Just let me know if this is normal! THANKS!

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I've never heard of any ALF that staffs an RN unless that RN is the ADM, or any ALF where an LPN only has 30 residents? More like 100 or more. What state? As far as all those pesky daily calls from the PCAs, do you make rounds when you get to work, so you know what's going on beforehand, and can prioritize things? It'll save you a LOT of time. Other than that welcome to LTC. You'll get the hang of it.

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Okay, I get that you're probably making the assumption that I am complaining for no reason.

With that, I will end it here.

As far as "making rounds" when I get in to work: the moment I get to work, I am running from resident to resident to "fight a fire", as the very moment I walk in, I am being pulled in many different directions. I don't have a second to take my coat off.

But you make me realize: I shan't complain. :yes: I am not here to whine. I was simply looking for advice/assurances.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

In the area where I live, most of the assisted living facilities are staffed with medication aides (a.k.a. medication techs) who pass all the pills and eye drops, leaving the nurse free to do only the stuff that requires a nursing license. Does the facility where you work not utilize medication aides?

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At the facility I work at, meds and eyedrops are passed by PCAs and CMAs.

I guess my situation is normal for an assisted-living LPN. Heck, it sounds like I have it pretty good.:)

I think I just needed to vent because it's been a long week and we're understaffed at the moment. Plus, it's my first month as a nurse. I am sure that over time I will become more familiar with the residents and more comfortable in my routine.

Thanks.

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If you aren't salary why are you not getting paid for every hour worked? Sorry, but I'll be d@mned if I'm working 20+ hours for free. You shouldn't either.

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If you aren't salary why are you not getting paid for every hour worked? Sorry, but I'll be d@mned if I'm working 20+ hours for free. You shouldn't either.

Well, I'm a new grad...I guess I wasn't sure what was normal or not...

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If you aren't salary why are you not getting paid for every hour worked? Sorry but I'll be d@mned if I'm working 20+ hours for free. You shouldn't either.[/quote']

I agree ... I think that is illegal if you are on the clock if you have to clock in they should be paying you and also if you are coming in on call ...

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Okay, I get that you're probably making the assumption that I am complaining for no reason.

With that, I will end it here.

Far from condemning you, I was offering a suggestion to prevent needless calls, which can save you hours of time. As far as fighting fires, an ALF should be a laid-back place to work, unlike a SNF. The fact that you said there is also an RN an staff, I have to wonder about what type of facility you really work at. Like I said, a census of 30 sounds awfully low. Seems that you are in an ALF that takes clients that ought to be in a higher level of care place- ALF clients are not there for nursing care, it's an apartment complex, more or less, that offers basically unskilled services. That said- even in an ALF, 30 patients would be enough to overwhelm any new nurse.

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Far from condemning you, I was offering a suggestion to prevent needless calls, which can save you hours of time. As far as fighting fires, an ALF should be a laid-back place to work, unlike a SNF. The fact that you said there is also an RN an staff, I have to wonder about what type of facility you really work at. Like I said, a census of 30 sounds awfully low. Seems that you are in an ALF that takes clients that ought to be in a higher level of care place- ALF clients are not there for nursing care, it's an apartment complex, more or less, that offers basically unskilled services. That said- even in an ALF, 30 patients would be enough to overwhelm any new nurse.

In many ALFs Nursing care is provided. They accept resident who really need to be in LTC. I'm not surprised the OP is so busy, I'm just surprised anytime Nurses work for free. I'm not talking about you punched out and happened to find a resident who needs a quick helping hand. I'm talking about those who work for hours unpaid. At the end of the day the company you work for only cares about $$$.

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Yeah. A lot of the residents we have at my facility seem to need a higher level of care than one may expect at most ALFs-- catheter care, oxygen therapy, etc.

And also, yeah-- I think the owners are pretty money-hungry. They cut corners whenever possible.

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In many ALFs Nursing care is provided. They accept resident who really need to be in LTC. .

Good point. Many ALFs actually do or say whatever it takes to keep their census intact. They don't have the level of scutiny a SNF has, and things do go on in some ALFs that would curl anyone's toes. Maybe that's what happens in this case, it's an ALF full of sub-acute 'patients', rather than what an ALF ought to be?

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