How many residents do you care for Per Shift?

[NCIANurse]

I work 1400-2230 as an LPN (soon to be RN as soon as I take boards). I work in a LTC facility that has 68 beds that are always full. So, each night, on second shift there is always myself and 1 other nurse. We are constantly promised that we will "soon" get an OMT to help with med pass, but this never occurs. I am curious what other LTC 2nd shift (evening) nurses have to deal with?

My duties: I have 34 residents a night... all get pills at 1700, about 50% of these get pills again at 2000, and about 25% get pills at 2200. I have approximately 10 diabetics that need blood sugars/insulin at least once per shift, 3 wound dressings that take atleast 10 minutes each, I have 2 residents with G-tubes. Almost all my residents get atleast 5-10 different meds during our 1700 med pass. I have 10 residents with eye drops, 4 with weekly procrit injections, 1 with a colostomy that gets completely changed q3 days. This is in addition to the fact that our secretary leaves at 1500, so we answer phones, respond to faxes, get doctor orders, sign out meds from pharmacy, call family with labs/med change/condition changes, ect.

And then comes charting.... on average, of my 34 residents, at least 6-10 are skilled, so they require mandatory in-depth charting, usually 4-10 residents are "flagged" (i.e. monitor for mood changes d/t decreased antidepressant), and then any charting that comes from lab results, med changes, ect.

I'm just very interested in what other nurses responsibilities are, such as how many residents they are responsible for, ect. Even our first shift nurses (0600-1430) often get stuck with just 2 nurses and 1 OMT for all 68 residents. I'm very interested in what everyone else has to deal with!

[TheCommuter, BSN, RN]

Plus, I was lucky, considering that many LPNs/LVNs on this site have had as little as 3 days orientation as a new grad. I give them all a lot of credit, as I know I wouldn't have been close to being on my own after such a short period.

As a new grad in February 2006, I only had one 8-hour shift of orientation at a nursing home before I was cut loose to work on my own. Although I was promised 3 days of orientation, that particular facility did not have enough staff to fulfill that promise.

[supernurse1230]

Thank you for this recent post. I am orienting to a facility where I will be in charge day shift, and am a little overwhelmed and haven't even been on the floor yet.

I am currently figuring out how to strategize with time management.

I have a 6-3 shift, care of 35 residents.

BG checks, doc orders, talking to families, med pass on 2 floors!

However, the staff seems to be very helpful and although busy, they seem to really care for patients and they

enjoy gettting the job done.

I'm a new grad who wants to know good habits from bad ones.

Any tips from seasoned LTC would be greatly appreciated![well your on the right track, when you mention "time management", because in ltc, that is the key to success, and learning to prioritize your care, because there are state guidelines and regulations to keep in mind, also, with being a new nurse, alot of "seasoned" ltc nurses will have you believe that you should forget what you learned in nursing school, and do it "this way" or "that way", and thats where in my opinion nurses become just another "sloppy nursing home nurse", learn from your cnas, some may have been in this field a while, but dont go in demanding respect because of your title, because the cnas play a huge role in the nursing home, and are very unappreciated, take lots of notes, so that you can stay on track and not forget things, then complete these tasks before moving on to the next, this is where prioritizing comes into play, realizing what needs your immediate attention, verses what can hold for an hour or 2, and try to stay on top of your skills, if you give a med and dont know what its for, look it up when you go home, same with an unfamiliar diagnosis, also, use the patients chart as a tool, to help you deliver better care, because nurses are not the only ones who look and document in charts, there are doctors, therapist, dieticians, pychiatrist, etc, and you can broden you knowledge base, based on there field of expertise... good luck!

]

[supernurse1230]

i agree, if i would have known then what i know now, i would never have started out in a n/h, not that i dont enjoy the field now, but a new grad is putting her/himself at such a risk, because of how regulated nursing homes are, and are subject to be standing in front of the state board of nursing explaining why they did or didnt do something, and it was probably simply because they didnt know,

[supernurse1230]

i agree totally, the key word in long-term care is CYA (cover your a**), keep that in mind thru every aspect of care when your at work, especially when it comes down to documentation, because the rule is, if you chart, you did it, and you dont chart it, then you didnt do it, and try not to chart a problem with a resident, unless you plan on following that up with either a nursing intervention, (depending on what the problem is) or some other intervention, which may be contacting doctor, family, your supervisor, etc), i always chart when and what i tell my supervisor, b/c, you never know when someone will say, "well they didnt tell me that"

[supernurse1230]

Isnt that out of your scope?! oh my GOD

well i think the nurse to patient ration is 1:80, and that is just sad:yawn:

[hotflashion, BSN, RN]

...but a new grad is putting her/himself at such a risk, because of how regulated nursing homes are...

I can't claim knowledge from experience but I believe that the trouble is lack of staffing not regulation! I tend to believe that regulation is good, because regulations are standards and policies put down on paper, and once they're on paper, everyone knows what's expected.

I've always been very appreciative of ancillary co-workers, whether it's someone who is my peer or the guy or lady who empties the baskets. Jobs need to be done and people to do them.

That's my bit. Now to think of some snappy answers to interview questions.

[MaritesaRN]

This is an echo to my words lately- short staffing nurses only in turn COSTS more money with sick people getting by unseen and lawsuits IMO. People getting sent out to hospital more and more frequently because changes in their status aren't being caught quickly enough and treated at the facility before they get too dire. I know corporate puts pressure on management about the hours of nurses and having too many nurses on at one time.. but what the hell- I CANT do my charting until after I report off most of the time, and recently it as MY charting I stayed a few minutes after to do that could be saving us from a giant SBO lawsuit... (hopefully)!!! Plus- it's my license to protect as well!

Screw corporate. :)

Oh yea, and to answer the question about staffing, lately the census has been super low because so many people are having to be sent out to hospital (possibly a product of daytime short-staffing), but I usually have about 30-32 when upstairs is full at 64. To give you an idea- on my shift I've been finding people who need hospital attention ASAP and our census is now at 55 upstairs. We had a diarrhea bug going around that really took it's toll on a few of these fragile people..

I take my hats off to you ladies for taking care of our elderly people. You know as nurses, we should afll get together and have one run and managed by nurses. I am sure everybody will work to the best since everybody have a share in this company. his way we know the inside of the residents as nurses , and owning it is another positive thing . Sure we will hire an accountant , trained some for MDS or billing experts , etc. But I am sure administration by nurses will make a difference , especially when all the people working there will have a share of the stock or expenses, and believe me thsi will change a lot of things and thinking !

[SuesquatchRN, BSN, RN]

I can't claim knowledge from experience but I believe that the trouble is lack of staffing not regulation! I tend to believe that regulation is good, because regulations are standards and policies put down on paper, and once they're on paper, everyone knows what's expected.

Oh, my, are you in for an awakening! The regulations change according to who is interpreting and what their agenda is that day. As a unit manager my function is very little to do with nursing and everything to do with insuring that State can't ding us on "possible harm" because, and I swear we got dinged on this, someone snuck a cigarette in the shower and we didn't do a full 3-shifts=back investigation after he said, "No, I wasn't smoking."

[MaritesaRN]

Oh, my, are you in for an awakening! The regulations change according to who is interpreting and what their agenda is that day. As a unit manager my function is very little to do with nursing and everything to do with insuring that State can't ding us on "possible harm" because, and I swear we got dinged on this, someone snuck a cigarette in the shower and we didn't do a full 3-shifts=back investigation after he said, "No, I wasn't smoking."

I am sure regs may be an inconvenience, but this will set the rules , and this rules will protect the residents.....no matter how you look at it regs is good. Think , without it , how much more can administrators in LTC can get away with. Wish we have this kind of Regs in banks huh ???? yes, it is inconvenient but a necessity.

[SuesquatchRN, BSN, RN]

I am sure regs may be an inconvenience, but this will set the rules , and this rules will protect the residents.....no matter how you look at it regs is good. Think , without it , how much more can administrators in LTC can get away with. Wish we have this kind of Regs in banks huh ???? yes, it is inconvenient but a necessity.

Huh? And the regs require more and more and they mandate nurse:patient ratios - where?

I don't know how long you have been working in LTC but your comments are naive.

[MaritesaRN]

Huh? And the regs require more and more and they mandate nurse:patient ratios - where?

I don't know how long you have been working in LTC but your comments are naive.

I am glad that I have read and listened to other LTC nurses becaseu they gave me info on both sides. Yes, different opinions from different interpretations , not to mention the different personalities, Yes, I may be naive but I am trying to understand as to the differences of opinions here. I am sure that the kind of administrators running the place does make the difference. I am not trying to pass judgement ...I am trying to learn as to why some people can work it , and some can not...is it attitude or does LTC really sucks w/ ratios and regs????

[CherryAmes_RN]

responding to the OP...

i work at a SNF/rehab & have recently been assigned a steady hall on the acute rehab unit. i work 3p-1130p (1130 if im lucky )... i have 25 patients. 99.999% of the time, when one is discharged on 7-3 i get one on 3-11. (we have no computers- paper charting & paper admission packets. good times.)

besides my 2 med-passes & the "easier treatments..." staples, sutures, oxygen & nebs... narcotics... heres some other stuff to keep me busy- my patients "this month" have...

11 blood sugars (with sliding scales... about 4 also get lantus @ HS)

2 woundvacs

1 external fixator

4 PICCs- 2 with IVABT

1 colostomy

1 urostomy

2 foleys

2 casts

1 recently graduated from a halo to a miami j

3 dialysis caths

2 AV fistulas

as a new nurse, im definitely learning time management i know alot of people think itll be hard to get into a hospital- that we dont getting med-surg experience @ facilities like this. i didnt see half of this stuff when i was on clinicals in the hospital. i did 150hrs in the ICU & loved it & ultimately do hope to end up there. but my orifice this isnt good experience!

(as an aside... for my 1st 3months working here, i floated & spent most of my time on the long term units- those are crazy too. still 25pts... less narcs, less IVs, more confusion... wounds (some woundvacs), colostomies, GTs with bolus/continuous feedings, trachs, SP caths, etc.