I am a new grad RN working on a subacute/rehab unit at a LTC facility. Received 2 weeks worth of orientation and have some questions.
I average 18 pts. on the 7-3 shift. I was surprised that the CNA doesn't do vital signs in the am, was told that they are not "certified" (huh?) so it's my responsibility as the RN to get vs. Now, we all know that the majority of the senior population is on some type of cardiac or antihypertensive med, so that means I have to stop at each pts. door, wheel in the machine and take their complete vs, then give meds. First med pass is 8am and the seniors take a lot of meds! This process takes up a chunk of the morning. Oh yes, it's also the RN's responsibility to do blood glucose checks. Between the 8am, 9am, 11am, 12pm and 2pm med passes, I also have wound treatments, charting, follow-ups, etc. to do. At my clinical rotations in the hospital, the CNA or PCA always did vs and bg's. Is this job reasonable or am I just being a newbie? Don't know if I should start looking around for another job after getting some experience. Even my preceptor told me that she's lucky if she takes 10 minutes for lunch and gets to go the bathroom once a day. Thanks for your input!
In Ohio, our nurse aide program does involve training the girls/guys to take BP's. And our nurse aides here at my facility do obtain vitals on patients- most facilities have some type of vital sign machine and all it involves is putting on the cuff and hitting a magic button. But no our aides do not take nor would I want them to take my aptients blood sugars.
Sorry this is what long term care is all about. My LPN's are responsible for 34 residents- passing meds, treatments, skilled assessments, calling doctors, updating families, supervising nurse aides, dealing with endless problems with the pharmacy and sooooo much more.
Wow..I was kinda thinking that CNAs taking vitals happened everywhere. I understand if they are not certified and are nursing assistants.
Blood glucose monitoring....No. I think it is rather common across the board in LTC that no they do not do this. In acute or maybe even sub acute they might, but then they are trained a bit more.
We did our own vitals unless we specifically aked an aide to grab a set. They do NOT do finger sticks.
The 18 patients is actually a very reasonable load for meds/vitals in LTC. Seriously. I'm not saying that it's ideal, but as the system works now, it's good.
Specializes in Gerontology, Med surg, Home Health.
CNAs here do the routine vitals. I wouldn't give an antihypertensive with parameters based on a blood pressure obtained by someone else. The nurses do the CBGs...again because most of the time they are the basis for the dose of insulin based on the sliding scale.
18 doesn't seem horrible...if you're uncomfortable ask for some more orientation or some time management tips from some of the nurses who have been there longer.
You didn't mention how many residents the CNA's have but as a CNA if you want me to get VS's on day shift and need them by a specific time you will get a crazy look. :)
Unless the staffing ratio is very good, as CNA's our focus is adl's, toileting, meals, toileting, adls, toileting, turning, call lights, toileting, cleaning, adls, toileting again, answer the darn call light for the 15th time in a row, cleaning the tube feeding the nurse spilled, toileting, turning... ad nauseum.
Especially on day shift. Evening and night shifts give CNAs more time.
18 residents is pretty low for LTC as a nurse. You should not expect your CNAs to do it. They can help sure, but you should be handling these.
Of course, this is why nurses should be required to be CNAs.
Med Aides can do blood sugars in some states but they won't do yours because most likely they have their own. Cna's can't do blood sugars ever.
Specializes in Gerontology, Med surg, Home Health.
"cleaning the tube feeding the nurse spilled"....uncalled for remark. Should I say it takes ME longer to pass trays or meds because the CNAs leave a mess on the over the bed table? We're all in this together and if you haven't learned that by now........
"cleaning the tube feeding the nurse spilled"....uncalled for remark. Should I say it takes ME longer to pass trays or meds because the CNAs leave a mess on the over the bed table? We're all in this together and if you haven't learned that by now........
You pass trays? Obviously I wasn't trying to offend and am sorry if I did.I was just on a roll and wasn't really thinking anyone would read that much into it...
I live in Mississippi and where I did my clinicals, at a hospital and a long-term-care facility, the CNA's did vital signs, but not CBG's.
I am an LPN employed at a long-term-care facility and OP, you just described the duties of my job. The RN's where I work do admits, assessments, care plans and other things, but do not pass meds or do treatments. LPN's do those things. We also do vital signs, CNA's at our facility cannot.
Aren't there LPN's at your facility and if so, what do they do?
Just curious as to how things vary from state to state and actually facility to facility.
Specializes in Gerontology, Med surg, Home Health.
lol...yes, I pass trays, toilet residents, transport them, help with admits....we are all in this together and those who do not hang together are doomed to hang separately.
Specializes in Geriatrics, Hospice, Palliative Care.
Thanks CapeCodMermaid, I have a lot of respect for you! I, too, toilet, pass trays, and anything else to increase the comfort of our patients if the appropriate person isn't there to help. Toileting is a great time to do a skin check!
I'm a new-ish LPN at a subacute rehab that also has two LTC units; I have 18 pts, and on those horrifying days when I have to float to the LTC portion of the facility, I have 32. There's a pretty big difference in the acuity of the patients on each unit. I prefer the subacute because I learn so much every day, and because I have no idea how the LTC nurses get everything done "by the book". I have a strong sense that they don't (last time I worked there, several patients asked me why I was giving them treatments - said that they never had them before, even tho they had been signed out for weeks previously!).
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lol...yes, I pass trays, toilet residents, transport them, help with admits....we are all in this together and those who do not hang together are doomed to hang separately.
Obviously I wasn't trying to offend and am sorry if I did.I was just on a roll and wasn't really thinking anyone would read that much into it...
ADPIE10
195 Posts
Check the Nurse Practice Act in your state. Hopefully you've kept in touch with your instructors from your nursing program... shoot them an email. :-)