New LTC LPN, would love some insight/advice!

[BFoxLPN]

Hi all,

I just got my LPN license in August! It was a super long road to get here (as I’m sure most of you all can relate to). 
I started my first job 3 weeks ago in a LTC/rehab facility. I’m working in one of the LTC units. I knew the facility didn’t have the best reputation, but I chose them for a mix of factors including being a mile away and making a really good offer. My mom is a social worker in our local hospital and familiar with all the facilities in our area. She said they didn’t have the greatest reputation but that most of the social workers respect them because they accept patients that every other facility rejects- like patients on methadone/suboxone and patients who can’t pay much/at all. 
So far it seems that the staff tries hard to do their best but the ratios are just crazy. My unit has 31 residents to 1 LPN and 3 (sometimes 2) CNAs. I’ve gotten a lot better at managing my time and prioritizing but I still feel like I’m overwhelmed and rushing most of the time. The morning med pass gives me major anxiety. I can’t seem to get it done within the 2 hours. I usually start around 7:30-7:45 and on a good day I finish around 10:30am, but most days it’s more like 10:45-11am. Then I do my pre-lunch blood sugars and eat lunch at the computer while charting. After lunch I have a few meds and get my wound care done. I have 2 patients with pressure wounds, one diabetic patient with a leg/foot wound, and a hospice patient with colostomy and nephrostomy needs. 
Something that drives me crazy- why do the doctors/dietician schedule a single vitamin an hour before/after other meds?! I’ve checked and there aren’t any interaction issues. It would just save so much time if I could give that multi vitamin or that Vitamin C with the 2 pm meds.

Overall though I really am liking this job. I think with a bit more time I will get better at managing and prioritizing, and a handful of the residents have already gotten a little spot in my heart. 
But at the same time the staffing ratio makes me nervous. I covered a night shift last week and I hadn’t even made it through my initial rounds of checking on each of my patients when a bed alarm went off on my 2nd wing and I found my patient on the floor. 
She was not hurt, but did require a hip x ray and it was very very overwhelming and scary to me. I’m afraid that the staffing ratio is really upping my risk of getting sued or something, and that maybe I should look into a position in a doctor office setting that doesn’t pay as well but also doesn’t cause so much anxiety…

Can anyone offer some advice/words of wisdom? LOL. Any tips on SAFELY getting thru med pass faster would be greatly appreciated. I’m also curious if anyone has some advice on how to kindly tell other staff/patients that I have other more urgent priorities at the moment than getting them remote batteries or a new water cup, etc…

Thanks!! :)
 

[amoLucia]

I had a philosophy - 'you can be next, but you can't be now'. Of course, I didn't say this to any pt/family/staff, etc. But a trick might be to very ostentatiously make a to-do entry on your cheat-sheet so the pt will see you mark it down (and double underline it for emphasis!) Just explain, but get back to them in a reasonable amt of time! And make sure they know you are good to keep promises.

Some complimentary words - you seem to be having very realistic observations & not being panick-y like so many newbies. No new job is easy, and you look like you're approaching your responsibilities sensibly.

Some of the overwhelming angst for newbies comes from your unfamiliarity with many of your pts. You don't know the finer their details when you walk into their rooms. Like in school, you pretty much knew where pt's every freckle was!  It all comes together slowly and in one big mesh. After a little while, you'll be surprised.

But I will admit, even with all my years, I was comfortable with MY pts, on MY unit, with MY staff, and I knew where all MY things were. I would be floated occ, and was not happy when it happened. Like you newbies have a similar feeling. IT GETS BETTER!  Honest!

Don't prematurely think about jumping ship! You'll pick up speed. DANG! I was slow, but I was careful. I'd be better the next shift! You too. And speed ain't all it's cracked up to be.!

Just one word of advice and request - please make sure you have your own malpractice insurance. Hope is you'll never need it, but it protects YOU (just like auto insurance).

And welcome to AN.