HELP !! Can anyone else handle LTC ??

BerryHappy · May 15, 2009

I am sorry it's starting out so hard for you. It takes at least 8 months to get a routine and really feel comfortable. Depend on your CNA's to help with EVERYTHING except med pass. You've have got to start using them! They know as much as you do (almost) but they will not show it unless you ask. Remember, they work for the same LTC you do, not just for you. Respond immediately when they need something and they will do the same. Send them to the kitchen, set up the dressing change but have them do it, put one of them in charge of the phones (or ignore the phones), and HIDE when you need to finish pprwk! Family does not understand the trouble we get into from inc pprwrk! Sit down to finish pprwrk and do not get up unless someone is bleeding! You can do this you just have to become more organized! 25 pts is not that bad, it is usually MUCH worse! Put yourself FIRST, if you don't care for yourself, you can't care for anyone else! CLOCK OUT ON TIME! Stop staying late...you will KILL YOURSELF doing that. ENDORSE! ENDORSE! ENDORSE! The next shift might get mad but too bad! You are new and they were once too! As you get more experience you will manage your time better.

Good luck!

kermitlady · May 15, 2009

I agree with everything the above poster said except for setting up your dressing changes. Changing dressings is outside the CNA scope of practice.

NC Girl BSN · May 15, 2009

I agree with everything the above poster said except for setting up your dressing changes. Changing dressings is outside the CNA scope of practice.

I agree! Letting others do your duties is a great way to get you license taken. I worked in a Nursing Home for 18 months as a LPN and got my RN through Excelsior. It was the best thing I ever did. I know work in a hopsital with a different kind of stress. The load is so much lighter but the decision making is critical. Nursing Home work is not easy. I slaved away on the 3-11 shift also and I had 30 patients. I knew that I wanted more out of life. It was a big motivator to finish the Excelsior program. Hang in their and keep studying. How far along are you? Visit us on the Distant Education board. There are several EC students and graduated over there.

LPNtoRNVickyLynn · May 15, 2009

Hang in there. I graduated as an LPN last July and I'm just now to where I feel comfortable and I have the added stress of being PRN so I'm always on a different floor. I'm also a Excelsior student. I agree with the others about using your CNA's more effectively. They are a great resource as long as you use them within thier scope of practice. Also, don't stay late. Nurses need to help each other out. We have all had days that we have had to leave something for the next shift to complete. You don't want to take advantage of the next shift so it's a balancing act. A lot of the stress I think after you first graduate is that you feel like you have to do it all on your own and you can't ask for help (or more correctly delegate). You must use your CNA's. They can call the kitchen and much more. It's amazing, you show them that you respect them and need them and they will do anything for you. Sometimes they get a bad rap and feel like poopper scoopers (what one of my CNA's stated) but if you show them that you know they are capable of more you will see more out of them. Again within their scope of practice. Good Luch. Don't quit!!!! :yeah:

David13, MSN, RN · May 15, 2009

When you spoke of nurses "giving 150% only to go in the following day & get written up for something soooo completely ridiculous", it brought to mind the fact that the ratio of licensed staff to patients is extremely high in LTC. The types of ratios you see in LTC today are not representative of the level of patient acuity that is currently being handled in these facilities. However, nurses are being held accountable for all of these patients almost as though there were time for 1:1 care to be provided. Add to this the unrealistic expectations of family members and oblivious LTC administators, and you have a fine recipe for nurse "burn out".

travel50 · May 15, 2009

I am the DON at a LTC facility, and I truely understand your dilemma. It is hard, and no one understands how hard until they get in there and do it. The state regulators, families, corporate, etc., all have such unreasonable expectations. As David13 said, we are expected to be as responsible as if we were doing 1:1 care. On my 3-11 shift, we have 60 residents and 2 LPNs. But we now also have an RN around the clock. I have the RN doing the treatments, and helping deal with families, etc. Has made a huge difference in the stress level of my nurses. If you stick with it, you will eventually get a routine. But NEVER have the aides do your dressings. That is on the list of illegals....well, it is in my state. It may be perfectly legal in some states, but I still wouldn't do it. And don't stop working on your RN.

stressed5242 · May 16, 2009

Thanks everyone for your encouraging words. The CNA's i work with most of the time are excellent, they are also very busy. but like everywhere, some are great & some are hiding in patients rooms with the curtain drawn ha ha. I think I will try and stick it out to get my experience, but I don't think LTC is for me. When I become an RN, hopefully some other doors will open, that is what is great about nursing, you can bounce around untill you find your niche. I actually had a friend of mine who said to me "why are you so stressed, don't nurses just pass out meds?" Ha Ha, yeah right !! Thanks again everyone :)

NursingStudent5548 · May 17, 2009

I was a CNA in LTC facility only a few weeks ago. Our nurses weren't nearly this stressed... This sucks... Reading your post appauls me.

Our nurses never touched trays, never got replacement trays. They rarely passed meds.

We had a medication aide...(very effective despite the hesitance from some ppl)

The nurses were strictly in charge of doing dressings, answering phones (CNA's were allowed but if a family member had a question about their loved one...We had to refer them to the nurse), treatments, and charting.

By the way, in EVERY state I have ever worked at it is ILLEGAL for aides to change dressings (including applying new dressings, so far as even a bandaid)

The aides were responsible for obtaining all vital signs...even hourly after a head trauma (from fall).

This was also an incentive for us to keep them off the floor!!

Our facility had one nurse for 46 patients.

More history on the inner workings... Our facility is a private owned by a single family. Its the oldest nursing home in our state.

Average monthly fee was $4k per resident...give or take for private rooms, or suites.

On 3-11 we had 6 aides working... we had no nutrition aides... We passed all the meals cleaned up the dining rooms...including mopping.

We took out the trash... bathed all our residents whose bath was scheduled.

Rotated our residents, changed them, transported them to their meals, reported any suspicious changes (change of mental status, abnormal vitals, bizarre behavior, etc.)

It sounds to be your CNA's are playing dumb... Aren't you authorized to write them up.

Warn them if you catch them or recieve more complaints about them hiding they will be wrote up!!!

Good luck stick with it!!

stressed5242 · May 17, 2009

I could write them up, but I really don't want to, I don't want them turning against me, I need them to report skin issues to me, If i start writing them up , believe me, they won't tell me anything, then it's on me & I am screwed !! All of my nurse friends told me this happens alot in LTC. The CNA's at my place are responsible for bathing, feeding, changing pt, nothing else. I would love it if they could answer phones & obtain vital signs, but they are not allowed to in my place....I will just suck it up for a few more months...Thank you for replying :)

Trailer · May 17, 2009

How long is this going to continue? How long are we going to have such horrible patient-to-staff ratios? I suppose as long as we're willing to do it, the people with the money will keep putting it on us.

If we don't unionize at some point, nursing will become a revolving-door profession. That is, new nurses are churned out to replace the nurses who have been overworked and/or have lost their licenses due to poor patient care--poor patient care resulting from inhuman expectations.

But, so long as we need the paycheck, we will keep doing whatever they say. But it sure seems like something has to break. Maybe we should all quit, and then advertise ourselves as private contracted nurses.

I'm just so POd at what is expected of nurses for less than half the pay of an MD--OR A PLUMBER!

stressed5242 · May 17, 2009

Trailer, I love your post ! So True, I have been working on my own for about 6 wks. I have already had 4 falls on my shift ! I am going home so stressed & upset, I hate it ! This job isn't rewarding at all, I leave every day feeling guilty ! I found a bruise on a pt's back while doing a skin check, i documented, told the next shift nurse during report, well guess what ?? The following day, my unit manager tried to write me up for not filling out an incident report ! I told her that I didn't know i had to fill one out, It was never brought up in training & i am still learning. I went to the director and told her that it was ridiculous that I am being written up as a new nurse for not filling out paperwork that I wasn't even aware of, beside I FOUND the frikan bruise, and thought i was doing the right thing. how is it possible that i got myself in trouble ?? I told the DOA, i would have been better off ignoring it !! I told her this place wasn't for me, and i was giving my notice ! She asked me to stay & tried to encourage me that i was doing a great job. (I know she just doesn't want the hassel of training someone else ), of course she killed me with kindness & I told her i would stay. She acted like she was doing me a favor by squashing the write up !! give me a break ! I wish i stuck to my guns & left! My husband tells me everyday to quit this place, i want to but I feel like a failure quitting, and I am scared in this economy it may take me a long time to find another job, and i wouldn't be able to put this place down as a reference (They would give me a bad one if i left, they do it to everyone ). I feel so trapped & miserable !!