A concerned LPN!

gil3 · May 19, 2014

Hi, with all the comments I'm starting to put things in perspective (in a positive way). Thank you!!

gil3 · May 19, 2014

Am I a cat?? Jk! I just changed it, thanks!

oldielover · May 19, 2014

It can be rough as a new grad to go into a night shift position in LTC. I agree with other posters in that you should give it more time. Challenge your mind to think globally. I started out same as you, been doing it for 27 years. Good luck!

gil3 · May 20, 2014

It can be rough as a new grad to go into a night shift position in LTC. I agree with other posters in that you should give it more time. Challenge your mind to think globally. I started out same as you, been doing it for 27 years. Good luck!

Thank you for the encouragement! :up:

bellcollector · May 21, 2014

gil3, I really feel for you. When I first started I got 2 days orientation and 1 shadowing and was then immediately 3rd shift charge in a skilled LTC geriatrics facility. I had the back which were what we called long termers. I had 50 residents and 2 non CPR certified aids. The front had anywhere from 30 to 45 higher acuity residents with 2 nurses and 3 also non cpr cert. aids. It was very overwhelming not to mention unsafe. I felt woefully unprepared. Before I had a chaInce to adjust they made the whole facility skilled. Residents got moved around but the nurses and aids stayed put. This meant that I now had several higher acuity residents with the exact same pt/to staff ratios. I did a lot of reading online and you tubing to try to increase my knowledge and I came here a lot for advice and support. There are very knowledgeable and experienced nurses here more than happy to help you understand things. One very kind nurse here instructed me (privately of course) on proper use of an OPA. We had never covered this in school and repeated requests of management I still had no clue what an OPA was let alone how to use it. Thank God for AN. I learned on the floor pretty quickly to hit the floor running and get as many things done as possible in case of an emergency. I often joined the aids on rounds because in helping them it gave me a chance to do skin assessments and any treatments due on my shift such as dressing changes without having to wake up the residents needlessly. Were I worked there were a lot of such treatments on 3rd shift. We were also responsible for keeping track of BM's and giving any needed supps. I filled in on 1st and 2nd. 2nd shift seem to be the busiest in terms of activity as that was usually when MD's finished at the office and rounded at the facility. It was also the shift that had the most visitors. As far as I could tell all 3 shifts and later 2 shifts when we went to 12's seemed to have the same amount of work. Each had their difficulties, 1st had to deal with management and a few visitors, 2nd had to deal with the MD's rounding and lots of visitors, 3rd had to deal with the shortest staffing and stocking but no less treatments, meds or assessments. One thing I appreciated on 3rd shift we worked as a team and found ways to be more efficient. My 3rd shift aids went so far as to bring in their own bath and body products to use on the 3rd shift showers that enjoyed it. You could always tell which were the 3rd shift showers. Invariably there will be some emergency and or interruptions when you are your busiest that is why I always tried to get everything I could done at the beginning of the shift and tried to stay on top of things. Believe me if you do your job correctly there won't be much down time. It was scary and hard and though I don't work in that environment anymore I still feel it is unsafe and much less than what our elders deserve it was, however, a great learning experience in prioritizing and organization. Develop a great relationship with your aids they are invaluable to you. Best wishes.

ttrevino42 · May 21, 2014

I guess I am the Devil's Advocate here because I feel that that nurse to patient ratio is too much for a "New" nurse. I understand that it may be a "good" ratio for a nursing home nurse, but for a "new" nurse, it can be very overwhelming and too much to handle. People think nurses "go to nursing homes to die or retire from nursing" (I have always hated that sentiment), but nurses in nurses homes have to rely VERY MUCH on instinct and years of training to know when things are wrong with people for the pure and simple fact that you "get to know" patients and don't always notice when things are not quite "right" without a lot of experience under your belt. I used to work as the MDS nurse for a nursing home, which meant that I had to ensure that documentation was an accurate reflection of the patient to ensure that we received the highest qualifying reimbursement for services. However, most of the time I found documentation to be lacking for the simple fact that something that is actually considered a behavior was written off by staff as "just Jack being Jack". This was NOT the case - it was a patient who needed to be addressed by MHMR service. With this said, I think you should follow your gut instinct and do what YOU think is best. Besides, a hospital setting would allow you to sharpen and hone your skills. Good luck, either way!

Been there,done that, ASN, RN · May 21, 2014

35 "residents" is an outrageous workload and an unsafe ratio, new grad or not.

You have the position because more experienced nurses will not accept that ratio.

You are right on to look for a better position. When you land an interview, the answer as to why you are seeking new employment will be obvious and honest.

Good luck!

caliotter3 · May 21, 2014

Chances are high that the only other job you might be able to obtain would also be in the same type of facility, and with a worse ratio, try 80 patients to one nurse. It commonly takes a good year or so before you start to feel less stressed. Develop a good working relationship with the other nurse(s) on shift. Help them when they need it, and they will help you. That cooperation goes a long way to making it easier for all.

TheCommuter, BSN, RN · May 22, 2014

With this said, I think you should follow your gut instinct and do what YOU think is best. Besides, a hospital setting would allow you to sharpen and hone your skills. Good luck, either way!

Let's be realistic here. The OP is in Florida, and acute care hospitals in that state have not utilized new grad LPNs in a very long time. As a new grad LPN in his geographic region, his only feasible employment options are nursing homes, private duty, assisted living, home health, hospice, physical rehabilitation centers, or clinics.

Junebug903, LPN · May 27, 2014

My first year was the hardest. I cried all the time. I felt so bad for constantly asking so many questions. On 3-11 as a new grad, I had 30 patients. I would be there sometimes until 1 or 2am just trying to finish charting. On 11-7, I had 60 patients. You get used to the workload and your time management gets better. Working in a nursing home is really hard work. The patients take way too meds and there are too many patients for each staff member. The poor people don't get the attention they deserve. Best of luck!

Illusionist · May 28, 2014

I think there should be a law against these wrong practice of giving too much workload or patients for nurses. It is not safe for all parties involved.

ProudLPN10 · May 30, 2014

I have been an LPN for just over 3 years. I have worked in LTC and assisted living. I can say, I am FINALLY feeling mostly comfortable in my position, in LTC. I am not trying to discourage you, but want you to know, it takes a while to get comfortable and really "get your hands dirty." You learned your skills and now is the time to REALLY learn them :) My advice to you, stick it out, as others have said, for at least a year. I would say, get on the list (unless you really want to work NOCS) to get moved to another shift. I started out on evenings in LTC, then went to a day shift in assisted living (worked closely with RNs) and have not been on day shift in LTC for a full year. I have learned the most during my time on day shift in LTC. When physicians round, I am not afraid to ask them questions, build a relationship with them and they will gladly teach you. I am also not afraid to ask my RNs questions and have also learned, they don't always have the answers either. On eves and days, there are other LPNs to ask and figure things out together. For right now, when you have questions, I definitely say come here to allnurses, it's where I have learned a lot too. Also, on your days off, google some of your residents' diagnosis, such as CHF, diabetes, COPD, contractures, dementia, etc. With that, plan to learn something new every day!! Enjoy, I LOVE LTC :)