LTC nurses, what does your day look like?

Lmomma · Mar 1, 2015

Anyone? Please :)

txnurse2014 · Mar 2, 2015

i am a new nurse graduated aug.14' and I got a job the day after my license posted. i work at a rehab. but half my patients are LTC pts. The days are busy.I do all my own treatments. Days are filled with orders,labs and assessing pts and tons of documenting.I send pts out to ER or out for dr. visits or dialysis.My days are not routine and thats how I like it. Of course I have days where I get two admissions and have to send a pt. out all around the same time and my stress level is at its max or I feel like crying. It took time for me to get a good rhythm and I have a nurse friend who has helped me a lot. Clinicals was not a realistic view of the challenges physical and mental you will face. I think you just have to experience it on your own.

ibegyourpardon · Mar 2, 2015

I work evenings at assisted living.. Im responsible for 40 residents (some with GTube and colostomy) and have 3 CNAs. this is my day in a nutshell.

clock in. check where I'm working. count narcotics. get report from previous shift. make a list of issues from previous shift that need to be followed up on. flag orders for the dinner med pass. stock med cart. receive lab results and MD orders via fax, f/u with them as necessary. do dressing changes and put on compression devices that need to be done, since it's still an hour til dinner. do med pass. administer ppd shots to new hires at the facility... most of whom quit before it's even time to have them read. receive pharmacy delivery. take my break. start answering all phone calls to the facility and forward them respectively, as the receptionist has gone home by now and I am now the receptionist. begin evening med pass. sign MAR and chart. hope and pray no one falls or injures themselves. fill out accident report if fall or injury occurs.. V/S, description, treatment, call family, fax report to MD, begin neurochecks if fall is unwitnessed or they hit their head. Do new admissions if applicable. send residents to ER if condition warrants. assist CNAs with their work if they are impossibly swamped. get yelled at by demanding irrational residents and family members that don't understand what a CNA ratio of 1:15 entails.

the uneventful quiet days are okay, as its actually possible to get everything done and not be completely exhausted by the end of the night....

other days I feel my patience being stretched thin and wonder why I still work there while telling myself I don't get paid nearly enough.

bsnprg · Mar 2, 2015

I work evenings at assisted living.. Im responsible for 40 residents (some with GTube and colostomy) and have 3 CNAs. this is my day in a nutshell.
clock in. check where I'm working. count narcotics. get report from previous shift. make a list of issues from previous shift that need to be followed up on. flag orders for the dinner med pass. stock med cart. receive lab results and MD orders via fax, f/u with them as necessary. do dressing changes and put on compression devices that need to be done, since it's still an hour til dinner. do med pass. administer ppd shots to new hires at the facility... most of whom quit before it's even time to have them read. receive pharmacy delivery. take my break. start answering all phone calls to the facility and forward them respectively, as the receptionist has gone home by now and I am now the receptionist. begin evening med pass. sign MAR and chart. hope and pray no one falls or injures themselves. fill out accident report if fall or injury occurs.. V/S, description, treatment, call family, fax report to MD, begin neurochecks if fall is unwitnessed or they hit their head. Do new admissions if applicable. send residents to ER if condition warrants. assist CNAs with their work if they are impossibly swamped. get yelled at by demanding irrational residents and family members that don't understand what a CNA ratio of 1:15 entails.
the uneventful quiet days are okay, as its actually possible to get everything done and not be completely exhausted by the end of the night....
other days I feel my patience being stretched thin and wonder why I still work there while telling myself I don't get paid nearly enough.

Where is this place ? Sounds supper scaryðŸ˜³

Here at the LTC I pass meds and meds and more meds ....

Sent from my iPhone using allnurses

wanderlustnurse88, RN · Mar 2, 2015

I work evenings at assisted living.. Im responsible for 40 residents (some with GTube and colostomy) and have 3 CNAs. this is my day in a nutshell.
clock in. check where I'm working. count narcotics. get report from previous shift. make a list of issues from previous shift that need to be followed up on. flag orders for the dinner med pass. stock med cart. receive lab results and MD orders via fax, f/u with them as necessary. do dressing changes and put on compression devices that need to be done, since it's still an hour til dinner. do med pass. administer ppd shots to new hires at the facility... most of whom quit before it's even time to have them read. receive pharmacy delivery. take my break. start answering all phone calls to the facility and forward them respectively, as the receptionist has gone home by now and I am now the receptionist. begin evening med pass. sign MAR and chart. hope and pray no one falls or injures themselves. fill out accident report if fall or injury occurs.. V/S, description, treatment, call family, fax report to MD, begin neurochecks if fall is unwitnessed or they hit their head. Do new admissions if applicable. send residents to ER if condition warrants. assist CNAs with their work if they are impossibly swamped. get yelled at by demanding irrational residents and family members that don't understand what a CNA ratio of 1:15 entails.
the uneventful quiet days are okay, as its actually possible to get everything done and not be completely exhausted by the end of the night....
other days I feel my patience being stretched thin and wonder why I still work there while telling myself I don't get paid nearly enough.

Do we work at the same place :) That sounds like my work. 31 residents and 2-3 CNAs (PSWs in Ontario).

Days are always busy. Come in, count narcotics, listen to report. Then start med pass 7-830 or so. Then do skin assessments, dressings, vitals, calling MD for any orders, lab work, answering the phone (no reception here), dealing with families. Deacling with demanding residents. Then lunch med pass, bit more paperwork and then home. Hope no one falls otherwise that's vitals q15 x 4, then q30 x 2, then q1h x 4, then q4h x 24h. I don't have time to do all that. And we occasionally have to do IVs (or at least maintain then) and palliative care.

Lmomma · Mar 2, 2015

Wow that sounds crazy busy! Does it pay well??

I work evenings at assisted living.. Im responsible for 40 residents (some with GTube and colostomy) and have 3 CNAs. this is my day in a nutshell.
clock in. check where I'm working. count narcotics. get report from previous shift. make a list of issues from previous shift that need to be followed up on. flag orders for the dinner med pass. stock med cart. receive lab results and MD orders via fax, f/u with them as necessary. do dressing changes and put on compression devices that need to be done, since it's still an hour til dinner. do med pass. administer ppd shots to new hires at the facility... most of whom quit before it's even time to have them read. receive pharmacy delivery. take my break. start answering all phone calls to the facility and forward them respectively, as the receptionist has gone home by now and I am now the receptionist. begin evening med pass. sign MAR and chart. hope and pray no one falls or injures themselves. fill out accident report if fall or injury occurs.. V/S, description, treatment, call family, fax report to MD, begin neurochecks if fall is unwitnessed or they hit their head. Do new admissions if applicable. send residents to ER if condition warrants. assist CNAs with their work if they are impossibly swamped. get yelled at by demanding irrational residents and family members that don't understand what a CNA ratio of 1:15 entails.
the uneventful quiet days are okay, as its actually possible to get everything done and not be completely exhausted by the end of the night....
other days I feel my patience being stretched thin and wonder why I still work there while telling myself I don't get paid nearly enough.

RNBearColumbus, BSN · Mar 3, 2015

OK, here's a typical day on my 33 resident LTC unit:

7a-7:30 AM: Get report, count narcotics.

7:30A - about 10A: Morning med pass, including Bps for BP meds, and a couple of accuchecks for residents that eat late. Our facility does BID med pass. Most meds scheduled for either 7:30A - 11:30A or 7:30P - 11:30P. We keep odd med times to a minimum.

10:00 - 10:15 Break. (Yes, I actually do get one. )

10:15 - 11:30: Treatments , doing skin assessments on resident's who are getting showered, making follow up calls, scheduling appointments etc. Mostly administrative stuff.

11:30 - 12:30: Lunch time meds and accuchecks. This med pass is mostly q6 or q4 pain meds for only a few residents.

12:30 - 1P: Lunch break (Yup, I get one of those too. I ALWAYS take a lunch. It's a good 30 minutes to get off the floor, and decompress)

1P - 3:30P: Finish treatments, more skin assessments, charting, any procedures like cath changes etc that require a little more time, enter any new orders, follow up on labs etc., do rounds with MD or CNP if needed.

3:30 - 5P: Last med pass, dinner time meds, accuchecks. Again, not too many meds here, mostly pain meds and meds that can't be scheduled in the BID med pass times. I'm also usually helping answer call lights during this time, since the STNAs are busy getting people ready for dinner.

5P - 7P: Assist the STNAs in the dining room if I'm able, help feed resident's , answer call lights white my "minions" (lol) are working hard in the dining room, Make phone calls to families Re: any new orders or non urgent changes etc. , restock med cart for the next shift, verify STNA charting is done, cross all my Ts and dot all the I s.

7P-7:30: Give report to night shift, and get out.

Some tips:

Learn to prioritize! Most of your resident's just need their meds and maybe a dressing changed. Do it and move on. There will always be a smaller percentage of your resident's that need more attention. Prioritizing will give you the time to spend with them.

Keep things organized. Nothing worse that a messy nurses station when you're trying to find lab results, new write orders etc.

Cultivate respect and teamwork with your STNAs. If they see that you are willing to help when you can, they will be willing to help you when you need it. (I'll admit, I'm lucky to have the crew I have on my shift. They work well together, and I rarely have to follow up to make sure things got done.)

Take your breaks. Errors (Med or otherwise) happen when we get frazzled or tired. At least take that 30 min. lunch break to sit, eat, and decompress for a bit.

blue82 · Mar 6, 2015

as a new nurse...thanks for your advice....right now i dont know what to expect

LVNgoingtoRN · Mar 20, 2015

New grad nurse here, will be working in short term care soon I am scared and nervous. I know first few weeks will be hell hopefully I will get a hang of it soon and would be able to prioritize to make my job easier.

janelduke1 · Apr 25, 2015

I'm truly blessed--I work in a non-traditional facility with 'cottages', sort of like group homes for the LTC patients. We have 8 cottages on campus. Day and evening shift nurses have 2 cottages each, 13 'elders' per cottage. We have 3 'elder assists' per cottage (CNAs or Med Aides), one of which is designated to be the cook/housekeeper only. The elders are free to choose when they want to get up and have breakfast, making med pass long and drawn out, but our med pass times are from 7AM-11AM, so we can adjust med times as needed. If we're lucky enough to have a med aide, they do all the breathing treatments, eye drops and simple skin treatments. They also pass some of the meds. I do the majority of medication pass, any invasive skin treatments (currently I only have one in my two cottages), doctor and family calls, charting--though we are not a medicare or medicaid facility, so the charting is minimal, such as for antibiotic therapy, help with cares and feeding elders as able (I was a CNA first, so I love to do patient care), and assist with activities, as the elder assists are also in charge of all activities in the cottages. It's a neat environment. I've been a nurse for 25 years, and this is the best job I've ever had. The work is rewarding and fun, simple stuff, and really 'patient-centered care'. Yes, I do use my nursing skills--we have occasions when one of the elders becomes ill or takes a turn for the worst, and I need to use my assessment skills and call the doctor--but most of my job is about team-work and enjoying my elders. The really neat thing is that I am not 'supervising' the elder assistants, they have a cottage guide--sort of like a unit manager--who does that. She is not my boss, we do have nursing supervisors who manage the nurses, but I am more of a mentor to the elder assistants. I can suggest care ideas and ways to make the cottage run more smoothly, but ultimately, the responsibility for discipline falls on the cottage guide. That took some getting used to, as I was always a charge nurse over my CNAs. I had to learn to step back and allow the elder assistants to be their own self-led team, and simply offer advice if needed. Like I said, this is a whole different environment, but should be a model for future LTC facilities. It's great!