New grad starting in LTC

snuffyRN · Oct 10, 2009

20:1 is great I do overnights in LTC and am 50:1 days and pm's are 25:1

zefutebolera · Oct 10, 2009

20:1 is great I do overnights in LTC and am 50:1 days and pm's are 25:1

How do you feel about 50:1?

hotflashion, BSN, RN · Oct 11, 2009

50:1 sounds totally nuts to me!

CapeCodMermaid, RN · Oct 14, 2009

I worked in a place where the night nurse had 60 residents! One of the other nurses called out and she was expected to be responsible for 110 people!!!.. she did it. If it were me I would have been on the phone to the DNS or ADNS or supervisor or somebody before I'd put my license on the line....crazy.

On the other end...my nurses have no more than 20 with a nurse manager and 5 CNAs and they think they are over worked.

RNMLIS · Oct 15, 2009

LTC chaos on wheels

how in the world is a nurse give good care to the many fragile residents with those ratios - everything seemed to be done on a just on time basis...passed on to next shift or not done at all. Worked in a for profit ltc and felt the staff . were poorly treated and stressed. The residents clearly got less care than they deserved with their 5 minutes of care per shift....worked at a not for profit and had more residents but there was more patient support at not for profits.

i loved the geriactric clientele however i will no longer work in the ltc environment. Be careful you can learn but protect your liscence.

zefutebolera · Oct 17, 2009

I guess I really have to be careful and protect my license. Any other tips? such as your daily routine?

Amiller0313 · Oct 30, 2009

Hello!

I am a new grad myself and have been working in LTC for a little over a month now. I have about 20 residents to take care of. I work 7-3 or 3-11 these shifts are very different from one another. 7-3 there is PT and OT going on ( in the facility that i work) so you need to know that schedule and then docotors appointments and hair dresser appointments, that shift is very busy. 3-11 is mostly what I work, So this is how a typicall 3-11 goes for me, come in do rounds with CNAs checking residents alarms if they have any, narcotic count with 7-3 shift, listen to report ( we tape it, faster that way.) certain days are lab draw days so you have to see if any labs came back and if they are critical or PT INR's then fax and call the Doctor, and pray you hear back from them before 5. Then i tell aids who I need temps on and weights on and let them now any issues with residents that would interfere with there care at night. Then I get passing meds, doing bp's, LS, O2 sats, on the residents that need it, you will get to know them and now who needs BP or apical pulse before passing meds, answere phones, talk to family members, G-tube feedings, help aids toilet or transfer as much as you can, then dinner help feed anyone that needs assistance, make sure aids fill out "eat sheets" so you know how much dinner and fluids they had. ( if you have residents on fluid goals or restrictions you MUST tell the aids how much they can have on there shift. after that aids are getting everyone to bed.. continue med pass along with dressing changes, treatments such as creams and lotions that need to be applied, generally 2 residents get a shower a night, you must go in the shower room and do a skin assesment. I generally get done with everything ( if its a smooth night around 1045-1115) I never really take a break cause i want to do good assessments on resident i don't know or that need assessments. Now if there is one issuse it can set you back pretty good. I went into work one day 11am-11pm actually did not leave till 2am! sometimes that happens. You got to remember its not speed, its acuracy. If you know that you have done everything right and to the best of your knowledge and you are leaving an hour or hour an a half after you shift then so what. Its easy to make med errors with 20 residents or forget to do something, my first day i thought WHAT THE HELL AM I THINKING!!!!! and i was down, now only a little over a month I LOVE IT, residents grow on you, and they remember your name. I wanna be eventually ( long term goal in Critical care Nursing but I am 24 and fresh out of school! I have time) LTC is a great place to start as a new nurse I think because you learn TIME MANAGMENT SKILLS LIKE IT NOBODY'S BUSINESS! and they are for the most part not critical ( like in the hospital). You get your confidence in LTC when you are just starting out. A lady that works with me and has been there for 3-4 years and also does per diem in the hospital said going from one day of 20 patients to 3-4 is awesome. SO reallly hang in there! Trust me it is a good place to start. Feel free to write me about any questions. Never Never Never hesitate to call the docotor or doctor on call if you feel in your gut something is gonna go really wrong or is already there! :)

:yeah:

Heart 2 serve · Oct 10, 2011

Hello!
I am a new grad myself and have been working in LTC for a little over a month now. I have about 20 residents to take care of. I work 7-3 or 3-11 these shifts are very different from one another. 7-3 there is PT and OT going on ( in the facility that i work) so you need to know that schedule and then docotors appointments and hair dresser appointments, that shift is very busy. 3-11 is mostly what I work, So this is how a typicall 3-11 goes for me, come in do rounds with CNAs checking residents alarms if they have any, narcotic count with 7-3 shift, listen to report ( we tape it, faster that way.) certain days are lab draw days so you have to see if any labs came back and if they are critical or PT INR's then fax and call the Doctor, and pray you hear back from them before 5. Then i tell aids who I need temps on and weights on and let them now any issues with residents that would interfere with there care at night. Then I get passing meds, doing bp's, LS, O2 sats, on the residents that need it, you will get to know them and now who needs BP or apical pulse before passing meds, answere phones, talk to family members, G-tube feedings, help aids toilet or transfer as much as you can, then dinner help feed anyone that needs assistance, make sure aids fill out "eat sheets" so you know how much dinner and fluids they had. ( if you have residents on fluid goals or restrictions you MUST tell the aids how much they can have on there shift. after that aids are getting everyone to bed.. continue med pass along with dressing changes, treatments such as creams and lotions that need to be applied, generally 2 residents get a shower a night, you must go in the shower room and do a skin assesment. I generally get done with everything ( if its a smooth night around 1045-1115) I never really take a break cause i want to do good assessments on resident i don't know or that need assessments. Now if there is one issuse it can set you back pretty good. I went into work one day 11am-11pm actually did not leave till 2am! sometimes that happens. You got to remember its not speed, its acuracy. If you know that you have done everything right and to the best of your knowledge and you are leaving an hour or hour an a half after you shift then so what. Its easy to make med errors with 20 residents or forget to do something, my first day i thought WHAT THE HELL AM I THINKING!!!!! and i was down, now only a little over a month I LOVE IT, residents grow on you, and they remember your name. I wanna be eventually ( long term goal in Critical care Nursing but I am 24 and fresh out of school! I have time) LTC is a great place to start as a new nurse I think because you learn TIME MANAGMENT SKILLS LIKE IT NOBODY'S BUSINESS! and they are for the most part not critical ( like in the hospital). You get your confidence in LTC when you are just starting out. A lady that works with me and has been there for 3-4 years and also does per diem in the hospital said going from one day of 20 patients to 3-4 is awesome. SO reallly hang in there! Trust me it is a good place to start. Feel free to write me about any questions. Never Never Never hesitate to call the docotor or doctor on call if you feel in your gut something is gonna go really wrong or is already there! :)

I just started as new grad in LTC and your advice here is soo pertinent to what I am going through. Thank you much. Hope I can contact you if I come across other questions. =):redbeathe:redbeathe YOU GIVE ME HOPE!!!!!

username33 · Oct 13, 2011

Thank you your post! I am a new grad in a LTC. When I started my job I had 20 residents and was feeling frustrated about my responsibilities over there. It is very fast paced job. I was thinking if it was just me feeling overwhelmed or other new grads were going thru the same experience of being under constant stress as well. I guess there is nothing wrong with me and I am just human being. So, it is just impossible for new grads to perform their job like nurses with 10 years of experience. I deceided to slow down and to prioritize my responsibilities. I hope the things will get better soon. At least I know that it is not only me who has these kind of feelings and emotions while working in LTC. Understanding that others are going thru the same situations at work place gives me a peace......I am just one of them....

Linka · May 29, 2012

Do you guys ever feel like you don't know what you're doing? do you feel like you had a good orientation?

Hey everyone,
So I finally got a job after months of searching. I got hired in a LTC, they claim that the nurse-patient ratio would be 20:1, is that good? I've been reading a few posts here and I've heard that LTC is not a good start for a new grad, but I'll try me best to survive! :) So I'm here to ask for tips, and any advice from everyone. If you work in LTC, can you please share your daily routine? I would greatly appreciate it! Thanks everyone!

RingaLing · Jun 7, 2012

Interestingly, the nurses in my facility are at a 1:15 ratio and the CNAs are at 1:7. They all think they are horribly overworked. When I started as a charge nurse, my ratio was 1:30. Just an observation.