New Grad RN in LTC Needs Advice Please!!

Specialties Geriatric

Published

Hi All,

I am a new Grad RN recently hired in a LTC/SNF/Rehab with a 25 patient load needing medications, treatments, etc. My question is how on earth can one person pass meds (in typical marge quantities, most crushed in applesauce, several narcotics and G-tubes, etc.) and finish in 3 hours or even 4 hours??? :confused: I did basic math and this leaves 3-5 minutes per client start to finish! Yikes.

This was my only job prospect for the moment, and I do think I am getting some decent experience with clinical skills, handling patients with varying degrees of acuity, etc. as well as daily verbal and telephone orders, lab requests, etc. Whew! I am freaking out on medication administration alone never mind adding in the occasional health crisis or patient crash. On occasion they bring down a certified medication LNA but I am worried about when they DON'T- what then? I'll be passing 8am meds at 12:30? That's crazy.

I know of at least one serious med error recently which resulted in a patient being hospitalized, I'm afraid that's going to be ME!

Any thoughts? I appreciate any feedback, thank you!

So happy I found this thread! I am in a similar position, start my job on Monday on a Short-stay/rehab unit. 50 beds on the unit, and they divide it between 2 or 3 nurses. I'm not sure about number of nursing assistants. From what they have told me, it sounds like getting all the charting done is going to be the most difficult part until I get used to it. I'm nervous but very grateful to have a job! Good luck to you!

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Yes I think most new grad nurses who start in LTC wonder--am I crazy? The first few weeks you probably WILL stay late, I know I did. I started out almost 2 years ago at the facility I currently work at. It still is a heavy workload and overwhelming at times. My patient load is 35-40 patients with a med aide. But I am getting really good Geri-psych experience and great time management skills. I will take them with me when I get my RN and move on. Just take it one day at a time, try not to let yourself stress too much and remember that you can learn from anything.

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Thanks for the advice. I worked in LTC as an aide for 2 years, was responsible for med-pass because I worked in assisted living. I know this experience will be a lot different because the patients have a lot more going on, g tubes and all kinds of things i'm not very familiar with, but I'm very excited to learn. Just have to stay positive I guess.

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I am so glad I stumbled upon this thread. As a new grad seeking employment, this has definitely perked me up a bit about expanding my options into the SNF/LTC sector. After 4 months of unsuccessfully seeking acute care experience, I've finally decided to look into SNF/LTC. This seems to be a great way to practice my time management, and I feel as though if I can handle the SNF/LTC workload, I can just about handle any workload... and I thought handling 3 patients and pushing at least 10 meds each on time was a handful! Thank you to everyone for your input!. Let's hope I can find employment somewhere :)

- nurseJU

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Specializes in Pediatrics/LTC.

I am happy to read about this. I am a new grad nurse, and I was having some difficulty finding a job....so I have two per diem30 jobs in LTC, and I have up to 30 patients....I have only worked a few times on my own....but my 8 AM med pass runs into my 12 PM meds...which then run into 2 PM....then I have to stay so late to chart and catch up....I hope that it gets better with experience...that will be my only saving grace. Right now everytime I get home I feel like the worst nurse in the universe....and I have worked so hard to be a RN, but my excitement is dwindling :(

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Specializes in OB, Peds, Med Surg and Geriatric Nsg.
can I ask you all too about signing off on treatments done by the aides? Is this standard procedure? It's hard to tell being new, what's what- what's OK, or what's just something bogus being done in my facility: for example my MNA pulls a set of meds, crushes them and then I'm the one to administer-well how do I know what is even in the mix, or if it even should be crushed?[/quote']

Treatments being done by CNA's and you signing it off is fine limiting to treatments that can be done during AM and PM care like antifungal ointments, nystatin powders, baby shampoo to eyes and moisture barriers to skin.

MNA pulling out a set of meds and crushing them and you having to admminister it is a big NO-NO:down:. One rule I learned at nursing school is that, "He who prepares it, shall give it." So never ever administer a med if it wasn't you who prepared it.

Good Luck and welcome to LTC! It could be overwhelming and challenging in a couple of months, but it does get better. It only takes time so enjoy everyday learning new things.

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You will learn time management for sure. It will get easier and easier as you learn what routine works for you.

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Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.
I am happy to read about this. I am a new grad nurse, and I was having some difficulty finding a job....so I have two per diem30 jobs in LTC, and I have up to 30 patients....I have only worked a few times on my own....but my 8 AM med pass runs into my 12 PM meds...which then run into 2 PM....then I have to stay so late to chart and catch up....I hope that it gets better with experience...that will be my only saving grace. Right now everytime I get home I feel like the worst nurse in the universe....and I have worked so hard to be a RN, but my excitement is dwindling :(

Honest, it will get better. This evening, I got my first med pass done in 1 hr 15 min. Other evenings, it just goes on and on, and on, so I just have to muddle through it, knowing the shift will end eventually. We have computerized charting for just about everything, and it is great. A lot of the the charting for nurses notes is standardized, but I always add my :twocents:. I can not see myself ever going back to paper!

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Specializes in LTC/Skilled Care/Rehab.
Honest, it will get better. This evening, I got my first med pass done in 1 hr 15 min. Other evenings, it just goes on and on, and on, so I just have to muddle through it, knowing the shift will end eventually. We have computerized charting for just about everything, and it is great. A lot of the the charting for nurses notes is standardized, but I always add my :twocents:. I can not see myself ever going back to paper!

We are supposed to move to computerized charting and I can't wait! Whenever we have to write a new order we have to write it in like 5 different places. I think that increases the chance of medication errors. Plus we will actually be able to read what the previous nurses wrote. Half the time I can't read any of it!

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For those new grads who posted here in March, are you still working in LTC? If so, do you feel less overwhelmed?

I've been working in a SNF/rehab for 4 months and it doesn't get any better, I still have panic attacks before going to work most of the days . I'm starting to hate nursing because of LTC. I never thought it was going to be sooo hard.

Thank you

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Specializes in Home Care.

I've been working in LTC since April, I am definitely doing much better and certainly not as overwhelmed.

For the most part I work with the same group of residents every weekend. This, I am sure, makes my job so much easier.

My job isn't easy, there's a lot that needs to get done on a 12 hour shift. Some days I feel like all I do is push the med cart.

Overall I am satisfied with my job.

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I can relate to the recent grads in LTC. I took a job as RN in a rehab/residential facility shortly after graduation. I had limited training and orientation. During my floor training, I was sent home halfway through my shifts because census was low. Day shift has 20 residents to 1 nurse. It takes me 3.5 hours to pass meds. I am completely overwhelmed and ready to call it quits after 5 shifts. Scared to death that my inexperience and high resident to nurse ratio is going to cause an error. Not to mention the large number of meds dispensed to each person!

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