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!
Specializes in A little of this & a little of that.
Most but all facilities I have worked in had CNA's get routine vitals. The exception is always if the med administration depends on it, like antihypertensives with parameters and pulses with dig. Also the reason nurses usually do BG's. In CT is legal for CNA's to do routine BG's but I have never seen a facility allow it. In sub-acute 18- 25 patients is generally a good ratio. However, when I have had that many there have been treatment nurses, med nurses and a unit manager/charge nurse/desk nurse on the day shift to handle the rest of the duties. The majority of meds and treatments are scheduled for that shift so that licensed nurse staffing can be lower on the other 2 shifts. In this state (and others I have worked) NA's must be certfied and certification includes learning how to do vitals. Usually more experienced CNA's are assigned to sub-acute.
With regular LTC patients daily are q shift vitals are rarely required, the exception being with some meds as above. Even those on anti-hypertensives, etc are usually done weekly. Most sub-acutes here have LTC pts mixed with true sub-acute so that you don't have to get vitals on all of your patients.
I would put feelers out to others in your area. Maybe other students you graduated with and as mentioned former instructors and see if this is status quo in your area. If you feel too overwhelmed there may be better positions for you.
Thanks for your reply. It's nice to know that I'm not alone. I have so much admiration and respect for LTC nurses. As much as I love working with the senior population, I know that this won't be a long-term position for me. My plans are the same as yours...get experience and move on!
Yes, there are LPNs at my facility here in NJ, however, they are assigned to the LTC side not sub-acute which is where I work. It's interesting how job responsibilities vary from facility to facility. Perhaps hospitals are more standardized? Food for thought....
Not entirely true, maybe in LTC, but I work in the hospital & with a quick little training session our CNAs can & do blood sugars all the time.
When I was a CNA in LTC I did in fact have to get VS, & the facility I worked at as a nurse extern also required CNAs to take VS. However, I have heard of LTC facilities that do not utilize CNAs for VS. I guess it just depends on the location & the facility.
Most but all facilities I have worked in had CNA's get routine vitals. The exception is always if the med administration depends on it, like antihypertensives with parameters and pulses with dig. Also the reason nurses usually do BG's. In CT is legal for CNA's to do routine BG's but I have never seen a facility allow it. In sub-acute 18- 25 patients is generally a good ratio. However, when I have had that many there have been treatment nurses, med nurses and a unit manager/charge nurse/desk nurse on the day shift to handle the rest of the duties. The majority of meds and treatments are scheduled for that shift so that licensed nurse staffing can be lower on the other 2 shifts. In this state (and others I have worked) NA's must be certfied and certification includes learning how to do vitals. Usually more experienced CNA's are assigned to sub-acute.
With regular LTC patients daily are q shift vitals are rarely required, the exception being with some meds as above. Even those on anti-hypertensives, etc are usually done weekly. Most sub-acutes here have LTC pts mixed with true sub-acute so that you don't have to get vitals on all of your patients.
I would put feelers out to others in your area. Maybe other students you graduated with and as mentioned former instructors and see if this is status quo in your area. If you feel too overwhelmed there may be better positions for you.
Thornbird,
Thanks for your reply! You've provided me with a lot of helpful information. I have an average of 18 patients in subacute and I am doing everything - meds, treatments, requesting med refills from the outside pharmacy, f/u on md orders, charting (thankfully, that's only 1x/day), etc. Sounds like my facility could use another set of hands, like an LPN, but I know that staffing issues are in all of our jobs and the bottom line is what matters. Yes, I am feeling overwhelmed and if my preceptor, who has been an RN in both acute care and subacute care for 20+ years, is overwhelmed....well, that's not a good sign for me. I think that I will put in my time, get experience on my resume, and see what else is out there!
Boy, I don't know where you are going to work that gives you six weeks of orientation but good luck. Our nurses get alittle over 2 weeks and I think that is all I received way back when. There are times when short staffing doesn't allow you to get orientation.
The fact that she is a new grad, first job, etc. That would be the the optimum situation. My facility gives new grad RN/LPN's six weeks. Its only fair. If she had worked in a facility or hospital for a few months before staring this job, I dont think she would feel so slighted about the 2 weeks. But straight out of school, 2 week orientation is not enough.
Where I work each nurse has up to 25 residents depending on the census...The amount of nurses does not go up...There are always 2 nurses on the floor on days and evenings. One LPN and one RN...They do the exact same things for their ends of the building: pass meds, do treatments, do blood sugars, ect...MOST nurses have the aides do VS on evening shift regardless if the resident is on alert charting, for a med, ect...one nurse that I know of actually does her own assessments for blood pressure. On the dayshift and night shift the nurses do their own blood pressure...I guess because day shift aides are so busy (as if the day shift nurse isn't??)...I don't understand it but I don't question it either...I guess my take is (and I'm an aide so it's not as if my opinion matters) if you are doing an assessment or for a med then shouldn't the nurse do it??? BUT again maybe I'll understand once I'm out of school...Also I have had more than one nurse tell me they spilled tube feeding on the floor or on a resident and I need to clean it up or do a full bed change on so and so...Without even an offer of help....I DO realize it's my job to do bed changes and clean up messes but it sure would be nice to have an offer of help considering the nurse made the mess...But again maybe when I'm on the other side I'll understand...Also I hope I didn't offend...This post sure wasn't intended in that manner
...Also I have had more than one nurse tell me they spilled tube feeding on the floor or on a resident and I need to clean it up or do a full bed change on so and so...Without even an offer of help....I DO realize it's my job to do bed changes and clean up messes but it sure would be nice to have an offer of help considering the nurse made the mess...
Good luck. :) I said the same thing and got jumped on... :chair: Don't mess with the nurses hehe. They bite...
Good luck. :) I said the same thing and got jumped on... :chair: Don't mess with the nurses hehe. They bite...
I was actually referring and backing up what you said...I was not attacking anyone at all! In fact there are plenty of things some of the aides do that I don't agree with...just like some of the aides do such things...I'm kind of in the middle (or so I feel) because I'm going to school to be a nurse but yet I'm still an aide...there shouldn't be but there is alot of anger between the aides and nurses...everyone is on the defensive (at least where I work!)
Thornbird
373 Posts
Most but all facilities I have worked in had CNA's get routine vitals. The exception is always if the med administration depends on it, like antihypertensives with parameters and pulses with dig. Also the reason nurses usually do BG's. In CT is legal for CNA's to do routine BG's but I have never seen a facility allow it. In sub-acute 18- 25 patients is generally a good ratio. However, when I have had that many there have been treatment nurses, med nurses and a unit manager/charge nurse/desk nurse on the day shift to handle the rest of the duties. The majority of meds and treatments are scheduled for that shift so that licensed nurse staffing can be lower on the other 2 shifts. In this state (and others I have worked) NA's must be certfied and certification includes learning how to do vitals. Usually more experienced CNA's are assigned to sub-acute.
With regular LTC patients daily are q shift vitals are rarely required, the exception being with some meds as above. Even those on anti-hypertensives, etc are usually done weekly. Most sub-acutes here have LTC pts mixed with true sub-acute so that you don't have to get vitals on all of your patients.
I would put feelers out to others in your area. Maybe other students you graduated with and as mentioned former instructors and see if this is status quo in your area. If you feel too overwhelmed there may be better positions for you.