For all who have or do work in a nursing home....

  1. for all who work in a nursing home, i am just wondering how you can possibly provide the best care to the clients you serve. i work in a home care facility, and at the most, i have 16 pts to care for. with these 16 patients, i pass medications, administer tube feedings, get blood sugars, give insulin, do breathing tx's, catheterizations, and apply creams. thats not counting all the charting and everything else involved. i'm working non-stop (and have actually gotten quite fast) until around 1930. that gives me about 30 minutes for lunch, if everything goes well. well, at 20:00, it's time to start the next med round. i feel extremely busy all day, and i only have 16 pts. i've heard in a nursing home you can have up to 40!!! how in the world do you actually have time to assess these clients and administer all the medications on top of that?! it seems as if the only thing you would have time for is popping pill after pill, and popping pill after pill again. isn't that all you would have time for? do you just get really fast at it and grow super human capacities?

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  2. 14 Comments

  3. by   weirdRN
    I have learned to multi task and be super organized. Some days I am the Pigeon, Somedays, I am the statue... sometimes things go great, sometimes, not. Mostly, I make lists and check stuff off as I get it done.
  4. by   k3immigrant
    i tried a rehab facility as per diem & the load is only 10 patients but my gosh, there's no way you can do everything. i finished passing my 9am meds by 11am which it's time for 12noon meds. the reason it took me that long, i stayed w/ the pt until they take their pills & explained each med action. i am not a new nurse & it has been my habit to explain med action & what to watch out for. i quit after 3 weeks & preferred working in acute setting. whenever i get a pt admitted from a nursing home/rehab facility i always get the picture on how these nurses in nursing home/rehab facilities work very hard w/ a very difficult patient load.
  5. by   care4u247
    I currenlty work as a nursing supervisor in a nursing home and over see 128 residents. When I have a nurse call out I work on the floor. I have 32 patients and yes the med pass is endless, not counting doing all the treatments, dressing changes, creams, resp. treatments and so on plus the charting and doctor calls. It is not easy I feel like I am just pushing pills. That's on a good night, what happens if something goes wrong with one of the resident's like a fall or someone has to be hospitalized or an admission or 2 comes in than that really stresses your night. I feel your concern, I don't think it is going to get any easier though.
  6. by   miracle1986
    I worked in a skilled nursing home as a charge nurse, doing all the job requirements you were doing, only I had 32 beds and 2 aids on my afternoon shifts. Then I started getting mandated on 2 wings-midnight shift. Having 64 patients and 1 aid per wing. NO, we cannot give the proper care. I say back to hiring the "orderlys"--pay the big guys to do the lifting. Pay more and get more help with aids. But the owners of the homes won't pay. That is why they have the bucks and we have the bad backs. We can't change the system, just do our best. OH, I quit the second night they mandated me. I now, am almost finished with my R.N. and I will go back to that facility and help make some changes.
  7. by   Liddle Noodnik
    Quote from WhimsieRN
    I have learned to multi task and be super organized. Some days I am the Pigeon, Somedays, I am the statue... sometimes things go great, sometimes, not. Mostly, I make lists and check stuff off as I get it done.
    ha ha, love the pigeon/statue analogy.

    There was no way I could keep up with tasks on days or eves, IMPOSSIBLE! and sometimes on nites too. At least on nites I could pace myself somewhat. There was as much, if not more, work to do since there were fewer nurses (I was often "it"). There were fewer emergencies. There were fewer docs and family members to short out my brain (I swear I have a.d.d.).

    I could spend a little more time if necessary for a patient who was scared or dying, and be with family members a little if they were there, without thinking the whole time that "OH MY GOSH, I am going to be late on my meds!" because I didn't have 800 of them to give in an hour! I also liked being able to work with the CNA's and be more of a team. To do days and eves is just too scary for me to fathom, since one thing forgotten or casually done could have dire consequences

    Not too encouraging, am I??

    I do think that asking more seasoned nurses how they do it, borrowing their template for getting and giving report and keeping notes for yourself, etc. are very helpful.
    Last edit by Liddle Noodnik on Dec 10, '06
  8. by   kieta2006
    Hi i work in a Asst.living for a non-profit organzation for Lutheran senior service in MO. and we have the same problems with all the med pass,admissions,recaps,3months H&P's,lab reqs.,and now they want us to pick up a whole new positions in laundry and told the people in laundry that they are not needed anymore.The nurses there are only CMT's we are very unhappy we talk to the upper superviser and they told us if we dont like it we can always move on.It 7 CMT's and 1LPN all the cmt's has been there 6yrs and longer and don't wan to move on is there anything we can do to fight this we start JANUARY we tried EEOC,Labor board, but they wantmess with them so i know what u mean when u say were over worked with no pay. We have 40 resdent and 117 people in independent living
    Last edit by kieta2006 on Dec 28, '06
  9. by   not now
    Honestly, I sometimes wonder how I make it out in eight hours with 53 residents on my side. I've been there almost a year and a half as an LVN (two and a half years if you count my CNA work!).

    Where I work a majority are so confused they don't care what the pill is for or no matter what I say it's for all I hear is "Is this the stuff for my mouth? Ok, I'll take it. I think it's working.." (confused 80 something who took nystatin for a few days and thinks her KCL is her nystatin (am I spelling that right? It looks wrong)).

    Then I have some who pick at the pills and ask me which each is for.

    I make time for everything, I don't know how. Granted the TX are done on the AM shift (I work PM) by the TX nurse so all I have left to do it check TED hose and elevate legs. Heck I even help the CNA's clean wheelchairs when I have time.

    I worked in a Subacute unit for a few months thinking it would be wonderful. I learned a lot but was bored out of my mind. Seven patients all vents and GT's. I would do nail care, position, check restraints, shave, put lotion on my patients...and I was still bored out of my mind by midnight.
  10. by   4everlearning
    I currently work in a skilled facility and I am the only nurse in the building at noc with 5 cna's. I have 111 residents at the moment.. no, it's not a typo..111. No med tech, I have about 15 scheduled meds to give, not counting the 3 gt's and iv's at the moment, and my skin assessments, and the medicare hall.....etc, etc... and this is pretty much the norm in the area, as I have checked into various other employment opprotunities. I'm about ready to call it quits as far as nursing is concerned. thank goodness the aquity at the moment is not to high!!
  11. by   TheCommuter
    I work the long term care unit of a large nursing home and have 18 stable geriatric patients. I quickly pass their medications, obtain blood sugars, perform simple treatments, and chart. I usually have plenty of time for extended lunches and almost always leave on time when my shift is over. I admit that some aspects of the care are substandard, but we truly do the best job we can with what we've been bestowed with.
  12. by   SitcomNurse
    Your shift sounds like my old 3-11 shift. Meds, dinner, treatments, my meal at the desk :smilecoffeecup: (its 830) meds, 15 min pee break, charting.

    But, it all gets a rhythym, even where you know at which pt. you can hold off to take care of the guy/gal that fell, or is readmitted...or newly admitted.

    I only had 25 pts. but i made it work, somehow.

    Also, when you know your patients, you can easily recognize that there is a change today that wasnt there yesterday. Daily assessments are full when ill, and quick when well.

    As a day nurse with 30 patients, I gave my CNA's autonomy, I assessed everything they asked me about(they are my eyes) and after 3 days of treatment, I let them apply the miconazole to groin, dermagran/zinc based ointment to abraided/closed red skin, emolients, shampoos..anything that didnt need a bandage! Any change in condition, they made me aware. Is the rash getting better? You bet I looked myself after 7 days. so they had 4 days to be 'in charge" of their patients wellness. And then ask them their opinion... Utilizing the ancillary staff is utmost important in situations where you dont have enough time.

    Its not impossible, with the right frame of mind. :innerconf
  13. by   kdmmomRN
    I tried to work in nursing home once. I was training to do it PRN because I was needing more hours. I was working part-time in ER. I hated the nursing home job. I was on orientation, trying to learn my job. I didn't get to know my patients historys because there was no time. All I did was pass pills, & give what treatments I could. I didn't know what pt.'s were coming or going from the facilty. I had 2 halls(40 pt.'s). It was awful. The facility didn't want to give me more than 2 wk.'s orientation. I felt patient care was being compromised. I quit. I worked too hard to get my license. There were so many oppurtunities for mistakes to occur. NOT worth it!
  14. by   Patti 2nd gen RN
    I work on a rehab--on nights, each nurse has 16-20 patients. Nights by nature are feast or famine-- The way to make it work is to pick your priorities---TRAIGE< TRIAGE<TRIAGE---and, much my administrators dismay--overtime when needed. Sometimes I have time to burn, other nights, I work 4 hours overtime just to keep my head above water and do non-essential paperwork the next time I come in. And teamwork is essential. and the most frustrating part is when ambulance people or hosp nurses treat us like idiots who couldn't make it in REAL nursing--like less urgent means less important--they just don't know--I use all the skills I used in the hospital for 10 years even more here--there is no doctor on duty--our assessment skilss are essential. Without the support they have in the hospital for code teams, IV teams, only sometimes for blood draws, and less supportive technology--we are essential, and often overlooked by our professional journals and CEU companies. But don't let management bully you ---There's always another job out there for nurses, but there I only have one license.

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