New Grad drowning in LTC

anonomous · Jul 3, 2015

Wow, all of these posts where extremely helpful. Thank you!!

dudette10, MSN, RN · Jul 3, 2015

You LTC nurses rock! I've never seen a thread by an overwhelmed new grad that was full of so many seriously helpful posts.

Everline · Jul 3, 2015

Love the detailed responses on this thread! To the OP: I don't work in LTC, but rather I'm a bedside nurse in a hospital. I feel much like you even though I have many less patients than you at a time. I am stressed, have some of the same challenges you mention and sometimes don't know how I can make it through the day. Most of my days are awful and I go home feeling like the clumsiest and most stupid person around. I can only imagine how difficult it would be to be in your situation with more patients and therefore even more responsibilities. I admire you for what you are doing and wish you great success!

Blondenurse83 · Jul 3, 2015

Sorry you are dealing with all of this! I started my nursing career in LTC as my first job, and it was pretty overwhelming. Having so many patients to pass meds on and assess as well as dealing with staffing issues and everything else was difficult. Hang in there, I learned a lot and I think it really benefited me when I moved on to a hospital position. I really did learn a lot of prioritization and time management skills that helped me. Good luck!!

TheCommuter, BSN, RN · Jul 3, 2015

This thread has been moved to the Geriatric / LTC forum with the ultimate goal of amassing more responses from those who work in LTC facilities. Good luck!

downsouthlaff, LPN · Jul 3, 2015

New LPN in LTC of 6 months here. It gets better. Learn to priortize. Cut corners. Combine med passes ex. Give 4pms and 6ms heck even 8pms together when applicable. Know residents habits. Know yoir doctors , and know the autonomy they give you or dont give you, every doc as different. Go to an experienced nurse you trust with questions. Be firm but proffesional with difficult time consuming residents. Dont be afraid to drop the by the book mentality and take some shortcuts that of course will not pose a serious threat to residents. Use every minute wisely. It gets much better!

wanderlustnurse88, RN · Jul 3, 2015

I'm going to advise against combining the 4pm and 8pm med pass. You still need to stay within that hour either way. If there are residents getting some meds at abnormal times, see if that is something that can be changed. If they only get the med once a day, it should be at a meal time or bedtime. I know some meds interact with others, so it might mean that they are getting daily meds at both breakfast and lunch. Try to see if you can work with pharmacy to eliminate unnecessary med pass times and see what can be combined.

When I'm doing a meal time med pass, I start with the walking residents who are in the dining room first. Those are the ones who tend to leave quickly after a meal and it's hard to track them down if they are gone from the dining room. The residents who are in brodas and need staff assistance to eat usually go last since it takes them awhile to eat. And even if I don't get them during the actual meal, they are usually brought close to the dining room or nursing station afterwards that I can catch them then.

I will only run to answer the phone during a med pass if I'm waiting for the doc to call me back. Everything else can go to voicemail and I will check it after the med pass.

Make sure your med cart is well stocked. Enough applesauce or pudding, enough med cups, cups, spoons etc. We usually have night shift stock the cart so it's ready for day shift.

Let the other staff know that they should not be interrupting during the med pass unless it is important.

It usually takes me about 75-90 mins to get my med pass done for 31 residents. Once you get into a routine and you know how people take their meds, who likes or needs them crushed, who is going to resist you and the best way to get them into them, it will go faster.

A tip that I have for the residents who get crushed meds and are difficult to get meds into. I try to use as little applesauce or pudding as possible so it's less times you have to give them a mouthful of crushed meds. If I can get it in one scoop, all the better. Doesn't always work.

It will get better :) took me about 6 months to start to feel comfortable. I've been there for almost 3 years and I love my job (most days).

downsouthlaff, LPN · Jul 3, 2015

I'm going to advise against combining the 4pm and 8pm med pass. You still need to stay within that hour either way. If there are residents getting some meds at abnormal times, see if that is something that can be changed. If they only get the med once a day, it should be at a meal time or bedtime. I know some meds interact with others, so it might mean that they are getting daily meds at both breakfast and lunch. Try to see if you can work with pharmacy to eliminate unnecessary med pass times and see what can be combined.
When I'm doing a meal time med pass, I start with the walking residents who are in the dining room first. Those are the ones who tend to leave quickly after a meal and it's hard to track them down if they are gone from the dining room. The residents who are in brodas and need staff assistance to eat usually go last since it takes them awhile to eat. And even if I don't get them during the actual meal, they are usually brought close to the dining room or nursing station afterwards that I can catch them then.
I will only run to answer the phone during a med pass if I'm waiting for the doc to call me back. Everything else can go to voicemail and I will check it after the med pass.
Make sure your med cart is well stocked. Enough applesauce or pudding, enough med cups, cups, spoons etc. We usually have night shift stock the cart so it's ready for day shift.
Let the other staff know that they should not be interrupting during the med pass unless it is important.
It usually takes me about 75-90 mins to get my med pass done for 31 residents. Once you get into a routine and you know how people take their meds, who likes or needs them crushed, who is going to resist you and the best way to get them into them, it will go faster.
A tip that I have for the residents who get crushed meds and are difficult to get meds into. I try to use as little applesauce or pudding as possible so it's less times you have to give them a mouthful of crushed meds. If I can get it in one scoop, all the better. Doesn't always work.
It will get better :) took me about 6 months to start to feel comfortable. I've been there for almost 3 years and I love my job (most days).

I have 41 residents and probly 38 of wich get 8pm meds. If its Trazadone or another sleep aide or a controlled substance wich accounts fpr probly 10 of my residents, i will hold off until 8pm. If they get house supplement, mag oxide, MVI, at 8 there going to get it between the hours of 4 and 6. Its not feasible to do 2 big med passes on 41 residents, treatments, Weekly charting , 5 plus skilled notes, ABT, and MDS charting , plus sign mars and tars and 41 residents in 8 hours. Unless i want to stay til 1:30-2am daily. Wich then will get you reprimanded by the DON and Adminstrator for overtime. Now at my first LTC i had 27 residents compared to the 41 i now have and that made a world of difference!

Adele_Michal7, ASN, RN · Jul 3, 2015

I'm going to advise against combining the 4pm and 8pm med pass. You still need to stay within that hour either way. If there are residents getting some meds at abnormal times, see if that is something that can be changed. If they only get the med once a day, it should be at a meal time or bedtime. I know some meds interact with others, so it might mean that they are getting daily meds at both breakfast and lunch. Try to see if you can work with pharmacy to eliminate unnecessary med pass times and see what can be combined.
When I'm doing a meal time med pass, I start with the walking residents who are in the dining room first. Those are the ones who tend to leave quickly after a meal and it's hard to track them down if they are gone from the dining room. The residents who are in brodas and need staff assistance to eat usually go last since it takes them awhile to eat. And even if I don't get them during the actual meal, they are usually brought close to the dining room or nursing station afterwards that I can catch them then.
I will only run to answer the phone during a med pass if I'm waiting for the doc to call me back. Everything else can go to voicemail and I will check it after the med pass.
Make sure your med cart is well stocked. Enough applesauce or pudding, enough med cups, cups, spoons etc. We usually have night shift stock the cart so it's ready for day shift.
Let the other staff know that they should not be interrupting during the med pass unless it is important.
It usually takes me about 75-90 mins to get my med pass done for 31 residents. Once you get into a routine and you know how people take their meds, who likes or needs them crushed, who is going to resist you and the best way to get them into them, it will go faster.
A tip that I have for the residents who get crushed meds and are difficult to get meds into. I try to use as little applesauce or pudding as possible so it's less times you have to give them a mouthful of crushed meds. If I can get it in one scoop, all the better. Doesn't always work.
It will get better :) took me about 6 months to start to feel comfortable. I've been there for almost 3 years and I love my job (most days).

I agree to an extent, but there are times when it makes sense. If someone's only 8pm med is a Plavix or a Senna and its already 6 o clock, you might as well give it to them... But the preference is to try to change the med time to stay in compliance.

Adele_Michal7, ASN, RN · Jul 3, 2015

Another "hack" I have with patients who take their pills WHOLE is to place any pain pills or "priority pills" (aka meds you know they ask about or get concerned over) into a separate pill cup. When you go into the room, you can say, "OK Mr. Doe, here's your 5 pm meds with the Norco you requested (or whatever the pill is) I find when I put all the pills in one cup, one of the following happens:

1. Pt dumps out pills into bed frantically looking to be sure preferred pill is there, spilling on floor in the process

2. Patient will ask you to show them the pill anyway

3. Patient will want to take that one first or separate

Just find good results doing this and it eases their minds.

Adele_Michal7, ASN, RN · Jul 3, 2015

Oh, and have a storage style clipboard. Inside try to keep frequently used forms like pharmacy order sheets, investigation forms, etc. Saved time when you have 'em at your fingertips :)

Oswin · Jul 3, 2015

I have 41 residents and probly 38 of wich get 8pm meds. If its Trazadone or another sleep aide or a controlled substance wich accounts fpr probly 10 of my residents, i will hold off until 8pm. If they get house supplement, mag oxide, MVI, at 8 there going to get it between the hours of 4 and 6. Its not feasible to do 2 big med passes on 41 residents, treatments, Weekly charting , 5 plus skilled notes, ABT, and MDS charting , plus sign mars and tars and 41 residents in 8 hours. Unless i want to stay til 1:30-2am daily. Wich then will get you reprimanded by the DON and Adminstrator for overtime. Now at my first LTC i had 27 residents compared to the 41 i now have and that made a world of difference!

I've been working in LTC for a while and know what you mean. There are some pills that I will give at different times. However, I NEVER recommend a new grad do this, especially at a facility i'm not familiar with. Reasons being:

1. chances are they don't know all the meds they're giving. It's unfortunate, but it's true. Plus, I can almost guarantee they don't know potential interactions that could occur by giving pills at the wrong time. If all someone gets at HS is a daily lisinopril or something, I'd ask someone more knowledgable (DON/MD or whoever's approval you need for your facility's policy) about moving it to be with another med pass to simplify things for everyone, including the resident. If you approach the DON about this from the angle that the residents go to sleep early and don't like to be woken for meds that don't need to be given at that time, they tend to be more interested in changing it (in my experience, anyway)

2. Some DONs are more strict about that stuff than others. As a new nurse to the facility, people are going to be watching her. I've known people in some facilities who were fired to giving meds at the wrong times instead of requesting the orders to be changed.

3. If state comes in and she never learned how to do her med pass per the orders, she's going to be even more flustered and more likely to make a mistake which could really hurt her and the facility.

Give yourself time, OP. You will get faster and more efficient as you learn your residents and your meds!