med pass for 60 clients?

[HannahLPN]

Hi,

I'm new here, hope it's okay that I started a thread....really looking for some advice. I work full time in an assisted living facility. Level 2 care ( this is in Canada, which means minimal assist....although the lines get blurred!).

It's a new facility, and we only have 19 residents so far. We have 60 beds, and have been told there will still only be one LPN per shift at that time. I do not see how this is realistic....if meds are done properly, you need more than two minutes per client...because things always come up.

On top of that, we carry two phones. We take dr's orders, do treatments, call pharmacy, deal with family, supervise the CNA's....everything. There is no RN in our building.

The other phone is, get this, the receptionists phone for when she is not available...she works 8-4. So, during the am med pass, and supper time, we get phone calls such as "can you put me through to"...we are interupted, and have to go look up a number. We also have to let people in the building, as it rings to our phone to unlock the door.

There is an independent living apartment building which is full and attached to us...if one the residents falls, needs a nurse, or calls 911, you got it....we have to go over.

Yesterday, because of call ins, I had to work alone. Morning med pass for 19 ppl, get them up and dressed, and did I mention answer the calls until the receptionist came in, and oh look, there's a family waiting for me because their father is under adult protection and they want to argue. I also had to send two ppl out to hospital, one with pneumonia, one with undiagnosed CHF.....so those things come into play as well.

I was completely overwhelmed with 19 ( although, normally, there would be a cna, and we will be adding more on as the client list goes up).

Is it realistic to expect 1 LPN do meds for 60, treatments, answer the LPN phone, the receptionist phone after hours, be available for emergencies for another residence, and oh wait, I forgot to mention, we serve meals in the dining and clean the tables afterwards......and still be aware and assessing, charting and everything else an LPN does....has anyone ever worked in assisted living? if this is the norm, then I would like to know, and will start looking elsewhere, as much as I love my job most days. I fear for my license as the place fills up....and am wondering if my concerns are valid enough to go to management.

[caliotter3]

Unfortunately these are the conditions in many places. One just does the best one can under the circumstances.

[LUV ALZ]

I once worked at a facility where I was the only nurse to 55 pts in one building. All Alzheimers and yes they think you are superhuman and can do med pass, a Tx and take a Dr.s order while comforting a family member. To top it off if I was working a noc shift and the the other nurse for the other building called off you were expected to handle both buildings. The Alz building was about 1/4 of a block away from the assisted living building and if you were handling both (could easily be over 130 res total for both buildings) you had to run back and forth in the middle of the night (spooky as heck) between the 2 buildings to pass meds at night and 6 a.m. I quit after 9 months. And FYI there is no way you can do a med pass in even close to the time it is supposed to be done on 60 residents with all of those interruptions.

[Peds_Nurse]

OK, so I understand that this is the "norm" for most assisted living places, however, as Hannah mentioned, she fears for her license. I, too, work in assisted living, but the facility is also sub-acute care with a high level of surgical wound dressings, the acutity level is very high, not many are stable and we handle hospice, so that means family issues, etc. We also do MD orders, phone, etc. Isn't there some type of guidelines with the state board of nursing or a federal guideline to prevent these facilities from "raping" the nursing staff and forcing them to work at this pace?

[guest2210]

I, too, worked in a few ALFs where if you were able to do the work and get it done, then they expected more out of you. If you show them you can do it, they will expect it from you all the time. On more than one ocassion, I had 66 residents to do meds, txs, orders, fingersticks, send out if needed, etc. And yes, whenever they were shorthanded, they would pull the other LPN to another unit and I'd end up having to do it all, because they knew I could do it. I was there less than a year. Short of reporting the unsafe staffing to the governing agency in Canada, I'm not sure what else you could do, other than look for something else with better staffing. Good luck to you.

[Simba&NalasMom, LPN]

Sounds absurd to me personally. Unfortunately, it is the norm in lots of places, and jobs are not growing on trees these days. Some find that type of job doable; others don't. I personally am horrid at passing meds (I also live in a state which uses med aides, so I'm not exactly in med-passing shape).

One advantage you have is a low census at this time which will gradually grow. Perhaps as the census grows, you will be able to grow into the job gradually, so it's not so overwhelming. Remember, you and only you can decide if it's a fit.

In ALFs in my state, staff is allowed to pre-pour meds in the medroom and put each room's meds in an individual cup before going out onto the hall. Is that an option for you? That definitely saves a lot of time, although I'm sure several will argue that that practice makes it way too easy to mix up meds/residents.

Also, with practice and experience, you will become faster and faster and also become better at prioritizing. Give it some more time.

[Simba&NalasMom, LPN]

OK, so I understand that this is the "norm" for most assisted living places, however, as Hannah mentioned, she fears for her license. I, too, work in assisted living, but the facility is also sub-acute care with a high level of surgical wound dressings, the acutity level is very high, not many are stable and we handle hospice, so that means family issues, etc. We also do MD orders, phone, etc. Isn't there some type of guidelines with the state board of nursing or a federal guideline to prevent these facilities from "raping" the nursing staff and forcing them to work at this pace?

In my state, there are staffing rules for nurse aides (no more than 7 residents on days, 11 on eves, 20 on nocs). Sadly, no such rules apply to nurses. And while I reallllly value a good CNA, you should hear them whine when it even looks like it's close to their staffing limit!

[e-nursey]

I just completed my fourth day working the 7-3 shift at a 5 floor LTC as a new graduate LPN nurse. I am very stressed to say the least. I have worked on two floors and today was my second day on the dementia unit where I believe I will me working permanently. Today was also my second med pass to 26 patients which took over 3 hours. The other nurse completed her meds in about an hour and a half. I was just informed that as of Monday I am working 8-4 and expected to pass the 5 o 'clock meds, which start after my shift but essentially I was told if I start early I should be finished (as if I'm not already upset about the length of my current med passes)...but wait there's more. Because I'm in orientation the charge nurse took half of the floor and I took half of the floor. In reality one nurse is in charge of the 50 patient floor for the entire shift; meaning that next week I will be passing all of the meds to 50 patients in the morning and expected to give 5:00 meds to 50 patients. Why, if I'm passing 5:00 meds would my shift end at 4, and if it took me 3 hours to pass to 26 patients how do I manage 50? I was already stressed out about the time it's taking me to complete the med pass but now I'm purely overwhelmed. I am a perfectionist and as a new grad have high hopes for the role of a nurse. Not only do I precisely check what I'm giving and how much, but I also want to understand my patients condition and for their safety and my own be able to properly assess them and chart details efficiently. I have had to locate the patients whom I don't even know yet and stay with them until they finish, try to figure out where all of my medication is located in my drawer and constantly run around in chaos. In all of the madness I can't comprehend how I can efficiently complete med passes and still have time to check the status of a patients condition for charting.

I didn't even get started with the fact that I'm supposed to run morning report with 50 patients whom half I haven't met and the other half I still have trouble recognizing. I am desperate to know how to balance med passing so that I at least have time to worry about the rest of my job. I keep reading about colored tabs, lining meds up etc. but there are no tabs at this facility and every medication comes in a 30 tab package, meaning you have to pop them out individually.

Sorry for venting onto the website but I am on overload! I hope it gets easier!

[CynicallyVexed]

Unfortunately this is the life of a LTC/Assisted living LPN on nights... If you have medicare/skilled tho you can't have more than 25 in the state of TN, but there is more to come with that than 60 LTC/Assisted living patients... At least they give you phones to carry around instead of locking up your cart in the middle of the hall way and running to the desk... and I hate to say it, but you also end up remembering what 60 patients take every night and every morning... I haven't worked in a nursing home in 6 months and I can still tell you what they all get.. lmao

[rachkim]

Well I see the point I am an LPN with 64 patients right now 2 days a week and I pass meds,B/S, or tube feedings to at least 41 of them, I also work 11-7. The other 2 nighst a week I work on the rehab side and it only has 19 beds, easy nights. However I go over and help the LPN on the other side. I was actually told not to anymore today when I went in on the easy side. Dont know where the info came from but I still did because they need help. I hope it did not actually come from anyone in a position, because that really distraught me. I have never worked anywhere I was told not to help someone, what kind of team work is that. It may simply be one side against the other, or someone does not like her, haven't been there long enough to figure that out yet. However I am not doing it because it is my job, but because it is te right thing to do. So I really would like to know the legalities, only because they are probably using the number 2 nurses even though one only has 19 patients or less. But no matter how it turns out I will help, even if I don't get help when I am there. I guess when I chose this field I expected that more people would want to help people and to me that is in every aspect.

[Simba&NalasMom, LPN]

Was the person who told you not to help your supervisor?

It's important that you know your chain of command in your facility so you know who to go to when these things come up. Is it possible that they do not want you helping on the heavier side because if you leave the rehab side there is no nurse?

I personally think it's awesome that you want to help the other nurse, and it is the right thing to do. I would just clarify with my immediate supervisor (e.g. DNS) that it's ok per facility policy. :)

[dakjaxday]

I am new here too so I just saw this. I have a similar experience with an assisted living facility. I just graduated in June and took my NCLEX-PN 2 weeks ago. I was offered a weekend charge nurse position I had alot of doubts about doing this right out of school but after talking with the director of care who assured me that I could do the job I accepted. After just 2 days of training I learned I would be the only LPN in the facility with 40 pts all to myslef with 2 cna's. One who was just hired. All meds were given at different times of the day and the person training me was still giving 8 o'clock meds at 11 am. On top of all of the paperwork new admits, transfers, d/c, and incident reports I felt this was way to overwhelming for a new grad LPN with 0 experience. After talking to the director about my concerns I was told that I needed to rethink my profession because this was nothing compared to what other jobs would expect out of me. I'm having alot of concerns now and wondering if she might be right. Is this normal for most LPN jobs or just assisted living jobs?