New Nurse being thrown to the wolves IN LTC HELP!

Gerinurse05 · Apr 2, 2005

What is a g tube nurse? Is that all she does?
On 11-7 I have 48 residents...5 or 6 tubes and at least 12 diabetics. This is with 2 Cnas.
On 3-11 I have 4 tubes, 7 diabetics, 3-4 cnas. 26 residents (LPN has 22) Meds, tx, orders, etc...charge.
LTC is never easy...you learn every day.

My g tube nurse does all the tubes on 2 halls....about 13 total at this time. She also does the fingersticks & the monthly summarys. She also assists in emergency situations if needed.

This leaves me to charge, carry out orders etc.

June8662 · Apr 3, 2005

In LTC I have 39 and usually at least 2 cna's but i also have a question. Does anyone know the legal limit as far as nurse pt ratio in ltc and also we have mandatory overtime. Any ideas on where i can find the laws on this one?

What is a g tube nurse? Is that all she does?
On 11-7 I have 48 residents...5 or 6 tubes and at least 12 diabetics. This is with 2 Cnas.
On 3-11 I have 4 tubes, 7 diabetics, 3-4 cnas. 26 residents (LPN has 22) Meds, tx, orders, etc...charge.
LTC is never easy...you learn every day.

LPN1974, LPN · Apr 3, 2005

In LTC I have 39 and usually at least 2 cna's but i also have a question. Does anyone know the legal limit as far as nurse pt ratio in ltc and also we have mandatory overtime. Any ideas on where i can find the laws on this one?

I don't know what state you are in, but where I am, I don't think there is a limit.

I worked a LTC, part time for 2 years, and had up to around 40-45 patients for a med pass.

And from what I've seen written on this board, that's not even a drop.

I've seen some say they had alot more than that.

I did med pass for these people, BS checks insulin, breathing treatments, etc.

I was not IV certified, and had to get another nurse to help me with any IV care.

On my regular fulltime job, in MR/DDS, I have an average of 60-65 people if there are two nurses, and if there are 3 nurses probably around 40, give or take a few, I haven't figured that one up to the minute detail.

But on this job, I don't have to do IV's. We do have a couple of G-tubes, for bolus feeds, 3 people on BS checks, out of those 3, 2 are on insulin.

However, we have an awful lot of treatments, of which are increasing everyday, due to the dentist we have. It just gets to be more and more everyday.

So, to your original question, I don't think facilities like this have a limit.

suznrn2002 · Apr 5, 2005

I am 50 years old and just got my RN 3 years ago. Before that, I worked every where in the health care system as a certified medical assistant, ER tech, admissions rep, ward clerk and nursing assistant. I did my nursing clinical senior year in LTC and stayed at the same facility. My facility here in WA state apparently is wonderful. :) While working the floor, I never had more than 28 patients on the evening shift and 22 patients on the day shift. My facility does not take ventilators but we do have tube feeders and lots of insulin dependent diabetics. When I first started, I didn't think I could handle the load, but with time, I did. I have moved from student, to LPN, to staff RN, to charge nurse now recently promoted to MDS/Restorative Coordinator...all in 3 years. My point? (I do have one!!) Everywhere I have worked, the nurses there always think they won't be able to hadnle their load. I've seen ICU nurses cry at the end of their shift after caring for FOUR patients...but....they came back the next day!! My advice, don't push yourself too hard and take your time! Rushing means errors. If you need help, ask for it. Ask your charge nurse, ask a co-worker who has a lighter hall and always, ALWAYS respect your nursing assistants. They are your eyes and ears. Keep copious notes on the resident's of your hall. I went home and made my own census that told me how they took their meds, whether or not they were on O2, had SVN's, eye drops, noon or HS meds, diagnosis, blood sugars, insulin etc. It sure made my next day easier and then, when I listened to report, I added any new info in my own writing. I also divided my notes into three columns...one for what I heard in report, one for what I needed to do that shift and the third was for anything that happened during my shift that I needed to report. I know I've bombarded you with lots of info...hope it helps just a little! If you can make it through nursing school, you can make it in LTC! Good Luck. Susan

dizzejan · Apr 6, 2005

not sure where you are ..but in PA the almighty PPD rears its ugly head..and the min is 2.7 nursing care hrs per resident in a 24 hr period...cna, lpn, rn's are all added into the mix...even if you are at 2.7 it is not enouogh hands on...but we muddle on.....

stidget99 · Apr 6, 2005

Whether LTC or an acute setting......I think that one of the results of the nursing shortage is all nurses being thrown to the wolves! Managers state "I think that you are ready" and that covers it all. I wonder if the nurse manager will come w/ you to your hearing at the BON hearings and stick up for you.....

dizzejan · Apr 7, 2005

oh stiget99......wouldnt that be interesting.......i think pigs will sprout wings and fly first i'm afraid....

DebbieP · Apr 16, 2005

Hello Im a new Nurse I just got my license on Feb 14, 2005. Im working in a ltc. They put me on a skilled unit. There are 2 sides On side is fairly light with 2 trach residents and 2 tube feeders. The other side is 6 trach patients, sacral wounds stage 4, 2 IV abt, and 6 tube feeders. I have not work this side by myself because I dont feel ready but they want to orient me to this side. The light side I have done by myself with no problem. My question is how do I deal with the extra load. Why would they put I new graduate there. I think because noone else wants to do it... I work 11pm to 7am and a lot of times the relief calls out!! IM stressed already and I havent been there for a month yet!! Please help me.. I have the opportunity to do homecare even though I dont have a years experience in nursing should I take it or stay and the LTC facility...

Wow...ltc is different here in Van Canada.I have worked in a few ltc facilities here and the situation was 70 patients,lots of po meds,catheterizations,enemas....just basic stuff so it's the perfect place for a new grad that wants to start off slowly.The downfall is you lose a lot of your skills.G tubes,trachs,IV's you'll find on our respiratory,med/surg wards not in long term care,very rare anyhow.I think you just need to take a look at all the different career opportunities in the nursing field and research the qualifications,what a typical day is like etc...this way you will have a better idea of where you may be best suited.I made the mistake of graduating from the Rn program,working for 2 years getting stressed and freaked out and then quitting.Now i have been out of practice for 9 years and am going to take the refresher program.Am i freaked out YOU BET,but now I am looking and researching different areas so that I can find my niche in nursing.I know it's what I need to be doing....I just don't know where.All the best to you in your future endeavors.

CapeCodMermaid, RN · Apr 16, 2005

It's not just LTC that throws nurses to the wolves. I had my first job in a hospital on a med-surg floor. Orientation had consisted of IV training. I arrived at 2:45 for my first ever 3-11 shift, and was told I was in charge! But, I said, this is my first night. The supervisor laughed and said "You're an RN...deal with it". So I did...got through the evening...didn't kill anyone. Later I took 10 years off to raise my kids. My first job back...on a 60 bed unit in a SNF. I walked onto the floor and was told...."there you go...those 30 subacute patients are yours"...that's what it's like. You either do it well or go work elsewhere. Not everyone can work LTC. I knew a nurse working in an ICU who told me that she couldn't work LTC, she had tried it and lasted a week and a half!

DebbieP · Apr 16, 2005

It's not just LTC that throws nurses to the wolves. I had my first job in a hospital on a med-surg floor. Orientation had consisted of IV training. I arrived at 2:45 for my first ever 3-11 shift, and was told I was in charge! But, I said, this is my first night. The supervisor laughed and said "You're an RN...deal with it". So I did...got through the evening...didn't kill anyone. Later I took 10 years off to raise my kids. My first job back...on a 60 bed unit in a SNF. I walked onto the floor and was told...."there you go...those 30 subacute patients are yours"...that's what it's like. You either do it well or go work elsewhere. Not everyone can work LTC. I knew a nurse working in an ICU who told me that she couldn't work LTC, she had tried it and lasted a week and a half!

I know I have been thrown to the wolves as well many times.There are good places to work and bad places.....good nurses and bad nurses...I can't believe that your first night working as an RN she said you're in charge...that is just crazy.Charge nurses have experience on top of their RN status.Good for you for getting through the night without killing anyone.I know it's scary at times.What is SNF?Where do you live?Most of our facilities are pretty good with being supporting new nurses.They are mostly training hospitals so they are used to lots of newbies.Right now I am trying to figure out where I want to do the clinical component of my nursing refresher course.I don't want to be thrown to the wolves lol ever again so I'm really studying and researching the areas I might be interested in so that when I start my refresher I will be one step ahead and even further ahead when I apply for that job.Where are you working now and how are things going for you?

lindarn · Apr 16, 2005

Hello Im a new Nurse I just got my license on Feb 14, 2005. Im working in a ltc. They put me on a skilled unit. There are 2 sides On side is fairly light with 2 trach residents and 2 tube feeders. The other side is 6 trach patients, sacral wounds stage 4, 2 IV abt, and 6 tube feeders. I have not work this side by myself because I dont feel ready but they want to orient me to this side. The light side I have done by myself with no problem. My question is how do I deal with the extra load. Why would they put I new graduate there. I think because noone else wants to do it... I work 11pm to 7am and a lot of times the relief calls out!! IM stressed already and I havent been there for a month yet!! Please help me.. I have the opportunity to do homecare even though I dont have a years experience in nursing should I take it or stay and the LTC facility...

Nursing has never quite figured out/accepted, that a required "internship" after graduation from school, would cut down on burn out, smooth the transition from school to real life practice, and provide more credibility to the nursing profession. All other health care professions require this, including doctors, physical therapists, occupational therapist, etc. That is why they all require a minimum of a bachelors' degree as entry into practice, (latelyu, thei is now a Masters Degree and a doctorate), and none of them feel the need, nor be expected to, to be able to "hit the ground running", the day after graduation. I remind people that these professions ALL earn considerably more than nurses do, and enjoy far more respect and credibility than we do.

An internship of at least 6 months should be required of all new graduates before they take the state board exams and become licensed. That would also end the debate over how BSN grads just cannot cut it after graduation because they do not have enough clinical in their undergraduate schooling. New nurses would feel more secure, and not be as overwhelmed as they are, even going to a med surg floor in a hospital.

Linda, RN, BSN, CCRN

Spokane, Washington

LPN1974, LPN · Apr 16, 2005

What is SNF?

SNF....Skilled Nursing Facility