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

lookingbeyond, BSN, RN · Aug 1, 2008

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

Wow, that is a very good idea that I didn't know was possible...

barbarake21 · Aug 1, 2008

First of all, I'd like to thank everyone who's contributed to this post. I'm in the same boat so it's good to see that I'm not alone. I've been a LPN in LTC about three weeks by now.

I am also the slowest person giving meds and everyone keeps telling me I'll find my own 'rhythm and shortcuts'. But that advice is simply not very helpful since any 'shortcut' would threaten my license.

It's a shame because I like LTC. I like getting to know the patients and I like having some sort of routine. But I can see that it's going to be impossible to do it 'right' and 'in a timely manner'.

I get along really well with the people (both patients and fellow employees) and everyone has been very kind and helpful. Even the one notoriously crusty charge nurse likes me because "she's a worker". I do try hard - I'm not goofing off or taking breaks - but it's impossible to get everything done in the amount of time given.

And I agree that management closes its eyes to the shortcuts they know the 'good' (i.e. 'fast') nurses are taking until they're forced to do something about it because something happens.

I feel discouraged at this point because I like 'nursing' but I don't like the environment. (And my particular environment right now is better than most, I don't know how some of you handle it.)

B-Soulz · Aug 4, 2008

i've worked in ltc my four years of being a nurse, and at first it was very stressful, but being that i work 11p-7a shift, my med pass is not nearly as long as the first and second shifts, so i'm able to do things correctly and i don't have to cut corners to get the job done. if you don't feel comfortable with cutting corners while doing certain things, then don't do it. if your license are on the line, then please don't do it. my license is my family's livelyhood, so i don't do anything to jeopardize it.

1hat3b1lls · Aug 10, 2008

hi everybody,

[color=#483d8b] i can't believe how so many people in this forum feel the same way i do. i have been in ltc for a month now and i have to admit, this has been a nightmare. i wanted to become a nurse to give resident's priority care, but it just doesn't seem that way. other than slow med-passes and short-cuts, i don't understand why we are responsible for cna's. meaning, why are we giving them their assignments? i think there should be a "head" cna giving out their duties. when i walk into the unit every morning, the cna's that have been there the longest looks at me like i'm stupid for assigning them their "assigned" section and then argue with me that they can't do 3 showers...also cna's that get pulled from another unit absolutely annoy me. they come down to my unit with an attitude and expect me to give them their assignment and give them report about every resident they have. being a new nurse and never a cna, i cannot tell them if a resident wears a pull-up, blue, pink, small, large, ex-large diaper! i don't even have the time to assess my own resident, what makes them think i have the time to pull up their night gown and look what kind of underwear they are wearing?! i'm sorry about the ranting, but i feel that nurses should not have to give the cna's their assignments. i don't know about elsewhere, but i just hate doing cna schedules.

AngelaLPN08 · Aug 10, 2008

I love LTC, however it depends on where you work. Here we have "Good Sam" facilities and I love them! They utilize Medication Aids, and have a TX nurse! Plus 2 nurses per hall. I can't imagine how you can handle all of the stress you have. I worked in a LTC where there was one nurse to 35 residents and they were always there for extra hours. I had a paitent fall once and the charge nurse said. Oh he's fine don't write it down because I dont want to do the carting! Oh I was disgusted, I almost did not become a nurse!

I work at the VA and there are some shortcuts we do, but typicall nothing that will deal with the med pass. It took me a while to get my med pass down, but it was possible. We also rotate meds and paitent care so we don't always have to do med passes.

Good luck and always remember all the stress we went threw to obtain our Licence! Nothing is worth the risk to me!

levisandtees · Aug 12, 2008

I couldn't agree more...I too am a brand new LPN and just survived day three at LTC...my preceptor seemed very understanding that I had never done procedures (such as flushing G-tubes, drawing up insulin because everyone at the clinicals I attended had the pens, etc.) but when it came to me doing it, I apparently was taking too long because she either pulled the thing out of my hand (syringe that I was attempting to flush with) or sigh and say "here just let me do it" (in the case of the insulin)...as if I wasn't already stressed/frustrated enough!! One moment she would say that we needed to help CNAs answer call lights (which I readily do as a former CNA) and after I DID answer a light she berated me for doing so, saying that we didn't have time for that (and certainly don't have time for chit-chat with the residents as we're passing meds). My head was spinning by the end of the shift. Thank goodness my preceptor yesterday was the complete opposite--she was beyond wonderful...she made me feel comfortable and allowed me to perform the procedures at my own pace--and CORRECTLY for that matter (heavens--I feel indebted to her for this!!). I think that if I can "stick with" her for my last days of orientation I'll be so much better off...ratio is 40:1...just getting to know who is who and how they take their meds is such a learning curve...we "tag-teamed" meds and treatments yesterday so at this moment it hurts my head to think about doing it all on my own...I already feel, though, that coming in an hour early to get organized with a to-do list (for vitals, accuchecks, treatments, weights, who is leaving for the day, etc.) will put me ahead of the game somewhat...I understand that doing so won't guarantee I'll be out on time, but I think I will feel better prepared to start the day and deal with crises as they arise. Best of luck to all in this boat!!

Crystal2dish · Aug 12, 2008

how long does it take for a new nurse to feel comfortable working in ltc? the average length of time is about six months to one year. by the time you have reached that marker, you will either love it or hate it and be ready to leave.

if you love it, you have fallen in love with the residents you care for and understand that the ltc is not the next best thing to a funeral home, as so many "outsiders" do. there is life, love, laughter, friendship sharing, drama, and a richness of life up close that a nurse anywhere else wouldn't have the opportunity to experience to the extent you do. some residents have families that you will almost become a part of, while other residents need you to look after them as though you were their family because there is no one else but you. you will learn the gentle art of patience, listening, and the rhythms of your floor well enough to "sense" when something isn't right. then you will use your nursing to validate or investigate. it can be a privilege and an honor to work as a nurse in ltc.

the downside is the paperwork, the shifting politics, the high staff turnover, and the general lack of supplies and equipment. sometimes the food is so nasty that you wouldn't feed it to your dog, the staff toilets have seen better times, the housekeeping doesn't, and there is a smell that pervades everything and never goes away. there is always work to be done, pills to be passed, narcotics to be tracked, residents who turn critical during your shift, and the bad apples who see ltc's as easy pickings for their narcotic fix.

the best advice i can and have given to newbie nurses to ltc is to trust themselves. take the time to give the correct med to the correct patient at the correct time. practice good nursing and don't get sloppy and careless just to get to break on time. there are "tricks of the trade" to maximize your time while minimizing risk for error. these will come in time. you will spend time off work looking things up like policies, meds, disease processes, etc. the bad eggs are good and slick at throwing curveballs your way to try and create confusion. but stick to your guns and be the nurse you want to be. your patients are the ones who will be depending on you. keep them safe above all else.

secondary tip would be that there are a wide variety of ltc facilities out there. you may need to work at more than one to find the ltc that is right for you. all of them are hard work and lots of it. but if you are a nurse for all the right reasons and have some ethics and smarts, you can only grow as a nurse.

good luck! :nurse:

jenbet · Aug 12, 2008

You r absolutely right! It is so hard,Safe short cuts work!

Working LTC as a nurse is nothing like what they teach you in school. You have to take shortcuts, but that I mean doing blood sugars in the hallway, giving insulin in the hallways or dining room, doing a so, so assessment because time does not allow for a full head to toe unless its an admission and then you do your very best and hope you don't miss anything while of course everyone's meds, and treatments are due, orders need to be processed, someone falls, someone needs to be sent out. If you did everything by the book you'd never get done with your med pass, and then if state came in you'd get a good job for following the rules, but get in trouble because you are over you 2 hour window. Or do you take safe shortcuts and get your med pass done so that you might actually get to do some assessments, paperwork and take a break. Basically, you're damned if you do, and damned if you don't. I always figure the time that state catches me doing one of my shortcuts and yells, then I will then ask them to show me how to do it in a timely manner appropriately within 2 hours when there are other things going on besides just the med pass. State inspectors wouldn't know how to work LTC if there life depended on it. I know these rules are in place for safety, but don't try to enforce what you can't do yourself. We as nurses took a oath to first do no harm, and as of yet, thank god, I haven't hurt anyone using my fastest, yet most accurate med pass yet. Good luck and you'll figure it out eventually.

pattylpn54, LPN · Sep 4, 2008

I got my LPN license 8/8/08 and start orientation in a LTC on Monday. I was looking forward to it, but after reading these posts I'm terrified. Is it really as bad as it sounds? Is there any chance of being able to be good before 6 mos. are up? Please give me back some of my hope!!

Fiona59 · Sep 4, 2008

LTC is a form of hell for nurses. You either love it or hate it. It depends so much on the facility. If by the end of your fifth shift you are sitting in the parking lot wondering why you are there and don't see any light at the end of the tunnel, it's not the right facility for you.

I wish I had listened to my "inner" voice and ran instead of toughing it out for nearly two years. I'm an acute care nurse and will work at Rotten Ronnies before I worked again in LTC>

alabastershadow · Sep 5, 2008

oh god. I took a job in LTC!

For some reason i think that should really be the title of this post. I mean I've been working at long term care for 7 days, and I'm not thinking it's going to get any better.

I have cried myself to sleep. I've made a med error, that I didn't even KNOW i made. I take 6 hours to do the eight pm med pass. The building is so strange in it's design, the rules and regulations have changed twice since i started. And I dont know if I'll ever figure anything out.

I'm supposed to do night shift, six pm to six am. But currently because I have no idea how i'm ever going to do anything there, and am completely overwhelmed. I am on day shift working with one or two nurses who do things 'the right way'

They are good nurses. But there way is not right.

So far i've seen "lets draw up eight people's medications without looking at the mar" "leave the meds at the bedside" "Crush meds for people who are not supposed to have crushed meds."

let's play hide the medications in the applesauce...when the patient takes the medication more quickly and with less risk for choking by taking them individually.

On nights i have 32 residents to me.. myself.. and I. that would be great if i were three people. And yes I know this is probably a small amoount of people. 32.

At six pm every single person has a blood sugar check. that's thirty two freaking sticks. over half of them have scheduled lantus and prn humolog injections on sliding scale.

Then you have five to ten who will refuse every medication until you go through them and explain JUST what they do.

Still doesnt sound like that much when i'm typing it. I swear to god it is.

We have two tube feeders, both of which can take meds and eat by mouth. They each have dressing changes due at that exact time.

one or two will be in the floor by the time i get to their room so far everytime i've walked the hall.

The aids....

disappear.

the proctor/preceptor whatever...

disappears...

I have literally stopped my med pass, locked the cart and went into the bathroom for fifteen minutes and bawled one each med pass since starting.

It's bad enough I've thought of ways that i wouldn't have to go back to work. These are not the good kind of ways (like findinga new job) I seriously don't know each night that i come home (or day) if I can go back into that building and do it again.

six hours later after getting there. starting anywhere from 30 minutes to an hour early and it's 12am by the time i'm finished. I grab something to eat while i start to chart. But oh no! there is more meds at 12.. not many just a handful, but they are on opposite sides of the halls.

I get those out of the way and sit back down to my now cold food, and my charting. (have i mentioned i'm a smoker?) I get up and smoke a super quick cigarette, and now begin charting in earnest.

I get two charts done when patient x wants a breathing treatment, well tough. he doesn't have one. and i've been informed that i cant call the doc for one, so i have a patient who is freaking out because he cant breathe (he has copd) and the doctor has denied prn updrafts.

go back to charting... another patient wants a pain pill. ok i can do this. I take it down, back to charting (i'm just on my second chart and it's now 2am)

somehow they go to sleep. I smoked a cig. sit back down and chart on two more charts. at this point they look pretty much the same

'resident resting in bed with eyes closed vital signs. no c/o pain at this time. will continue to monitor."

of course there are skin audits, that would have been great if i'd been able to catch them while awake. Now i've got to hope to catch the aides on their round to check the resident out from head to toe just looking for scrapes contusions, anything.

Don't forget weekly progress notes,a nd most of those people are on the hot rack.

so i've now got to rechart. i get near the end of my never ending charting and there is another delima teh four oclock feedings.

I rush to get those done, switch out 60cc syringes and back i go to the desk to get the last few charts done. I look up and it's already 5am.

I have to get my six am med pass done by 15 to 6 so the oncoming nurses can have their count. RIGHT.

Of course it's five and i forgot to get temps of the fridges, and high and low levels on the glucometer so i have to rush to do that.

i now start my med pass at 515. I give an endless amount of synthroid. do eight glucose checks and finish passing the rest of the medication. Invent a new way to get a dying man to take his pain medication, pray that the man across the hall doesnt choke on the medication he has and i am done. I hope.

look at my watch and it's 610. crap. hurriedly count the med carts to find that I made a med error. At this point i cry in front of everyone.

I dont think i can do this job.

cut to today. did day shift. helped/watched nurse for yesterday and today. and i'm still not sure i can do this job. I'm still not sure i can get up on wednesday and go back in.

I got a call from a hospital that pays about a dollar less an hour, but.... has a much smaller work load. would it be very very wrong of me to take the interview???

Can I in good faith accept another job and say 'i can start in 2 weeks' and give the notice when i'm not through with orientation? or is that horrible. I'm just really not sure i can do this job.

Butterflybee · Sep 5, 2008

From what Ive heard from others, you need to give yourself more time because you can do it, it just takes time and it's hard for most of us in the beginning. Like i said, that's what i heard. Except you sound to me like you want a position that isnt like what youre going through. I say do what you need to do for you. You and you alone know what inner turmoil you are trying to deal with. If you feel you need to take the other job, take it. Your peace is most important. I dont know but i wouldnt want a frazzled anyone working on me. I know you can do it. I say do what is right for you and only you know what that is. I wish you peace and much success in your career. Im sure a year from now you will look back at this and know this was another rite of passage. Im rooting for you. Youll do it. It will be my turn soon, im looking for my first job...yikesssss

oh god. I took a job in LTC!
For some reason i think that should really be the title of this post. I mean I've been working at long term care for 7 days, and I'm not thinking it's going to get any better.
I have cried myself to sleep. I've made a med error, that I didn't even KNOW i made. I take 6 hours to do the eight pm med pass. The building is so strange in it's design, the rules and regulations have changed twice since i started. And I dont know if I'll ever figure anything out.
I'm supposed to do night shift, six pm to six am. But currently because I have no idea how i'm ever going to do anything there, and am completely overwhelmed. I am on day shift working with one or two nurses who do things 'the right way'
They are good nurses. But there way is not right.
So far i've seen "lets draw up eight people's medications without looking at the mar" "leave the meds at the bedside" "Crush meds for people who are not supposed to have crushed meds."
let's play hide the medications in the applesauce...when the patient takes the medication more quickly and with less risk for choking by taking them individually.
On nights i have 32 residents to me.. myself.. and I. that would be great if i were three people. And yes I know this is probably a small amoount of people. 32.
At six pm every single person has a blood sugar check. that's thirty two freaking sticks. over half of them have scheduled lantus and prn humolog injections on sliding scale.
Then you have five to ten who will refuse every medication until you go through them and explain JUST what they do.
Still doesnt sound like that much when i'm typing it. I swear to god it is.
We have two tube feeders, both of which can take meds and eat by mouth. They each have dressing changes due at that exact time.
one or two will be in the floor by the time i get to their room so far everytime i've walked the hall.
The aids....
disappear.
the proctor/preceptor whatever...
disappears...
I have literally stopped my med pass, locked the cart and went into the bathroom for fifteen minutes and bawled one each med pass since starting.
It's bad enough I've thought of ways that i wouldn't have to go back to work. These are not the good kind of ways (like findinga new job) I seriously don't know each night that i come home (or day) if I can go back into that building and do it again.
six hours later after getting there. starting anywhere from 30 minutes to an hour early and it's 12am by the time i'm finished. I grab something to eat while i start to chart. But oh no! there is more meds at 12.. not many just a handful, but they are on opposite sides of the halls.
I get those out of the way and sit back down to my now cold food, and my charting. (have i mentioned i'm a smoker?) I get up and smoke a super quick cigarette, and now begin charting in earnest.
I get two charts done when patient x wants a breathing treatment, well tough. he doesn't have one. and i've been informed that i cant call the doc for one, so i have a patient who is freaking out because he cant breathe (he has copd) and the doctor has denied prn updrafts.
go back to charting... another patient wants a pain pill. ok i can do this. I take it down, back to charting (i'm just on my second chart and it's now 2am)
somehow they go to sleep. I smoked a cig. sit back down and chart on two more charts. at this point they look pretty much the same
'resident resting in bed with eyes closed vital signs. no c/o pain at this time. will continue to monitor."
of course there are skin audits, that would have been great if i'd been able to catch them while awake. Now i've got to hope to catch the aides on their round to check the resident out from head to toe just looking for scrapes contusions, anything.
Don't forget weekly progress notes,a nd most of those people are on the hot rack.
so i've now got to rechart. i get near the end of my never ending charting and there is another delima teh four oclock feedings.
I rush to get those done, switch out 60cc syringes and back i go to the desk to get the last few charts done. I look up and it's already 5am.
I have to get my six am med pass done by 15 to 6 so the oncoming nurses can have their count. RIGHT.
Of course it's five and i forgot to get temps of the fridges, and high and low levels on the glucometer so i have to rush to do that.
i now start my med pass at 515. I give an endless amount of synthroid. do eight glucose checks and finish passing the rest of the medication. Invent a new way to get a dying man to take his pain medication, pray that the man across the hall doesnt choke on the medication he has and i am done. I hope.
look at my watch and it's 610. crap. hurriedly count the med carts to find that I made a med error. At this point i cry in front of everyone.
I dont think i can do this job.
cut to today. did day shift. helped/watched nurse for yesterday and today. and i'm still not sure i can do this job. I'm still not sure i can get up on wednesday and go back in.
I got a call from a hospital that pays about a dollar less an hour, but.... has a much smaller work load. would it be very very wrong of me to take the interview???
Can I in good faith accept another job and say 'i can start in 2 weeks' and give the notice when i'm not through with orientation? or is that horrible. I'm just really not sure i can do this job.