**HELP!! ICU RN Working PRN in LTC??

kummerspeck · Aug 26, 2016

I work 11-7 full time in LTC. I love my shift. It has its "quiet" days and its "busy" days, and they can change in a matter of seconds. I like to always review all of my meds/treatments at the start of each shift, and get my eyes on each patient pretty quickly. Depending on how many you are in charge of during your shift will determine how busy you are, really. When I am on one floor, I have 11-12 residents that I care for and it's a pretty easy shift, but when I'm on the other floor, the acuity level is much higher, and I have almost 30 that I look after (with some LNAs). It's busy, but it makes the time go by quickly. Med times in the AM are always busy, no matter how the rest of the night goes.

Spoiled1, MSN, RN · Aug 26, 2016

Thanks for your feedback. What suggestions do you have for organizing shift to accomplish med passes and other duties in 8 hours for 15 or more patients? Also, what questions should I ask on my first shift regarding the patients since I am a new agency nurse?

kummerspeck · Aug 26, 2016

I would be sure to ask about how to properly document (if they're paper or computer-if they're computer make sure to try to sign in before they leave!). You should ask about how the patients take their meds, and if anyone is on anything new, a foley, etc. Your LNAs will be a real help if you have them. Have them take you through a chart real quick (paper or computer) and have them explain where to document stuff. Know where to find the phone numbers of everyone you might need to contact. Also have someone show you where the supplies are that you might need. It's good to have a thorough report. At my place, if I'm reporting to agency, or on a new resident, I tell them as much as possible so that they know a little of what they might expect.

You'll get the hang of it fast, just try to get as thorough an introduction as you can from the shift you're relieving. :yes: If they're start reporting on a resident and say "they're good" and that's it....don't take it, ask questions. Since you're starting you need more than that.

Spoiled1, MSN, RN · Aug 26, 2016

Thanks again! I'm hoping for the best.

CapeCodMermaid, RN · Aug 28, 2016

1. 10 patients on nights is a whopper of a lie.

2. I am mightily insulted that you don't think working in a nursing home is a real job.

meanmaryjean, DNP, RN · Aug 28, 2016

1. 10 patients on nights is a whopper of a lie.
2. I am mightily insulted that you don't think working in a nursing home is a real job.

I suspect OP just meant that her 'real job' would be the one for which she just completed grad school- not dissing LTC. I saw nothing disrespectful of this work environment in her post. Rather, she was concerned enough about wanting to do a good job that she asked for advice.

lindseylpn · Aug 28, 2016

I suspect you've been lied to as well. I've personally never heard of a ratio that low in LTC. I'd say the average is around 25.

When I worked LTC we had 25 patients (skilled) to 55 patients (non-skilled) a night and 2-3 CNAs. At 10:45 When I first came in I'd get report and then count, see who I needed to chart on for the night and make a list of vitals I needed the CNAs to get. I'd check off on the crash cart and test the glucometers. I'd check the fax machine to see if the previous shift forgot to put any orders in and I'd write out the orders if they did.

First med pass was at midnight so, I'd stock my cart and do med pass.

After med pass I'd do any labs or treatments scheduled for the night. We did all labs, Foley changes, tubing changes etc on nights. I'd draw any blood needed, collect urine samples, change out IV, feeding and o2 tubing. I'd do all the wound care treatments, trach care, colostomy bag changes etc scheduled for the night.

After treatments I'd start charting. This is usually around the middle of the night and when everyone would want some prns.

Around 4:30 I'd start getting ready for med pass, stock the cart, get water and juice etc. At 5a I'd start med pass, do 30 on 1 hall switch carts and then do 25 on the second hall.

I'd finish med pass around 7a, give report and count.

After report I'd finish up any charting, fill out any incident reports and send out any faxes needed to the Dr's or pharmacy.

I usually clocked out about 45 mins late around 8am.

They was a typical night, very busy. Hopefully they weren't lying and you only have 10. í ½í¸€ Good luck

Spoiled1, MSN, RN · Aug 28, 2016

Thank you. No disrespect intended. I was only trying to explain my situation.

Spoiled1, MSN, RN · Aug 28, 2016

I suspect you've been lied to as well. I've personally never heard of a ratio that low in LTC. I'd say the average is around 25.
When I worked LTC we had 25 patients (skilled) to 55 patients (non-skilled) a night and 2-3 CNAs. At 10:45 When I first came in I'd get report and then count, see who I needed to chart on for the night and make a list of vitals I needed the CNAs to get. I'd check off on the crash cart and test the glucometers. I'd check the fax machine to see if the previous shift forgot to put any orders in and I'd write out the orders if they did.
First med pass was at midnight so, I'd stock my cart and do med pass.
After med pass I'd do any labs or treatments scheduled for the night. We did all labs, Foley changes, tubing changes etc on nights. I'd draw any blood needed, collect urine samples, change out IV, feeding and o2 tubing. I'd do all the wound care treatments, trach care, colostomy bag changes etc scheduled for the night.
After treatments I'd start charting. This is usually around the middle of the night and when everyone would want some prns.
Around 4:30 I'd start getting ready for med pass, stock the cart, get water and juice etc. At 5a I'd start med pass, do 30 on 1 hall switch carts and then do 25 on the second hall.
I'd finish med pass around 7a, give report and count.
After report I'd finish up any charting, fill out any incident reports and send out any faxes needed to the Dr's or pharmacy.
I usually clocked out about 45 mins late around 8am.
They was a typical night, very busy. Hopefully they weren't lying and you only have 10. ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ Good luck

Thank you for this very thorough breakdown of your shift. Like others have said they're probably lying about the ratios. I'm preparing for the worst, and hoping for the best. I want to do a good job and most of all a safe job.

Spoiled1, MSN, RN · Aug 28, 2016

I suspect you've been lied to as well. I've personally never heard of a ratio that low in LTC. I'd say the average is around 25.
When I worked LTC we had 25 patients (skilled) to 55 patients (non-skilled) a night and 2-3 CNAs. At 10:45 When I first came in I'd get report and then count, see who I needed to chart on for the night and make a list of vitals I needed the CNAs to get. I'd check off on the crash cart and test the glucometers. I'd check the fax machine to see if the previous shift forgot to put any orders in and I'd write out the orders if they did.
First med pass was at midnight so, I'd stock my cart and do med pass.
After med pass I'd do any labs or treatments scheduled for the night. We did all labs, Foley changes, tubing changes etc on nights. I'd draw any blood needed, collect urine samples, change out IV, feeding and o2 tubing. I'd do all the wound care treatments, trach care, colostomy bag changes etc scheduled for the night.
After treatments I'd start charting. This is usually around the middle of the night and when everyone would want some prns.
Around 4:30 I'd start getting ready for med pass, stock the cart, get water and juice etc. At 5a I'd start med pass, do 30 on 1 hall switch carts and then do 25 on the second hall.
I'd finish med pass around 7a, give report and count.
After report I'd finish up any charting, fill out any incident reports and send out any faxes needed to the Dr's or pharmacy.
I usually clocked out about 45 mins late around 8am.
They was a typical night, very busy. Hopefully they weren't lying and you only have 10. ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ Good luck

Thank you for this very thorough breakdown of your shift. Like others have said they're probably lying about the ratios. I'm preparing for the worst, and hoping for the best. I want to do a good job and most of all a safe job.

PMFB-RN, RN · Aug 28, 2016

1. 10 patients on nights is a whopper of a lie.
2. I am mightily insulted that you don't think working in a nursing home is a real job.

The OP in no way hinted or indicated that she didn't think working in a nursing home was a real job. Not even a suggestion of that and I am totally mystified as to how you could have misunderstood her comments so drastically.