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Discussion

Is this a normal patient load for LTC?

I recently got a part-time position at a LTC hospital. I'm a little over 1 month in and feel overwhelmed with my patient load.

My load is 21 patients, with at least 8 who are deemed "acute care", as in they require IV antibiotics, parenteral feeds, huge specialty dressings, colostomy, jenunostomy, trach, etc. I have 1 LVN who comes to help out with the more stable patients, but she/he also has to float to 2 other units, so I am often alone. At least I have 3 VERY helpful orderlies who are quick to help me out.

I prioritize my care to the acute/sicker patients, and only when I'm done with them do I move on to continue giving meds/assess the stable patients if the LVN is still busy on the other units. I often end up giving some meds late because I'm behind schedule, and staying 30 min after my shift doing paper work.

I don't feel comfortable with this patient load, and when I brought this up with one of my preceptors she brushed me off that I'll have to learn to manage the load like she did. I don't know if I can, and may need more orientation, as I only had 13 days orientation spread out over the past month, and ended my orientation period last week. I may need to ask for more time.

What is your patient load, and how do you manage? I feel with this load, I'm not giving the one-on-one care I want to give. Granted, I'm certainly learning a lot, so I hope I can figure out how to improve my time-management.

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    Yep, that unfortunately is the normalish patient load in LTC. I'd say 20-40 patients is probably average. When I worked LTC we had 25 in the skilled wing (Hospital step down, trachs, tube feedings, iv ABX, many dressings etc), 40ish in the dementia lock down unit and 55 in the LTC unit. 2-3 CNAs per unit and an extra nurse on the lock down and LTC units on day shift only.

    In LTC you don't really get to spend a lot of time on one on one care. It's more like moving quickly from one nursing task to another, with the main task being med passes.

    It does get easier once you get into a good routine. Time management is key. Browse thru the LTC forums and there are some good posts on time management/tips. Making myself a to-do list and scheduling out my shift worked well for me. Good Luck.

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    I had 25-30 patients but only ever 1 or 2 ivs. I also didn't really have a huge amount of "acute" patients but dementia patients were just mixed in with everyone so it got pretty nuts at times. It seems like you have the right idea on prioritizing and just need to get comfortable with the inability to have any one on one time. I know it is incredibly difficult and some days are way better than others. I also made a master to do list with times of meds etc at the start of shift. I had to learn how to put a certain face on and not let patients trap me with tedious unnecessary things. When you learn your patients, it gets easier to know which are the most likely to jam up your flow. Good luck with your new job! :)

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    I had to learn how to put a certain face on and not let patients trap me with tedious unnecessary things. When you learn your patients, it gets easier to know which are the most likely to jam up your flow.

    Yet then we're accused by many CNAs of "not helping them."

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    Yep, sadly that's normal. I have 24 right now with 2 more empty beds that could be filled at any time. It's a mixed population of subacute, dementia and LTC that are reasonably oriented. There are 3 tube feeds, 2 ostomies and we just finished 2 residents IV ABX. On day shift and PM shift it's 1 nurse and 2 CNA's nocs gets 1 nurse and 1 CNA

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    I was reading this post because Im thinking of quitting my LTC job (too much drama and stress), but then I saw your avatar. Are you also a nurse that likes anime or is it just by chance? :)

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    • Author

    Thanks for the help guys. Now that I got more time in, I've learnt how to cope. I prioritize-prioritize-prioritize!!

    My management is much better now, and I'm grateful for my LVN!

    Time management is always thrown off when I have to stay in the pts room for 15 minutes to observe them slowly take their 10 pills one-by-one, haha, but I'm feeling better with every shift.

    To those who think LTC is a snoozefest, boy are they wrong.

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