How long did it take you to feel comfortable in LTC?

Ambier · Nov 3, 2007

Okay, here goes. First off I would like to tell you that the times that are assigned to the meds are not usually set by the doctor, they are set by your facility. Starting 30 minutes or so early is a common practice that every nurse in my facility does, especially after supper when everyone wants to go to bed at 7. I work 40:1, give or take a few. The most important thing to remember is NOT to leave meds at the bedside. :nono: Just tell the resident that you can't leave it...most will understand. And if they don't, TOUGH! You're doing your job right. The one thing that keeps me going after two years in LTC is seeing the smiling faces of my resident's every day. I have found that if I keep a positive attitude and can make one resident smile my day was good...plus I'm a little bit of a smart orifice with them. They love that. Good luck. :lol2:

momtorun · Nov 7, 2007

I have been an LVN for 7 years. I have always worked in Correctional healthcare. I am making the big jump to the " real world" and accepted a position in long term care. I was very excited about it until reading these posts. Now I feel like I might have mad a very bad decision.

Fiona59 · Nov 7, 2007

I worked in LTC for roughly four years. Never did feel comfortable, so I left for the safer, greener pastures of active treatment.

Better patient ratio, more backup, management that values its staff, security that will remove hostile, rude families. I love the hospital.

lvlissl2ebecca · Nov 8, 2007

I've been working in LTC for 2 months now and I can't say that I HATE it. I can say that it is the most stressful, busy, and time consuming job I could imagine. I don't know how but I have managed to get my med passes done on time (yes I start at 7:45 to pass 9pm meds). Of course, I have not ran into anything major in the middle of med pass yet. I'm sure on one of the busier nights that I will have some trouble if there is a fall during. I found a few shortcuts, that the state may not like (such as carrying a few treatments with you on medpass and catching the residents as you go) which do not jeapordize patient care. I've seen nurses start an hour before the one hour window .. which I, myself, am NOT willing to do.. that is a little much IMO, but thats their license not mine. Though, I try to stay as organized as possible.. and that helps time wise.. For example, after getting report and counting, I will go through the Tx. book and see what treatments I have and write them down and scratch them off as I do them (I usually carry the wound cleaner and skin prep etc. with me on my medcart in the bottom drawer).. state wont like that but you HAVE to do these little things that dont effect patient care to be the most effecient nurse. I still have big fears when it comes to talking to doctors. I dread having to page one of them because I get questions that I can't answer, and I feel like a dummie. The most I can do is have their chart nearby and tell the doctor I will look it up, because other than that I don't know these residents as well as other nurses and it cant come from the top of my head. The most you can do is teh best you can do.. and thats all they can ask of one person. I dont feel that I will be in LTC long because 1. its not challenging enough for a new nurse who has no experience, meaning you do the same routine and see the same things every day.. and i feel i should be seeing new things and learning. 2. Its very stressfull and trouble is around every corner if you aren't careful.

dream'n, BSN, RN · Nov 13, 2007

In my experience it takes a good six months to start feeling somewhat comfortable, and a year to be really proficient in a new job. Don't beat yourself up over the learning curve, it takes quite awhile.

Also, I know of the nurses of whom you speak that do the 'short-cuts.' Some short-cuts you will learn are safe and helpful, but some :nono: . I've seen plenty of nurses that took dangerous short-cuts and were thought of as the 'best' by management because they were quick, get caught in the end (or worse) and it wasn't pretty. Just remember that as long as you practice safe, the worst that can happen is you won't keep up with the pace and will have to find a new job. You could live with that. The worst that can happen with unsafe practice, is much, much worse.

TheCommuter, BSN, RN · Nov 13, 2007

Here are some common LTC shortcuts that are dangerous, and should be avoided at all costs...

1. Administering antihypertensive meds without first obtaining blood pressures

2. Not periodically checking the temperatures of patients on antibiotic therapy

3. Not assessing periodically for s/s of infection in patients on antibiotic therapy

4. Not offering hydration to save time (a patient of mine went into renal failure due to this)

5. Performing dressing changes without first cleansing the wounds/skin tears

6. Insisting that the patients swallow 20 pills at once to save you time

7. "Pencil-whipping" monthly assessments

8. Not documenting

9. Not changing the administration set on g-tubes regularly (this promotes infection)

Godswill · Nov 18, 2007

ok I am a post-op nurse who started in LTC and who currently still works prn at my LTC. guess what i feel LTC is my easy job. it less stress than hospital to me .Yes i have 40 residents, but guess what i know them so well i can look at them and know if something is wrong. i have a little bond with each one of them. Geri is my love and my passion. the truth is that LTC is not for everyone. i have loved LTC since clinicals. LTC can only run well i find also if u have a good relationship with your Cnas they are the back bone of a good LTC. u have to know you can depend on them to check the pt b/p and temp if you put it on thier assignments. If you truly like LTC give it time it will get easier, but if you hate it its not for you. bottom line is u either love it or hate.

ps on the other hand i am still trying to feel as confident as a post-op nurse, but i know i like it so i know it time, i will be a awesome nurse, you have to believe in yourself;)

Dierdre · Nov 19, 2007

LTC is not possible without shortcuts. The last time I added up the amount of time needed to take care of my LTC residents including meds, breathing treatments, eyedrops, inhalers, treatments, fingersticks, insulins, other injections, assessments, charting, and actually managing the staff, I came up with a need for 22 hours of work a day. I spent three hours a day in the dining room uselessly feeding people that any competent nursing assistant could have fed better and faster than I did, another hour a day in 'stand up' (a daily 'meeting' that was basically a report for administrative nurses so they could get their care plans done without looking at the charts), and didn't take a lunch break for three years. This left me five hours (if I didn't have an admission or a death) to deal with 22 hours worth of work. I told my boss daily that I didn't have enough time to do my job. Caring about that was not in her vocabulary, about every two weeks I was in the office getting a solid orifice-chewing about not being able to get thus-and-so done (always 'essential' paperwork, the patient care was done).

I went to work eight months ago in the plasma industry. I strongly recommend that people leave LTC in droves until the management is forced to staff to appropriate levels.

PlatinumDymondz · Nov 21, 2007

I know exactly how you feel, I just began working in a LTC as a new LPN two weeks ago and it has been one of the most stressfull experiences ever. And that's considering the fact that I had been working as a CNA in my facility for two years before I became a nurse so I am already familiar with the staff, the residents, and the policies. Also, because I know the staff, I was given 10 days of orientation on the floor, with an option to continue if I felt I wasn't ready, instead of the usual 2-3 days. It seemed like I had everything going for me but yet still when I was placed on the floor for the first time on my own I felt like a deer caught in the headlights. First, I got to work for 7am but didn't start until after 8am because the night nurse was still putting away meds on the med cart, then it took me 45 minutes to do about 10 finger sticks and give coverage. By the time I was ready to give morning meds it was already almost 9am and i had to give morning meds to 40 patients and finish by 11:30. Sounds doable? Not when most of the meds I had to give was for hypertension or CHF and before I give them I have to get vitals and for some reason the machine wasn't working properly. And not when I had to stop every few minutes to connect/disconnect pegs for the CNAs who wanted to get their residents out of bed. By the time I looked around it was 10:30 and I had only given about 5 people meds. In the end, the desk nurse and my supervisor had to help me out by giving out some of the meds and doing some of my finger sticks. I'm so thankful for kind people.

nitewarrior · Nov 21, 2007

It seems this way in all LTC's I have been in. You just have to develop your own rythym and pattern. Unfortunately we have to take short cuts. But I never leave pills setting I mark a refuse and if the time frame allows return for a second try but if not they dont get them. If it is a super important med I call the MD to get an order for admin out of timeframe

Rexie68 · Nov 25, 2007

I hate to say it, but on the rare occasion that I pass meds (did that for 15 of my 18 years as an LPN), I might take some shortcuts. I start my med pass a little early, I've let experienced CNA's do a dressing or two, and yes, I have left a med at the bedside, going back to make sure the pt has taken it. Was that right? No way. And I never did it with anything but an OTC, but still........I'm being honest. Have I prepoured meds? Yup, you betcha. When I originally started (in 1989) that was procedure. It's not supposed to happen anymore, but it does occur. I've waited till the end of my shift to sign off my treatment book. (NOT med book). Again, not correct, but what's a girl to do? If you have anywhere from 25-75 patients, depending on the night, you do what you have to do to get the job done as safely and effectively as possible. I may have had from 5-11 G-tubes, 2 IV's running, 3 trach patients.....and 5-7 CNAs. (thank God for wonderful CNA's!!!!!!!!) If no emergencies happen, I can get done and out the door at a reasonable hour. It's not like it was in school. I still make sure I physically check every patient at least once during the shift, but in no way can I do a full assessment on everyone. I guess the bottom line is that you have to do what is right for you. Try not to judge the others too harshly...they're doing their best, too. We all have different levels of "bending the rules" but know that no matter what, our patients health and our license is on the line every time we step on the floor.

lookingbeyond, BSN, RN · Aug 1, 2008

Hi, I am a new LPN (less than 2months) working in LTC ~ and hating every second of it
Every day I feel incompetent & frustrated. Unfortunately, I work in a facility where many nurses *do not* do the right thing (ie: pulling meds & getting them ready before a med pass, putting meds on residents bedside tables & walking out, starting med pass early ~ more than 1hr before scheduled time ~ in order to finish on time.)
My med pass is slow, d/t being new & following the rules. Other nurses tell me "cutting corners" is part of being a nurse in LTC & I just have to learn to make my own system. Ugh.
Last night a Res. didn't want to take all of her regularly scheduled meds at once. I said, "Ok, I'll bring the rest back later." Then she got upset & argued w/me saying that everyother nurse lets her keep her meds in her room & take at her convenience ~ she started yelling at me, calling me crazy & accusing me of trying to OD & kill her! This woman has some dementia, but not a lot. This scene went on for 20min. I finally let her keep the meds she was clutching in her hands but took the rest from the room & marked it as a Refuse. I know I should have tried again later, but she was sooo aggitated & she had the important pills (BP & psych) the ones she didn't take were vitamins & stool softener.
Unfortunately, many nurses *do* leave her meds in her room for her~ so she isn't totally unjustified in being upset w/me.
I have noticed that at my facility, nurses who do their job effeciently (even though they take illegal shortcuts) are thought of as good nurses. Nurses who go by the book or take their time are not respected by other nurses or aides. Experienced nurses tell me it is better to be slow & thorough ~ yet in the next breath they will complain about Nurse "X" who takes 3hrs to do a med pass. Honestly, is it like that everywhere?
Stuff like that is just one example of why I am already so stressed out. Does anyone have advice for the first year of LTC? How long did it take you to feel comfortable?

I am so grateful for this writing. Every single word is ME. I've been in this for about a month and have already been "talked to" by administration....