New wound care nurse in nursing home

gem4monge · Jul 7, 2013

Hello All, I just recently got hired as a wound care nurse in a nursing facility in California. I got 2 days orientation and was sent out on my own. I'm in charge of changing the dressings of GT tubes,care for any wounds, ulcers, and catheters of 32 patients on my own. I'm a little overwhelmed to say the least. Is this normal for one nurse to be in charge of so many patients? I thought there was a limit in California but does it just apply to hospital settings? I'm concerned about all the paperwork that needs to get done on daily basis. I'm working 8 hours shift and they do not pay overtime so most of the time I have to clock out and stay to be able to finish my paperwork or it will just accumulate for the next day. If the patient census goes down they send a CNA home and I'm also assigned patient care to 2 patients aside from my own work. I know they are going to be on me because if a patient gets an "in house" ulcer then I will be held responsible because Medicare wont pay for it. Its been really hard to find a job and only 4 or 5 out of my 50 classmates have a paying RN job. I don't know what to do. I'm scared I've taken on more than any one nurse should handle. Is this normal practice in home health? I don't want to jeopardize the safety of my patients or my own license. Please help on what I should do. I was also recommended by someone that has worked there for 15 years and I don't want to let him down if I quit

LadyFree28, BSN, LPN, RN · Jul 7, 2013

In my area, the case load is that much...I'm on the east coast, major city.

It IS overwhelming to do treatment visits. It is a learning curve. Is it positive to ask for more orientation? I also suggest prioritizing. Are some clustered in one area? Who has a simple wound vs a complex wound with more assessment? Is there a patient you absolutely need to see first.

Those factors will help in order to get the treatments done, as well as paperwork, write as you assess, then make sure you write a nareative note, whether SOAP or SBAR (depending on policy) to document the most pertinent I information. If you use OASIS correlate what is the POC under nursing care and write correlating with the interventions in the POC the most pertinent information. HTH!

Bringonthenight · Jul 8, 2013

Wound care nurses in my country have additional post graduate certificates/diplomas in wound care or at least some experience before they can become the only "wound care nurse" for a facility.

I know it's tough to get work where you live but wound care is a very complex field that often requires a lot of knowledge as you would already know as every wound/patient is different.

I suggest requesting time with your manager to follow an experienced wound care nurse for a sort of "orientation". Get the time needed to build your resume then transfer to the acute setting/wherever you really want to work.

erika.RN · Jul 8, 2013

I am confused...are you in home health or nursing home setting?

gem4monge · Jul 8, 2013

Erika I'm in a sub acute skilled nursing facility

JustBeachyNurse, LPN · Jul 16, 2013

Duplicate threads merged and moved to more appropriate LTC Nursing forum to elicit further response.

CrunchRN, ADN, RN · Jul 16, 2013

Are you a new grad or experienced nurse?

wyogypsy, RN · Jul 16, 2013

That workload, especially if you work 40 hours per week, is less than that of any wound care nurse that I have ever known.

I would make a spreadsheet of the treatments, list each patient's room then name down the left side, then put the treatment that needs done, and a column for how long the treatment took. When I can visualize it on one sheet it makes it not so overwhelming for me. After a few days you learn which treatments take just a couple of minutes (g-tube dressings), and which take longer, as well as the best time for each patient. You should be doing 'wound care', not routine care such as changing the dressing on a healed g-tube site, or changing catheters. You do not need to monitor bruising or healing cuts/lacerations requiring no further treatment.

Your time needs to be spent measuring wounds, describing them, making sure you are doing the appropriate treatment, and that your documentation is complete. Make sure that treatments aren't being done more often than needed.

There are times you will be swamped with treatments, wound vacs, packing huge gaping wounds, etc. There are other times you won't hardly have any wound care. During the times that your acuity is low, you could offer to change g-tube dressings and catheters during those times if that is acceptable to your supervisor. They may want you to do them all of the time though.

During the times you are learning, or slammed, be careful of what extra that you do, or how long you take with those patients that want to visit. Until you can get your job done in the time allotted, don't volunteer to do extra things - though at times that is very difficult.