New LPN = questions about handling emergencies

[sparkle823tami]

Hi, I am a new LPN graduate in Illinois. I have been offered a couple jobs where I would be the only licensed nurse on staff. One is for a DD facility and the other assisted living. I don't really want the assisted living because I want to continue learning new skills.

My main question is about emergencies. I am a little concerned about being the only nurse on staff and handling a crises situation. Does anyone work in a similiar situation? The most common emergencies are falls.

I'm thinking I should probably wait until a job opens up at a LTC facility where I can be with other nurses because I feel like I still have so much to learn. Even at a LTC facility, I still will have to know how to react in an emergency and I feel like this wasn't covered that much in school. Any advise or ideas will be appreciated.

[pagandeva2000, LPN]

I have had this dilemma as well. School didn't teach me much, either. I had my license since 2006, and work in a hospital clinic. Working in hospitals are far different than working in LTC and Assisted Living, because we have more medical staff around for support, and for the most part (at least where I work), we can call for a Rapid Response Team if someone is in crisis. Also, we have RNs working directly with us. LTC, assisted living and home health usually either have one supervisor on duty on the evening and night shifts, or are available via telephone. That frightens me, because I don't feel that equipped to deal with emergencies, either.

What I would do, though, is to learn the policy and procedures regarding emergencies and review CPR during the hiring process/orientation. Learn where the crash cart is, make sure vital signs are done and document everything that seems to be unusual....ie; adventitious lung sounds, using assessory muscles for breathing, skin color, etc... They should tell you who you call. I have not worked anywhere except my hospital, but I believe if I were working as the nurse alone in one of these facilities, I would obtain vitals immediately, call 911 and have a note of each thing that made me feel that EMS had to be called. Document who you contacted (ie, supervisor, etc...). Again, I am not sure, either. But, in a pinch, that is what I think I would do. I feel your pain.

[Lexxie, LPN]

Pagendeva pretty much hit everything. The only thing I would add is to notify the PCP. My facility requires it - even in an emergency situation.

[AngelaLPN08]

Those are great questions to ask during an orientation. The facility I worked at only one Nurse was on at night. I would think that would be a scary thing but we had all of the procedures very CLEARLY written out in a book on the desk. It told all the charting/papers we would need as well as people to call. As the other people said learn their procedures, and ask tons of questions!

Good Luck

Angela

[Miss Cola, BSN, RN]

I work at an ALF-101 unit facility- and most times I am the only LPN in the building. At first this was REALLY scary to me !!! Sometimes I still play the "what-if" game with myself. But once you get to know the CNA's at your facility and if the patient happens to have a private duty aide, they will alert you of anything that seems suspicious. Once you get to know your residents, you can tell when something is off as well. Falls are my most common emergency. Don't stand the people up right away-check ROM, if one leg is shorter than the other (hip fx), pulses of ext., check for bumps on the head, and if the person says they hurt-BELIEVE THEM-even if they aren't all there!(call their POA if they arent able to communicate) Send them out for evaluation right away! Elders bones are brittle and break so easily!

You may not think you will learn new skills, but you will. Working your way up from an ALF is a good way to start. Looks great on your resume and you can go to home health, ltc, and it is a fabulous place to work if you are persuing your RN (schedules are great and stress level is not so bad) This is just my personal opinion.

I have had emergency situations as well-and the saying is-"when in doubt, send them out!" Many ALF's are not equipped with a crash cart, so be sure you know your BLS, where the AED is, and have a phone on you at all times to call 911. The family and PCP will need to be notified, and you will have to fill out an incident report and complete nursing notes.

Policy and procedure for you facility is key, make sure you know where to find a copy and read through it!!!!

[pagandeva2000, LPN]

I even appreciate this advice. You sound like an organized person who doesn't let this get to you!

[linzz]

All these responses are just what you should do so I will share an experience I had at an ALF. I had a lady fall, I did vitals, checked ROM, her pain level and she said she was fine, (but she really wasn't) so myself and an aide slowly got her up and back to bed. Well I went back to check on her about 20 minutes later and she said her arm was hurting and sure enough it was swollen, so I called 911, and sent her to the hospital. If I had to do it over again, I would have just sent her out in the first place. What Miss Cola said was right on about sending them out, when in any doubt at all.