My dilemma working in the nursing home

[nerdynurseme]

Hi everyone, I dunno if it's normal or is it just me. I'm a new RN here in Canada (had 1 year pediatrics experience in Singapore) and I just got hired in a long term care and already worked 8shifts since then. I'm having problems when it comes to my work, coz in our nursing home I always get evening shifts which is the hardest.There's only one RN who's in charge with all med pass. I only have 4 PSW's and no RPN in the evening unlike in the morning there's one or two RPN's who's in charge with the med pass. I find it difficult to remember each resident because I am being assigned to 3 different floors and I only get 3 shifts per week and my facility did not give me a proper orientation. Is it just normal here to have 1 nurse for 45residents without any RPN to help with the med pass? I don't think it is still safe for the patients, because honestly with the volume of work I don't get to assess and even know each resident one by one. I need advice on how to manage my time and become efficient with the med pass. I get yelled by residents because of course I'm slow and some of the meds are late because i have to check the bracelets of each resident. It takes me 3-3.5 hours to complete my med pass. I don't even have time to eat and it's really not healthy. Please, any advice would be appreciated. It's driving me nuts and I always palpitate whenever I come to work coz I'm still not comfortable with it.

[Daisy_08, BSN, RN]

That's not A crazy # in ltc depending on the pts. I could have 50 retirement type and get my eve med passed done in an hour. Or 30ish heavy pts and get in done in 1.5.You need to learn how to safely cut corners. Knowing the rt's will make it much easier. I would pour all the meds for a whole table at a time, not best practice but it's the reality of ltc.

[loriangel14, RN]

Yeah having that many is normal from what I have seen and heard. With time you will get quicker with the med pass once you get familiar with the residents and thye meds.

[joanna73, BSN, RN]

I have 30 residents, and provided nothing major happens, I can get my med pass done in 1.5 hours. You need to be organized, but also learn to get in and get out. Some people will try to keep you in the room for the smallest thing. Try: "Hi, it's the nurse. I'm here with your evening pills. Call if you need anything." Spoon in their meds, give fluids, or watch them take their pills, say goodnight, leave. Next. That's how we work fast in LTC.

[Fiona59]

What was improper about your orientation? Whenever I worked LTC, orientation was three shifts for days and if you are lucky two on evenings. Orientation is for you to learn the facilities routines, not to learn the skills they expect a nurse to have learnt in school or previous places of employment.

Reality is there are far fewer meds on the 15-23 shift than on days and fewer dressings.

I could tell you about hell shifts I've worked in LTC but your workload doesn't sound bad. You have 4 aides. Many have worked with two aides and survived.

Like everyone has said it's about organization, good time management skills, and knowing which corners to cut. And always remember that patients can refuse med. They say no three times, move on.

Breakfasts used to be hell, 15-20 tablets and liquids and you have to stand there and watch while the resident picks through them, sorts by colour or shape and then puts one in their oatmeal and swallows. Then repeats the process until they are finished.

LTC is hell. I admire an nurse who works there by choice.

[Daisy_08, BSN, RN]

. They say no three times, move on.

They say no once, put it in their ice cream

[joanna73, BSN, RN]

Re: assessments: depends on the resident's condition. We learn how to conduct a thorough head to toe, but realistically, any floor you work...there is no time for a 15 minute assessment on each person. As you are walking into their room and giving meds, you're assessing. Certain residents that I detect are deteriorating, and/ or if there's orders to check vitals and blood sugar, I will. You have to use your judgment. Residents who require more time will have it, but that's where your prioritization comes in. If the person is relatively alert and not in distress, their meds are spooned in, fluids, siderail and call bell check, good bye. Otherwise it will take 3 hours to give meds, which we don't have.