For those working OR who have worked in LTC

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Hello all! I wanted to post this in the general discussion to get input from those who have worked in the field at any point....

I am at LTC facility which as gotten several 'dings' from the state. It has a poor rating. I am new here and orienting. I have over 30 patients who have to get meds at 5 pm and then again at 9 pm. LOTS of meds. LOTS. They also get treatments too. LOTS of them.

The CNA's do not do much. SO... how in the world do you pass 100 plus drugs and do all the treatments in 8 hours... PLUS distractions?? The LTC facility that I work for WILL NOT LET YOU STAY past your time... NO OVERTIME.. you get in trouble...you have to be OUT in 8 hours. So HOW are you supposed to do all this?? I use a 'dated' med cart that I drag down the hall behind me with MARS and old charts. No computers (Pyxis) like I am used too.

I see rushing and med errors. I do not feel safe here. It seems impossbile to get it all done AND done RIGHT. :(

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Specializes in Lvn to RN, new grad med/surg.

Been there, done that! You have two options.. Stay or Don't.

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Specializes in LTC, Dementia, OBG, Home Health.

From the 4 different LTC facilties I've worked at over the past 6 years, there's only been ONE that had a good rating and didn't work their nurses as you describe. That was the State VA Nursing Home in Land O' Lakes, FL.

The other 3 are just as you described (All in the Tampa Bay area) All I can tell you is that you do one of 3 things:)

1)Work off the clock, like I've seen WAYYYY to many nurses do.

2) Start circling what you don't get done & pass it on. (As one of my old NH's stated, "It's a 24 HR facility....BLECH!!! I understand that mentality, but when it's EVERYDAY b/c you're SO OVERWHELMED?

3) Lie about what you do/don't get done (NO, I'm NOT ADVOCATING THIS!!!!! It drove me NUTS when nurses I worked with did it!!!!!)

You just have to get into a groove as quickly as possible and get as much done as humanly possible as you can. I broke it down once in an 8 hr shift, with 30 patients, we have 16 MINUTES to devote to each patient (That's EVERYTHING, from meds to charting to treatments......) AND that's WITHOUT a 30 min "lunch" break. If you factor in that little tidbit (a break...ha-ha), you get 15 mins w/ each pt. That is the ONE thing NO ONE ever told me about nursing......was how strapped you are in actually CARING for your people. However, just the fact that you CARE enough to CARE about the difficulties tells me that you're in the right place!!!Keep on praying, keep on trucking and I wish you the absolute BEST in your career!!!!!

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Specializes in Cardiac, Neuroscience, LTC.

I hate to say it, but it is pretty much par for the course in LTC. I've worked at a couple of LTC facilities and they were actually very good ones, with very good ratings. I had good CNAs and that was a big plus. But the rushing and the 100s of pills were the same. It's a no win situation, one of the many reasons I left LTC. The one good thing is, with time, you learn the residents and their meds. You actually will memorize them. You still need to use the MAR, but it will be more of a reference...to make sure their haven't been any changes to medications that you were not told about in report. The saddest part is if you don't have good CNAs, those residents are suffering, because the nurse sure doesn't have time to give them a whole lot of individual attention. I would look for another facility, with a better rep....don't put your license on the line, because they will not stand behind you if you make a mistake.

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If you like your license, get out of there...sounds like w place I used to work in...they tried to get me to rewrite nurses notes to cover up a reportable...I said hell no, got sick called in the next day they called and fired me...I told them oh by the way I made copies of the notes you tried to get me to rewrite so don't think YOUR building is safe from the state....

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Specializes in LTC, Dementia, OBG, Home Health.

Sorry for all the formatting code, I don't know what's wrong :(

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Specializes in Long term care.

I work in a facility with the old style med cart too and the Medea, no computer, and sometimes I have all 44 residents on the floor to pass too. Try getting those residents who can on a pass Meds anytime schedule and use your charge nurse to see if any meds are unnecessary and can be dc'd as well as as any unnecessary treatments. That helps alittle, then get organized with a system of routine, as you learn your residents you get much faster, and make friends with the aides in order to get their help.

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Specializes in Medical and general practice now LTC.
Sorry for all the formatting code, I don't know what's wrong :(

I tried to clean it up a bit :)

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I can tell you that most LTC facilities are like this, unfortunately. I worked night shift at one, and had 52 people by myself to administer medication to, check blood sugars, do treatments, document and often finish what new admission paperwork day shift didn't complete.

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Specializes in tried almost everything/LTC.

I have been in LTC for many years, in GA and CO. Unfortunately, it seems, these issues are the same in facilities everywhere. I agree that once you get to know your residents and staff, it will get better. However, that is the scary time when I think there is a greater chance for errors. All you can do is be extra careful and vigilant (which is your personal best). I also agree that unless you make friendly with the CNAs you are doomed. Some will never do what they are supposed to do, but most really do want to be good CNAs. The best way to accomplish this is to make an effort to learn their names, genuinely compliment them for handing vitals in on time, answering a light on time, ...anything you see or can think of. Then, always try to thank them as they head out. (Since we usually don't get to clock out together. Nurses are trying to finish our work:/) The massive amount of pills I don't think will ever change, it may get worse. I have left 2 facilities, in my career, within my probationary 90 days because they were so bad. Both had an extremely good hourly pay rate, and bad state ratings. The pay IS NOT worth it! These days, I am choosey. I work in smaller facilities where I will have less than 30 residents. (Even that is too many.) I always start with the mentality that If I can't get up to speed, and feeling comfortable in a couple weeks, I'm outta there! Chances are, if you aren't feeling right; something IS wrong there. Oh, and I'm working mostly day-shifts when there is a charge nurse to take off orders, a wound care nurse for treatments, activities to keep the residents busy, and I'm not required to go to the dining room to feed. Best wishes to you!:up:

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Get out! Get out! Get out! I am currently having to answer to the Nursing Board as we speak because I worked in a facility just like you described! It is impossible to get everything done, the DON and Admin. know this and don't care. The residents don't get proper care, and do you know who gets thrown under the bus if anything happens? YOU! It's your license on the line! This "do the best you can " mentality is exactly what got me and others in this mess! I am a good nurse, and I know that. I care deeply for the residents I cared for. Something needs done with the way our long term care is done. I don't know what that something is, but we owe it our residents to figure it out. It is very possible that I may never work as a nurse again. I was trying to find another job but not in time. Trust your gut, and don't just do the best you can with what they give you to work with. If you complain too much, they know they can dig something up in 5 seconds to fire you for. Then, they will report you to the Board for something they trained you to do, and every other nurse does to save time. I will never work in LTC again. Of course, I may not work as a nurse again either. Good luck to you! .....But run like hell!:banghead:

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Thanks everybody! That was very helpful!! Yes. I just do not really feel right there. It was a choice between this place (which has been dinged by state for MANY errors and they threaten to write people up for everything), and another facility that has 5 stars, with excellent ratings, but they do not pay as much. The 5 star place is not full time, BUT you get close to full time hours.

My gut TOLD ME to go with the better rated facility, but I wanted the full time with the higher pay. So I went with the lesser one. Well so happens the good acility, called me back the other day by mistake really (HR ended up having two copies of my resume, and the head of HR called me). They told me if I ever decided I wanted to work there... that I was welcome. The position I had applied for was still open. They called me back on accident after I had turned down the job three weeks earlier. HR said they were sorry they had called back... just happened a second resume of mine ended up back on one of their desks... Fate I guess. Well I called them back yesterday and yes, they hired me!! So, I start the 5 star facility next week. Money is not everything! ;) Especially in nursing. I value my life and my license!

Sometimes you have to go with your gut!!! THANKS EVERYBODY!!! :)

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