Am I overthinking this?

I don't have that much ltc experience and will leave the bulk of your questions to others. I can say that an ltc med pass will get MUCH faster as you get to know the pts-esp if this is true ltc rather than short term rehab. See how long the other nurses take- remember you will know these pts well- how they take their meds, who to find where, who's who and you likely will know some of their med lists by heart. 30 pts sounds on the high side but within the realm of possible for a true long term unit.

As far as emergencies etc you will also know the pts and their baseline and be able to tell fairly quickly when something is off. This is all assuming again that this really is long term care and not a short term skilled/rehab unit.

I was initially overwhelmed by my 30-45 pt me passes when i started intermediate care but once you know people it will be exponentually faster. Whether this is safe or not in my eyes really depends on the acuity of the pts (old with lots of dx does not necessarily mean unstable although it could).

As for less staff later in the night, the stable lt pts should be in bed between 8 and 10. Your hs med pass is probably long but you can probably start early with some. After that though is mostly catch up time-overnight meds do happen but really should be minimized in ltc for pt and staff sake.

I probably would say no to it. I've been doing LTC for 20 years. We have a LTC hall with about 25 residents and a mixed/ short term hall with 25 residents. We each take a hall. Yes, the LTC residents are more stable, but that changes...they tend to have more meds, might need crushed, still have treatments etc. Most admissions come in on 3-11 and more in the evening...around 5 or so. And....I'm still getting orders for other issues from the MD.

Now...if they are truly stable ltc residents and you have a decent, stable CNA staff...maybe I'd consider it.

A 30 person med pass is certainly within the norm for a SNF. Is it easy? Heck, no! But it is doable. The more you do it and the more you get to know those residents the faster it gets. After a little experience you should be able to at least come close to that two hour mark. Of course there are days that no matter how experienced or fast you are that it just can't get done in that time frame. After all, sometimes stuff happens that will slow you down. When those days come, and they will, don't sweat it too much. I have worked LTC for 20+ years and have not once seen or heard of a state tag for late med administration. Also not every med pass will be 30 residents. In my experience at least one of the med passes is considerably smaller. Not every one of these residents will receive medications every four hours.

As far as there being no regular PM or NOC staff, that may or may not be a red flag. It can be incredibly difficult to find good, qualified staff in LTC. Where I work we have been working "short" on both CNA's and nurses so long that is has become the norm rather than the exception. From your post it sounds like you already work there, so you know if it is a good facility with supportive management. If it is, don't let the lack of regular staff hold you back. If on the other hand you already know the facility can't hire regular staff because nobody wants to work there and they are the only facility in your region that has issues with staffing that would be the huge waving red flag that should make you consider saying no.

I was orienting there. Red flags all over. I agonized over it for 2 days and realized there was NO WAY I wanted to work under those conditions, so I let them know that. Feel so much better. : )

I worked at a LTC facility and I was the only RN with 2 CNAs from 11-7... I had 44 patients 13 of them had G tubes. I was able to do the pass in two hours butttt not right away. Most of the patients in long term care understand med time is not talking time and they take their meds and run. But I learned who my talkers were and saved them and the G tubes for last so I could be done with the majority on time. Most LTC and SNF have trouble keeping staff because they typically do not pay as well as hospitals, and they also have a huge workload. It's something to be alarmed about but honestly not unusual in this setting keep an open mind get some experience and move on is my best suggestion. I been there