New LPN in LTC and I am drowning

Candyn · Jul 8, 2012

I think you are doing an amazing job. I can not believe how you did with that many patients and that many things happened.. I only have 4 and sometimes 5 and I feel like drowning if something happens that requires extra time or attention. I learn that there are good and bad days in nursing and what I do is after a bad day, I will think about it, ask myself "What could I do to be better" and learn from it. (Of course I still feel like a horrible nurse but think about it: there is nothing I can do or go back to do.)

MsRNtoyou · Jul 8, 2012

I feel so ashamed hearing numbers like 30 and 50 per nurse - I have between 18 - 22 patients, am going into my 1st month on the job and I am drowning. Is this not the career path for me? I worked so hard to try to find a job - and I cannot even manage (on average) 20 patients. I work 2nd shift - I get my cart organized, label which patients on my hall get FSBS and skin treatments, and I finally thought I had it - I was able to start charting at 7pm one night last week. But then there was a new admit. Then a fall. I spent at least 45 min. getting the fall situation under control and montoring the patient, then I have another patient yelling at me (yelling - literally - NURSE! NURSE!) which upsets the other dementia/alzheimers patients on the floor - so one or two of them start screeching too - in the middle of all that I have a CNA come tell me one of the alzheimers patients took their clip alarm off their shirt and threw it across the room under a bed (we are out of bed alarms - hense the fall with another patient) - and while I am monitoring the fall patient I have another patient telling me he is in pain and will wait outside for me - I told him thats fine, I will be out in a few minutes, I had to monitor a resident that had fallen. He gets upset with me - starts badmouthing me as he wheels away because I dont drop everything and give him his pain med - so after I am done sorting out fall risk person I have to go sort things out with irritated pain med person - then man with alzheimers keeps trying to slide out of bed and by then it is about 830 and i havent started my 2nd med pass. A new patient doesnt trust our facility and requests that I bring in each of the packets of meds that I am giving her because she doesnt believe that I am giving her the right thing - so that takes 20 minutes because she is new and I have to go to the other side of the building to receive her meds from the pharmacy drop off that happened at 7 as well. I dont want to compromise patient saftey - but I am not getting off my 2nd med pass until after midnighte - the 3rd shift nurse has been there over an hour and its time for him/her to pass meds and I still have the cart because I dont want to compromise a patients saftey because of other issues I had to deal with earliier in the evening. I am learning a lot. I LOVE my residents, but I dont know how to improve on my med passes. I am even multi taskiing and doing more than one thing while I am passing out meds (vital signs, assesments skin preps) while I am in the room with one patient - and I am not staying and talking to them for any amount of time at all. I leave every nite at the earliest midnight - on Friday I didnt getoff work until 230. And I still missed stuff - or I feel I did anyway. I just dont know how to get it all done and not compromise the patient saftey. People keep telling me I will get into a routine - when? Things are always going toc ome up. Its never gong to be smooth - so I need to adjust. Any advice/support is appreciated. Im drowning.

I am a new nurse as well (in my 3rd month) and on average I am responsible for 25 patients so I understand! If your facility uses bingo cards, see if you can mark the cards in the top corner so you know which ones to automatically pull at what time (Write "6 am" for example). And then take some extra time whenever you have down time to sort the meds for your shift towards the front so you can pull them quicker when it's time. Of course you will check with the MAR to ensure there were no new orders since the last time you were there. This all works better if you work the same floor and shift everyday.*

Daisy_08, BSN, RN · Jul 8, 2012

When I first started LCT it was very normal to stay an hour late. By about my three month mark it was much more manageable. You learn how to speed up, with out hurting rts. Of course a death, a fall, an admission ect will throw everything off. I remember being so excited the first night I got out on time.

I think in time you will find you grove. Best of luck

UP.RN · Jul 8, 2012

I think it sounds like you are doing a wonderful job. At my facility, I typically manage care for 25-30 patients. I am going on my 3rd month in LTC now and I can say that 30 patients can still be a lot to juggle. However, my facllity has a med aid passing the majority of meds unless our census drops. If you are passing all of your own meds and doing all of the treatments, you are doing great for your first month I think. However, since I don't know how your facility is run I would suggest you ask your DON/fellow nurses for feedback. Ask for their input on how they pass meds more efficiently/manage their time. My coworkers have given me some of the best advice.

CapeCodMermaid, RN · Jul 8, 2012

You've been there for a month. Cut yourself some slack. You will get faster as you get your routine down.That said....alarms don't prevent falls. They make noise and irritate the residents. Don't make a habit of writing on the cards of meds. In some states it's against the regs.As for the woman who wanta to see all her meds, get an order for her to self-administer if she's capable. It'll save you and your co-workers time and aggrevation.

JZ_RN · Jul 8, 2012

You will get better, but believe me when I say that the problem is NOT you. The problem is the unrealistic and unsafe amount of patients that you are assigned to. Do not feel bad.

WingnurseMsT · Jul 9, 2012

I feel like I have walked in your shoes a few miles. The more experienced nurses will tell you it will come to you in time. I know this seems impossible but it is true. One day before you realize it things will fall into place. This happened to me while I worked over Christmas. Holidays. Those two days were the best days I had since becoming an LPN the Aug. of that year. You will learn little tricks that will help your med pass happen quicker and then those tricks will click into order and things will smooth out. This all seems impossible but I say again I feel like I have walked in your shoes and wandered down that path. Best of luck to you!!!

lifeisgood2012 · Jul 9, 2012

Thanks you all. I just feel like my confidence is shot. I know it will get better - I just get so concerned about putting a resident in danger. Most of the nurses there are seasoned and get very frustrated with how long it takes me - I know we all have to start somewhere - but they dont remember that. My license is on the line and I would rather take longer now and get my routine down and frustrate someone than put my residents at risk of an error. I can take a little mouthy-ness here and there from impatient people - I cannot take losing my license. Most of the time I do ok, most of the residents seem to get along with me and most of the time I have a fairly good attitude and want to jump in and learn how to do new things. All of those are positives. And I just need to hold on to those during this time. I am simply overwhelmed which is apparently normal for anyone in LTC no matter how long they have been there. I have learned a lot in 3 weeks too. I am proud of myself for not walking away. I truly hope it gets better. Thanks again.

SCSTxRN · Jul 9, 2012

I just want to chime in - sounds like you're doing ok. The learning curve is steep.

Do your CNAs not do vitals?

I worked LTAC starting out - my typical shift went Pain meds. Assessments (including skin) Check MARS sign off vitals Pull meds. HS Meds. Wound Care. Pain meds. lunch and potty break. Turning. Charting. Turning. Pain meds. Pull AM meds. AM meds. Charting. Breakfast. Go home.

Psych is much easier, in terms of the work load. Most days.

PrimaFacie · Jul 9, 2012

The problem is the unrealistic and unsafe amount of patients that you are assigned to.

I strongly agree with JZ_RN.

About 5 years ago I took a night RN position in LTC. I had always done ER & OB and was pretty efficient, but in my 'old age' I wanted to try something slower pace. I found very quickly that LTC was not slower pace.

Med pass was overwhelming. 40 pts/nurse. The nurses who knew the residents well had a huge advantage. Trying to identify residents by their photographs in the med-cardex was a joke since hardly of them looked like their picture and they were all over the place when i needed to pass meds....dining room, etc and many didnt know their name.

I got very frustrated with other nurses advising me to take unsafe shortcuts and I gave up when I found a bunch of pre-filled insulin syringes on the insulin cart. (pre-filled by another nurse, who apparently thought this was quicker than properly doing the sliding scales that were ordered.) I reported that as part of my resignation letter, but my understanding was that this was not so unusual there.

I hated every minute of my LTC experience.

If a resident was really lucky, they got 10 minutes of nursing care per day. BTW, how much is Medicare paying for that 10 minutes? $300/day?

Because of this experience, when my mother was in a rehab for 2 weeks before she died, I stayed with her every minute so she would not be neglected/abused. I know some, or even most are not like I experienced, but I was so traumatized!

Maremma · Jul 9, 2012

Oh dear I feel so bad for you! I am LTC too and a pretty new nurse. I understand how frustrating it all is. I more often than not cannot get done in time either now. I have been put in a permanant hall that is a mix of LTC and rehab making it a great big zoo!

Speed really does come with time. There are just to many new things to learn in a very chaotic environment. You need to give yourself time to become familiar with everything. It is not you. it is the nature of the job.

One of the things I learned real quick was to prioritize in order that I can "hand over the cart" at the right time and then finish all my own work after the night shift nurse takes responsibility for the hall. You do not need the extra stress of having coworkers angry at you for making them start late and getting them behind.You also can work faster on the other stuff once another nurse is in charge of the hall.

For example if "crap hits the fan" and someone falls for example. I will ONLY do the absolute most essential things required at the time it happens. In our facility we must call "Dr rehab" to room whatever" so the RN super comes to "assess" the patient.Help get them off the floor, vitals, call family, call or fax the "FYI to Dr and save the rest for later. I keep my vital sheet with me on the med cart and the patient stays in the hall with me so I can keep getting my vitals as I do med pass. If they have a skin tear etc again bare minimum. cleanse apply bacitracin cover with clean dry dressing. Worry about the paper work part later.

Do not try to do treatments while getting meds out. if you must stay late to finish all your own work, again better to finish treatments after you handed off the cart and the next nurse is responsible for the hall. They don't need you to be done with treatments for them to get started with all their own work.

It takes a little time to learn your residents too but I have also learned to use my census sheet to make slash at each persons name after giving their meds. That helps me ensure I do not miss anyone and can more safely "jump" to the ones that I need to take care of first to avoid problems with later. For example if I know a patient takes seroquel or ativan routinely I make sure they are at the top of the list on who gets meds first. it is less likely they will become behavioral and wind up on the floor or something. As unfair as it sounds I also am quick to jump to the "trouble makers" that are more demanding right after any on psych meds of any kind. it also prevents problems interrupting the med pass. You know like taking off and needing chased down in a temper tantrum because you didn't drop what you were doing and get them what they want first. Little tricks like this will become more and more apparent to you as you learn your residents.

Where is your RN super while you are drowning by the way? In our facility the RN super is suppose to help the LPN if crap is hitting the fan. For example, a fall they should be calling the family Dr etc for you so you can get back to med pass as quickly as possible. I can see our RN super getting in an awful lot of trouble for not helping a brand new LPN that has only worked as a nurse for less than a month!