Job Offer - Patient Load Resonable???

[joey1967]

Hi All,

New to this forum. I need some input ASAP. Was offered a job today in LTC. I am an RN - will be responsible for 32-40 patients with two LPN's to *manage* whatever this means, as I feel LPN's don't need to be managed, they are trained health care professionals. Additionally, if an RN does not show up for a another unit (there are 7 units in total), I will also be responsible for the patient load on this unit as well, including the meds, calls to MD's, staffing - potentially I could have 80 patients. Things are super tight at this facility and they are in crisis ie. severe nursing shortage, manager very upfront about this problem right now and says they are trying to do everything in their power to change this but it is tough (nursing shortage everywhere) Duties include: Meds, Treatments, Call MD's, and Staffing, no personal care as there are 5-6 attendants per floor per shift. I am new to LTC, and coming from acute, this seems too unreasonable, however, not sure what the average ratio is in LTC. Can someone give some input into this. The facility is new and is very nice, however, I've come to learn to know that this means diddley squat when it comes to workload. I want my patients to be safe under my care, this doesn't sit well with me. Anywhoooooo....??????

Thanks,

JJ

[CoffeeRTC, BSN, RN]

If you are just supervising...okay, maybe. What exactly will the LPNs be doing? What shift will this be? What type of pts will you have. (some res in LTC could qualify for sub acute) If you are needing to supervise,pass meds, do treatments,call docs and staffing....Heck no for up to 80 people.

I've been doing LTC for about 10+ years and quit my last job that I was working PRN at. I feel that I've seen a good bit and am rather flexable,but they had me working the floor with 25-32 res on two units. That is were I drew the line. Being new to LTC..maybe it isn't a good idea to start off this way?

[joey1967]

Hi,

Thanks, I totally Agree. I am sort of bummed because the facility is about 6 blocks from my house. I did a google and found a few complaints with the union about working conditions and staffing levels, and this was just in May, and nothing has been done to resolve the problem since then ,because the manager said "they are still working on staffing levels". So basically, I think doing 32-40 is ok, one unit is subacute, there are a couple of locked wards for dementia and three words for the more stable, cognitively intact people.The manager was leaning towards the fact that they have very hard time staffing on weekends, which means I'd be between 2 units and that freaks me out. She said the LPN's do pretty much the same as RN's but they are short LPN's as well. Anyway, have to let her know today - I could do casual which basically means I have no committment under union contract, I could try picking up a shift here and there to see how it goes. If it is really bad then I just don't pick up anymore shifts. Hate to do this though, always looks crappy on the resume.

Thanks :)

[joey1967]

Hi,

Should have mentioned - The 80 patients could mean ANY shift, no gaurantee there will even be 2 LPN's on, who do the same thing, i.e. meds, accept they do not take orders from Dr's. The manager said I would have to leave my floor and then go to another unit to do the meds as well. Nothing changes, I still have all the responsibility, and not just managing, doing meds, treatments, dr's call and staffing, I just do it for two units. It sounds bad, anyhow....

[SuesquatchRN, BSN, RN]

There's no way one person can handle all of that. The meds alone require two people.

[ebony2]

I Greg it's nice to know you are interested in LTC. It has been very rewarding for me. However don't even think about opening yourself up for such vague sets of responsibility. If you are still interested have them spell out the real deal and hold them to it. There is absolutely no way one nurse can be responsible for the well being of 80 residents unless its strictly at a supervisory level. Making assessments. guiding others how to proceed, conflict resolution, interventing with difficult residents and familes. covering the lunch breaks etc. If it involves med pass, transcription and treatments and these tasks cannot be delegated to others, no way. If I were you I could not attempt what is humanly impossible to do well. LTC needs you but don't set yourself up to fail Good Luck

[LesMonsterRN, ADN, RN]

It sounds like it could be a huge gamble with the staffing issues. If you didn't have to pick up an additional unit it could be okay, even if you only had 1 LPN with you during a shift, but covering 2 units, including meds, screams unsafe patient load to me. With 7 units in the house you stand a good chance of more than occasionally having to pick up another unit. Don't do that to your license and career.

[augigi, CNS]

It's easy to get staff if they are willing to pay to staff properly. There is no way in the fiery pits of you-know-where that I'd accept responsibility of 80 patients for even one minute.

[gitterbug]

RUN! This is not a job you want to consider. I agree with other posters, if pay and conditions were just a little better then staffing would not be such a problem. Meds for 40 patients can be a nightmare, much less adding a few more. Things always start popping during a med pass, or when part of the staff is on lunch break. If you are really interested, then revisit with the DON and discuss what you would be willing to do. Do not be surprised if they do not seem interested in your plan once they find out you are not going to be one of their overworked, underpaid, overstressed stooges. Let us know how it goes. Good luck.

[gitterbug]

Joey,

One more thing? Did this DON mention how they cover for call-ins? What about when you have worked 16 hours because there is no other nurse to cover the job? Is she going to come in? Are there agency nurses who cover on a regular basis? Get lots more info and then decide. He$$ may only be 6 block from your door too but that does not mean you want to go there.