I work at a great facility.......?

[randomlymade88]

I really do. I have usually 23-25 residents. ~14 are usually LTC, and the rest are rehab. My LTC residents aren't usually too needy... but my rehab residents are very needy. Luckily I do usually have enough time to tend to all their needs promptly. I pass medications, do treatments, 2 weekly skin assessments, incident reports if needed and chart. There is another nurse on the unit who handles admissions, discharges, labs, and Dr. phone calls. If that nurse is overwhelmed with admissions and labs, I step in and help with as much as I can. The job isn't very stressful and I love it. But there have been talk of us getting trach residents. Didn't know if it was true or not- but we now have an updated procedures book with trach care in it. This has a lot of people sort of 'freaked'. It has me freaked. I don't see how I will be able to handle ~8 overly needly rehabs residents, ~12 LTC residents and ~3-5 trach residents???

Is it possible? Is my not very stressful job that I love about to disappear?

Advice, encouragement, stories, etc needed!

[CapeCodMermaid, RN]

As with other parts of the health care industry, we in LTC will be expected to take care of sicker and sicker patients. The ones we get now used to be on a med-surg floor at the hospital. The ones on the med-surg floor used to be in the ICU,and the ones in the ICU used to be...well....dead! In LTC we are expected to do more with less ancillary staffing, less reimbursement, and MORE regulations.

We have residents with trachs in my facility. It really doesn't add that much more to your day unless the trach is fresh. We're trying to beef up our skills and therefore our short term population by looking to get a respiratory therapist at least part time. If we're going to have to take care of these people, we need the training and the staff to do it.

[INLPN93]

That is a lot of mixed needs pts to care for even with some desk help.

Adding trach pts is not always easy.

Some trachs require constant suctioning, and monitoring. I've had trach pts but it has never been more than 1-2 on my hall/unit.

In all honesty, I do not like being in the position of having them on my unit/hall. Simply because the 'what ifs' are too much for a license to handle.

I have had two people fall within minutes of each other, a last minute admit, a re-admit from the hospital with major order changes, I know you said you have desk/phone help but really trachs in LTC are not safe.

They require alot of attention that with the typical pt/res load makes them incompatiable for safe care.

I had one guy who through mucous plugs on a regular basis and there were times it was me for 5-9 skilled residents and 12 intermediate care residents and this poor soul. I won't do it again. I also had one that required little care beyond the basic trach care. Either way, I would think long and hard over whether or not I would take on a trach again with that many on my to care for list. It really is to much. And I think in the apporpriate setting I would really like trachs. Once you get comfortable with them, they aren't hard or scary. But they do require lots of care and attention.

[CoffeeRTC, BSN, RN]

I have that many residents and a mix of acutity too. I also do the meds, tx, orders, etc..we have had trachs before and I have to agree, unless they are fresh and or having problems (frequent suctioning,etc) is isn't that much more work.

[optimist]

The facility I work for has 30 patients per nurse.Of that assignment, at least 8 will have trachs and 10-12 will be Gtubes, all of which are skilled patients.This nurse does have the luxury of a med tech (most days) and treatment nurse but she is solely responsible for all labs,MD calls,staffing issues,frequent suctioning,emergencies (no RN supervisor),peg feedings, IV's and so forth. Enjoy your rehab patients (though they may be needy) and the extra nurse!

[Blackcat99]

OMG!!! I think LTC is hard enough without the added stress of trach patients too. I do not think trachs belong in LTC at all . Not safe at all. Some trachs do indeed require constant suctioning and monitoring. Thank God, I no longer work in LTC:yeah: I do private duty with one trach patient and he needs constant monitoring.

[noctanol]

At my facility we have trach pts, i think you are having a holiday at your facility, dont mean to be rude. Here is my pt load, 2 trachs, 3 g-tubes on total care and 35 more residents, mostly half skilled. The almost all my pts are sicker than sick, on IV antibiotics, scheduled suctioning, bolus feedings etc. I dont like my job but im an LPN so i have to stick to it, and with the economy the way it is, i am just greatful. Ive heard horror stories from school mates, friends. Always remember, there's always someone having it worse than you, and in healthcare, its thousands who have it worse than you.

[MisMatch, LPN]

The LTC facility I work at has ~350 residents on 5 floors. I work on the respiratory floor, and 1 hall is dedicated to vent/trach patients. It hasn't been a problem because there is a respiratory therapist there 24/7/365 that does all trach/vent care. The RT office is located in that hall with 2 RT's at all times; 1 for that hall, 1 for the rest of the facility. I have learned a lot from the RT's so it's been a great experience. With the number of residents we care for in LTC, I would NOT feel comfortable caring for these vent/trach residents without knowing there is a RT right there at all times. Because the RT's are right there, and most are willing & able to teach us, it has been a great learning experience for me as a new nurse.