Long Term Care Facilities

Pediatric Critical Care Columnist · Jul 25, 2016

You aren't likely to have a long list of patients to care for each shift; in acute care peds the ratio is typically 1:4 or 5 while extended care peds is more like 1:3. And you won't have any trouble keeping them straight. Because unlike in adult LTC, each of these kids will be unique. There's are obvious differences between a 4 year old and a 10 year old. Even trached, ventilated, tube-fed children are very different from each other. Although you're only getting a brief orientation, you most likely will not be alone.

Organization will be crucial. Many of these kids will have seizure disorders and/or spasticity so getting their meds on time will be important. Most will be bolus fed and getting those going near the regular time will also be important. If it were me, my day would look something like this:

0700-0715: get report and make med/feed/treatment list

0715-0725: prepare meds

0725-0745: basic assessments of each patient

0745-0800: med pass

0800-0930: bathe, do GT and trach care and dress patients for the day

The rest of the shift will be taken up with performing required treatments, physiotherapy, play time, feeds, diaper changes and so on. Documentation is usually much less detailed than for acute care patients and won't eat up much of the day, although careful documentation of teaching is essential.

Working 3-11 will entail feeds, treatments, meds and getting them into bed for the night. The order of activities will be well-established and you'll follow the routine already in place. Remember that even if they can't speak, they still communicate. These kids are easy to become attached to and often have very loving families. Some don't. Those are the ones I gravitate toward. Some of these kids die. You'll need to prepare your heart for that. Best wishes!

offandaway · Jul 27, 2016

I am printing this and bringing it with me. Thank you so much for the detailed reply! I was expecting 15 kids on vents.

offandaway · Aug 1, 2016

An update: it was terrifying and I'm not planning on going back. High patient load (9:1) with no orientation, no break, and so unsafe that I was shaking during my first med pass. I thought about toughing it out, but I've worked too damn hard for my license.

BittyBabyGrower, MSN, RN · Aug 4, 2016

That is awful, but we get back some kids to our PICU from places like this. They are basically a nursing home, not a rehab facility. It makes me sad to know that after we fix them up they have to go back. The last time I was up in PICU we got a little girl who was filthy, I swear her trach ties hadn't been changed in weeks, her hair was dirty, her nails were in dire need of cutting, her GT looked a hot mess. It took me and one other nurse 4 hours to get her cleaned and straightened up. Poor baby, but a lot of

them end up in such facilities because there really isn't a lot of places for peds to go. Heartbreaking.

Pediatric Critical Care Columnist · Aug 5, 2016

Wow. Just wow. I can't even imagine a patient load like that... with those kid of patients. That's all kinds of wrong. I'm glad you're not stuck there.

LoveMyBugs, BSN, CNA, RN · Aug 7, 2016

Sad to hear.

I got my start in pediatrics in a LTC facility for medically fragile children. In my state we had medication aides to do the med pass and CNAs to help with Turing and changing as a RN I would oversee a pod of 24kids with 3-4 CNAs and a medication aide. The kids were well cared for. I learned a ton about seizure disorders and treatment and G/J tubes.

I only moved on because I desired something more fast paced.

The facility that I worked at was/is well respected at the children's hospital I now work for....

I know this isn't the answe to your original question, but just wanted to say that not all medically fragile children's facilities are like that, I got a Month of orientation