New-ish RN, 30 residents please help!

Specialties Geriatric


Hello fellow nurses!

I've been reading all nurses since I was a nursing student. I graduated in may last year. Started out in subacute rehab part-time - stayed for about 5 months, 20 residents/day. Managed well enough, felt like I was making a difference most days. I was recently hired full time elsewhere and just finished orientation @ an LTC. In my new place I have to do meds, tx, charting, fs, labs, md calls for 30 res and sometimes also charge duties including staff assigments, mds and whatever things come up and ppl are directed to "speak with the nurse".

It's been about a month and I am getting very discouraged. So many of the res are extensive assist, more GT's than PO.. the PO's need so much coaxing everyday just to take their meds. Others want to punch you in the face. So many of the res are lonely, I wish I had more time to talk with them and really take care of them but every day I hit the ground running, every meal time I have to stop and help feed, everyday there is a 30 min meeting about what we are doing wrong (cutting into medpass), every 10 min a cna is calling to "come quick" for some little thing, family members standing over my medcart glaring at me (even after I explain please let me finish with this res first, its dangerous to distract a nurse while she is drawing meds.. but w/the customer service focus nowadays I will probably get in trouble for saying that), needy res wanting the curtains moved/tv fixed/better pillow "RIGHT NOW!!!", call bells that have to be answered within a few secs or the supervisor comes charging down the hall...

Even with my "brain sheet".. whose on what feeds, who has early PT/OT, who is going out etc.. I'm still not finishing within the golden 2 hours.. its more like 4 hours and then the 2nd med pass begins...I don't even take a meal break and I wouldn't mind that if I could get out on time but after my shift ends.. after handover, count out narcs etc I still sit for hours charting because almost every one needs daily notes. Don't get me started on the faulty bp machines where the cuffs pop off and take forever, pulse ox doesn't work.. asked for new ones and still nothing.... What can I do to make this work? Quitting is not an option... I see other nurses finish on time. Many disgruntled co-workers.. I've also seen a few RNs quit in the short time I've been here... but I can't. I guess I just need some understanding and advice from the allnurses community. Please help me...

Thank you

First of all...... Take your breaks!! If you don't take care of you, you can't expect to take care of anyone else.. ...

The first thing I would do is get your med times changed... This will be a HUGE help, and it is as simple thing to do.

The first half of my hall is sched for 9am meds and the 2nd half is sched for 10am meds. this turns a 2 hour med pass into 3 hours. Also look at your Med passes and see if anything can be combined and sched it accordingly. It won't work for all of your Residents, but every little bit helps....

My first med pass includes all 30 of my Residents of course, but my 1&2pm passes, are down to less then 10 residents. allowing me time to chart and stock etc.

The Residents that need coaxing, put their meds in food, or a drink that you know that will finish.

Tell your CNAs that unless it is an emergency or high priority, to make notes and tell you the little things all at once and speaking of CNAs, why are they not doing your vital signs?

Staff assignments, they are adults, let them decide among themselves, if they are unable to do this, then tell them you will have to, then put them all where they don't want to be, and it won't take them long to work out their own system.

If you allow family members to run over you they will.... I have been known to put them in their place in a very in a very nice way. If this was your mothers medicine would you want me to ignore giving it to her, so I could discuss a non-emergent matter with another Residents family member? The answer is Always NO!......... Then I say give me about 15-20 minutes and I will be happy to speak with you, They get the hint and it also shows them that I have no favorites and all of my Residents are important to me.

These are just a few of the tidbits that come to mind....... From what I have seen in LTC it takes 4-6 months to find your groove and actually be able to clock out on time!...... hang in there

ps. I'm thankful for each cna/tech on my shift and love it when we can do team nursing together! I just wish we all had better ratios so people wouldn't get burnt out and leave! It's hard for the everyone including res who are unfamiliar with different staff every few months. Since reading other posts I see its been this way for years.. is there no hope?

Thank you Finallydidit ! These are great tips! The CNAs can take bps but that is always done last for them (30 min to end of shift) because at start they are busy with getting res OOB, washed up, fed and we have 1/2 hr monitoring flow sheets/dayroom monitoring etc, hydration pass, snack pass, then 1/2 the res want to go back to bed or family says they do.. there's only one lift in the whole place.. I think if I asked them can you please do the VSs first they would laugh at me.. cause during the "meetings" they are berated for not getting res in and oob fast enough or someone is wet and family complain. Thats why I do the VS for all the res on my assignment.. I may try your idea of letting them do their own assignments time I'm charge.. if hell doesn't break loose this will be a great help! :D

Specializes in LTC and Critical/Acute Care/Homehealth.

I really can't add anything to this. You will, in time come up with your own way to do things.

OMG I'm experiencing the same exact thing!!! I am a new LVN graduate. I recently got a job at an assisted living facility. I am currently caring for 60 residents which i think is INSANE!!! It's only been a week and I am very discouraged. I'm questioning my nursing career. I just feel that I am very slow with my med pass and there's so much to do and can't prioritize because my brain is going crazy. Plus, when there's an emergency I freeze and panic and I second guess my assessments.

Goodluck! Hopefully we can both get through this!

Specializes in ED/ICU/TELEMETRY/LTC.

First of all, you are the nurse. CNAs should be instructed to have V/S done by 9 AM.

Call bells, let the nursing assistants know they need to be answered. Answer them if you can. If the charge nurse comes flapping down the hall, say "Can you get that for me? I'm tied up."

Staff assignments? Why are they changing every day? The rooms should be grouped and if you have X number of staff, they have the X number of rooms.

See if you can stand up during the meeting? It might cut down on the time it takes.

When the doctor is in the building talk to her/him about the possibility of moving some of the one time meds around so that the AM med pass is not so heavy. There are a lot of meds that don't matter when they are given.

And now the charting. Do you "chart heavy"? "Resident has had 460 cc po fluid intake all day and has voided incontinently x1. Urine

is foul smelling and concentrated. Currently on ABT for UTI, and has no adverse signs and symptoms noted."

I would chart. "ABT for UTI. 460 po intake, void x1 incont."

Hope some of this helps.

Angie1368 congrats on graduating, passing the nclex and finding your first job!! When I was a student I thought the hard part was over haha how naive.. Wised up to reality my first week working! haha

Alot of people tell me you start off slow because you don't know the res well.. for some, you have to catch them at the right time or they will refuse. Since you're new too they probably have to get used to your face before they feel comfortable. Makes me think of *don't take candy from strangers* lol Hopefully you don't have to float around in the beginning so you will get to know them better and better.

In my old place cnas would ask me before they take res somewhere and that made the pass much easier but that was the culture of the place. At my new place everyone is trying to haul a$$ and its every man/woman for themselves..

If you need to vent, alot of LTC nurses feel the same daily headaches! Good luck!

Thanks Dixie for your reply! Yes I am the nurse but I'm also new there. That's the way they've been doing things for years. Some of the staff there have been there since I was in elementary school! I do have some ideas.. but right now I just need to survive!

I agree with you on the staff assignments.. I don't know why it can't be like the licensed nurses.. come in, see there's only 2 of us.. ok u take high side, I take low side.. GO! If there's 3.. low, high, Tx GO! Only 1 for now? Pray. Go! For the CNAs it's so complicated. The way the assignment sheet is set up, everyday you have to decide who gets what break. The current charge nurses goes: last time you had early lunch, this time you have late. Last time you did showers this time you do monitoring.. darn thing takes 20 min to figure out! Then someone gets pulled.. lol Also according to policy.. it should be based on acuity/how heavy each assignment is but I see that's ignored. Enough headache already?

Once I get a feel for the drs I will see if they're receptive. One nurse said to me "nursing judgement my butt! We can't even put on a warm compress w/o MD order"

Do not let my reply fool you. If I have 20 res to chart on I keep it as short as possible. But for *reimbursement purposes* they want you to keep mentioning the same darn things over and over, most res charts are thicker than a dictionary! We're also an all paper facility.. any new orders? Time to initiate another careplan!!

Perhaps you've been in the biz longer and have fine-tuned alot of these issues.. hopefully oneday soon I can too!

newrnltc, I was unable to get a New Grad position at a hospital, and ended up taking a LTC position because it was better than no job. I have been there 6 months. I am getting more efficient at time management, but really, all that means is I've now become quite familiar with each resident, I know what meds they get and can pop em and crush em faster and convince them to take them with only a few occasionally resisting/refusing (geri-psychs are a particular challenge) but for the most part I have become a familiar face and have earned the Resident's trust. Am I becoming a more skilled nurse? Nope. Am I learning new skills? Nope, I am losing skills that I learned in nursing school. We have no IVs on our floor. No GTs. I have done one foley (in 6 months!) It was my hope that after 6 months "experience" I could apply to hospitals and get a real nursing job. I've spent the last 3 weeks updating my resume and applying everywhere. If I hear back, it's a rejection. I am so discouraged. I feel the longer I stay here the less marketable I become. I no longer can apply for new grad programs because technically I am "experienced" but realistically, I have no more experience than a new grad. Our CNAs are great, but we are chronically understaffed and they are not allowed to do vital signs. I do my own vitals with a bp cuff I had to purchase myself, the facility doesn't supply them. We have a receptionist part time but when she is not there we have to drop everything and answer the phone. We also have to drop everything and feed the residents, 3x a day during a12 hour shift. I clock out from 1 to 3 hours after my shift ends due to the ridiculous and repetitive documenting - all hand written. Quitting is not an option for me either. I need the money. I'm sorry for the Debbie Downer vent! I'm just so frustrated.

Thank you!!! I totally agree w / u. I thought school was tough but man once u officially start as a new grad nurse it's like HELL!!! Seriously the residents don't trust you, some will refuse, while others u have to chase and find their location to give meds. It's such a pain. I've always wanted to be a nurse but w / this job, I'm not sure anymore. I know I should be thankful that I got a job as a new grad w / no experience, but the feeling I get while working is not worth it for me. I think I need to start off slowly. I need a job w / fewer residents or just something less chaotic. Btw I'm also on call so I can never sleep well because I feel like I'm always waiting for a call. *sigh*

Specializes in Geriatric/Sub Acute, Home Care.

I am not one for giving encouragement on LTC/Sub Acute...I did it for 17 years and despised the beginning I enjoyed it immensely but my situation and environment was so different....I worked with Actors and actresses in a LTC/Assisted Facility, It was the greatest job I ever had in changed drastically and the facility lost its best DON. Since then I have never been able to find a job like that one.. But...dont be discouraged, I know its a tremendous amount of work....AND I MEAN TREMENDOUS......what I did was when I was off or came home from work I would make notes/and changes on my shift so things would flow worked partially...but as you know things happen unexpectedly. BUT....remaining calm and having a good team(CNAs) with you that will get you through it all. I at times treated my CNAS to dinner...chinese, or pizza...they really appreciated it. So if you want to call it bribery you can, but I NEVER talked down to my Aides....NEVER...they were my heart and soul on the job. My eyes/ears/and hands....most times....So I would think if you got them into a easy smoothe routine that they could all work with, and give them good report on your patients, you will have a better time of dealing with the bad times that pop up......HOPE I HELPED YOU.....

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