Reality in the LTC - page 2

Do you all think that one nurse for 30 residents is an "average" number? And for the nurse taking care of these residents in an 8 hour shift, is it realistic for her to do all meds, all treatments,... Read More

  1. by   BowlerRN
    I work PRN in a nursing home where I'm responsible for approx. 40 residents. (including their meds, tx's, assessments and charting) Our policy is to preset our meds, we have little med cards that we set up with each person's meds. This makes breakfast go by much smoother since everyone seems to get 10 different meds! We've never had a problem with this when the state surveyors come.
    The aids always do the vital signs and pass am snacks. I usually find a little time to help take a couple people to the bathroom and walk people to and from lunch during my shift also. I guess I don't have an abundance of treatments to do and don't usually have to worry about being short-staffed of aids.
  2. by   LauraF, RN
    What happens at our place is that there are 2 nurses, or a Nurse and a CMA. One passes the meds, and the other one does the charting, treatments and insulins. It works out well. If you are on meds, that is all you do. Any nursing issues goes to the other nurse. Now that being said if the "charge" nurse gets bogged down and you have time, it is assumed that you will help out.
  3. by   Jo Dirt
    When I work in the nursing home I usually have 42 patients. And yes, you are expected to do treatments and meds and all that other stuff.

    Of course, you realize it isn't about "quality" care for the patients and satisfaction for the nurse. It's like an assembly line. Work it work it work it.

    But there were times it wasn't so bad, either.
  4. by   SuesquatchRN
    We do things "by the book" where I am but we are exceedingly well-staffed. I don't pre-pour ever as here in NYS the state will cite you in a heartbeat for that one. I did in my last facility and they were always freaked about the state.
  5. by   Jo Dirt
    Quote from marjoriemac
    Have never worked with any nurse that does everything by the book yet.
    I worked with a nurse who did try to do everything by the book. She was very hard to try to orientate to the unit. When I would try to explain things everything turned into a big argument about how it is suppose to be done "this way". When she got out on the floor and started doing things "her way" she would be there at 2:30AM when the shift ended at 11PM. Naturally, management had some talks with her about this. She ended up quitting after a few weeks.

    You've got to learn when good enough is good enough and what things are priority over others.
  6. by   banditrn
    I have 42 residents, part of them skilled - the CNA's don't do vitals in this facility - they figure they have enough to do as it is, and I agree. Occasionally if all I need is temps, I'll send one out with the thermometer.

    I will usually go in and do the vitals on the skilled residents when the CNA's are in the room so that we're not waking them twice.

    I do set up some of my meds in the AM - I have ONE HOUR to do a crap load of them, plus some blood sugars and a bunch of treatments. I'd never get done otherwise.
  7. by   txspadequeenRN
    i have worked at several jhaco certified nursing homes in the ft worth area.

    Quote from thecommuter
    most nursing homes are not jhaco accredited. jhaco accreditation is mandated for hospitals, but not for nursing homes and other ltcfs.

    i worked at a psychiatric hospital that was jhaco accredited. however, i have never worked at a jhaco accredited nursing home.
  8. by   txspadequeenRN
    if you have 30 patients and you stop to chart every time something happens'll be there until next week. that just isn't feasible .however, i carry a clip board and a roster to write down times and incidents then chart at the end of the shift.

    Quote from raeth
    our instructors have consistently encouraged us to chart as we go. like someone said, if it's not in the chart, it never happened. this has been stressed to us a lot in school. also, delegating vitals to aides is actually in our textbooks... works if you're using student nurses too!
  9. by   nursedawn67
    Quote from pnurseuwm
    Do you all think that one nurse for 30 residents is an "average" number?
    And for the nurse taking care of these residents in an 8 hour shift, is it realistic for her to do all meds, all treatments, chart and get out on time at the end of her shift? (a first shift position)
    Those of you in long term care do you all usually get out in time or are you still doing things (charting etc.) past your official quitting time?
    Just very curious.

    I usually have about 25 residents (first shift) and on a good day yes I am out of there on time....On a busier day sometimes I am out on time (if I cut my breaks short) and sometimes I am over a bit charting. But we try to help eachother so that we can get out of there on time. And yes we do all our own charting, meds and treatments. I also carry my "brains" (scrap paper) in my pocket and I write down things, so that later in the day I can chart everything.
  10. by   jill48
    Quote from txspadequeen921
    if you have 30 patients and you stop to chart every time something happens'll be there until next week. that just isn't feasible .however, i carry a clip board and a roster to write down times and incidents then chart at the end of the shift.
    that's what i said too. of course, if i have a patient going out somewhere and the chart is going with them, i will chart all the pertinent things. otherwise, the patient care is going to come first and the charting will have to wait until later.this is by my book - "jill's big book of nursing"
  11. by   Liberty Bellpn
    I've worked in JHACO LTC facilities for a long time and had various numbers of patients of varied acuity. The facility I work at now has a 60 bed unit divided with 3 nurses responsible for everything for their 20 patients...20 pts isn't alot, but when you figure in all the lab results arriving on the 3-11 shift, (with abnormal INRs,etc) physician orders being written by NPs late in the afternoon, and any c/o's to MDs, it makes it interesting! I try to eyeball the orders first, for anything pertinent (new antibiotic, etc), before I hit the floor.If I have any IV's I check them immediatly,and also the Gtubes, and trachs.THEN, on to the meds.
    Then it's time to check the BG of the 12 (count 'em,12!) diabetics, and administer SS a/o'd... I never prepour--big no-no.(The pharmacy consultant would show up and check my cart just as I did that, with my luck!Or the state!) I feel a constant sense of urgency---the need to get things done in case something comes up like a fall, skin tear, altercation, or emergency--and it always will happen just when you think you're catching up with your work.
    Then I have to get to the treatments, and find doing them is the easy part, yet signing and charting them takes, I guess my answer is it's do-able, but it ain't easy....and hello, BTW, I am new here!
  12. by   Raeth
    Quote from TheCommuter
    30 patients is an average LTC patient load.

    Let me reveal the dirt. You won't get done on time if you choose to do things by the textbook. However, you will get done early if you take a few shortcuts (preparing meds ahead of time in little cups, charting as you go, asking an aide to obtain your vital signs, etc). It might not be safe, but no patient of mine ever was killed or harmed. I hope no one flames me for revealing these things. :uhoh21:

    I worked the 3pm-11pm shift in LTC, and was always done with everything by 8pm. I would always set up my meds beforehand, get the treatments done all at once, and chart until the oncoming nurse came to relieve me.
    I was just replying to this comment, I have honestly yet to see a nurse that charts everything right after they do it. In my experience as a NAC and now a nursing student I have seen how crazy it gets. It wasn't my intention to sound judgemental.

    I wish in my NAC days that the nurses would have realized that we might not always be able to do vitals... even when we would be doing a whole hall alone because of call-offs some would still be on my ass to do them. Then they leave on time and you're there two hours late... In general though, I was happy to do vitals for most of the nurses... and it was definitely expected of us.
  13. by   pnurseuwm
    So do you all suggest doing assessments AND meds at the same time? or like give all residents meds THEN assessments and treatments at the same time?
    The facility I'm talking about has a unit clerk and then will have a charge nurse that is suppose to "do orders and talk with the doctors". What do you all think of this?