Umm...I will have 47 residence to care for !!!!!

Specialties Geriatric

Published

I am oreintating as a new grad for the 3-11pm shift. I have found out that I will be doing all the meds, charting and treatments for all 47 of them. Is this even legal?

The unit manager doesn't help with anything on this unit, and the last two people hired on the station both quit after 2 weeks!!! How in the world can a new grad ( me) that doesn't know any of these patients, or have any prior LTC experience get all this done? Meds I could do. But add treatments, charting, and doing the new admits..NO way! I am starting to think I went into something that I won't be at very long.

After a couple days of orientation I am learning a little about the paperwork but it seems like such an uphill battle. Any advice from TLC works?

Specializes in Knuckle Dragging Nurse aka MTA.
How is it possible to give meds to all of these pt's in a 2 hour window?!! What about tube feeders? What about all of the patients that need their meds crushed? What if you have 20 insulin dependent diabetics that need accuchecks and insulin before supper? I just can't imagine being able to do this without super human powers.

its impossible to fit all that in in 2 hrs.

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Specializes in designated med nurse,med surg,hh, peds.

I work agency here in central illinois. I go to one home regularly on 10:30-7 shift, and am in charge of 60 residents. 20 get am meds. I have 4 foley flushes,a 2 straight caths and 2 g-tubes to flush and give meds to. I at this time have 4 regular treatments to do, sometimes up to 10 dsg changes/treatments, and charting for 12 to 15 medicare residents. From 10:30-11:15,I come in, count,get report,review MARs,then I go do my first straigh cath at 11:15 -11:45 (resident likes to talk) My CNAs get my vitals for me. 11:45 to midnight I review my vitals and chart them in the chart as well as the treatment book.I then set up my 6 am med pass. Then I go do my treatments as the CNAs are doing their rounds. I come back and after making rounds and chart a little more. Then I do my foley flushes. If no one climbs out of bed,dies, falls,or needs to be sent out I get to go to lunch between 3-3:30 for 30 minutes. If someone falls etc. no lunch for me ! I generally start my med pass at 5:05, if I'm lucky and everyone cooperates I finish my med pass at 6:10. I go do my last straight cath, chart the results, finish up my I&Os (again thank you CNAs I couldn't do it with out you).Day shift comes in at 6:30, we count, I give report and finish up any late occuring paperwork/charting.I usually get out between 7 and 7:30 depending on who the oncoming nurse is and what time she gets there. I might add I have been doing this for 15 years and have developed a system that works for me. I will also add that I have been sent to another facility where I am the only nurse in the building for 60 residents,32 of which get 6am meds,4 have G-tubes,and 2 get bolus feedings during the 6am med pass, and all four get flushes at 6 am. Even with setting meds up ahead of time, I had to stop my am med pass to give report, then finish it. I also had to do the accu checks and give insulins. I had meds at 12 ,2, 4, 5 and 6 am. (I wish I were exaggerating). I spoke with my ageny, who had me speak with the DON,who had the nerve to tell me I DID NOT pass meds to 32 residents,that the work load on noc shift was NOT heavy! :angryfire I told her that I begged to differ, that I make a list of who gets what and the time and that I started my med pass at 4:15am and did not get finished until 7:15 am. I told her that I felt that this was unsafe for one nurse to do, especially since almost all of the bid and qd treatments were put on nights. The DON said she'd look at the MARs and treatment books and see what could be done. (Oh, I forgot to mention that there is a med nurse on days,and a treatment nurse)I also told her that I did not take a lunch break, and that I finished my charting at 9:30 am. I have agreed to go one more time to see if it's any better, if not,I have informed my agency that I will NOT go back,(even though I was requested by name to fill a maternity leave position) that I worked too hard for MY license to lose it because a home doesn't want to staff properly.Luckily for me my agency is backing me on this one. I would have to say that 47 residents on 3-11 is too many. You cannot pass meds to that many people in the required 2 hour window. Insist on help, or get another job, but alot of the homes have similar nurse patient ratios. You could also contact the ombudsman and or the state and lobby for safe nurse patient ratios.

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Well, I am a manager in LTC. I have been doing it for almost a year now. I love it but at times and most days it's very busy and can get stressful. We try to split the assignments up that will be fair to all shifts. We look at the medicare charting, the clinical monitoring charting, the dressing changes and so on. One of the things we do is try to get all the medication scheduled anywhere from 6am until 10 pm. One of the reasons for this is because NOBODY wants to be woke up in the middle of the nite for a pill. The other reason is that the nurse would have to pass the meds if we didn't. Now the tube meds are different. The nurse does pass tube meds during the nite shift.

All of our daily dressing changes are done on day shift. Sometimes when the change is BID then it can't be helped but to be on day and night shift both.

I feel that sometimes we look around at other people and think boy I would like to have their job it looks easy. We have to remember that a job is exactly what it says "A JOB". They all have pros and cons that go along with the territory. Just because you may not see your unit manager "doing anything" as far as the floor work that doesn't mean that she isn't busy. There are lots of things that is to be dealt with on a daily basis. ALL of our nursing jobs are very hard.

If you are not comfortable in your current situation I suggest you use your chain of command. If you don't have the results you feel you should have then go with your gut feeling and move on to something else.

That's just my opinion. Ya'll know that opinions are like armpits....everybody has a couple and some are pretty stinky. haha

Huggz,

Kelly

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I also feel that this is far too many pts, particularly for a new grad. It's just not worth risking your license over. I'd advise you to give it careful thought before going into this. There are soo many opportunities for nurses now, and I for one will agree with what the above posters said about really *needing* that support/backup from coworkers during your first year or so of nursing (and even after that really!)

GOod luck with whatever you decide but it seems that they are being very risky by putting a brand new grad into a position to care for so many pts.

Keep us updated, ok? :)

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I agree with Suzanne. Look for something else.

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Well, I am a manager in LTC. I have been doing it for almost a year now. I love it but at times and most days it's very busy and can get stressful. We try to split the assignments up that will be fair to all shifts. We look at the medicare charting, the clinical monitoring charting, the dressing changes and so on. One of the things we do is try to get all the medication scheduled anywhere from 6am until 10 pm. One of the reasons for this is because NOBODY wants to be woke up in the middle of the nite for a pill. The other reason is that the nurse would have to pass the meds if we didn't. Now the tube meds are different. The nurse does pass tube meds during the nite shift.

All of our daily dressing changes are done on day shift. Sometimes when the change is BID then it can't be helped but to be on day and night shift both.

I feel that sometimes we look around at other people and think boy I would like to have their job it looks easy. We have to remember that a job is exactly what it says "A JOB". They all have pros and cons that go along with the territory. Just because you may not see your unit manager "doing anything" as far as the floor work that doesn't mean that she isn't busy. There are lots of things that is to be dealt with on a daily basis. ALL of our nursing jobs are very hard.

If you are not comfortable in your current situation I suggest you use your chain of command. If you don't have the results you feel you should have then go with your gut feeling and move on to something else.

That's just my opinion. Ya'll know that opinions are like armpits....everybody has a couple and some are pretty stinky. haha

Huggz,

Kelly

How many residents are the med aides passing meds to? Who does the accuchecks?

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Specializes in designated med nurse,med surg,hh, peds.

Re: nursekln's post.... The only problem with setting a lot of meds for 6 am is that the residents have to be woken up at 5 am to get the med pass done by 6 :30 am so the oncoming day shift can get report. We don't use med techs where I work, the ONE night shift nurse does it all. Meds (not counting eye gtts) for 32 residents 2 bolus tube feeds with meds, and 2 continuous tube feeds with meds. And accu cheks and insulins....It is not safe for 1 nurse to attempt to pass that many meds in that amount of time.

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Hey. I too started off my new career in long term care. My first week of orientation was on a floor with 40 patients-I thought I would lose my mind. The remainder of the floors have like 30 patients and believe me, by the end of the summer I was zooming right along. No time to sit around but I did get my meds, treatments and charting done along the way. I am per diem also. Anytime I got sent to the floor from hell I would call home to say I would be a few hours late. Good luck.

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If you are going into this job knowing that you can't handle it, then you really are in trouble. I work a 50 bed unit and am the only nurse on 3-11 most nights. We have Rn care coordinators for the whole building (almost 500) and Rn managers to handle staff issues, but again it's one nurse to 50 residents. And yes it is hard and no you will not get a break most nights. But if you know that you can not handle it going in, then go somewhere else. Because when you do make a mistake and God forbid have to go before the board who do you think is going to back you up?

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My staff struggles on 3-11 with an assignment of 22 residents, and 2.5 NAs. No subacute, just regular med run, regular charting, a few treatments and some dementia residents. No TF's, trach, suction, or any of that. They also have a supervisor, except on the weekends. Think I'll refer them to this post.

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Specializes in Knuckle Dragging Nurse aka MTA.
My staff struggles on 3-11 with an assignment of 22 residents, and 2.5 NAs. No subacute, just regular med run, regular charting, a few treatments and some dementia residents. No TF's, trach, suction, or any of that. They also have a supervisor, except on the weekends. Think I'll refer them to this post.

Oh I would be in heaven to have only 22 patients. I just got two more admits so I have 49 patients now!! 4 nurses aids. 5 GT patients. Too many diabetics to count, although I only need to do "finger sticks" on about 11, twice during the shift. I have to answer all the phone calls, pass all the meds, chart on all the daily charting and 3 weekly summaries, do all the treatments (there are about 40 to do ranging from protect barrier cream, to complete hard stage 2 - 3 and 4 decubs. How do the lvn's before me get all this done??? Oh I know.. they dont do it, but chart that they did. I do everything I am suppose to do and have to say at work and extra hour UNPAID!!!!. I have put my two week notice in . The DoN is pissed off cuzz they gave me a 3 week orientation and now I am quiting. Screw this place. I am not losing my license and I am tired of being thier slave.

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Been there, get out fast!

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