Is this normal?

[brookebarky]

I'm a new RN grad and luckily had no trouble finding my first RN job. I was so excited to start, but now my emotions have changed. I work in a LTC facility with three units and approximately 150 residents. There are 2 LPN's/TMA's on each unit along with nursing aids. During the day shift, there is an RN on each unit. Due to the RN shortage at this facility, I am the ONLY RN on staff during the evening shift. Keep in mind, this is my first RN job.

I know it is normal to be anxious your first few months on the job. I've been employed for four months and am in constant panic! I have to juggle all three units, act as a "Screener" when new residents are admitted, be the "HUC" when new orders need to be processed, and be the "scheduler". I feel so overwhelmed and not supported. When I have a question, there is no one to turn to since there isn't another RN.

I'd just like some other thoughts on if this is how other LTC facilities are and some advice or words of wisdom!

I really appreciate it.

[HouTx, BSN, MSN, EdD]

You should not be put into this position as a new grad. As the only RN, you are legally responsible for clinical direction of all subordinate staff. You are accountable for accurate recognition of problems & ensuring appropriate interventions for all the patients. I realize that your LPNs may be very experienced and competent, but their scope of practice as legally defined in the state Nurse Practice Act requires them to work under the direct supervision of an MD or RN.

Many state BONs also have restrictions on supervisory roles for new grads for a period of time... recognizing that new grads need to have qualified supervisors immediately available until they become fully competent. Check with your BON for specifics before approaching your boss with ideas on how to meet all the requirements. If they insist on a structure that puts you in violation of your own professional and legal obligations, you have no choice but to resign. Jobs come and go - your license is forever.

[Fiona59]

How do you know where the OP is working?

LPNs work under their own license/practice permit and are legally responsible for their own actions

[amoLucia]

Sounds like she's got some supervisory responsibilities assigned to her. Management has her as an RN on 3-11 for their reasons, so even if LPNs are still responsible for their actions, she IS the top license on 3-11.

To OP - please consider carrying your own malpractice insurance to protect yourself.

>>>>>>>>>>>>>>>>>

I know, I know, I know!!!!!!!!! I sound like a broken record re insurance to many of you out there who may have noticed that I preach INSURANCE. Please know that I am NOT an insurance rep, nor do I have any intere$t in the industry. I just don't trust anyone out there anymore.

I think newbies have been bamboozeled into a false sense of security and/or complacency and when coupled with their newness, they are at high risk. Better to protect themselves than be sorry!!!

[jadelpn, LPN, EMT-B]

When you have a question, perhaps ask the LPN....he or she may be able to answer it for you. Addtionally, why not have a unit charge LPN on each unit, as well as a lead CNA on each unit. That frees you up to do what you need to, and the charge can come to you with any issues. Rotate these responsibilies amongst the LPN's and the CNA's each shift.

[nurseprnRN, BSN, RN]

How do you know where the OP is working?

LPNs work under their own license/practice permit and are legally responsible for their own actions

Yes they are, but if you read carefully, the nurse practice act also puts responsibility squarely in the shoulders of the supervising RN to know when the LPN is exceeding scope of practice. This would be a legitimate concern for any RN of any experience level who's the "only RN in the building."

[jadelpn, LPN, EMT-B]

Well, I would assume that since it is not mentioned, LPN's are not exceeding their scope of practice. And in LTC, I do think it is often common for LPN's to be in charge of units.

This would certainly free the RN up to be more focused on administrative duties as indicated, and yes, I do think that delgating when appropriate is a good thing.