New grad is the only nurse in the building.

quiltynurse56, LPN, LVN · Nov 17, 2015

I work 2-10 in LTC. After about 5 or 6, I am the only nurse in the building. Not sure if you have gone through orientation, but you will be given much information on how to handle certain situations. My DON and ADON take turns being on call. This means that at any time during the night, we can call with questions should we need to do so. The longer you work there, the more comfortable you will feel being the only nurse there. I kind of like not having admin around the whole shift. Most orders have been done by the time they leave too. Not that they don't have me doing them, just that by supper time, you aren't going to have Dr. offices calling in. Not sure how all that works in an Assisted Living facility though.

My main point is, they won't leave you hanging so to speak. There will be someone available to call should you need to do so.

LPNtoRNin2016OH, LPN · Nov 17, 2015

Would I have been comfortable with that as a new grad? I am pretty sure I wouldn't have been, the experienced nurses were great sounding boards and great help. I think like poster said above, if you have someone to call at all times, you should be fine. I would be fine with it now but that's after 5 years....

RescueNinjaKy · Nov 17, 2015

Forgive me if I'm wrong but I was under the impression that a lpn requires collaboration with a rn or provider. If you're the only nurse in the building and you're a lpn, doesn't this open you up to all sorts of liability issues and practicing out of your scope? This could be just my state that has this but if I were you I would review your states rules first.

JustBeachyNurse, LPN · Nov 17, 2015

In assistive living there are likely standing care plans like home health. Medication aides do most of the med passes. These are generally stable people that are not safe to live alone at home. Most need 24/7 HHA level care with nurse oversight & coordination generally speaking. Which still doesn't mean it's a best choice for a new grad LPN

LPNtoRNin2016OH, LPN · Nov 17, 2015

Forgive me if I'm wrong but I was under the impression that a lpn requires collaboration with a rn or provider. If you're the only nurse in the building and you're a lpn, doesn't this open you up to all sorts of liability issues and practicing out of your scope? This could be just my state that has this but if I were you I would review your states rules first.

In my state they do not have to be present in the building but we have to have a certain amount of RN hours in a month and one must be on call if not there. There have been many times I have been one of two LPNS and we are the only nurses in the building on the weekend

LPNtoRNin2016OH, LPN · Nov 17, 2015

plus both our night shift LPNs are by themselves with 50 patients 11-7..

LPNtoRNin2016OH, LPN · Nov 17, 2015

In assistive living there are likely standing care plans like home health. Medication aides do most of the med passes. These are generally stable people that are not safe to live alone at home. Most need 24/7 HHA level care with nurse oversight & coordination generally speaking. Which still doesn't mean it's a best choice for a new grad LPN

Oh man, wish that were the case! Assisted living is like half of the people you speak then the other half REALLY need to be in skilled/LTC unit but generally management doesn't want to loose the money so they will keep to the point they begin constantly falling. At least that was the 2 I experienced. There were 0 medication aides and the HHAs only showed up once a week to shower the resident, if that.

quiltynurse56, LPN, LVN · Nov 17, 2015

Forgive me if I'm wrong but I was under the impression that a lpn requires collaboration with a rn or provider. If you're the only nurse in the building and you're a lpn, doesn't this open you up to all sorts of liability issues and practicing out of your scope? This could be just my state that has this but if I were you I would review your states rules first.

In my state, a RN must be in the building 8 hours each day and available on call. We have 7 nurses and 3 of them are RNs as well as the ADON/MDS and DON. That makes 5 out of 9 total are RNs

TheCommuter, BSN, RN · Nov 20, 2015

Staffing with one licensed nurse on the off-shifts is fairly common in smaller nursing homes and assisted living facilities. While it is not ideal for the only nurse in the building to be a new grad, it happens.

If a situation arises that has you stumped, call the DON at home. And of course, if an emergent situation arises, call 911 to get the resident out of there.

Good luck to you!

vintagemother, BSN, CNA, LVN, RN · Nov 29, 2015

When I was a new grad, my first job was PM shift and all admin and other nurses left by 4 ish (1600)

It was kinda hard. But that was not just because I was the only nurse, it was because this ALF did things strangely. [emoji51]

In my 2nd job, after 2 months there, I was also the only nurse when I worked PMs. But this facility had better systems. I felt and was supported by the RN don and the other LVNs. I could call/text my DON or other nursing staff on their days off when I was working. It was a great working environment.

Another poster mentioned she didn't understand how an LVN could be left alone without an RN. That's the same assumption my instructors in my RN program have about LVNs.

I've tried to explain LVNs do work without an on site RN in many settings....

TheCommuter, BSN, RN · Nov 29, 2015

Forgive me if I'm wrong but I was under the impression that a lpn requires collaboration with a rn or provider. If you're the only nurse in the building and you're a lpn, doesn't this open you up to all sorts of liability issues and practicing out of your scope?

Nope.

As long as an RN or provider is available remotely (via phone call), this covers the collaborative portion of the LPN/LVN's practice. When I worked night shift at a nursing home alone as an LVN, I called my nurse manager (RN) at home for clinical guidance or the medical director (MD or DO) for telephone orders.