For all who have or do work in a nursing home....

[skittlebear]

for all who work in a nursing home, i am just wondering how you can possibly provide the best care to the clients you serve. i work in a home care facility, and at the most, i have 16 pts to care for. with these 16 patients, i pass medications, administer tube feedings, get blood sugars, give insulin, do breathing tx's, catheterizations, and apply creams. thats not counting all the charting and everything else involved. i'm working non-stop (and have actually gotten quite fast) until around 1930. that gives me about 30 minutes for lunch, if everything goes well. well, at 20:00, it's time to start the next med round. i feel extremely busy all day, and i only have 16 pts. i've heard in a nursing home you can have up to 40!!! how in the world do you actually have time to assess these clients and administer all the medications on top of that?! it seems as if the only thing you would have time for is popping pill after pill, and popping pill after pill again. isn't that all you would have time for? do you just get really fast at it and grow super human capacities?

[Patti 2nd gen RN]

I work on a rehab--on nights, each nurse has 16-20 patients. Nights by nature are feast or famine-- The way to make it work is to pick your priorities---TRAIGE

[nurseangel47]

At LTC facilities I've worked for we had to do med passes, treatments, all things related to nursing role. Unless you have a treatment nurse, yes, you usually feel like you AND your residents are getting the short end of the stick. We usually had 28 to 30 residents per nurse on first and second shift. I always felt like all I did all shift was count narcs, get report, give meds, chart a little, give more meds., chart, go home. It was ridiculously time consuming giving meds! So many, so many to crush and appeallingly "get" the resident to swallow. Gtubes to irrigate and unplug. Txs. got done after all meds given and some of those were rapidly applied by that point. Terribly stretched to the inth degree, these LTC nurses! And I wonder why...the beds in the facilities cost an arm and a leg! Guess it's the "bigwigs" above us all making those huge annual salaries!

[LCAlpn]

My team has 21 beds. I keep my own clipboard which I use like the now-defunct kardex so that I am up to date on orders/condition changes/etc.

I check as I go and write notes to myself on this and sign out/off everything on the MAR/TAR as I do it.

Most assessment can be done while interacting with patients, but one needs to be present in the moment with them and acctually pay attention to what they say and do and how they present.

The number ONE problem with time is actually the "help" I have....

aides on cell phones, hiding out in rooms, gone off the unit, refusing assignments,resenting being asked to do anything,insisting they are :grown: and can't be directed to do other than what they want to do at that moment. I end up having to empty dirty trashcans, reposition people, etc,etc while my aides are sitting around "waiting for meal carts to come up" ordering food eating or just generally hanging out. Sadly,more gets done when there is understaffing that fully staffed because then its celebration time.

Management is blind to it, throw out write-ups,refuse to have a proper orientation. The administer advised me that the best way I could help was to "stop bitching".

As for the "real" work? It does get faster as you go along, get to know people and how they like to be cared for.

The difficulty does indeed come from management and corporate consultants. At least that's where I work. I hope that isn't how it is everywhere. But after about 10 years of being banished to LTC from the hospitals, I'm afraid this place isn't much of an exception.