How do you handle 10 patients at once

madwife2002, BSN, RN · Oct 18, 2015

Prioritize your care, be methodical-great time management

Divide your work load between you and the LPN

Or what has worked for me in the past

Work together going from room to room, obviously starting with the patient which needs you the most-before you start your day make sure you visit each patient say hello and explain you will be back

Marier · Oct 18, 2015

I agree thank you for your response !

emmy27 · Oct 18, 2015

Make a quick prioritization plan with your teammate at the start of the shift. If you're in a state with a restrictive LPN scope, figure out what things you're going to have to do specifically and what things she'll be responsible for. For instance, in many facilities, LPNs can monitor blood transfusion but an RN must initiate it, and in some places LPNs can do ongoing assessments but not admission assessments. Figure out what you personally *must* do and divide the rest of the work accordingly.

Make sure you know what the LPN scope in your state and at your facility actually is, since this is your regular workflow. I have seen plenty of facilities that pressure LPNs to work out of scope even according to their own organizational policies, and pressure RNs to sign off on it. It'll come back on both of you if that happens and there's a problem.

Middle and upper management in some places is fine with saving money by staffing in such a way that LPNs have to perform RN scope work and then blaming the overwhelmed RN "supervising" them if there's an issue.

BonnieSc · Oct 18, 2015

I used to work with two great LPNs and one that I couldn't trust at all. With the two good ones, they were open to dividing the work however I chose. Some RNs would divide the assignment in half and only deal with the LPN's half for IV pushes (they couldn't push in that state) or questions/emergencies. I wasn't really comfortable with that as it wasn't how I was educated; we both worked with all ten patients. I assessed all of them and the LPN passed most medications. After assessment we divided up the dressings. Generally I charted assessments while the LPN did tasks like starting IVs. I did patient education on discharge; the LPN followed up on assessment needs, walked with patients, etc. (CNAs did vitals, I&O, most bathing.) It worked really well and I enjoyed being part of a team and sharing knowledge.

The LPN I didn't trust would do things like skip dressings and chart that patients refused meds, without having offered them. I basically had to treat her like a CNA. I didn't understand why I seemed to be the only one who didn't get along with this LPN, until a couple of my colleagues laughed and told me it was because the rest of them had given up on her long ago, didn't trust her to do anything, and so didn't bother trying to get any work out of her. Watch charting of anyone you've delegated to very carefully until you feel confident of their work.

It's also important to know who you can trust when, as you say, several patients go bad at once. Don't underestimate an experienced LPN, they can take care of a lot--that goes for the CNAs, too. Don't feel like you need to be everywhere at once, stay with the priority until the situation stabilizes, delegate the ongoing care, move to the next to make sure everything's going as it should. A good LPN/CNA will (if you've communicated you can't leave another patient) find another RN to help in an emergency. You can also call your charge nurse, nurse manager, or any RN to say "Hey, can you check on [LPN] in room 203?" Then that nurse will know the LPN can continue to be the primary there if everything's okay, rather than stepping in and taking over unnecessarily. An RN will usually be able to quickly assess the situation to see if it's out of the LPN's hands (or s/he may know that him/herself).

Also, schedule your staggered lunch at the beginning of the day. It's absolutely delightful to go to lunch knowing that someone who actually knows your patients is going to be looking out for them. I always give the LPN first choice of lunchtime.

TheCommuter, BSN, RN · Dec 1, 2015

I (RN) work with an LPN and we care for 10 patients together.

You, as the RN, should be providing primary care to five of the 10 patients. The LPN should be the primary nurse for the remaining five patients, and you'd be responsible for performing any procedural skills that are not within his/her scope of practice.

As a previous poster mentioned, divide the workload in half. You cannot effectively render care to 10 med/surg patients as the primary nurse for all of them. It's called team nursing for a reason.