advice needed badly

Nurses General Nursing

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Hi everyone, this is my first post. I really need some advise. I interviewed and was offered a job today at a Transitional care unit. I am still not sure what to do. I have been an Lpn goin on 9years but in Ltc. This unit was described as similar to a LTC floor (for pts. not sick enough for the floor but to sick to go home or waiting for nursing home placement.) I was told the pt ratio would never be over 13:1 with one cna for the unit, no RN charge nurse on the unit from 7p-7a,(the shift I got) Any IV pushes due and a Rn off the floor would have to do it. Charting is all computer and every med has to be scanned with the pts. bracelet.(I've only done paper charting) Does this sound normal as far as pt ratio's and no Rn charge on the unit.. Any advice would be appreciated..

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Too many patients and not cool with not having an RN assigned there to take care of things. I'd pass on the job. This is skilled nursing and they are going to want a lot of extra specialized charting to be able to be reimbursed so that will add to your load.

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

I worked on this type of floor and had 15 patients with 1 CNA. I found it to be a stressful situation.

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Too many patients and not cool with not having an RN assigned there to take care of things. I'd pass on the job. This is skilled nursing and they are going to want a lot of extra specialized charting to be able to be reimbursed so that will add to your load.

Thats kind of what I was thinking, however I currently take care of 40 pts. Ltc days with only a unit coordinator who has there on job to do, I run like crazy there also, mix of skilled,ICF,alzheimers etc...so just wondering if this would in anyway be better/worse. however I realize the pts on the TCU unit would probally be more acute than the LTC pts.

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Actually, sounds like what we call "swing" beds for people we can't cut loose but can't send home, either.

It doesn't sound bad to me. I did 40 c 2 aides NOCS and they were all sleeping except for my couple of sundowners who required a lot of redirection and attention.

Really, if you have an RN on call I think you're okay - nights.

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No RN charge at night is not safe, but LTC facilities have no money, so this is the trend. I think what you need to think about is whether you want to work with no RN on staff. Awfully risky to your license. You might want to look for another position that is safer.

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No RN charge at night is not safe, but LTC facilities have no money, so this is the trend. I think what you need to think about is whether you want to work with no RN on staff. Awfully risky to your license. You might want to look for another position that is safer.

This is actually a hospital unit, I currently work at a LTC but we have no Rn charge there either after 3pm.

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No RN charge at night is not safe, but LTC facilities have no money, so this is the trend. I think what you need to think about is whether you want to work with no RN on staff. Awfully risky to your license. You might want to look for another position that is safer.

We LPN's are fully licensed nurses and quite capable of calling the MD should a situation require it. I certainly am, and do.

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Specializes in behavioral health.

Im a new grad, but it doesnt sound very good. too sick to go home? how sick does that mean? I have an image of 13 confused patients, all incontinent, sundowning, all taking tons of meds every 6 hours >_<. are they patients that receive maintenance fluid i work at night and know it is much harder to get support even though you supposed have the need.>

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I was the only licensed staff at night for 21 subacute and 32 long term care residents with anywhere from one to three CNAs depending on how many showed up for work. Of these CNAs, only one could be trusted. I had a time of it. New admits going bad, calling the MDs and getting orders for IV ATB when I was newly certified in IV, but had yet to have my first on the job stick. Residents falling in the middle of the night and the CNA tells me about it with a smirk on their face on their way out the door at 7 am. Etc., etc., etc. The ADON refused to answer her phone when I called her in the middle of the night when I was being overwhelmed. That was the status of my RN supervisor: she didn't answer her phone. When she came to work in the morning, she was incapable of starting the IV on my resident. Residents dying on me at the same time as others fall and others go bad. One with a central line who the MD wants me to monitor exclusively. It didn't take me long to quit. Would I have quit had the RN come in and helped me out? I don't know. But the other LVNs quit also. And they had years of experience on me. I don't think 13 patients would be bad if you could count on your backup to answer the phone, but if they are as worthless as mine was, you will have a difficult time.

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Specializes in Med-Surg, Psych.

Computer charting and scanning meds take a lot of time. I think you could find a better position.

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Specializes in LTC/Rehab, Med Surg, Home Care.

Doesn't sound like a bad situation to me, but I'd ask about specific IV training and their on-call policy. You need to know who you can go to if you need help. I have a separate IV certification, BTW. Our sub-acute wing is 12:1, with 1 CNA, although the wing is actually 24 pts. So two CNAs and two LPN's.

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