New Grad in LTC - Feeling Overwhelmed (21 pts)

Specialties Geriatric


I started my first job as a RN yesterday and was completely overwhelmed with my responsibilities. When I went for my interview and talked with the DON I was under the impression I would be managing and taking care of their 21 bed sub-acute unit with some help, like one maybe two LPNs. Well I did not realize until yesterday, that the unit was mine and only mine. I have 2 CNAs to get the pts. washed, in their chairs, and feed however; that's all they are allowed to do as per their contract and union. So I am left with 21 patients that need all their meds, dressing changes, suctioning, IVs, and documentation. To me that sounds crazy!!! I am fine with doing work and busting my butt, but 21 patients for one nurse seems unsafe. On top of that I was only going to be give 3 days orientation but I asked for more and got 5, which I feel still isn't enough.

I just want some feedback to see what other people think about my patient load and situation. I know being a new grad is hard and everything will come with time but like I said before, I think anyone would feel unsafe with 21 patients.

PS-So it doesnt sound too "extreme"...Not every pt needs dressing changes, has IVs, or needs suctioning. Its like each pt has one "extra" like one pt has an IV the next has a wound and needs dressing changes, the next is a trach and needs suctioning and around the unit we go like that.

That is straight up crazy!!!

Specializes in Pediatrics, Med-Surg, ER.

:eek:If I were you I would not walk but RUN away. As a new grad, you are too inexperienced to basically run this unit with 21 patients all by yourself. And with only 5 days of orientation? The way these patients sound, with ivs, meds, suctioning, dressing, etc, I think 21 would be too much for 1 nurse with tons of experience. I mean, if something goes bad, what kind of help will you get and how fast can they get there?

I think you should talk to your DON some more about this position, especially if she gave you the impression that you would have help. Ask her if she's had successful new grads in the past...perhaps there's a reason this position was vacant in the first place. I know I sound completely pessimistic about this job but I really think that you may have been put in a bad situation. You have 21 lives that are your responsibility, and you have a license to protect. I know jobs are hard to come by but I would start looking for a position that gives you time to orient with another RN. (On a side note, were you an LPN before becoming an RN or is this your first nursing position ever?)

Specializes in ED, Long-term care, MDS, doctor's office.

I have had many years of LTC and, unfortunately, that is about the normal ratio. The residents used to be stable and easy to care for, but now they are younger, larger, and are afflicted with way more complex medical conditions. Lots more of admits and discharges, too...Good Luck:)

18 or 19 patients in LTC in NC ... but that's with prior nursing experience!

sandan rnstudent

Specializes in Peds Medical Floor.

Not to sound like a jerk, but welcome to LTC.

Specializes in LTC.

Yep, thats LTC . Being organized is the key.

At the LTC facility I worked at last year, as an aid, there was 39 residents to 1 nurse. I made up my mind that when I got my nursing license there was NO way I would ever work there.

So... what is the actual acuity level of the 21 residents? Post-acute, recovering, ortho, or long term care and stable and predictable? It makes a hugh difference. If LTC, not sub-acute, you are lucky, nice unit has only 21, most have 40. If sub-acute, how many are truly sub-acute? This is prn suctioning or always suction? Dressing changes are pretty common on any unit, passing meds is just a piece of it. Charting on the "alert" folks, otherwise if LTC, what charting? CNA's get vitals, you chart them. You had clinical experience in LTC? Acuity is the key.

Specializes in LTC, assisted living, med-surg, psych.

I would have loved to have had only 21 residents on the LTC unit I worked on before I got my current job.........I realize that it must seem overwhelming to a new grad, but believe me, the ratios are a whole lot better at her workplace than at the vast majority of the ones I've worked in.

Specializes in LTC, Psych, Hospice.

21 pts in LTC? Sounds like a dream job to me. My first job was in LTC and I had 30 pts. Three days of orientation.

Sorry to hear about the situation that u r currently in re: being responsible for 21 pts. I worked as an LPN in a LTC n that number is not unusual. I had 30 residents: including passing med, dressing changes, acute charting, etc. This was before we had a tx nurse. My current PRN usually staffs at least 30 residents. There r 3 individual homes with 10 pts to each house. So u can imagine the walking, family members calling, incidents, request for PRN medications. U r constantly going from one house to the next. The upside: all the patients have their own rooms n their medication are kept in a locked cabinet in their rooms -no pushing a medicine cart n we have a small netbook we used to pass meds(all computer charting) only used the big MAR as a backup!! I suggest u try to set up a system to manage your time effectively b/c dealing with a large number of pts can put u behind when incidents occur!! If u feel unsafe u may need to apply to other jobs n make sure ask questions re: job requirements n duties!!

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