shiningstarinpa 1,068 Views
Joined: Feb 17, '13;
Posts: 16 (50% Liked)
; Likes: 25
If you want to be successful as a manager, I suggest you "catch" your staff doing things right. Let them know you appreciate their hard work. And be willing to help someone everyday--even if it is just for 5 minutes. Too many managers walk around looking for everything to be wrong, and with an attitude that they are to good to help anyone lower on the totem pole then they are.
Don't know if this is the kind of tip you were looking for---but it is what your staff wants you to be.
I work in PA in ltc. At one point the census in our building was getting pretty low. The DON was talking about the possibility of having an lpn in charge of the building during the night shift if our census fell below a certain level. I don't remember what the number was, but there is certain patient load you can carry without an rn in the building. There has to be one on call and able to reach the building in a certain amount of time. Not sure if this helps since I don't know the details, but at least you know that in PA it is possible to have an lpn in charge of a building.
You will find out that when a resident is admitted they will go to wherever there is an empty bed. If roommates don't get along for whatever reason they can change rooms later.
I have seen roommates of different cognitive abilities get along very well. Sometimes the alert, oriented resident gets a sense of purpose by "watching over" the cognitively impaired resident. And the cognitively impaired resident can get extra attention from a roommate.
I have also seen many problems between alert, oriented residents sharing a room.
So finding people who make good roommates is not predictable basing solely on cognitive abilities.
I have about 25 residents also and it takes me between 2-3 hours to pass meds. It is closer to 2 hours when everything goes smoothly--residents in their rooms(not the dining room or therapy), residents ready to take meds(not needing to be toileted, not busy with whatever) and staff is not stopping me (therapy asking questions, activities asking about residents), and staff not needing help with direct care. When all the above happen and you maybe throw in a fall, or change in condition it can take 3 hours or more. So I guess there really is no average.
I have been in ltc for a long time and the lpn on the hall has always done the admission assesment. All our assesments are done on the computer so I go in to the assesment print out a blank copy and take it to the room. This way I know what to look for and what questions to ask. This way when I get back to the computer I have all the information I need.
When I started in long term care over 20 years ago the average age of the residents on my unit was probably in the neighborhood of 75. Now on the unit I'm working the average age is probably around 65. I have several "grandmas and grandpas" but more of my residents are to young to retire. They are there either because of drug/alcohol abuse or extreme morbid obesity. Also I have several younger residents who are there because of mental health issues. Unfortunately in my area there are not enough group homes for folks with MH/MR issues---so they end up in nursing homes, where we are not able to truly meet their needs.
I doubt they switched you to the acute side because they didn't think you could handle the long term side. Sorry to say, but I don't think they care if you can handle it or not. Face it, you are the "newbie" and will be moved to wherever they need you. The nurses who have been there longer probably refuse to switch halls---no matter what.
As far as trying to speed up by "memorizing" the meds so that you can fly through and just skim the MAR, forget it. Even on long term units meds do change. You don't want to find out after you gave the meds that the dose was changed, or the time was changed, or that the med was d/c'd. And don't count on the nurse who received the orders to change dose-time-or d/c a med to have either marked the box with the change or to remove the d/c'd med. People do get busy and sometimes miss a step when orders change. So take your time passing meds. Just try to avoid distractions--residents wanting to chat--other staff asking you questions which could wait. In other words, you know what you need to do for safety. I would rather run a little late and give the right meds---then be done early and worry about errors.
You are lucky. My facility is 4 hours away from our Omnicare pharmacy. We receive 2 deliveries Mon.-Sat. one around 8-9 in the evening, the other 3-5am. "Stat" orders---forget it, we are told to ask for a "drop ship" from local pharmacy (through Omnicare). This can take 12 hours---if they O.K. it. So I can honestly say I wish we were only 45 minutes away.
Yes, this is the reality of ltc. Short staffed, call-offs every shift.
My advice to you would be---don't try to change things---you are the new one in town, and the staff there really do know what they are doing. They will resent you if you walk in with the attitude that you know everything.
Second--don't be afraid to ask questions---your lpns know their patients, the families, and the MDs. Most will gladly help you--and appreciate your asking. This shows you appreciate their skills.
Third--just take it one day at a time----you will find your own way of doing things.
I agree completely, but it is not only a problem with patients at home. Had a resident in ltc facility on 4 bp meds. Wonder of wonders bp would by 80's over 40's. MD would stop all bp meds., and not order any bps be monitered. Checked bps weekly anyway---nursing judgement. Bps started to be 180's over 90's. MD put back on all 4 meds again, without perameters, or even an order to moniter bps. Went through this scenario 3 times before finally getting MD to order one bp med with parameters. Resident doing well at this time----but if not for constantly updating MD who knows what would have happened.
I have been a nurse for many years, and no I don't memorize anything. I carry my report sheet with me at all times and write one word reminders with times. I call this my brain, and if I misplace it, forget it, you're not getting a very good report. So my advice is to carry a little notebook with you and develop your own shorthand. Don't rely on memory alone, you are sure to write the wrong thing for the wrong person.
Answer only the question that was asked. Do not volunteer any information. If you don't kow the answer to a question be honest---tell then you don't know but you will find out---then do it---find out and report back to them.
I've been in ltc for almost 25years and I hate to say it but I'm tired. I'm an LPN on a 20-25 bed unit working with 2 nursing assistants. I know this sounds like a small unit to some of you, but it is the behavior of the residents that make it so hard. I have 2 residents that frequently need 1:1 (remember there are only 3 of us on this unit), so I am often passing meds while having a resident sit in a wc by my cart, or having a resident behind the desk while I do my charting. I also have a resident who likes to throw food, so I end up with my scrubs decorated to the point that my RN supervisor asked me one time if I wore my scrubs while painting because of all the splatters. I have 2 residents who are very physically agressive, and feel it is a good day if I leave without a new scratch or bruise. On top of this I have a resident who will turn the call bell on--and if not answered within 30 seconds begins to scream like her hair is on fire. The rest of my residents are the typical mix of physically/mentally/cognitively impaired adults we are all used to.
Despite all this, there are still moments that I would not give this up for the world. I do love my residents, I just don't know how much longer I can physically/mentally take this.
Any advice would be greatly appreciated. Don't tell me to talk to the supervisor/administrator---I've tried, and was told if I can't handle it I should look for another job.
If state said you need 3, then you need 3. You can call the state anonymously and report low staffing. They have to investigate. That should get the admin attention. If not, I would look for another job......don't lose your license for this place.
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