Need advice - transitioning from hospital to LTC

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Hi everyone,

I am an LPN who left postpartum (1:6 ratio sometimes 1:8) to go to LTC because I relocated.

I need all the input I can get!

I have only worked the floor (orientation wise) for 2 days and so far these are the concerns/questions I have:

Is a 1:30 ratio normal? (evening shift by the way 3-11)

Are you SUPPOSED to check the 30 charts at the beginning of the shift? I am used to going through and checking all of my ordered medicines but this seems to not be expected of you in LTC.. especially since I don't even know how you would be able to!

I have so far been unsuccessful (probably an understatement) at passing all 29 residents meds on time.... and doing the tube feedings (4) on time....

I had the nurse helping me notifying doctors, rewriting orders, etc and she also ended up finishing my med pass and doing 3 of my 4 tube feedings. AND she did my charting.

I really wanted to be able to attack this and do it on my own but I don't see it getting easier?

Also, I haven't even had time to see why these people are there, what all their Diagnoses are, etc because I am so overwhelmed and busy with the med pass!

Advice? Systems you use? etc?

ALSO: I was told in orientation in the office to do a weekly medicaid charting along with my skin assessment but none of the nurses on the floor seem to know about or do the weekly medicaid head to toe? But they do say they chart on people with pegs/catheters/ax daily.. so maybe that's why? Hmm....

and

What about cath care, peg tube care.. when are they expected to be done?

Thanks

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Hi everyone,

I am an LPN who left postpartum (1:6 ratio sometimes 1:8) to go to LTC because I relocated.

I need all the input I can get!

I have only worked the floor (orientation wise) for 2 days and so far these are the concerns/questions I have:

Is a 1:30 ratio normal? (evening shift by the way 3-11)

Yes.

Are you SUPPOSED to check the 30 charts at the beginning of the shift? I am used to going through and checking all of my ordered medicines but this seems to not be expected of you in LTC.. especially since I don't even know how you would be able to!

No, new orders are typically flagged in some fashion. Order changes in LTC are not as common as in acute care.

I have so far been unsuccessful (probably an understatement) at passing all 29 residents meds on time.... and doing the tube feedings (4) on time....

I had the nurse helping me notifying doctors, rewriting orders, etc and she also ended up finishing my med pass and doing 3 of my 4 tube feedings. AND she did my charting.

Takes time, you'll speed up once you learn all your patients. Some you have to give first, some last, some need certain meds in certain ways. Once you learn all their individual needs you will speed up.

I really wanted to be able to attack this and do it on my own but I don't see it getting easier?

Also, I haven't even had time to see why these people are there, what all their Diagnoses are, etc because I am so overwhelmed and busy with the med pass!

Advice? Systems you use? etc?

ALSO: I was told in orientation in the office to do a weekly medicaid charting along with my skin assessment but none of the nurses on the floor seem to know about or do the weekly medicaid head to toe? But they do say they chart on people with pegs/catheters/ax daily.. so maybe that's why? Hmm....

I am sure there is some type of special form you have to fill out. Usually a particular shift is responsible for this and some type of calendar as to who needs what charting done when.

and

What about cath care, peg tube care.. when are they expected to be done?

Thanks

Should be orders in a TAR somewhere, if not then check with facility policy.

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Specializes in LTC.

You do not have to check the physicians orders in the chart against the mar. Your meds will be late. Theres no way to pass 30 residents medications safely in 2 hours. 2 minutes per resident? I don't think so lol

PEG tube care is usually done per shift. or 7-3 and PRN. Look at the site. Does it need a good cleaning? Check the TAR.

I needed help from the other nurse on the unit also when I first started. You will speed up. I find it helps to do the G-tube patients first. Also go in room order if possible.

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Any comments on the nurses who say if the resident wants all their meds at once (5 and 9s), then it is okay (as long as it isn't the same med, of course)?

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Specializes in Gerontology, Med surg, Home Health.

You can't give 5's and 9's at the same time. If the resident insists, get an MD order to change the times.

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Any comments on the nurses who say if the resident wants all their meds at once (5 and 9s), then it is okay (as long as it isn't the same med, of course)?

Pt has the right to change times of administered meds, plus it allows the resident to take control of their own healthcare needs. Pt empowerment.

Just leave a note for the Doc and ask if its ok to put them together.

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I have worked in LTC off and on for over 13 years, first as a CNA, then LPN, and now RN. I love it. I have seen alot of nurses with hospital backgrounds come through the doors and really struggle. You have to lose the mindset of working in a hospital. You have to think like you are in your resident's home. Most of them will be stable most of the time. You can not possibly assess each resident, review each chart, and document on each resident. You don't have to in LTC. You have to learn to relinquish care to your CNA's. You have to learn that when you have to get your meds, treatments, charting, etc. to do, it is okay to tell a resident that you can't help them right now, but you will find someone that can--your CNA. Having a CNA background, I know what the job entails. I can do their job, but they can not do mine. Delegation is the key. You also have to be willing to help the CNA's when you have a few extra minutes of time in your day. They will respect you more and be more receptive to your lead. Unfortunately, resident's are not the hard part of LTC. The families make the job unbearable at times. They expect miracles sometimes. It is hard to convince some of them that if momma didn't eat at home, there is a pretty good chance she won't eat at the nursing home. Stick to it, you will find your groove. It is very rewarding to have the opportunity to share someone's last days with them. I wish you good luck, and yes 30 residents to 1 nurse is the norm.:nurse:

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