Is this risking my license?

[chende]

Hello, I just found this website, and need some advice. I just graduated and looked around for hospital jobs for a while, with no luck. I settled with a job in a long term/acute care facility. It wasn't what I wanted, but I figured I could at least take it until I could find something else. I work night shift, and there are around 70 residents at this facility and I am the only RN. I don't feel comfortable being there alone considering they only gave me 5 days of orientation, and I am a new grad. I feel like in an emergent situation, I would not know what to do. A few nights ago, the computer system was out for 6 hours during my shift. I called everyone on the list (the DON and administrator included) and no one answered their phones. I didn't know what to do, so no one got their meds since they have no paper charts. I could have harmed someone by doing that, but I didn't know what to do. So, my question is, do you feel like I am risking my license in any way by staying at this job?

[silverbat]

there should also be a DON(DNS) to contact, or an on-call Nurse to contact. You also pass meds for 70? that sounds wrong to me, sorry, but it does. I have workedin several LTC in a couple of states and the worse ratio I have seen is 60 to 1 med nurse and 1 charge nurse with 3-4 CNA's for days. Is this day shift? or nights. Nights, I can see this, if there are few if any meds/treatments.

[CapeCodMermaid, RN]

What's with the 'nocte'? The word is nights...it saves no time to type nocte. I have 3 units. One unit has 60 residents...overnight there is one nurse and 3 aides. We do not give meds or do treatments on 11-7 unless absobloominutely necessary. There are 10 glucometer checks at 630 and maybe 15 people who get synthroid or Fosamax on that shift. Anything else is absurd. People need to sleep. We are almost 100% electronic. The system has crashed twice...we demanded a workaround from the company and got one. If the system crashes we are still able to print the MAR offline. I'm the DNS and ALWAYS have my cell phone with me. My ADNS answers her phone if they skip over me and call her. Speak to the DNS and let her know of your frustrations. Honestly, she/he may not know.

[nightstalkerRN]

I can sympathize. I work in a SNF on noc shift. We have varying kinds of patients: Dementia/Alzheimer's, fresh from hospital post surgical, long term skilled care, and Hospice. I normally am responsible for the care of 50-55 patients in the locked down Dementia unit and the Medicare rehab unit. At times I am responsible for 90-100 patients (the whole facility) when an LPN calls in sick with no replacement. Our patient medical records are all computerized. We have one computer terminal that is able to print out paper copies of medication administration records even when "the system" is down. We also have a three ring binder "Nurses Manual" that details procedures for death of a patient, admission, discharge, etc.

It sounds like your facility has chosen not to take some very simple steps to cover all situations. My DON is not easy to contact on the phone at night either but when she does not answer I call the Assistant Administration of the facility, and then the Administrator if necessary. Trust me, they do not like being awakened and usually there will be some sort of change in procedure and policy following.

I have also been known to call a 1st shift nurse and ask her if she would come in an hour or two early to help. It never hurts to ask and sometimes they say yes. If management wants to know why the extra hours then very frankly explain.

[chende]

Okay, to answer all the questions.. There are paper MAR's. Unfortunately, I did not know how to access them, and no one answered their phones to inform me how to do this. It is LTAC, but it is only about 1/4 acute care. Not all of the 70 residents has meds throughout the night (probably around 30 of them, including IV meds), and no treatments are given unless it's necessary. The work is doable, but my concern is the lack of response when calling management. I don't feel comfortable being there by myself with no one to ask questions, and when I try to call someone, no one answers. I don't want to have to turn in my 2 weeks notice to my very first RN job without having another job first, but I feel like this is what I may have to do.

[casi, ASN, RN]

Are you sure they aren't TCU rather than LTAC? The LTAC's in my area have a max of 5 patients at night, because those patients are still really freaking sick.

I'd nope right out of there if I were you. No new grad should be the ONLY nurse in the building without access to any other resources. What happens when a full code goes into cardiac arrest? You can't start CPR, call 911, and get the paperwork ready all at once.

[noc4senuf]

I have seen those numbers in LTC many times over the years. It also depends on the type of residents on the unit. As a DON, I am on-call 24/7, even if one of my managers, supervisors, or ADON is the appointed one for that day/week. The issue I have with the poster, is the comment about "settled" for a job in LTC. I don't care how bad I would need nurses, I would not hire someone who is "settling" to work with my residents!