First LPN job in LTC...is this the way it really is?

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Hi I am a new graduate nurse and I just got my first job in a long term care facilty. We have rehab, alzheimers and a psych unit. I am so happy to have a job and to get 3 weeks of orientation but a few things have me confused. I am hoping to get some imput from more experienced LTC nurses.

1.) Med Pass - we were always taught to check med, dose, patient id, etc 3x. The patients in our facilty do not have id bracelets on. In the mar some of the patients have pictures but not all of them and they don't always look the same as the picture. The alzheimers and psych patients can't always tell you who they are or sometimes tell you they are someone else! They lay in each others beds and I have found some with clothes with other peoples names in them. I have resorted to asking the cna's " is this so and so". The cna's are very busy and I think get a little annoyed with my constant questions about who is who. Even though I am orienting, I do med pass by myself. It seems to take me about 3 days to get the 28 or so residents memorized but I still get very nervous giving medications w/o positive id. Is this common?

2.) Treatments. The nurses mostly just sign off on the treatment book. When I was in school I did all treatments myself at clinicals...if I signed it, I did it. (but I had less patients and no paperwork). Nurses at work say the cna's put zinc and barrier creams on when they change the residents but I have yet to see any white coated butts! The nurses just do the bandaging and dressing change treatments. Is this normal?

3.) In the locked down psych unit patient wander around alot. Men go into women's rooms uninvited. It is common for residents to walk off with other residents items. I have heard family complaing about this. I even had one resident say she had been raped. The regular staff said there is no way this happened and that this particular resident shouts out all kinds of things and that it is a part of her dementia. However, given that the male patients enter the females rooms, I can see that this could have happend...a activities employee reported it to social services. The social service director(who looks like she is 12) investigated it and some of the nursing and cna staff got angry an complained about interfearance :confused:

4.) Medpass. I work 7-3, first med pass is 9am, residents are pulled for activities and therapy in the morning. Many of my patients are gone from 9 - 11:30. We are not allowed to interupt therapy or activities for meds. We are suppossed to give meds within a 30 minute window of the time they are ordered for? Excuse me but ***** :eek:

I asked the ADON what to do about this, she said well we are not suppossed to interupt therapy or activities but sometimes when I worked the floor I would sneak the meds to them in my pocket...I don't want to sneak anything, I want to do the right thing...wish I knew what it is. Currently I start my med pass as close after shift report as possible and get the patients first who I think might leave.

5.) Paperwork. What a cumbersome task. We do not have computer records and the paperwork is totally interfearing with getting the job done. We have 2 people (cna + nurse) recording vitals in three different places...does that make sense? We have 3 ring binder after 3 ring binders full of cumbersome paperwork, that must have your full attention while you are suppossed to be caring for the patients? (don't the patient's need your full attention?) Sometimes I think it would be better to come in 1/2 hour before your shift starts and stay 1/2 hour later to do this while some other nurse is caring for the patients, but this is not allowed.

Please let me know...is this just the way it is. Do I just need to learn "real world nursing" as I hear so much about. Can I use the "real world nursing" argument when I am before the board because I messed up (I don't think so) Are there facilities who are better about patient care than this, should I be looking for another job?

Somebody with some experience please help me out!!! :confused::uhoh3::eek::confused::uhoh3::eek:

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Specializes in Geriatric.

I don't know what to say. We are exactly on the same page right now. I graduated & got in the job and will be on the floor by myself on Monday. It is hard to see what they are doing compared to what we were taught in school. But to lessen my anxiety, I tried to focus myself just to do the right thing and try not to pick up the bad habits that we see from them. I know it is tough for us new grad, but I always remember the right way of doing things, review my books for the s/s & just put patient's safety first. Good luck to us!

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Specializes in FAMILY PRACTICE, PEDIATRIC, ORTHOPEDIC,.

Oh my sounds stressing! I am about to start looking for work I too just passed my test and now am sending my fee for my license. Any insight to this type of nursing would help out. That is nerve wrecking since who advocates for us when the facility is so disorganized and we are just fresh out of school trying to do the right thing?

I am nervous to start at an SNIFF since i hear so many horror stories about new grads working there. :confused:

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Specializes in LTC, Memory loss, PDN.

No, it's not like this everywhere. What you describe is the type of facility where all the rules change once a year when state is expected to come around.

med pass - DO NOT COMPROMISE - you'll be painfully slow until you get to know the pt.s, you must get positive ID and yes it wont make you popular, but who cares

treatments - if a treatment is within the scope of a CNA, the CNA can sign for it - how about asking your DON to sign the MAR for the med pass you did

paperwork - learn to live with it (sorry)

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Specializes in Pediatrics, Geriatrics, LTC.

I was surprised a year ago when I first started in LTC as well.

Your place sounds a little extreme even to me.

The residents usually have ID bracelets on. Ask your unit mgr or ADON how you are supposed to be ID-ing these residents. You will learn them all in short time. Forget about getting done on time, it never happens.

The wandering is common but people should not be in and out of each others rooms. As the nurse on the floor, stop that behavior. You could be blamed if something is missing and/or someone gets hurt. Plus the residents need to feel safe. Report any excessive behaviors and definitely chart them! CYOA

paperwork is always gonna be there. get used to it.

Treatments are not supposed to be done by CNA's. Some facilities allow them to do the barriers creams but if you are responsible for it getting done, and it's not being done, you better do it yourself or some other nurse will report you. again...CYOA.

Don't take anyone's word for it that "this is way we do it here". Ask the higher ups or you may find yourself without a job. Nurses for some reason are a CYOA bunch of people. You aren't there to be popular so I can't say it enough...Cover your own butt!

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Specializes in ICU, PICC Nurse, Nursing Supervisor.

you ltc experience sounds about normal to me ...every place i have every worked at pretty much functions like this....however, i wont put up with mess like this with therapy and not giving meds during....as the nurse you are in charge of the patient and if they want to take the patient to therapy then they better make a stop at my med cart on the way out or expect to get interrupted during therapy.

4.) medpass. i work 7-3, first med pass is 9am, residents are pulled for activities and therapy in the morning. many of my patients are gone from 9 - 11:30. we are not allowed to interupt therapy or activities for meds. we are suppossed to give meds within a 30 minute window of the time they are ordered for? excuse me but ***** :eek:

i asked the adon what to do about this, she said well we are not suppossed to interupt therapy or activities but sometimes when i worked the floor i would sneak the meds to them in my pocket...i don't want to sneak anything, i want to do the right thing...wish i knew what it is. currently i start my med pass as close after shift report as possible and get the patients first who i think might leave.

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Wow...

I have to agree that you need to CYA!!

Maybe you are being treated a little like the newbie, but it is YOUR license and you know how things need to be done, so just try to do it the right way (as best you can!) cause when it comes down to the wire and a mistake is made, chances are all fingers will be pointing in your direction. But at the same time, you are still fairly new there and will get into the groove of things. Just keep your standards where they should be and eventually people will (hopefully) try to meet you halfway. Last, this is probably going to be a temporary stop on the ladder, so just pay your dues and learn as much as you can! :)

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Thanks to everyone that replied. I worked 3-11 last night and left the facility at 1am. I did all of my meds and treatments right, I helped served dinner (we were short of staff) and I took patients to he restroom when the cna's were unavailable as I did not want anyone to fall trying to go to the bathroom themselves. I had 1 fall report, 1 discharge and several daily and weekly chartings that I could not start until after shift change at 11:30. Oh yea, and what happened to the nurse who was suppossed to be orienting me, she was rolling around in a patients wheel chair because her hip hurt! Everyone got to take lunch and breaks but me. I am considering turning in my resignation. I am afraid if I stay here Iam going to loose my license or die trying to keep it! After this job I am going to try one more place and then it's MacDonald's here I come! :banghead:

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Specializes in LTC, Memory loss, PDN.

Mickey D :nono::nono::nono:

When I first moved to the state I live in now, I had 3jobs in about as many months. I did get frustrated and worked in a factory for about a year. Eventually I found a great facility and ended up working over ten years there. (who am I to say no to Mc D, right?)

Are there any non profit facilities in your area? Most of my best jobs have been working for not for profit organizations. It doesn't mean these facilities don't have to watch the bottom line, but the climate is much more resident and employee oriented.

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Your experience sounds just like mine has been! I can see your frustration and feel it too! But.... I can give you some hope! It may all seem so very difficult right now... but it does get better!!!!!!!!!!! Please remember that you are in your first weeks of orientation and working on the floor. It does get better!!!! I promise! Once you get to know the residents, routines and what not, that will help! Write notes for yourself and keep reviewing them. For this old brain, it helped!

As far as the med pass and therapy thing, go ahead and find the resident and give them their meds! Unless the therapists are bucky about being interuptd, they will let you give the meds. What is a 2-3 minute interuption in comparision to a resident being in pain because they did not get their meds or whatever.

If you have TMA's, use them for your treatments. They are trained in doing that! But, they do need to earn your trust! You could even have them do your vitals for you, etc....

Keep your head high, don't let it get you down, it does get better! Once you get the hang of it, you'll be fine!

:redpinkhe Michelle

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Specializes in Alzheimers, Muscular dystrophy.

Yes unfortunately it is like that at a lot of LTC's. You will eventually get the names memorized and the meds memorized. the med mem helps cuz you know what they need, they should be in order in the cart so you can quickly check what you are pulling with what is on MAR. If the skin is intact the aids can do the barrier creams. If you don't see and white bottoms or smell the lantiseptic hunt down the aid and make them take the resident to the room and put it on them.......NOW. After the second or third time they will get the hint. Hint for your aids with the lantiseptic, if it mixed with a little a & d ointment it will come of easier during brief change. It's all about developing a routine. Also look for "stupid med orders" such needing to wake a pt ad midnight to give them a Vit c and get changed so it coincides with another time of your med pass. Paperwork get used to it.

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Hi. I just wanted to ask how you got hired in LTC as a new grad? I got my license 6 months ago and I still don't have a job. - Im in SF area. Need some advice please....

thanks : )

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