Just started in a skilled nursing, need advise!!

NurseCubanitaRN2b, BSN, RN · Sep 17, 2009

You're new at this, and be grateful that you found a job. I'm not trying to be mean, I'm just saying be thankful. As I said you're new at this, and it's going to take time to learn and to be quicker. Unfortunately that's how it is in this type of environment. You have to work quick, and get as much done as possible before your shift is over. Unfortunately that's how anybody that works in this type of environment has to be. IMO, I believe that nurses in the nursing homes have wayyyyyyyyy too many patients to deal with. You explained it all that you had to do. You're in the middle of med pass and a doctor calls you and you have to stop etc etc. Then before you know it, there's a fall. Now you've got to stop med passing in order to assess the patient after the fall and then start on your neuro checks. Then of course there is your charting that you have to do. 26 patients for one nurse, MY GOD, we must do something to stop this from happening. If corporate wants quality care, then they must provide enough nurses to provide that quality care. Statistics shows that when you have more staff on, you will have less falls, and less complications in other areas.

newcalvn · Sep 17, 2009

Thank you so much! I agree, its too many patients!! I was just thinking that if they had 2 nurses with 15 patients, that would be more manageable and the patients would have more quality care and more 1 on 1 time. But, their budget is already down the tube with medicare cuts and stuff, they even reduced the amount of hours for CNA's and LVN's. We only are allowed to work 7.5 hrs right now.

NurseCubanitaRN2b, BSN, RN · Sep 17, 2009

Cutting corners will only lead to more turmoil. But it seems that the almighty dollar is far more important than quality care for patients. What a shame.

Plagueis · Sep 17, 2009

I'm sorry to hear about your frustration, newcalvn. However, having that many patients seems to be pretty typical in skilled nursing, based on the numerous other posts I've read on this site.

However, you mentioned that you spent 3 hours of your own time charting. I assume this meant that you were not on the clock when you performed your job duties. If this what your employer expects, that would make for an interesting call to your local labor department, as it's illegal for you to work "off the clock." There are other posts on this site that mention this particular employer "requirement." Beware.

NurseCubanitaRN2b, BSN, RN · Sep 17, 2009

Plagueis, that's so true about working off the clock. At one of the facilities I used to work at I too was required to work off the clock as a CNA if I didn't do everything I was supposed to do. When my DON told me that, I whipped out my cell phone and called my cousin (two of them are attorneys) WHO'S A CIVIL RIGHTS ATTORNEY and told him in front of her what I was being required to do. Did she turn white as snow, and after that I was never asked to work off the clock again. Unfortunately other nurses and CNA's were doing it, but I would talk to them about their rights in front of management, oh boy did they despise me, but they couldn't fire me because they knew what I was capable of doing. Scream attorney and you will get a change of heart. DON'T EVER WORK OFF THE CLOCK.

Unfortunately it's the norm to have so many patients per nurse in these types of facilities, but it's straight up WRONG. You're overworked and the patients are undercared for. It's a wonder why we have so many grouchy nurses and CNA's. As the nurses do everything for the patient medically speaking. The CNA's are everyones helpers, they do everyones job from dietary, laundry, housekeeping, activities, and also their own jobs.

newcalvn · Sep 17, 2009

Thats so true...I will not do the charting on my own time anymore. There are nurses that do everything and clock out on time and leave. So it makes me feel like its my fault, so I should do it on my own time. But, I understand what you say about the labor laws. I have to chart, right? Say if I don't chart, then what happens?

Plagueis · Sep 17, 2009

Of course you have to chart, but you should stay on the clock until you are finished with it. If you working nonstop during your shift, and you still don't have time to get everything done in 7.5 hours, you are being overworked, and you have too many patients to care for. This seems to be standard operating procedure for many skilled nursing facilities and nursing homes.

I know that other nurses seem capable of getting everydone before overtime accrues. However, they are probably more familiar with the patients, so they have a routine down. They know who takes pills whole, crushed, and some nurses memorize their patient's MARs, so that saves time, too. (Not recommended; they could have new orders.) Also, other "shortcuts(questionable practices)" are used by some nurses to get everything done on time. This can include things such as combining meds (i.e. giving 9 am and 1 pm meds in one shot), prepouring, or starting a med pass early. The Geriatric and LTC area on this site has more information about these practices. (Which the State inspectors would say are illegal.)

NurseCubanitaRN2b, BSN, RN · Sep 17, 2009

If you don't chart then your license is in jeopardy because if you didn't chart it, it didn't happen.

If those nurses do everything on time and clock out and leave on time, it's because 1. they are very fast or 2. they didn't do everything and they don't care.

NurseCubanitaRN2b, BSN, RN · Sep 17, 2009

In the nursing home setting you have an hour before and an hour after to give your meds. I wouldn't recommend combining your meds in order to save time (9am & 1pm) because they're ordered for a specific time for a reason. Some it might not matter because of the med type, but there are others that are crucial for a specific time.

newcalvn · Sep 17, 2009

Thanks you all for your support, its great to know that I have somewhere to go to for questions and concerns. I will follow all of your recommendations. Unfortunately, my husband hates to see me this way...he is seeing how hard I work and mentioned to me today to maybe I should find something else that I would like, perhaps a different environment. I wouldn't be happy either if my hubby worked all day and then went back to work for another few hours (on top of it, for free).

Alibaba · Sep 17, 2009

I feel your pain but like someone said before, once you know your residents (as long as they dont keep changing assignments on you) you will get your routine down and follow it pretty closely even with the distractions. I would say keep your chin up for a little longer while you find a better fit. Treatment nurse may be a great way to learn your residents. As someone else said..........Never work off the clock. If something happens while you are off the clock, the employer can say you are not covered and you were doing your own thing....

Good luck