Is this too much?? Or am I just new??

nursenow · Jul 25, 2009

I have been a LPN about 3 months at a LTC. First off the told me I would have ten days oriantation, never more than 20 pts blah blah blah more broken promises. But my question is... Is this too much: 25 pts total, 7 DM 3 or which have outageous blood glucose levels frequently in the 300 and 400, 4 tube feeders, 3 ABT IV's, 2 trach pt's, 4 require wound care on my shift, everyone has at least 1 kind of cream, alot of these patients have dementia, 2-3 skin checks per day, 1 monthly summary per shift and 9 pts that require charting (although I chart on alot more). In this facility the nurses are they only ones allowed to answer phones so we are constantly getting pulled away from our carts to talk to family, doctors or tell someone their work schedule. When we have admissions it is all on us the nurse no one else helps. I feel like they give me too much. This is just an example of one hall I am normally assigned to. To top it all off we never have supplies, they only give us supplies on thurs, I have worked an entire shift being out of soap(SOAP??? I had to buy my own on break!!??? What in the world??) when the DON was informed she said to ration it more closely. So now every time a CNA needs soap I have to give them a med cup full. Sorry I guess this is a rant. I am currently looking for a new job, I can't work in a place pts and staff get treated like this.

I think the lack of supplies thing is unacceptable but the rest is not unusual for an LTC. Only 25 patients is better than alot of places. I have 25 at a SNF/LTC but other floors have many more. I believe the sate of calif allows either 32 or 35 on AMs and PMs. NOc is allowed 60. (don't remember exactly but the numbers are close)

It is no wonder that so many of those creams, Vitamins, breathing treatments... dont get administered on a regular basis. Nurses just sign for them and no one knows. It is pretty sad. I also know that alot of nurses will give many of the 9pm meds at the 5pm pass...(anything but narcotics) in order to give themselves time to chart at the end of the shift. Sad to say but many psych meds that are given early will make the patient sleepy which makes for an easier shift. I am not telling you to do any of these things because it is not only just not "right" it is also illegal and could cause you major probs. I do know it is common.

Where I work we do a weekly charting every shift plus the medicaid/medicare charting plus ordering meds from pharm, putting med deliveries away, writing T.O.s and F.O.s plus the extra work that they involve, admissions(including assesments), charting for fevers, complaints, antibiotics, care planning every little thing. and the list of stuff goes on and on. It's NUTS.

It took me about four months of stress and freaking out to get to where I could do my job without getting fried or stressed out. I finaly got to where I can do it in the time required (most of the time). I remember one week I realized I could just do what I could do and no more. It was like a stone being lifted off my back. At this point most days I can actually take time out to chat with other nurses and I actually take my thirty minute lunch about twice aweek. Most days I clock out but stay at the nurses desk because if something comes up I dont want to regret going to lunch. A biggy was getting to know my patients, their meds and treatments. I dont have to read the treatment orders, I just do a quick check to make sure it hasn't changed and for new ones then do them from memory. Same with meds. I now automaticaly reach for things in the cart or on the shelf without alot of thinking which really saves alot of time. Hang in there because if the other nurses at your facility can do it, you can. They all went through the same thing.

nursenow · Jul 25, 2009

Depending on where you live, I am understanding that it is more difficult for LPNs to find positions in hospitals because they are pushing for BSN nurses. I agree that nursing homes are not great, but that may be the only options that a geographical location can offer Practical Nurses. My area still hires them, but the pickings are slimmer than what they once were.
On a more positive note, if one can be said for nursing homes; the care is more routine. If a nurse were able to have better patient ratios, it can be a good place to get basic skills down pact before advancing to the faster pace of the hospital.

I agree, I feel an SNF/LTC is a good place for RNs and LVNs to start. I am an LVN working towards BSN and I am happy I started out in LTC/SNF. If I can tolerate this I feel pretty comfortable else where. I have talked to RNs and BSNs working in other environments that started out in LTC and they have said it was good for their confidence, re-enforcing alot of skills and a biggy, both time management and STRESS management.

I am not sure of that comment about hospitals being a faster pace though. I did my clinicals at three hospitals (we were rotated through all departments including ER). Yes, the nurses were busy and stressed but, to be honest LTC/SNF is totaly nuts and I feel the staffing levels should be illegal.

Lovely_RN, MSN · Jul 25, 2009

I had 41 residents on my floor and I could deal with everything you stated except the soap rationing. That sounds positively Dickensian and it's a major infection control issue.

I'm absolutely disgusted by your DON. Giving each CNA only 30cc of soap per shift guarantees that they will not wash their hands frequently. I flipped out at work because they wanted to give 1 lpn and 3 cnas one box of gloves per shift and I wouldn't stand for it. I thought that was bad but this takes the cake...it's just plain old nasty.

nursenow · Jul 25, 2009

HAHAHA! I just read my last couple posts. I was just sitting here wondering if someone was going to reply. Man!! I think that is a sign I need to cut back on my coffee and get off this dang computer! Get a REAL life?

husker_rn, RN · Jul 25, 2009

As a fairly new nurse I worked in a facility that was that bad or worse; I thought that at least for my 8 hrs residents would get the best I could give. Finally wised up and realized that as long as people like me would stay under those conditions, the place had no reason to change.

pagandeva2000, LPN · Jul 25, 2009

I remember nurses putting meds in their pockets and signing for them because it was just too many to give. That alone makes me afraid to do it. If I do, I would try per diem at night to see if that makes ANY difference, but it is scary.

changeofpaceRN · Jul 26, 2009

I think that is too much regardless of experience.

Moogie · Jul 26, 2009

I agree that the lack of supplies, especially SOAP, is ridiculous. I've never heard of a facility told to ration soap. Yes, massive infection control issues abound. That in itself could be stressful enough to want to walk away.

I think part of it is that you're new, but you are also in a tough situation. Even as an experienced nurse, I felt overwhelmed reading about your responsibilities. The biggest trouble with being new is that you don't have experiences in other situation and don't know when you're being treated poorly or if your assignments are unrealistic. I've been a newbie in other work situations and was told, after struggling and trying to meet expectations I thought were too high, that my assignment was indeed unrealistic and that experienced people in that position would have refused the assignment. Very frustrating.

Things are not like this in every nursing job. Keep your ear to the ground, look discreetly for other positions and hang in there as long as you can.

Scrubby · Jul 26, 2009

I have worked in a nursing home and yes they were very careful not to waste supplies but we always had soap available. I woul not work for an organisation that was so stingy, in fact I would be informing your nearest aged care advocacy service on this one.

stephanienicole87 · Jul 26, 2009

Thanks for all the replies! Most were really supportive and encoraging.

To reply to some of y'all.

I am in Florida and a small town to boot. I don't mind driving but in the past 6 months there have only been 5 LPN jobs within 2 hours of me (that I have found and I search like a hound dog!). I am thinking of trying to get on with a clinic, although the $5 an hour pay cut doesn't thrill me, I worry even more about losing skills.

I am scared to file a report before I leave an even afterwards (but I will when I leave). The last person who did it annomously suddenly was never seen agian at work. Some/most of the other nurses can do it beause they cheat like some of you were saying. I mean a daily drsg change dated from 4 days prior, signed off everyday? ***? But most of the time nothing is signed. Tube feeders should have been hung 4 hrs ago not hung when I get there. I spend the first hour of my shift fixing others mistakes.

More ranting:

I worked 111 hrs in 2 weeks ( mostly becuz they fired all our PRN people and won't use agency) and only had 7 hours overtime on my check. They will be getting rid of one nurse each shift, so we will have to share our carts like 11-7 on all shifts! Some things I don't like to share: Men, underwear and NARC BOXES! And it has happened when our emergency narc box wasn't secured for 2 days becuz we ran out of numbered zip ties ( I refused to work that hall) A morphine vial went missing on another occasion.

Our 11-7 shift doesn't do tx or skin checks. I know it is nighttime but c'mon 2100 is waking some of them up right in the middle of their night's sleep.

They haven't even sent me to IV training yet. Sometimes on 11-2 there are NO IV certified nurses.

AHHHHHHHHHH I wouldn't even be upset i no one reads this it feels good to get it all out. Allnurses is better than a therapist! lol

nursenow · Jul 26, 2009

As an LVN in LTC I am not sure you are going to find a "better" work situation. Unfortunatly that is the way it is in LTC. I personaly have never heard of a facility that isnt a huge work load, but maybe there is one somewhere. The only big difference is whether they are not nice to you as you struggle under your load. My facility treats us like gold as individuals but we are still expected to be able to carry the load. I think with time you will be able to do it. Hang in there. Talk to experienced nurses at your facility to see how they deal with it.

northwoodsmom · Jul 26, 2009

Two things: 1. you know you need to leave and

2. how can you annonymously report this to a county/state governing agency. There are people/families counting on this home to provide their loved ones with what they are not able to give. This should NOT be happening.