LTC questions

Published

1) Is one nurse passing meds to 30 residents the LTC norm?

2) As a brand new RN, is LTC a bad place to start a career? By that, I mean that although I am fine with the work (except for being told I am way too slow getting meds passed), in the future will prospective employers see me in a less desireable light?

Thank you.

Specializes in hospital/physicians office/long term car.

When I work the medicare hall in my building I have 28 residents to pass meds for at 4 and 8 pm. I have 12 head to toe and full vitals assessments along with medicare charting on each of these. I also have treatments on several of these residents. If I work another are, it is usually 45-50 residents at a time with 2 med passes but no charting or vitals unless a fall, new admission, on atb or having probelms.

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Specializes in Med/Surg...psych...ortho...geriatrics....

Do any of you responding to Matt's questions, and any regarding LTC, have other nurses on the unit, serving in other capacities? Such as treatment nurses, or "charge" nurse ( overseeing the unit, md rounds,orders, etc)??Or have a unit clerk who answers the phone? I am an LPN, have 37 residents. All the beds are dually certified ICF/SNF, so at at given time I can have as many skilled residents as they see fit to put on my unit. I have had as many as 8 skilled/29 ICF at one time. And I am the ONLY nurse/clerk!. Meds,treatments,charting,doctor's rounds,orders from the doc, orders to write from the rehab dept., all phone calls, all family interaction, supervision of my CNA's....which is usually only 3, on 7-3 shift. I start my am med pass at 7:30, finish at 10:30 and have a 15minute break. Then I resume meds, starting with all the ac lunch, fingersticks/sliding scale insulins, and then into the lunch/post lunch meds. This usually lasts until 1:30 or 2pm. THEN, I have to do all the other duties I listed above. Oh,and now we have to review and sign off on the CNA's adl records...which are 4 pages long on every resident. And the manager has now said she is going to divide up the monthly summaries for the floor nurses on each shift. If I do my duties with no phone calls, or doctor's orders,family issues,etc. I can finish by 4-4:30. Most days I am there til 5-5:30. And Lord help you if someone has a fall! Then you got neuro checks and incident sheet to file, doc/families to call. Or find a skin issue...we have to do a skin impairment form,write tx orders,notify dietary to consult on nutrition, file a "change of condition" form, notify md/family.:bluecry1::bluecry1::bluecry1::bluecry1: My doctor tells me my dizzy spells are caused by stress. YOU THINK!! I know this is lengthy and probably repetitive of things I've posted before. But to those of you who have any help at all with other nursing duties, be very grateful.

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Specializes in LTC, Med-SURG,STICU.

In response to your question nsgnva, yes I have a unit supervisor. She does the doctor rounds and little else as far as floor nursing goes. I handle the doctor's orders, family calls and issues, do my tx, incident reports, ect. It honestly goes smoother when my unit supervisor is gone for the day. She gets in the way and wants to talk too much. I do not have time to chit chat like she does all day.

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Specializes in Med/Surg...psych...ortho...geriatrics....
In response to your question nsgnva, yes I have a unit supervisor. She does the doctor rounds and little else as far as floor nursing goes. I handle the doctor's orders, family calls and issues, do my tx, incident reports, ect. It honestly goes smoother when my unit supervisor is gone for the day. She gets in the way and wants to talk too much. I do not have time to chit chat like she does all day.

AMEN TO THAT!!! I LIKE HOLIDAYS AND WEEKENDS BETTER FOR THE SAME REASON....MANAGEMENT JUST GETS IN THE WAY

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Specializes in Rehab, Infection, LTC.
AMEN TO THAT!!! I LIKE HOLIDAYS AND WEEKENDS BETTER FOR THE SAME REASON....MANAGEMENT JUST GETS IN THE WAY

I'm a nursing supervisor and work weekends only. I wonder if I get on my nurses nerves? lol, i am going to ask them.

a few months ago our facility was sold to a huge LTC company. they have reduced our staffing numbers. we used to have 3 nurses for 50 patients on days/evenings and 2 at night with 5 cnas on days, 4 on evenings. now we have 2 nurses on both shifts and 3 cnas. and they wonder why our complain rate has skyrocketed!

all they have time to do is get the meds out and the charting. theres just no time for anything else. thats where i come in. i work the desk, answer the phone, call the docs, write and take off the orders, deal with the families and patient complaints, act as buffer for them when needed, i deal with the daily scheduling and call ins, i draw all the labs, start all the IVs and run all the IV med orders. in between all this i do infection control and do all the PAEs for the building, do weekend inservices and anything else required for my position.

the majority of us have worked together over 5 years so we are a very cohesive team. they yell what they need from me down the hall and i go do it, lol, like a good flunky, is what i tell them, lol.

but thats what it takes for all of us to get the patients taken care of. i went on vacation for 2 weeks this past summer. it was my first vacation in 5 years. i have now been forbidden to take any more vacations, lol.

our facility is such a high acquity. this past weekend alone, i had 21 different IV meds to hang on 7 different patients. when are the floor nurses supposed to find time to do all of that, get all the other meds out, chart on every sick patient, all the incident charting and snf documentation and get done by the end of their shift. not to mention on the evening shift it's common to get 8 admissions a shift. God love the evening shift supervisor's heart...she works hard! she has my admiration.

i dont understand the staff ratios, i just dont get it. LTC companies havent changed their ratios for years! i know for me, ive been in LTC since 92 and the staffing numbers are the same as they were then. yet the patient aqcuity has increased by leaps and bounds due to people getting pushed out of the hospital earlier! and the LTC corporates expect us to just deal with it or leave. they think they can just replace us. the mentality of "theres always someone to fill your place" needs to go!

i think i just went way off topic didnt i?

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Specializes in LTC, Med-SURG,STICU.

No, I do not think you get on the staff nurses nerves. In fact, I would love to have a unit supervisor that would do half of what you just said you do. However, I don't, so I deal with it and do my best to see that my res. get the kind of care they need.

As to the nursing staff to res ratios, they are horrible. I started in the nursing homes as a CNA in 91 and I can tell you that the aqcuity is a lot higher than it was then. I do not know what is going to make the LTC corps change their mentality. We have lost a lot of good nurses and CNAs because of it. There are many days that I ask my self if it is even worth going into work because I am so easily replaced. However, my res ask me where I was and how much they missed me when I am gone. Therefore, I know I am not that easily replaced (at least in there eyes).

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Specializes in Gerontology, Med surg, Home Health.

Perhaps when the government wakes up and pays us enough to take care of people we will have adequate staffing.

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Specializes in Geriatrics, ICU, OR, PACU.
Do any of you responding to Matt's questions, and any regarding LTC, have other nurses on the unit, serving in other capacities? Such as treatment nurses, or "charge" nurse ( overseeing the unit, md rounds,orders, etc)??Or have a unit clerk who answers the phone?

I staff a wound/treatment nurse, a desk nurse, and two unit managers (short term and LTC). Short term is, in my opinion, impossible to run without a desk nurse--I have either a MD or an ARNP on the short term unit daily. On the weekends, I staff a free-floating house supervisor on both 12 hr shifts, as well as a wound/treatment nurse, and a desk nurse.

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Specializes in Geriatrics, ICU, OR, PACU.
AMEN TO THAT!!! I LIKE HOLIDAYS AND WEEKENDS BETTER FOR THE SAME REASON....MANAGEMENT JUST GETS IN THE WAY

So, if you had a unit manager that helped you with anything you needed (families, patients going bad, incident reporting, admissions paperwork, discharge paperwork, and so forth) they'd "just get in the way?"

I'm really glad that my nurses don't think like you do.

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Specializes in LTC.
I staff a wound/treatment nurse, a desk nurse, and two unit managers (short term and LTC). Short term is, in my opinion, impossible to run without a desk nurse--I have either a MD or an ARNP on the short term unit daily. On the weekends, I staff a free-floating house supervisor on both 12 hr shifts, as well as a wound/treatment nurse, and a desk nurse.

Will you please call my facility and tell them that? :D

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Well you never know what the night will bring, but tonight I anticipate passing meds to 40 pts, 3pts who will be new admits. At least two nurses will be doing paperwork and 1 (me) will be passing meds. Why are more nurses designated to paperwork than passing meds? When will administration realize that caring for ltc/recent surgery/very sick/confused patients is not an easy thing to do?

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To help with our med passess, we changed some of the times. Some of our patients want their meds after meals.. so we bumped them to 0900. these types of changes can reduce the number of meds being given in a two hour time frame. It may seem like you're " doing meds all day", but if you actually give it a trial run, I think you'll find that the nurses aren't so pushed to hurry up and get done.

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