Quote from NC Girl RN
I worked in LTC for almost 2 yrs. I know its freaking you out now about the meds but if you get a permenant hall, you will learn your residents and TRUST ME you will learn their meds by heart. There is nothing wrong with that. You will soon find out that it will be a great assest to your speed. What I would do was have the MAR open and just go into the drawer and pull all the meds by memory. Then I would briefly glance at the MAR to make sure nothing changed. Then walk in and give them their meds. At my facility, most of the patients didn't even have name bands. Once you knew the patient, it was not an issue. LTC is mostly repetition. The residents take the same meds every day for the most part. Sometimes they added new meds or reduces the dosage on Cumadin or BP meds. Its so predictable in LTC. Sometimes a patient would fall or get really sick or die but it didn't happen everyday.
Everything is hard right now because you are new. It WILL get better I promise. As far as delegating to CNA's. Just make sure as your passing meds, that your residents are being changed and not neglected. Make sure you communicate when you want your vital signs so that your not sitting around waiting for them when you get ready to chart. Another thing that I stressed was for them to let me know when they leave the hall. This helped alot. Once you learn your job then the delegation part will fall into place.
thank you so much for your reply.. it was exactly what i needed to hear and right to the point , it made me feel much better.. how long did it take for u to adjust to the routine in passing meds? Thank God , i too, have a permenent wing that i will working on.. i will be doing 3-11s mon-thurs 32 hours per week. LTC was not my number one choice to work in, but the economy is in the dumps right now. there are no job openings where i live for new grads in the hospitals.. so i choose the LTC route.. my DON said that within 6 months if i get the hang of things she wants to train me to supervise.. did u have that experience?
as far as delegating to the aids.. so far ive worked one week in the morning, and the lpn i worked with really didnt delegate anything... it was 3pm and some of her patients vitals were still not done..and she was ready to chart.. her shift was 7-3 ..the lpn told me that whenever u have parameter meds dont trust the aids for the vitals. because the aids make up the vitals..?! i was shocked to hear that.. but thank you for your advice .. i really need to hear advice like this.. because i dont know how to communicate professionally and nor do i know whats in my scope of practice that i can delegate.. i mean yes i know most things from nursing school..buts its totally different in the real world.. i never really delegated anything in nursing school..although our instructor was pushing delegation the last semester.. it was hard to do since we were students..
im always afraid that what if i miss something or dont see a subtle change in my patient that i needed to report.. or what if i make some real bad mistake.. after all its my license on the line.. ughh.. it scares me to think this way.. did u have to fill out A&Is at your nursing home/ ? the sheet that u fill out if there is a new bruise or skin tear on a patient that is unexplained. i really dont get when those are filled.. my patient's arm was really itchy and the nurse put some hydrocortisone cream on it..and the arm had a rash.. she didnt have to fill out an A and I for that because she said it was a natural occurence, so it didnt need one,.and then other things that i found that are different from a hospital are that if there is something wrong with the patient or something happens on ur shift.. u have to notify the family? i dont think we did that in the hospital.. if the patient's oxygen sats drop and they need oxygen or they had a terrible night ect.. the family needs to know.. so that adds to more work.. and on top of it .. doing treatments and charting.. there is a pain assessment but the lpn thats training me didnt ask each resident about his or her pain scale and filled that out with mostly zeros for pain scale.. .. i mean it does look like lots of repetition and i hope, i too, can soon say that this is not that bad.. but so far i feel overwhelmed.