Calling all LTC Nurses; for advice/tips!

This is a long one but if you have the time and patience to read, and reply... I would be so thankful!

I have a new part-time gig at a LTC facility. I am looking for advice on how to manage your shift's duties. I will have 42 residents and don't want to be scrambling (at least, not all the time:sarcastic:).

I used to work at this facility as casual staff, and I could never get a grasp on how to accomplish everything I needed to do. I felt like this was related to the fact that I was casual and barely worked there (no chance to build a routine, or get to know staff & residents).

My anxiety was through the roof (could never sleep, feeling frightened whenever the phone rang, crying constantly, feeling pretty pathetic all around! Ugh:(). It got to the point where I had outright anxiety attacks when they would call me to ask me to cover a shift. It was a vicious circle... I stopped accepting shifts and eventually left the position so that I could work on my mental health. I am very hard on myself, I know this. I did develop very good rapport with the DON, staff, and residents so I believe that is why they have offered me this part-time job this time around.

I am hoping that with your advice, and the regular part-time status, I will have a more solid foundation to build on this time around! This time around, I am planning on accepting more call-in shifts, in addition to the scheduled ones that come with part-time status. I am hoping this helps build my confidence back up. I know I am a great nurse, and I am better than this!

Please offer up all your tips, advice, and words of wisdom on how you manage your day and how you help yourself feel less anxious in a job that can really mess with your nerves

[ponymom]

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

[ontarionurse14]

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? :)

[HyzenthlayLPN]

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?

[ontarionurse14]

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.

[NurseSunshineRay]

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.

[ontarionurse14]

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 :)

[NutmeggeRN, BSN]

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!