Day in the Life

NursesRmofun, ASN, RN · Apr 14, 2004

i'm graduating in may and have realized that hospital nursing really isn't my thing. just when i get to know someone, they're discharged! it's starting to feel a little empty already! i've also noticed that the patients i remember most fondly have often been geriatric patients.
so i'd like to know what a typical day or night is like for the rn and lpn in the ltc setting. do you have the chance and the time to develop relationships with your patients? what is the care-to-paperwork ratio? how are the stresses you face different from the stresses faced by the hospital nurse?
thanks for any advice you can provide.

there are a few positions in a ltc facility. usually, to begin with as a new grad., you might start out as a medication/treatment nurse -or- charge nurse. that usually means you come on, take report from the offgoing shift, make a cna assignment (if it isn't already made out), write in weights and v/s that are needed, had out medications on 20-40 residents on average, then do treatments (if there is no separate treatment nurse), chart notes and all other pertinent info collected....you also have to make sure the residents are safe and the work is being done properly by assistants. you may need to write out incident reports for a fall or something else. you may have to go to a emergency call for choking or cpr for a full code patient. i may be missing a thing or two. :)

the difference in stress level -in my opinion- is pretty large. i am much more stressed with hospital work. however, the ltc positions are not without stress. the work just seems a lot more predictable to me...although it isn't exactly the same everyday. however, you do get to know your residents...and that is enjoyable...and it contributes to the continuity of care.

miss_nurse2004 · Apr 17, 2004

I work in LTC, and an average day goes like this:

I get to work, count in and take report and am starting my 8:00 med pass around 7am. I have approximately 26 residents to care for (on 2 halls with 2 CNA's to each hall) and always have time for getting to know each of them. By 9 am my med pass is completed, then I begin my charting which includes medicare, hot rack, behaviors, I&A's or other incidents, and nursing summaries. I have approx. 4 skin assessments on different residents each day, but we have a treatment nurse who does primary dressing changes. I go to lunch around 10:45 and get back at 11:15. Then it's time for accuchecks before lunch and starting the noon med pass. Around 1 pm I finish my documentation and complete my 24 hour progress notes for the next shift LPN. I also complete any treatments, such as updrafts, etc. as necessary, and handing out prn meds quite often. I clear my feeding pumps at 2:30 and the next nurse arrives at 2:45 for report. We count out, report, and I am off duty at 3:15. We are supposed to take a 15 minute break twice a day, but I rarely find time for it....and quite frequently miss my lunch breaks. I don't think the stress is as bad as working in the hospital - I've done both. I myself prefer LTC because I have a bond with my residents...I am the primary nurse on my halls, working 5 days out of 7 each week, and my residents look forward to me being there each day.

Some LTC facilities do not keep the same nurses and cna's on the same halls each day, they tend to rotate shifts on the halls....which I don't like. Staying in one place gives you the opportunity to get to know your residents, especially when it comes to doing skin audits and watching for pressure areas.

I never had grandparents while growing up, and so I see each of my special friends as the grandparents I never had....and treat them accordingly, as if they were my own. These people deserve the best love and care we can give them.

mary761 · Apr 18, 2004

Thank you so much for your replies. It sounds like you both enjoy the setting very much and feel a strong bond with your residents. Forgive my naivete, but please--what are hot racks and I&A's? Also, how much management of staff is involved? Who is responsible for that--the RN or the LPN?

Thanks again for your replies.

allevi · Apr 20, 2004

I currently am working in both a hospital, and a long term care facility.

i am doing prn in ltc, and I think I may be insane. I too like the residents and enjoy getting to know them, but at the moment, I am too busy learning every resident and what they like, to take time to talk with them.

It is 60 bed facility, with one nurse on pm's and one on nights. If you are lucky there is a med aide to help with med pass, so far I haven't been lucky.

nursebedlam · Apr 20, 2004

l have worked the past year in a medical practice with 4 doctors, has been great, and i actually have the time to speak to people. I don't think l want to ever work for the hospital or aged care system again.

nursedawn67, LPN · Apr 20, 2004

i work in ltc, and an average day goes like this:
i get to work, count in and take report and am starting my 8:00 med pass around 7am. i have approximately 26 residents to care for (on 2 halls with 2 cna's to each hall) and always have time for getting to know each of them. by 9 am my med pass is completed, then i begin my charting which includes medicare, hot rack, behaviors, i&a's or other incidents, and nursing summaries. i go to lunch around 10:45 and get back at 11:15. then it's time for accuchecks before lunch and starting the noon med pass. around 1 pm i finish my documentation and complete my 24 hour progress notes for the next shift lpn. i also complete any treatments, such as updrafts, etc. as necessary, and handing out prn meds quite often. quote]
very similar to my facility, but we also have orders to write and doctors to call if our desk nurse is busy. also any incidental things that happen...falls, er trips, blood draws...etc. and we don't have a treatment nurse, so we have tx's to do.

nursedawn67, LPN · Apr 20, 2004

thank you so much for your replies. it sounds like you both enjoy the setting very much and feel a strong bond with your residents. forgive my naivete, but please--what are hot racks and i&a's? also, how much management of staff is involved? who is responsible for that--the rn or the lpn?
thanks again for your replies.

not sure on the i&a, unless that is the same as i&o which is the fluid intake and output of residents. hot racks were charts of residents that had something extra going on, such as a fall, uti, uri or edema.

CoffeeRTC, BSN, RN · Apr 20, 2004

I & A are incidents and accident reports. What's the hot rack? People needed to be charted on?? The previous posters have just about summed up my day except as the RN I'm responsible for supervising the CNAs and on some shifts that means babysitting and constantly running after them. 7-3 nurses may have to sit in on meetings or care plan conferences. We also are required to help during lunch and dinner (I'm normally just catching up with carting and doc calls during this time) We dont have a treatment nurse so I normally do them after dinner or hs or before breakfast on 7-3. During 3-11 shift I'm also resposible for finding replacements for call offs.

The biggest thing to remember is to be flexible.. I always start the shift off with a game plan, but sometimes it gets thrown out the window.

mary761 · Apr 20, 2004

Thank you for your input. I am unfamiliar with the LTC environment other than my experiences during clinicals, so I greatly appreciate your responses.

In your experience, do LTC facilities hire new grads? Do they provide a decent orientation for a newbie like me? Also, is there typically a preference for LPN's over RN's (or vice versa)?

NursesRmofun, ASN, RN · Apr 20, 2004

Thank you for your input. I am unfamiliar with the LTC environment other than my experiences during clinicals, so I greatly appreciate your responses.
In your experience, do LTC facilities hire new grads? Do they provide a decent orientation for a newbie like me? Also, is there typically a preference for LPN's over RN's (or vice versa)?

I think many do hire new grads. At least I have seen many that do for unit charge nurse or medication nurse positions. I don't think they prefer LPN or RN for a charge nurse/medication nurse position. So, I think either is fine. You would need more experience to get most other jobs in nursing homes in my opinion and experience. Good luck!

mary761 · Apr 22, 2004

Thank you! Wish me luck--I will be applying at a few of the LTC centers in my area next week. Thanks again for your replies.