More than 30 residents to one LPN...?

[fiddlercricket]

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. 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!

[vintagemother, BSN, CNA, LVN, RN]

I'm a new grad in an ALF, too. No more med aides. 36 residents to 1 LVN. Phone calls to families are reqd for change of meds, med refusals, scratches, incidents, etc.

You will get more efficient and fast within 4-5 weeks. I did.

My challenge is meds not available because they aren't ordered, also, no Follow up by other nurses staffed on my days off or by nurses on the other 2 shifts each day.

I was asked to sign a med error report because I didn't give a PRN OTC med because it was not available because house supply was not available and family failed to bring it in.

I was in 1st week of training when order was recvd. 4 wks later resident developed pneumonia and then I was blamed, in spite of the fact that there are *several* outstanding orders with no meds available. My supervisor hinted that my license is on the line.

Narc counts are inaccurate and my supervisor tried to tell me they weren't, the pharmacy must have given wrong amount.

Anyone have any ALF tips for me?!! (Sorry to hijack thread...I thought it related to your post. )

[systoly]

to answer your question:

no you're not crazy, but i do think you

could improve your charge of the PCAs

if you're busy with a higher priority task and

someone needs nails trimmed, thank the PCA for

bringing it to your attention, but instruct them to

remind you at a later (be specific) time or have them

leave a note at a specific area at the desk

the note needs to be specific and signed and dated, etc.

it is the PCAs responsibility to ensure that pertinent pt.

info gets passed on properly and efficiently and not

through the bathroom door (figuratively speaking)

[LaLaEm4]

Hi Vintage,

I'm curious about your experience in ALF...I interviewed today and asked to do an unpaid shadow day (tomorrow), because I'm concerned about the 36:1 nurse ratio they told me about. I have worked in LTC, passed meds to 20, so this number seems daunting to me. Are the residents MAR's as heavy as those in LTC? I really want this to work out but I'm not willing to stress over my license while taking care of a number that seems way too high...no med aides, either.

Thanks!

Em

[vintagemother, BSN, CNA, LVN, RN]

Hi I just saw your post. Let me know if you still have questions...I see you started your job about a week ago. How's it going?

I have moved on to greener pastures, still in LTC but different population, better management and systems already in place.