How long did it take you to feel comfortable in LTC?

Nurses LPN/LVN

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Hi, I am a new LPN (less than 2months) working in LTC ~ and hating every second of it :o

Every day I feel incompetent & frustrated. Unfortunately, I work in a facility where many nurses *do not* do the right thing (ie: pulling meds & getting them ready before a med pass, putting meds on residents bedside tables & walking out, starting med pass early ~ more than 1hr before scheduled time ~ in order to finish on time.)

My med pass is slow, d/t being new & following the rules. Other nurses tell me "cutting corners" is part of being a nurse in LTC & I just have to learn to make my own system. Ugh.

Last night a Res. didn't want to take all of her regularly scheduled meds at once. I said, "Ok, I'll bring the rest back later." Then she got upset & argued w/me saying that everyother nurse lets her keep her meds in her room & take at her convenience ~ she started yelling at me, calling me crazy & accusing me of trying to OD & kill her! This woman has some dementia, but not a lot. This scene went on for 20min. I finally let her keep the meds she was clutching in her hands but took the rest from the room & marked it as a Refuse. I know I should have tried again later, but she was sooo aggitated & she had the important pills (BP & psych) the ones she didn't take were vitamins & stool softener.

Unfortunately, many nurses *do* leave her meds in her room for her~ so she isn't totally unjustified in being upset w/me.

I have noticed that at my facility, nurses who do their job effeciently (even though they take illegal shortcuts) are thought of as good nurses. Nurses who go by the book or take their time are not respected by other nurses or aides. Experienced nurses tell me it is better to be slow & thorough ~ yet in the next breath they will complain about Nurse "X" who takes 3hrs to do a med pass. Honestly, is it like that everywhere?

Stuff like that is just one example of why I am already so stressed out. Does anyone have advice for the first year of LTC? How long did it take you to feel comfortable?

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Specializes in LTC, Urgent Care.

I had two weeks of orientation as a GPN at my facility. My first weekend on my own (I only work every other w/e), I could have cried. Here it was 1200 and I still had 4-5 residents to give their AM meds.

After 2 1/2 years, I'm still on the "slow" side, but my concious won't let me "breeze" through a med pass.

It's trial and error in finding a routine that suits you and the residents. I think that once you find that routine, it will get much easier. Being flexible is essential. You will no doubt always have that one person or so who HAS to have meds or whatever it may be at a certain time.

As far as the "short-cuts".. if you don't feel comfortable with something, just don't do it. If it's illegal, it's your license on the line, not anyone elses. Always protect that!

Are all LTC facilities that way? I've worked agency and all of the facilities that I was in had a heavy load (up to 35 residents) for the LPN. Between meds, treatments, charting.. it's nearly impossible to get finished and to feel like you gave the resident the best care that you could.

IMO no matter where you work, there is bound to be back biting from someone at some time. As long as you know you did your job to the best of your ability, try to let it roll off your back.

Well, I don't know if that was helpful or not :uhoh3: but good luck to you!

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I know how you feel. It took me months to feel safe and comfortable with the never ending med passes. I was very slow at first. I am not comfortable with leaving meds in the room. I watch every pill go down. I still have patients who get angry with me and say things like " the other nurse just leaves them with me". I will NEVER do that. That said, there are short cuts I will take. If I have the opportunity to start the med pass a half hour outside the one hour before window, I will. If you don't feel comfortable with that, don't do it.

You have to find out what works for you. You'll get there.

Good Luck and don't worry about what anyone else says.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I have been in LTC nearly 2 years, and it took about 8 to 9 months for me to hit my stride and feel like "my own nurse." In other words, it took almost a year to reach a level of confidence and perceived competence that I could feel comfortable with.

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Specializes in Community Health, Med-Surg, Home Health.

While I can understand your frustration, try and look at the situation; what is the census or nurse to patient ratio at your home. If it is high, then, it may be understandable (even if not acceptable) that the other nurses have devised short cuts. I have seen one nurse work with as many as 60-60 pts on the night shift, which is including G-Tubes, dressings, PO meds, glucose testing and insulin coverage. I KNOW a person in such a situation has made some alterations in how things should be done just to survive. And, that is without an emergency on the floor...which would certainly place a severe damper on the best laid plans.

You do not have to do what the other nurses are doing if you are not comfortable. As time rolls on, you will become your own nurse, practicing your own way. That will take some time, but don't be too hard on yourself. I don't work in a nursing home, I work in a clinic. I have found many creative ways to do the job to the best of my ability, and safely. But, it did take a bit of time! Be patient with you, and if seeing these things have made it uncomfortable, consider looking for a place where the volume is not as high, if that is possible. Good luck!

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Specializes in Community Health, Med-Surg, Home Health.

And, yeah, I am not for leaving ANY medication at the bedside. Anyone can walk in and take them, as well as a supervisor who may decide to write you up. Some things should just not be done. I'd rather wait for a better time, also, or as you said, write 'refuse' and try to come back later. That nurse that leaves them on the side is responsible for HER license. You just be sure to protect YOURS.

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Specializes in Mental Health.

As you stated you are new...and it's expected that you might feel inadequate. You have a lot to learn...and the environment that your're starting in is not exactly cream of the crop. I hate LTC...I started off at one and stayed for 6 months before leaving for corrections. And as of today I'm no longer doing that either...they don't need me because they are getting rid of PRN employees so it's back to Hospice...buts that ok I like hospice better anyways...theres always something else if your're a nurse...isn't that great.

Get your experience...and if need be...move on...unless you have a high tolerance for an overload of patients you will get tired of LTC quickly. :o

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Specializes in Acute Rehab, LTC.

I myself am a new LPN (3 months now.. woo hoo!) I also work in LTC and I *HATE* it. I can relate to what you're talking about.. especially how the nurse who takes all the shortcuts is thought of to be a "good nurse". My census is 33:1.. which from what I hear is pretty common in LTC. I think that the high census has alot to do with the frustration. I'm applying to every hospital I can in hopes of getting my foot in the door. I feel that I am a more hospital oriented person. But I know both have their down sides. Hang in there... or get out of there, lol.

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While I can understand your frustration, try and look at the situation; what is the census or nurse to patient ratio at your home. If it is high, then, it may be understandable (even if not acceptable) that the other nurses have devised short cuts. I have seen one nurse work with as many as 60-60 pts on the night shift, which is including G-Tubes, dressings, PO meds, glucose testing and insulin coverage. I KNOW a person in such a situation has made some alterations in how things should be done just to survive. And, that is without an emergency on the floor...which would certainly place a severe damper on the best laid plans.

You do not have to do what the other nurses are doing if you are not comfortable. As time rolls on, you will become your own nurse, practicing your own way. That will take some time, but don't be too hard on yourself. I don't work in a nursing home, I work in a clinic. I have found many creative ways to do the job to the best of my ability, and safely. But, it did take a bit of time! Be patient with you, and if seeing these things have made it uncomfortable, consider looking for a place where the volume is not as high, if that is possible. Good luck!

When I was an LPN, I worked LTC, nocs. I had 65 pts all to myself, w/ 3 CNAs. Half of my pts were LTC/behavioral, the other half were skilled/rehab pts. I never left meds @ the bedside, but I did utilize short-cuts which did not jeopardize pt care. I was very organized, and worked very fast. Still, I was not able to take a lunch break for two years.

The reality is that most work loads for LTC nurses are so unreasonable, that to do things the way we were taught in school, an 8 hr shift would be 12 hrs, and a 12 hr shift would be 16.

LTC nurses "pretend" they are doing everything by the book, and mgmt "pretends" they don't know that short-cuts are being taken, and that to do the job strictly by the book would be impossible. This is the unspoken way of LTC.

Nurse Patricia Benner dicusses this phenomena in her book: From Novice to Expert: Excellence and Power in Clinical Nursing Practice

ISBN-10: 0130325228

A conscientious, seasoned nurse knows how to safely bend things within the system in order to give all her pts the care they need in the time allotted.

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Specializes in Geriatrics/Family Practice.

Working LTC as a nurse is nothing like what they teach you in school. You have to take shortcuts, but that I mean doing blood sugars in the hallway, giving insulin in the hallways or dining room, doing a so, so assessment because time does not allow for a full head to toe unless its an admission and then you do your very best and hope you don't miss anything while of course everyone's meds, and treatments are due, orders need to be processed, someone falls, someone needs to be sent out. If you did everything by the book you'd never get done with your med pass, and then if state came in you'd get a good job for following the rules, but get in trouble because you are over you 2 hour window. Or do you take safe shortcuts and get your med pass done so that you might actually get to do some assessments, paperwork and take a break. Basically, you're damned if you do, and damned if you don't. I always figure the time that state catches me doing one of my shortcuts and yells, then I will then ask them to show me how to do it in a timely manner appropriately within 2 hours when there are other things going on besides just the med pass. State inspectors wouldn't know how to work LTC if there life depended on it. I know these rules are in place for safety, but don't try to enforce what you can't do yourself. We as nurses took a oath to first do no harm, and as of yet, thank god, I haven't hurt anyone using my fastest, yet most accurate med pass yet. Good luck and you'll figure it out eventually.

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I feel the same way. I have been orientating for 2 1/2 weeks now at a LTC with a new nurse. She does things your not suppose to do like not flushing the GT tubing, leaving meds in patients room, starting early....etc because she cant finish her paperwork. I did the med pass once by myself which took until 12:00pm( doing it the right way) and havent started the Pm meds yet. Our ratio is 30:1, which seems ridiculous.Managment has stoppped overtime, but expect you to finish all paperwork at the end of the day(they say manage your time better).They pay good, but I dont know if I would want to stay at a place like this and risk my license everyday.

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Specializes in Medical/Legal.
I have been in LTC nearly 2 years, and it took about 8 to 9 months for me to hit my stride and feel like "my own nurse." In other words, it took almost a year to reach a level of confidence and perceived competence that I could feel comfortable with.

Your post really made me feel good, so thank you. I've just completed my 1st month as a new LVN and I'm always the last to leave for the night.

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