Help! Acute care exp in long term care a nightmare

  1. Primary exp is in acute care 5 yrs LVN. I am wanting to change to long term care and have gone to a couple different facilities through an agency. You get little of any orientation, expected to know everything, but the most overwheming part is passing meds on time ( ???) to patients and treatments when you do not know them or reconize them. I have felt absolutely overwhelmed each time! Are their any tips on how to do this, a special routine like in acute care?
    Thank you
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    About Kashia

    Joined: Aug '03; Posts: 287; Likes: 196

    18 Comments

  3. by   SandraJean
    No tips. I do understand what you're describing though. Sorry.
  4. by   carolbear
    Going from acute care to long term care is hard enough, but to go from acute care to AGENCY Long term care has to be a nightmare. I can tell you from having experience in both settings, that the bet option would be to just do full-time LTC care at one facility. The trick to passing meds quickly in LTC is knowing your patients. Unless your on a medicare unit where there is a lot of turnover, you will know your patients, what they take and when the orders change. That is the key to LTC medication pass.
    Good luck, I feel your pain!
  5. by   leslie :-D
    a simple first step, is finding out who takes their meds whole or crushed.
    who needs, fingersticks, insulins and other pertinent, scheduled meds.
    then the rest is working your tail off.
    best of luck to you.

    leslie
  6. by   txspadequeenRN
    Are you planning on working through agency and doing LTC or just going to work for a LTC facility? One thing is finding out who is crushed and who is whole that is the first thing I find out . That will reduce your med pass time by at least 1/4. I have found with me at least that the first day may take me a while but the second day I can cut my med pass time in half. Its all about knowing your patients and how they take meds, organizing your time and getting the priorities done first then fill in with the rest. Hope this helps good luck toy you.. Ive been there.
  7. by   snowfreeze
    expect a 3 hour med pass, and earle58 hit the fine points, who takes meds whole or crushed, what to hide them in for the cautious, blood sugars, tube feeds continuous and bolus. Trust the nurse aids who know the patients, they have helped me a lot. I went from ICU to agency LTC and sub-acute nurse, it was an eye opener. My critical care experience helped a lot in quickly assessing problems and knowing when to just get back to work and when to call a doc or the medics.
  8. by   Lovin' my job!
    What ever you do...don't prepour! You think you'll save time but you're only increasing your chances of errors. When I started I talked with the reg LPN and asked the questions insulins? tubefeeds? etc just as the other threads suggested and keep a piece of paper taped to your med cart to jot down notes. It's really just time. Just follow the procedure as you were taught and all will go well.
  9. by   nurse_clown
    [FONT="Comic Sans MS"]my one part time job is in acute care. my other part time job is in long term care. i noticed a huge difference. in acute care, we just throw any size or type brief on the patients. in long term care, continence products are studied, counted, rationed and put on a certain way. in acute care we have DNR or not. in long term care we have "advanced directives": CPR or not and different levels of interventions. in acute care, we pass meds to 13 patients. in long term care, we pass meds to 40 residents!!! in acute care, we know there's a dressing change or treatment, we just document in the chart. in long term care, there's an actual treatment administration record that we sign. there's other differences and protocols that make each job vary. my director of nursing told me that i act like an acute care nurse when i'm there and there's nothing wrong with that. she considers it a good skill. we also have long term care policy manuals for everything. in acute care, we'll be lucky to find a policy in the manual. lol
  10. by   CoffeeRTC
    I also like to know of any major wound issues or pain issues or falls/ incidents to monitor and any iv meds.
  11. by   Simplepleasures
    This is the nature of the sub acute unit beast.Understaffed, overworked= UNSAFE .We can change staffing ratios if we have a VOICE,ONCE AGAIN, I am singing the UNIONIZE song!How else can we affect CHANGE? Any suggestions?
  12. by   banditrn
    Quote from ingelein
    This is the nature of the sub acute unit beast.Understaffed, overworked= UNSAFE .We can change staffing ratios if we have a VOICE,ONCE AGAIN, I am singing the UNIONIZE song!How else can we affect CHANGE? Any suggestions?
    I was in a union at the hospital where I worked, and while, initially, they helped me, in the end, they were worthless. And I found out later that my union rep was figuratively 'in bed' with the manager who was causing all the problems. Don't know what they did with her - no longer care.

    I agree that health care needs a good strong VOICE, but some unions, the way they are set up, do more to hurt than help.
    If there was a union in the LTC that I just left, then the couple of CNA's who do the most harm (most of the ones there are wonderful) would be there forever.

    I don't have any answers, either, so I guess the current union system is the best we've got. But it seemed like at the hospital when the contract came up, it was always about MONEY. Well, I already felt that I made a very good hourly wage - I wanted them to concentrate on the stinking staffing! But that always seemed to get pushed by the wayside in favor of more money. I finally realized that all the money in the world wasn't worth working under those conditions!!
  13. by   ns lpn
    I don't know about agencey nursing but I do know what its like starting out LTC scarey. Meds are the whole day, you'll see them at night when your sleeping, worry when you get home that you might have missed something even with your checks b/c there are just so many pills and then your suppose to find time for treatment ect..lol.

    If you ever get to stay somewhere long enough you will find it gets better, you will get through it quicker b/c you'll know all the residents and their needs but some places really push the envelope and you'll know this when you see the full time staff overwhelmed by their jobs and running late on their med passes...then run b/c if they are having a hard time getting through daily med passes your going to have the shift from hell.
  14. by   ns lpn
    Quote from banditrn
    i agree that health care needs a good strong voice, but some unions, the way they are set up, do more to hurt than help.
    the nurses in the union should be the voice.

    if there was a union in the ltc that i just left, then the couple of cna's who do the most harm (most of the ones there are wonderful) would be there forever.
    this is often true, but it also helps the good nurses as well. besides i don't feel rn's and lpn's should be in the same union as the cna's/pcw's because our issues are different.

    i don't have any answers, either, so i guess the current union system is the best we've got. but it seemed like at the hospital when the contract came up, it was always about money.
    if your voted union reps do their jobs then the issues that come to the negotiating table should reflect the major issues the staff want addressed. this being said i find alot of staff take the money over the other issues when it comes down to one or the other.

    all this said being unionized does not solve all the problems with ltc esp. not the staff/client ratio.
    Last edit by ns lpn on Nov 26, '06

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