Looking for advice for LTC

[Pipnurse]

Hello everyone!

I am in desperate need of some advice and I'm really unsure where to turn... so here it goes.

I am a new RPN grad, working in LTC. I have been on the job about three months. I had three days of training in my job, and then I started working evening shifts. On the evening shift there is myself and four PSW's on the floor. We have one RN who comes and does insulin's as there are many to do. Most of the shift the RN is working on coding at the computer.

I am responsible for 50 resident's medication (except insulin), treatments (averaging about 25 a day), assessments and vitals. To me this seems like a lot, but I don't know if that's a normal expectation of LTC. I take a 10-15 minute break on my shift and am still there 30-40 minutes past my shift almost every day.

I don't feel that this is safe, I am afraid for my residents, I am afraid for my licence and I don't really know how to make the situation better.

To make matters worse, I made an error the other day, where I missed giving a medication (thankfully the client was just fine) - I wrote myself up and delivered the paperwork to the DOC, being accountable for my actions.

Any advice is welcome. I'm scared, and feeling very inept at my job. I actually feel ill when I think about going to work. I graduated with over a 90% average, and I feel dumb struggling with this. Please help.

[Silverdragon102, BSN]

Moved to the Geriatric/LTC forum

From reading other threads sounds about right

[tnmarie]

I come from a family of LTC nurses. Between us, we have over 30 years experience in LTC. I'm sorry to say that this is in general, the norm.

In my current position, I am the only nurse in the building and essentially have one CNA. I am responsible for med pass, treatments, skin checks on ALL residents (plus the huge skin packet if I find anything), weekly charting on all residents, and our residents essentially get a full admission packet done on them quarterly and yearly that I am also responsible for doing. Naturally I do all cath changes, colostomy bag changes, and any U/As ordered regardless of what shift they are ordered on. These are just my baseline responsibilities and don't include falls, codes, admissions, q shift charting and other emergent situations. Oh and since I am the only licensed staff in the building, I don't get a lunch because I can't leave the floor and it is an infection control issue to eat at the desk (eww, anyway, thanks ).

As far as advice, I don't have much to give. If you are a new grad, try to stick it out for a year and then use your experience to move on to another area of nursing or a better facility. Most jobs want a minimum of one year recent experience in a facility. Don't sweat your license too much. Despite what you are told, it is very hard to lose your license and I think most licenses are pulled for diversion. I know I personally don't know anyone whose lost their license and I've seen nurses do some crazy stuff over the years!

Take the best care of the residents that you possibly can, learn all you can (even if it is how NOT to do things) and then move on. Good luck.

[Jessie71385]

Unfortunately, I agree with all the others. In long term care, we focus more on chronically ill patients, and improving their quality of life. Not necessarily their quantity of life. I appreciate your concern, and if you don't feel comfortable, you need to make your concerns known. Long term care facilities are cursed with poor staffing due to the unavailability of qualified staff or quantitative staff. My only suggestion is voice your concerns, and see how it plays out.

[VivaLasViejas, ASN, RN]

Sad to say, this is pretty much the norm in LTC. Some facilities are better than others, but almost ALL of them are understaffed and the working conditions less than desirable. It makes me angry because the residents deserve better than what the government (Medicare/Medicaid) is willing to pay for their care, but who am I to say what should be done? I want low taxes and less regulation, yet I also want our elderly to be taken care of properly. Unfortunately, change is not going to happen anytime soon, and in fact things are probably going to get worse before they get better.

But.....I will also tell you that you make a difference in those residents' lives. They may not remember your name or the fact that you've told them three times already where their room is, but they look to you as their champion and their advocate. No matter how busy you are or how much you may wish you could do more, they know you care. I worked LTC on and off for several years, and the residents always seemed to know who to go to when they needed a problem solved, a wrong corrected, a comforting word given. You can't always give everyone everything they want or even everything they need, but you can give them some much-needed care while you're doing dressing changes and other treatments, feeding them, even passing meds.

Since you're new, you are probably still working on getting your timing down; trust me, it doesn't happen overnight, so give yourself time to learn where you can cut corners (without compromising resident care!) so you can work more efficiently. Enlist the help of your nursing assistants in doing simple treatments as facility policies allow (e.g. lotioning feet and legs or putting barrier cream on intact skin); delegation is something all nurses must learn, and the sooner you do the better your shifts will go. Remember, you can do their job, but they can't do yours!

Best of luck in your job. I hope things get better for you very soon.

[Pipnurse]

Thank you all so much for your insight. I am really trying to stick it out, hope that I get my timings down and improve. It's a huge stuggle as the most clients I ever had through school was 5. I really really appreciate everyones encouraging words. I felt really alone and I just don't feel that I am providing the care that my residents deserve. *sigh* So sad that this is the norm.

PS. I have deligated every task that I legally can

[lumbarpain, ADN, RN]

Save Yourself now...get out while you can......if you feel its too much....find some other job very soon...you are new and instilled with fresh ideas and knowledge.....take it from a Old seasoned LTC/Sub Acute nurse of over 20 years.....just not my cup of tea anymore either.