Calling all LTC Nurses; for advice/tips!

Honestly with 42 people to be responsible for, things probably haven't changed a whole lot.

I recognize that the resident load is insane. It's not optimal, but I am able to handle it if I get a routine down pat. It's just reality for alot of LTC homes in my rural area. Do you have any advice? :)

A "brain sheet" is a must. Are you passing meds, doing treatments and the assessments/charting for all 42? Are all of them ICF or are there skilled residents in the mix?

Hi HyzenthlayLPN :) Yes I will be doing meds/txs/assessments + charting, for all 42. There is a Registered Nurse In-Charge for the building who will help in a crunch but unfortunately that really depends on which RN is working (some more helpful than others). It is a mix of ICF and skilled residents.

42 should not be acceptable if the facility is a "good facility". I have worked at a handful of facilities and there are really only a few types of facilities in Central Illinois: 1: Better/Best: 15-30 resident's constant supplies, decent food , generally understaffed with medium turnover.

2: Ok: 30-40 residents, only do well because they have a chain name, decent with supplies , good food at times, not as worried about overtime so stay decently staffed with medium turnover.

3:Bad: 40+ residents, little to no supplies, food is rarely good, always understaffed (3 CNA's, 1 nurse on day shift) constant turnover.

Mentally Ill LTC seems to have a lower standard to hold up to. They are often in buildings that are outdated, 50+residents, very little supplies, short on food, the staffing ratio is different depending on acuity of care, large amount of turnover.

Hi NurseSunshineRay :)

I am located in Ontario, Canada. While I have been at different facilities and experienced much of what you describe, this facility (despite resident-to-nurse ratio) would fall mostly under description 1. They are a small town facility with very low turnover, they pay their nurses extremely well, and are well-stocked with supplies and a pretty great menu for residents to choose from.

I know that 42 residents is a lot. I also know that I can do it, if given the opportunity to build a routine with them. I am seeking advice on how you organize your day :)

I have a patient list and take notes in report. I then review page by page the MAR and TX sheets, noting what has to be done ASAP or what can slide a little

I make sure to fully stock med cart with drinks, pudding and applesauce etc. I then make sure I know who needs VS parameters and make sure those get done and that I have thermometer, pulse ox , stethoscope and BP cuff as well as glucometer and supplies.

I make sure to review their PO status; full liquids, thinned or thicker liquids etc, so there are no issues when I am trying to get the meds into them.

And then I start! Early CBGs and before meal meds, followed by routine meds. I try to get the Tx done as soon as possible as well. I make sure the LNAs know if i need to look at some skin issue so the resident isn't all the way dressed when I get to them!

Good Luck!