I hate being a LPN in LTC. The horror!

MauraRN · Oct 25, 2009

Leeann, I too did 3 yrs in LTC/sub-acute care while doing Excelsior. I have great assessment skills because of LTC. We are just thrown out on the unit to figure it all out, no hospital-like precepting. So practice your assessment skills, get comfy with wet-dry dressings, tube feeds, IV meds, subq insulins and heparins and you will be much more comfy doing the EC CPNE. Get familiar with care plans too. LTC care plans are usually junk in LTC, but look at them anyway and figure out how they SHOULD be done. Work on your documentation skills and consider LTC as paid clinical rotations, it will help you stick it out until you are done with EC. It is such a shame that those of us who love that elder population just can't stay in that industry, it is going to get worse with the 50billion in medicare cuts coming soon. And hope that when you get your RN there will be jobs available again. The cycle of no nursing jobs now should start to be on the upswing in 2 yrs or so. Hang in there.

lisaannjamRN · Oct 26, 2009

MauraRN,

Thanks so much for the encouragement. I got through my first day as charge nurse, and I am happy to say I made it through. I will look at this experience as "paid clinicals" until I have completed Excelsior. And I will give those residents all the love and care that I possibly can in the interim. I do have a question for you, if you don't mind, as you worked in LTC. Did your LTC facililty expect you to work as an aide? And I mean actually work as an aide. If they are short on aides, and they are not certified in the Assisted Living or Memory units, they call LPNs and ask them to cover their shifts. The LPNs do get paid at their LPN rate, but I was wondering is this a "normal" practice. Also, when I work on the Memory Care floor, I am expected to give my early morning meds, shower and dress 3 people and get them to breakfast. In the afternoon, I am to "toilet" 3 or 4 residents and either help with making beds and replacing towels in the rooms, or help clean the tables off after lunch. My first day was rough. I did my meds, and got my first resident showered and dressed and I heard a resident screaming, he had fallen. Of course, I immediately went to him. In between helping the aides, I had meds, assessments, calls to the MD, dressing changes, speaking with families, incident report, 24-hr report, my shift report and nursing notes. I have to say they have 2 aides on for 15 dementia residents. These aides must shower, serve food, clean up, do activities, toilet...all of it. So, I dont' believe the aides are lazy, just overwhelmed and need and expect help from the nurse on duty. When I am on the Assisted Living floor, it is mostly meds and treatments for 30 residents. Thanks so much for reading this (if you have time...lol lol). Is an LPN working as an aide normal??? Thank you!!! God bless!!!

Plagueis · Nov 1, 2009

I'm still at the same workplace. It's still stressful, but as there's no other place to work, I have to stick with it, as I have a daughter to support, as well.

I haven't had to do any recaps/changeovers yet. However, whenever I've had a fall or had to send someone to the hospital, it puts me far behind on my med passes, so I end up clocking out late (I work 3 to 11 shift). I had to help with both of those situations regarding the paperwork, as I was never shown how to fill out an incident report before. I still don't know how to do some basic things, such as the procedure for when a doctor writes an order for a lab, how to program and hang a continuous tube feeding, or how to program an IV machine. I'm told that if these situations occur to just ask for help. I'm just trying to stick it out. I'm better at passing meds, I think, but I still get behind if something unusual occurs (i.e. a fall), even though I don't take breaks.

Candyheart · Nov 3, 2009

The common idea in this thread seems to me is that nursing is a lot of hard work, rife with libilty, highly regulated and filled with residents,coworkers, administration. Geeze, can't figure why a new nurse has stress. Also happens at the hospital, which some nurses seem to think is nirvana, the stress, too much to deal with etc. I like LTC because I personally like to develop a relationship with residents and try to make their lives better. When I started, I handed many meds in my dreams, cried on my way home from work, all that good stuff. Hang in there, it gets easier. As for some of the questions, borrowing -yes, not narcs.or the stuff you have in the narc box. Combing meds-realize that HS often means right after dinner. Trying to get meds down a sleeping 90yr old will convince you of that. As for supervisors 3-11 and 11-7, please! That's prime time for emergencies. That needs to change. Learning what works and what doesn't comes with experience. There is only one way to get it.

robby5313 · Oct 2, 2010

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.

you must be kidding me...you are supposed to sign that you gave a med when you didnt? Are you crazy....i would do what i could to obtain that med from the pharmacy and if that was not available...you bet your booty that i would write not available. I am guilty of borrowing meds....everyone does it....combining medications from different times....okay if it is still within your 2 hour window. Trust me, I know how the nursing home goes....if you don't have enough help it really sucks...and I didnt. I was the only nurse during the day for 40 patients. I counted one day.....i had to pass 289 medications, do 6 accuchecks and 7 insulins, 12 narcs, 5 breathing treatments in 2 hours.....while they are getting ready to go to breakfast, going to breakfast and coming back....it was torture. God forbid if someone fell or got a skin tear.