New grad LPN here, just got a new job in an LTC/SNF/rehab. I am working on the skilled/rehab unit. I'm a bit concerned because my week of orientation ends tomorrow and Wednesday, me and another new grad will be the only 2 nurses for about 45-50 patients. Each nurse on this unit, depending on census, gets between 20-30 patients.. which I know is par for the course for LTC facilities.. but many of these patients are a few days post-op or have serious health issues going on.
I am so slow at passing meds.. and I understand that speed comes with time.. but for some of these patients, they need insulin and cardiac/anti-HTN meds and those just cannot be given late. I know you might say I need to research the MAR and find out which patients are the most critical but hell, most of them are on some sort of critical meds. Today, one patient's heart rate was near 130 because we were late getting her her meds. The good, experienced nurse I was with today could not even finish everything on time.
I've just got a bad feeling about this. We were told when we were hired that they hired us because they wanted 3 nurses per shift instead of the 2 they have now.. which would break up the patient load into 15 pts per nurse (roughly).. but looking at the schedule, there's still the same 2 nurses per shift for the entire month.. except now I'm one of those 2. I almost feel like we were lied to? I'm going to talk to our ADON tomorrow and let her know how I feel about the situation. I am not sure I want to continue working at this place if I'm going to all of a sudden have 20-25+ patients to be responsible for. It's not safe for the patients OR for my hard-earned license. I HATE to be a quitter, that's not me.. but.. I just don't know.
If someone's heart rate is 130 because her meds were late, she belongs in the hospital not in a snf.
20-25 is not an unusual work load. I've been doing this for years and only in one facility did we have 3 med nurses and a nurse manager for a short term unit...and we had sick people straight from the ER and 3 days post op quadruple bypass.
Unfortunately, this is the type of patient currently being accepted into LTC/SNF. We are no longer the warehouse for the dieing, we recieve patients out of surgery as soon as they are "stable" (usually within 3 to 4 days post-op), needless to say being sent into a situation where thier Nurse has 29 other patients results in patients not getting the 1:1 care they need. I've said it before, these companies will accept any patient, no matter thier DX or TX needed, as long as they keep thier rooms filled and don't care about the Nurse. If the patient goes south they blame the Nurse not the census.
Unfortunately, this is the type of patient currently being accepted into LTC/SNF. We are no longer the warehouse for the dieing, we recieve patients out of surgery as soon as they are "stable" (usually within 3 to 4 days post-op), needless to say being sent into a situation where thier Nurse has 29 other patients results in patients not getting the 1:1 care they need. I've said it before, these companies will accept any patient, no matter thier DX or TX needed, as long as they keep thier rooms filled and don't care about the Nurse. If the patient goes south they blame the Nurse not the census.
Funny how they put the full-code in the farthest bed in the farthest hallway too.
Totally agree. In the past couple of months we've had a few patients admitted who.. two days later.. were sent right back to the hospital.
We recently had a resident with a very severe decub that required frequent and difficult dressing changes and of course pain management issues.. big time. Anyone with eyes(and a nose) can agree that he belongs in a hospital. We were discussing one night at work, why do they accept residents like this?
I am a CNA/EMT with 16 years exsperiance and work at a LTCF where on 2-10 we have 2 lpn and 7 cna for 80-85 residents and it can be a night mare at times. I have seen a lpn get 3 days of orientation and then was on her own...she was also a new nurse to the state with only 1 yr exsperiance in previouse state. I would say talk to the ADON/DON about some extended orientation or maybe ask why the 3rd nurse is not on the schedual yet?
I have 23 patients on 3-11 shift that are a mixed bag of LTC and subacute. I have roughly half a dozen accuchecks with coverage and they all have to be done before dinner, along with all of my other responsibilities. Last night I had an patient, when I took her 8pm meds in to her at 8:30pm tell me, "You do realize that these are LATE, don't you???", then she proceeded to tell me that she would probably have a seizure because I was so "lax" in allowing her pills to be "late". I told her that I do the best that I can, that I have 22 other patients who need me too, and that I will try to do better in the future. Inside I was boiling. I am SO tired of having to take the blame for nurses being spread too thin. Even in just the small amount of time that I was in her room talking her through this, three other people needed me at the same time. I hate my job. Love the residents, hate my job.
Me, personally, I can handle 25 or so. On 3-11 we have 2 nurses and 50 residents. Most, if not all of mine, are short term rehab and are like the ones you all have mentioned above. Post op knees and hips sent to us on day 3 and some other short term rehabs. We also get a lot of complex wounds and iv therapy pts...some TPNs. I normally have an average of 8-10 diabetics with qid checks, coverage and lantus, labs, drains, etc. Most of the admits come on 3-11 too. Most of our residents are younger now too. With that comes different needs (customer service issues) and different psych issues. (I'd kill for my Long term residents that "just" have dementia....heck...I don't mind the hitting, spitting yelling ones either)
As a new grad with little orientation....Yes.....this is a bit too much. I've been in LTC for years and started off with just the LTC residents..now that we've made a change to short term, more acute residents, I kinda enjoy the change. I couldn't see myself starting off in a place like this with the staffing like LTC.
Me, personally, I can handle 25 or so. On 3-11 we have 2 nurses and 50 residents. Most, if not all of mine, are short term rehab and are like the ones you all have mentioned above. Post op knees and hips sent to us on day 3 and some other short term rehabs. We also get a lot of complex wounds and iv therapy pts...some TPNs. I normally have an average of 8-10 diabetics with qid checks, coverage and lantus, labs, drains, etc. Most of the admits come on 3-11 too. Most of our residents are younger now too. With that comes different needs (customer service issues) and different psych issues. (I'd kill for my Long term residents that "just" have dementia....heck...I don't mind the hitting, spitting yelling ones either)
As a new grad with little orientation....Yes.....this is a bit too much. I've been in LTC for years and started off with just the LTC residents..now that we've made a change to short term, more acute residents, I kinda enjoy the change. I couldn't see myself starting off in a place like this with the staffing like LTC.
I love the long term residents. They are part of the family. Even though I've been smacked in the face, the butt, hand, arm. I've had my wrist in a death grip. They've yelled at me, threatened to spank me and call my parents. I've had crushed meds mixed in pudding almost spit back out at me. They keep me coming back lol.
I've become an expert at getting a confused resident whos about to bolt out the door .. to agree to "stay the night" and we will call them a bus in the morning. "No thats not a door.. thats just a window." "They locked the doors and the coat clerk has gone home for the night. But we have a nice room for you tonight.. they will be back in the morning"
Specializes in Gerontology, Med surg, Home Health.
Sick patients are accepted because, like it or not, this is a business and bills need to be paid. I don't take anyone my staff can't take care of and if the acuity is too high at the time, I won't take another trach/gtube/IV/q4hmeds/stage 4s.
I get hollered at daily from the admissions person but since I'M the one with the license..........
I told them I did not want to work on the skilled/rehab side.. just.. no. I do not feel like I'm practicing safely on that unit AT ALL. I need something slower right now. ADON told me I could have 1 more week of orientation on the LTC side, but then, yesterday, I find out I'm working on my own on the LTC unit this weekend (after only really 2 days of orientation over there - I've been on the other unit the whole time of my floor orientation). I would probably be ok - if they give me the same group of residents all weekend but that's not a guarantee. I do like the LTC side better but hell, I'm not even certain that I'll be able to work over there - there's technically no LPN openings on the LTC unit but they said they may try to figure something out by getting rid of one of their PRNs or something (seems like this facility has more PRNs than staff nurses....). It seems like they are desperate to keep me despite me being a clueless new grad. I remember something one of my instructors said the last week of nursing school: If a facility is basically BEGGING you to work and seems very desperate to hire/keep you - be cautious, because it's probably NOT the best place to work!
I think I'm just.. done with this place. Stick a fork in me.
It's understandable that you feel confused and upset by your "baptism by fire" into the nurse home business. Being a new grad and getting thrown into a situation that is nothing like what they told you it would be like in nursing school sucks. However, it's the reality for most new grads.
Now before you quit, do you have another job lined up? Are there a lot of opportunities for LPNs outside of LTC/SNF in your region? If there are tons of LPN jobs that require no experience (and are not in a nursing home) in your state then by all means quit.
If not then think really hard before you quit because the conditions you describe at your facility are the norm not the exception. Very few LTC/SNF will give you more than a few weeks orientation and most will give a new grad a few days. In addition to that, the ratio you described is not that bad. I was a new grad LPN thrown into an LTC/SNF position on 3-11pm with 40 patients, I was the only nurse, yes the acuity was just as bad as what you are describing. I had tons of pre-dinner and pre-HS fingersticks with coverage, 8 tube feeds, and two trach patients. This was in addition to people coming in for rehab and we had a bootleg hospice going on etc...etc. I would set up a CPM for the post knee repalcement and then I would run down the hall to give Roxanol to my dying cancer patient...then I would run to suction and give a nebulizer treatment to my trach patient and of course pharmacy would be calling and so and so's family member needed to complain to me right now. This was all the in-between stuff aside from the regular duties of med pass and wound care, IVs...central lines (which I wasn't even supposed to touch ), calling the MD for orders or to report labs...the demented sun-downers...the geri-psych schizophrenic patient who says he is "Tony the Umbrella Man" and he is going to kick my a** lol. Never mind patients returning from hospital or needing to go out...falls...CNA conflicts and insubordination....etc. It never ended.
I looked at it as a stepping stone to something better. I stuck it out for two years while I was getting my RN and I never looked back. That miserable job helped me develop time/people management skills as well as gain exposure to numerous medical conditions that I never dealt with during clinicals.
Apply to every non-LTC/SNF job you can even if you don't qualify for the position but don't quit this job(unless you got it like that financially). It's easier to find something when you already have a job and the longer you do this the better you will become at prioritizing.
Of course nursing homes/SNF's are the main employers of LPNs in my area. And no, I don't have another job lined up, but life is too short to feel stressed out & unhappy, dreading work every day. I don't have kids so I could probably afford to even work part-time if I had to. I plan on getting back into school to get my RN asap, anyway.
I don't believe that ALL LTC/SNF facilities are like this one, sorry. I became a nurse to provide good, safe patient care and I don't feel like I could ever really do that the way I want to at this facility. I'm not in this career for the $. Maybe long-term care isn't for me, I don't know at this point. I think it's best that I am honest with myself and what I want out of my career. My real goal is to become an OR nurse but of course, that could change.
Nope, all LTC/SNF are not like that one. There are some good ones but the majority are the same or worse than what you're describing.
You're right, life is too short to be miserable so I can't blame you for leaving if you have that option. I likely would have done the same if I was able to at the time.
Each nurse on this unit, depending on census, gets between 20-30 patients.. which I know is par for the course for LTC facilities.. but many of these patients are a few days post-op or have serious health issues going on.
The good, experienced nurse I was with today could not even finish everything on time.
Love the residents, hate my job.
gentlegiver, ASN, LPN, RN
848 Posts
Unfortunately, this is the type of patient currently being accepted into LTC/SNF. We are no longer the warehouse for the dieing, we recieve patients out of surgery as soon as they are "stable" (usually within 3 to 4 days post-op), needless to say being sent into a situation where thier Nurse has 29 other patients results in patients not getting the 1:1 care they need. I've said it before, these companies will accept any patient, no matter thier DX or TX needed, as long as they keep thier rooms filled and don't care about the Nurse. If the patient goes south they blame the Nurse not the census.