discouraged LPN in LTC

TheCommuter, BSN, RN · Feb 21, 2008

What is wrong with me??????

Absolutely nothing is wrong with you. You seem like a good, meticulous, and caring nurse who doesn't take any shortcuts with the nursing care.

Unfortunately, many LTC nurses survive with dangerous shortcuts due to the sheer amount of work that needs to be done. Some nurses "pencil-whip" the neuro checks with fake vital signs, record false outputs, sign the treatment book without actually doing them, and skip assessments all to save time. You're doing everything by the book, which is safe, but it is also time-consuming.

It's perfectly fine (and safe) to save time by giving all of the 1600 meds at 1500, as many LTC facilities permit the nurse to give meds 1 hour early and still be in compliance. You can also give the 1800 and 2000 meds all at one time (1900) and still be in compliance at most LTC facilities.

I survive with a "To Do" list that I write on my notepad. It will say things such as

1. Outputs

2. ABT charting

3. Neuro checks

4. Treatment book

5. Dialysis flow sheets

6. Fridge temps

7. 1600 meds

8. 2000 meds

9. Summaries

10. MCR charting

Every time I accomplish something on my list, I'll cross it out and move onto the next task that must be completed. With my list, I usually forget to do nothing. Good luck to you!

ER JUNKIE · Feb 22, 2008

:wink2::wink2:

I am trying to be the best nurse I can be. I am responsable for about 30 residents on second shift. I pass meds at 1500 (only 2), 1600 (a dozen or so), 1800(almost all of them), and 1900-2000 (almost all). I have half a dozen treatments of various complexities and various assessments depending on what is going on. Lately we have been short staffed, so I help when I can. If there is not a CNA to pass the snack cart, I must see that it gets done. It takes me about 30 minutes +/- at the start of the shift to get set up and on my way unless there are a lot of orders left from rounds, or labs on Wed, or other things that need documentation right off the bat. My problem is that I am having a heck of a time getting everything done that I need to get done. I am forgetting things like filling out turning records or responses to PRN meds. Especially between 1900 and 2200 all I do is run and try and get my meds done and my tx done. I am not supervising my CNAs well. I am beginning to think that maybe I don't have what it takes to be a good nurse. Also, right now, we are "Quarentined" because of an outbreak of URI. On Tues, we started 10 of my residents on ATB which meant that I had to assess each of them with full vitals and several other assessments like throat, lungs, etc. That night I also had someone fall and hit their head. No serious injuries but I had neruochecks in which I have to do vitals+ q15min x 4, q30min x2, qhour x4 and I had a lady we were trying to wean off a cath so I was unclamping the tube 10 min/2hours and recording output. If I had not had help from the nurse that works the other wing (who has as much work as I do, but never gets bogged down like I do) I would still be there today trying to finish everything. What is wrong with me??????
Thanks for listening,
Viane

Hang in there!! You are just having what I call a "moment". We all have those days where we feel like we fell short on our duties. Many days I look back and think that there was more I could of done for my pts etc...fact is, your doing the best you can, your aware of everything around you, you have your pt's best in mind and you do what you can. Nursing can sometimes be a thankless job...I'm sure your pts and families of your pt's would say THANK YOU for taking such good care of my (fill in the blank) if they thought of it! Keep your head up and keep doing what we do...Have a great day!

Viane1956 · Feb 23, 2008

Thanks for your kind responses. I am really wonder if I chose the right profession, though. Yesterday my DON asked me to pick up a first shift. I have not worked this shift before, but I felt like I needed to say yes because I am leaving for 5 days to be with my mother who is not doing well. Several people have had to fill in for me so I filled in on first. I felt like I didn't know what I was doing all morning long. Then I worked four more hours of the next shift and I felt like I was leaving things undone by not finishing my shift (another nurse picked up the last four hours of my shift). Anyway, all that to say that I woke up in the middle of the night having anxiety about how I did yesterday. I got up, dressed and went back to work at 0230 to make sure that I had done everything correctly. I double checked my paper work and all was fine. Now I am thinking that I am nuts. Maybe it will be good to be away for 5 days (and 2500 miles)

Thanks,

Viane

withasmilelpn · Feb 24, 2008

You are NOT crazy, (well maybe a little bit, as I think all nurses have to have a screw loose or two!) I make my own cheat sheet, divided in to sections according to the way I think. I like to have everything at a glance. I have a section just for patient follow up like VS, assessments and treatments. I have a 'to call MD' section, which I found helped me group together calls (In my early days, I used to forget or fail to realize that x and y patient had the same MD, especially when one had a more urgent issue, and doctors get irritated when you call them multiple times, never mind the saving you time factor!) I found that the report sheet we use didn't work for me, because in LTC not everyone has something to be addressed.

I also found that using a clipboard was helpful as I didn't misplace my cheat sheet and I could keep labs and other misc paperwork I needed to do in one place.

Other things I do, that others might think are weird, is always put the things I need like scissors in the same pocket. (black pens in right pocket, highlighter in left, gloves in pants pocket ect... I know, very OCD of me, but it works!) Cuts down on the 'search' factor.

Neuro checks in LTC are very hard to do, I wish I had an answer for you. As far as the other stuff goes, if you tried making a sheet that cued you in to things you are likely to forget, like pain evals it might help you. Plus I flag everything!

I think you sound like a caring and concientious nurse. Accept your style, too. I tell everyone that I am slow, because I am not going to compete for the "fastest nurse" title, I am competing for the "safest and adhering to standards" title!

Hugs!:redpinkhe

rukiddingme · Feb 25, 2008

Just a suggestion - but if you are the "main" 3-11 nurse in you area, review the medications, and see about making time changes to help even-out your medication pass. So you are only looking at giving out meds at two times, not 3 or 4. Also, if there are medications that patients are refusing to take, that you chart that, and after a couple of weeks, ask the Physician to DC them due to refusal, so you aren't continuously charting 'patient refused med' -- same goes with medications that are usually PRN, and someone is taking them on a regular basis -- get it scheduled so you save time on charting on the MAR's everyday.

Also, many CNA's have less to do than they let on -- so delegate some of your vital signs for them to take!! That's something they should know how & be able to do, like it or not.

Hope my ideas help. Tara

Bobs · May 31, 2008

Sounds typical! I believe your problem lies more with the 'system'than with yourself. I've only been an LPN for a short time; however, it seems apparent that LPN's are an abused class of nurses. Medication errors are inevitable with such a heavy load which is why I've already been advised to keep such errors a "secret" as they are so common!! I'm amazed at the general flavor of helplessness and diminished confidence I'm reading under the "LPN Section." Organize!

Snickers&DtCoke · Jun 1, 2008

I agree with al the other posts. I too, am in LTC and plan on staying for a while. My first thought was, "I hope she isn't the one getting those vitals." Yes, I'd say delegate what you can. I had a very frustrating first year mainly because I was admittedly set my standards too high. Can you believe I actually expected to be done with all my work, charting and all in 8 hours all the time? Then I noticed that my mentors hang around charting until 5pm regularly! Thankfully my facility does not grumble about OT. My suggestion is to RELAX, get your checklist so it works for you... Stay on task... delegate and save charting for last when possible so you don't interfere too much with 11-7s medpass. Don't be too hard on yourself. You sound like a nurse I'd like caring for me or my mom! ;-)

asoonernurse · Jun 2, 2008

Having been a CNA for almost a decade, I have to agree with gerinursetara.

We used to try to "make ourselves invisible" whenever the LVN/RN was close by so that we wouldn't get any extra work (and who wants extra stuff to do?)

So grab the nearest CNA (or go find one!) and have them pass the snack cart! A nurse shouldn't be passing the snack cart anymore than she should be off giving showers.

Once the CNAs get their residents up and dressed, etc. there's a void until they need to get them to the lunchroom for lunch. Make use of this down time and ask them if they would get vitals for you on rooms x, y and z.

Good luck. You sound like you already need a vacation! :chuckle

Regards,

Michael

Sherriblu · Jun 4, 2008

I have been an lpn since 1980 and have I seen the changes in long term care.They are using less nurses and the residents are sicker so it is m uch harder to work in long term care and a huge responsibility. Some homes are using just a Tma and Lpn which is m ore work for the nurse.I feel for you I really do.It is sad to me to see these changes. Just know I have seen many young nurses become discouraged as they couldnt keep up and I always tell them it is not you, it is the system!!! :yeah:

softstorms · Jun 15, 2008

You will be fine! You are doing a great job. Now learn to delegate. All those neuro checks? Give your CNA's the time line and let them do thier job. Most times, I find I only need to ask and they will do all I need. I can't change your med times or the amount of charting you do ( that is commen to all of us) but, remember...you are part of a team. A lot of our "eyes on" time can be done by our aides. Good Luck

MedSurgLPN2005, LPN · Jun 23, 2008

Before I got into med/surg I was a LTC nurse for 2 1/2 years, and I know how you feel. I worked in a facility with a 40:1 patient:nurse ratio. Let me give you a little advice...

1. Ask your doctor to prescribe you some xanax... ha just kiddin.

2. Dont obsess over med times, its impossible to get them all out exactly when they are supposed to be. Group meds together. Also, you will get faster with experience once you learn what the pills look like, generic vs. brand names, etc. Give PRN's, (laxatives, sleepers, pain meds, etc.) with routine meds if possible.

3. Stand up to your CNA's. YOU are in charge and YOU are responsible for running the floor. If you don't delegate every last task that you can you will only be neglecting your residents because you CANT do it all. Oh, and if I ever got caught passing a snack cart when I had 40 patients that needed me, I'd get written up! You shouldnt be doing their work, after all, will they do your tasks? No because they aren't licensed. Be firm, but be respectful and they will respect you. (If you're really nice, they might do your creams for you when they're doing peri-care.)

4. I used to do treatments during the med pass to save myself from having to come back to the resident's room. Plus, they will appreciate not being woken up when you finally get time to come back. It makes the med pass a little longer but it really saves a lot of time. Do your g-tube care when hanging your tube-feedings. Throw some NS and gauze on your cart, it will go a long way. Save yourself steps! Even as a med/surg nurse now, I try not to go back and forth. I get as much done in a visit to the room as I can, then move on.

5. Dont get too stressed out. (I know, easier said than done)... But the crazier you get, the foggier your mind is. Thus, the more distracted you get... the slower you are. Take a 15 minute break, clear your mind, and jump back in. You cant let the stress break you, it can make you forget all the reasons you became a nurse in the first place! P.S. I chew mint gum and it seems to stimulate my mind and helps me think more clearly and make decisions faster. (may be psychological, who knows? but it works for me.)

6. Harmless short-cuts are sometimes necessary to provide care that really matters. PRIORITIZE!!! I see people that have been nurses for many years and just cant seem to get it because they are too freakin anal with the less important insignificant things.. Mr. Smith's chest pain comes before Mrs. Doe's 1700 Colace.. Trust me, it can be late. With that said, be efficient and safe.

7. Last but not least, learn from your co-workers. We all learn from each other and we should all be open to new input and ideas.