I hate being a LPN in LTC. The horror!

rennyren314 · Sep 19, 2009

I'm a LPN, and I'm conflicted about whether to leave the LTCF I work at, even though I'm still on "orientation." I loved working in LTC as a CNA, but ever since I've been on orientation as a LPN, I hate it!
Although I'm still supposed to be on orientation, I've been on the med cart by myself a few times without warning, as there is usually a call out. I was told that I should be able to "figure things out" myself, as I'm a LPN (though a recent grad!). The other times, the LPN I was supposed to be with would take breaks away from the facility, leaving me panicked. I still don't have a clue about 90 percent of the paperwork/forms that I'm supposed to fill out as a LPN, because it has never been explained to me; I've been thrown on the cart to "improve my speed." My requests to learn more paperwork have been ignored. I feel overwhelmed and stresed out.
In addition, I've been told about some of the "interesting" habits that I've read about on this site, which I'm told is nursing-home gospel, such as:
combining meds from different times into one pass ("you won't get done, otherwise")
borrowing meds ("everybody does it; you can get in trouble if you don't give the med")
no supervisor, except on dayshift ("there are hardly any emergencies on 3-11 or 11-7")
signing that a med was given, when it wasn't even available, and couldn't be borrowed ("you can't write 'not available'")
I know there's more to list, but based on my experience, I seriously long for the days when I was a CNA. I wanted to be a nurse, but after this, I need to get away to another place where I have a better breaking-in period. I don't think I can last another day at this place, and I'm scared for my license, to be honest. I want to quit, but some of my friends think I should just tolerate the madness because I make more money. I can always work as a CNA until something better comes along, but I am still struggling with what to do. Any ideas, thoughts, or other horror stories would be appreciated. I apologize for the length.

Ugh, I had the exact same orientation. I was thrown on the cart by myself with my preceptor taking his cigarette breaks and saying "Oh, just tell me if you have trouble." Even worse he told me not to give the vitamins and OTC meds and to just concentrate on the big ones when I was orientating on days (I am a night nurse). I couldn't believe it. Our orientation is two weeks but is not concrete. If we ask for more time we get it. The night I come in and plan to ask for more time they throw me on our lock down unit by myself. I had no idea until 15 minutes later when I realized the regular nurse was not coming. I called my supervisor about it and she said "Sometimes you have to learn as you go." I was pretty ****** about that but slightly agreed with her and went for it. Luckily, that night went smooth. The paperwork is the worst. I had no real formal training of what needs to be filled out when orientating on days. Luckily for me when I was orientating on nights I had a FANTASTIC nurse training me. She showed me a lot and what paper work that needed to be done. Unfortunately, when it came to learn physician monthly orders I was already by myself on the floor so I had to "learn by doing" and would repeatedly be getting in trouble with my supervisor for not doing it right.

I've seen meds being combined, but I've only seen this on one unit which is 100% vent/trach patients. And they combined the 10pm and the 12am meds. So it slightly made sense not wanting to wake up vent patients for one 12am pill. Obviously, this is not condoned, I see this is as a use your own discretion sort of thing. With borrowing meds the facility can get cited for writing unavailable and it's considered a med error at my facility. Although that still doesn't stop me from writing unavailable. I view borrowing as another use your own discretion. The only thing I would never borrow are narcs (duh) or antibiotics. That's when I call the supervisor and see if I can get it from her and if not call the doctor and bother them.

Finally, OMG there should always be at least one supervisor every shift! No emergencies 3-11 or 11-7! Ha! That's when a majority of our accidents/incidents happen. If we didn't have a supervisor during those times we'd all be up sh*t's creek!

I am a new nurse and started my LTC just over two months ago. Just very recently I have finally gotten into the groove of things. Try and stick it out. I'm in the same boat as you and on my bad nights I go home feeling miserable and really questioning is this for me. But the next night I come in and a resident says something that really makes me feel this is worth all the crap. Don't worry you're gonna come into your own. Find a good nurse to lean on, they'll make all the difference. Someone you know you won't get crap for when asking questions and what may you feel is a "dumb" question. And if all is still going crappy, move to a different facility.

All the luck for you =)

Karynica, RN · Sep 19, 2009

Sorry to hear that you are having such a miserable time with your LTC job. WELCOME TO LTC! I have worked as a registered nurse at 4 LTC facilities and it's the same at every single one. My first evening of orientation I was placed on the med cart by the LPN who was training me, and sent on my merry way down a hall not even knowing ANY of the residents. Talk about a nightmare. It got easier as time passed, but that med pass was one from hell. As the RN I was required to work both the medicare hall and another hall. The LPN who worked with me got the much easier 3rd hall, but was required to do all the treatments on my hall 2 only because of all the extra work I had to do as the RN.

I have worked in facilities where the RN doesn't do the med passes, but at the majority of places I have done the med passes on 2 halls. Yes, it's a nightmare. We do borrow from other residents, not supposed to, but do it. Usually someone hasn't pulled a sticker on a card. I would call pharmacy and get that resolved immediately.

LTC isn't for everyone, but sometimes that is where the jobs are and you have to go where the jobs are. I am currently working LTC at a facility that has low census and 2 nurses working in 2 separate locations in the building. At least I am not alone as I was for many years at another LTC facility where I had 75 residents to myself on the night shift. It wasn't a good thing.

I wish the best for you. It does get better with time.

Plagueis · Sep 20, 2009

I've seen meds being combined, but I've only seen this on one unit which is 100% vent/trach patients. And they combined the 10pm and the 12am meds. So it slightly made sense not wanting to wake up vent patients for one 12am pill. Obviously, this is not condoned, I see this is as a use your own discretion sort of thing. With borrowing meds the facility can get cited for writing unavailable and it's considered a med error at my facility. Although that still doesn't stop me from writing unavailable. I view borrowing as another use your own discretion. The only thing I would never borrow are narcs (duh) or antibiotics. That's when I call the supervisor and see if I can get it from her and if not call the doctor and bother them.
Finally, OMG there should always be at least one supervisor every shift! No emergencies 3-11 or 11-7! Ha! That's when a majority of our accidents/incidents happen. If we didn't have a supervisor during those times we'd all be up sh*t's creek!

As far as writing "med not available," I found out that my facility can be cited if a nurse writes that. The alternative is to call the pharmacy to request a delivery ASAP, call the MD to ask that the med be held, and write out an incident report. The other choice is to borrow. What gets me is that after a certain time of the day, the pharmacy won't deliver until the next day, and it doesn't deliver on holidays!

We are also our own supervisor on the 3-11 and 11-7 shifts. If an emergency happens (i.e. fall or death), we have to stop the med pass and deal with it. We also are responsible for admissions, taking off orders, treatments, answering the phone, making appointments (we also apparently don't need unit clerks) and dealing with family members. Also, we are expected to do recaps/changeovers during our shift, too, near the end of the month! :eek: I know that LTC is hectic, but how on earth do any of you nurses who do work in this area get all of this done in one shift without serious overtime?

SuesquatchRN, BSN, RN · Sep 20, 2009

I know that LTC is hectic, but how on earth do any of you nurses who do work in this area get all of this done in one shift without serious overtime?

Practice.

dotherightthing · Sep 20, 2009

As far as writing "med not available," I found out that my facility can be cited if a nurse writes that. The alternative is to call the pharmacy to request a delivery ASAP, call the MD to ask that the med be held, and write out an incident report. The other choice is to borrow. What gets me is that after a certain time of the day, the pharmacy won't deliver until the next day, and it doesn't deliver on holidays!
We are also our own supervisor on the 3-11 and 11-7 shifts. If an emergency happens (i.e. fall or death), we have to stop the med pass and deal with it. We also are responsible for admissions, taking off orders, treatments, answering the phone, making appointments (we also apparently don't need unit clerks) and dealing with family members. Also, we are expected to do recaps/changeovers during our shift, too, near the end of the month! I know that LTC is hectic, but how on earth do any of you nurses who do work in this area get all of this done in one shift without serious overtime?

It may not get done, which is why I left LTC, you're still held accountable even though overtime is not acceptable. And even though, facilities are staffed for 24 hours, leaving something for the next shift is also unacceptable. It's very wierd.

rennyren314 · Sep 20, 2009

As far as writing "med not available," I found out that my facility can be cited if a nurse writes that. The alternative is to call the pharmacy to request a delivery ASAP, call the MD to ask that the med be held, and write out an incident report. The other choice is to borrow. What gets me is that after a certain time of the day, the pharmacy won't deliver until the next day, and it doesn't deliver on holidays!
We are also our own supervisor on the 3-11 and 11-7 shifts. If an emergency happens (i.e. fall or death), we have to stop the med pass and deal with it. We also are responsible for admissions, taking off orders, treatments, answering the phone, making appointments (we also apparently don't need unit clerks) and dealing with family members. Also, we are expected to do recaps/changeovers during our shift, too, near the end of the month! I know that LTC is hectic, but how on earth do any of you nurses who do work in this area get all of this done in one shift without serious overtime?

Wow, this place is really burning you out. Don't take that. There is far too much going on for one person to handle. I'd say to leave. You have a license to protect and there is too much going on over that is jeopardizing that daily. It does come naturally after a couple weeks and you get a routine. But it is rough. Changeover is coming up for us and we already started writing out the new resident care plan. Pace yourself. Some day's you're definitely going to be there an hour after your shift. It's gonna be fine. But something really seems off about the facility you're at.

newtress, LPN · Sep 21, 2009

I may be getting my first LTC position shortly. Glad I came upon the issue of meds not being available. So let me get this right. If a med is not available and you can't write "med not available or N/A" and you don't want to borrow, and you are 11 to 7 and no pharmacy exists to call for request.. exactly what do you write for the med miss officially to keep things straight and right for yourself and the facility?

Plagueis · Sep 22, 2009

I may be getting my first LTC position shortly. Glad I came upon the issue of meds not being available. So let me get this right. If a med is not available and you can't write "med not available or N/A" and you don't want to borrow, and you are 11 to 7 and no pharmacy exists to call for request.. exactly what do you write for the med miss officially to keep things straight and right for yourself and the facility?

According to my facility, one is supposed to call the doctor to request that the med be held for that dose, call the pharmacy (even though it's closed) to request delivery of the med ASAP, and fill out an incident report. You would have to check to see what your facility's policy is concerning meds that aren't available. FYI, I have yet to see a nurse actually do this. It's less work to borrow. Plus, I'm sure the State wouldn't like to see numerous incident reports about meds not being available.

newtress, LPN · Sep 22, 2009

Ohhkay, well thanx for the reply.

birdietiel · Oct 1, 2009

I am going through the same thing. I was thrown on the med cart. I have seen other nurses combining meds for 4 and 8, and other things that shouldn't be done. I am always out late because I do things by the book. Half the time the med isn't there. We even run out of narcotics for the residents, and have to use the emergency box. One time even that was out. There is a huge lack of communication at my ltc facility. There is no team work. People gossip all the time about each other. I don't get wrapped up in it. I don't feel very liked at my job because I'm new. I haven't learned all the forms yet either. I am learning them as I go. I'm stuck at the place I am, because there are no hospital jobs available here. Hopefully you can apply somewhere else. Good luck to you, and hang in there.

Ihoplover · Oct 1, 2009

Hi - one quick note for all of you at LTC that state you're stuck there as there are no other hospital jobs available near you - just a quick warning. Everything you're struggling with at the LTC is the SAME things I struggle with at the hospital (new grad too - May 09). I see things done like combining meds by other nurses AND nurses borrowing from other patients drawers AND the pharmacy doesn't send all meds up on time or at all also. AND I also have to answer to my boss if the meds aren't given to the patients AND I'm still learning the forms etc. So honestly a hospital is no bed of roses either. While it may not sound like a lot I had five critically ill patients yesterday on my unit under my care - 1 of which required me to be in his room almost 15-30 minutes out of EVERY hour of my shift - to hang IV piggybacks, give him morphine, assist with his BIPAP, help him urinate, etc etc etc the patient REALLY needed to go to ICU and I suggested same to the doctor who adamently disagreed with me (charge nurse did agree with me also - problem is he's a DNI so ICU doesn't really want someone who isn't a full code).........Then add to that my other four patients - 2 with chest pain (one on tridil-nitro drip), a complete care patient whose IV had to be removed due to bleeding and I had to start a new one plus attend to the skin on her diabetic ulcer legs and feet and skin on her buttocks also - of course passing all meds for 5 patients and contacting doctors regarding abnormal labs, writing orders, watching other patients so another nurse could do lunch (of course I didn't do lunch!) and the list goes on.........

I do feel for all of us - believe me - this is not any easy field to enter no matter WHERE you work - LTC, hospital etc. but I guess the focus of my warning here is don't jump from the frying pan to the fire thinking a hospital job will be better. Prayers to you all (they're the only thing that gets me through my shift!).

IMABSNRN · Oct 1, 2009

In addition, I've been told about some of the "interesting" habits that I've read about on this site, which I'm told is nursing-home gospel, such as:
combining meds from different times into one pass ("you won't get done, otherwise")
borrowing meds ("everybody does it; you can get in trouble if you don't give the med")
no supervisor, except on dayshift ("there are hardly any emergencies on 3-11 or 11-7")
signing that a med was given, when it wasn't even available, and couldn't be borrowed ("you can't write 'not available'")
I know there's more to list, but based on my experience, I seriously long for the days when I was a CNA. I wanted to be a nurse, but after this, I need to get away to another place where I have a better breaking-in period. I don't think I can last another day at this place, and I'm scared for my license, to be honest. I want to quit, but some of my friends think I should just tolerate the madness because I make more money. I can always work as a CNA until something better comes along, but I am still struggling with what to do. Any ideas, thoughts, or other horror stories would be appreciated. I apologize for the length.

No, these things you list aren't "right," but you also have to consider the reason you may be expected to do things like you describe above. Healthcare is one of the most heavily government-regulated industries, where beaurocracy (as nonsensical it may be) rules and staying in business boils down to having your papers in order and following the nit-pickiest rules--or being shut down. It's definitely a balancing priorities act and looking at the bigger overall picture. It's a game, though not a fun one. And unfortunately, staying in the game requires jumping through some of the most ridiculous hoops.