Overwhelmed at my LTC job...is this a normal workload for LTC?

Published

Specializes in Acute Spine, Neuro, Thoracic's, LTC.

so i feel totally overwhelmed at my job in long term care. i don't know if it is just me or if it is too much to ask of one nurse. it seems like some of the other nurses get by ok but i think some of them take a lot of shortcuts etc. sometimes i feel that i need to take shortcuts as well and this is not the practice that i want to have. i don't know if i am just extremely dsorganized or doing something wrong but i just feel that it is impossible to do the job that i have been trained in school to do. let me do the best i can to give you an example of my typical shift from yesterday:

i work 4:30pm - 11pm in ltc. so i arrive at 4:40 and go get report which takes till about 4:45. then i head to my unit and check the 24 hour report for anything else that might have happened and any new orders and any suppertime bgm's that i need to get, and drsg's that need to be done etc. at about 4:50 i start my suppertime med pass. this med pass i only need to do for about 20 people. at 5:30 i am done this and i do any dressings that need to be done and follow up on anything from day shift. in the meantime my care aides are always coming up with 10 million things they want me to check (sometimes these things are extremely minor and i find if difficult cause i just don't have the time!) a lot of families are also around at this time asking me for things and questions about their parents etc. i also process any orders that are left at this time and fax the dr if i have any concerns. then at 6 i am expected to take my break untill 6:45. most if the time i don't have enough time to do this. at 6:45 i head upstairs to get report from the 12 hour nurse who is going home. at this time i am now responsible for about 50 residents for the rest of the night.7 she leaves and i read the reports upstairs check who needs bgm's, drsg's etc. anyway so i start my hs meds up there at about 7:10. this is when things get crazy.so i have to do hs meds for over 50 people. when i start this at 7:10 most of the residents are already in bed so it takes extra long cause i have to sit them all up etc. it would take me from7:10 - about 9:30 to do all the med alone if things go without a hitch and the care aides don't call me for anything. yesterday for instance, i started my meds and one of the aides tells me someone has a cough so i need to go assess that ( we get in trouble if the care aid writes something in the 24 hour report and we don't chart anything about it) so i go check this person out and chart it. then i continue on my way. afew mins later another are aide comes and tells me one of the residents seems "off" so i have to go check that person. i keep going. i notice one lady seems really wheezy and i plan to come back and check on her later. also i have a list of things to follow up on from day shift. i keep on with the meds till i am done (waking up a lot of residents) finally i am done with my meds and i run back upstairs ( these residents i am responsible for are on 2 different floors) to do the drsgs for this one lady that has 14 different dressing. 3 of them are terrible pressure ulcers on her back that require packing etc. i have to hunt down all the supplies and a aide to help me hold her while i do it. these back dressings alone take me 30 mins to do and i am already running out of time. i realize there is no way i can do the rest of her dressings tonight. so i decide i will have to pass this on to nights even though i really want to and know that they need to be done now. but the lady in th room next door has a fistula bag that just "burst" off. i know that this is also at least a 15- 20 min prcedure. so i rush in there and do a quick job on this. in the middle of doing that the care aides tell me the lady down the hall is on the floor in her bathroom. so i have to leave the fistula bag and go assess the lady on the floor. i thn go back to the fistula bag lady and finish up. then go chart on the fall, fistuala , bag and the dressings. i realize i have no time to go back and check the lady who seems to have bad cough or the lady with the wheezy chest. it is already 11 (the end of my shift) and i need to to narcotic count, clean up my med room, write in the 24 hour report, and give my verbal report before i go. i simply do not have time to do the things that i know should have been done and i feel terrible. then i come on the next day and am spoken to by the doc becuase there was a med i forgot to sign off and i told the day nurse i would send a fa for her to register one of the residents for a transportation servie ( for an appointment that was weeks away) and i didn't have time so i left a note for the next shift saying i would do it tomorrow if they didn't get a chance. anyway i just feel it is impossible to do the job that i want to do and am expected to do. am i doing something wrong here???

Up Vote Up Vote ×

OMG I haven't heard anything like this before... I don't have much experience as I'm just completing my degree in nursing but 50:1 even with LTC is ridiculous and UNSAFE! I would say that 4 nurses would be more appropriate - which would be a ratio of 12.5:1... For an evening shift with them being in bed, and assuming none are acute, I suppose that you could probably pull it off with 2 - where one is managing medications and the other is assessing, and sharing the other work you mentioned. If someone is under LTC it is because they cannot take care of themselves at home... with that said, having only 1 nurse to 2 floors is very dangerous! you can't possibly know if one is up and has fallen and bleeding from a hemorrhage etc... I'm Canadian and we have unions here... Do you have a union? If so, I'd talk to your rep... because I would think you are placing your patients at risk by working 50:1 on two floors... Wouldn't your license be in jeopardy for a judgement call like staying in that environment without demanding something be done about this?

sorry to hear about your situation

Up Vote Up Vote ×
Specializes in Geriatrics, Home Health.

Would it be possible to change some of the HS meds to suppertime? Can any of your aides pass meds?

Up Vote Up Vote ×
Specializes in Acute Spine, Neuro, Thoracic's, LTC.

ivoryce - Unfortunately we do not have union :( And the ohter nurses do not seem to think it is as big of a problem as I do...but most of them have never worked anywhere else.

Not-A-Hat person - I was thinking about looking more into switching some of the HS meds to suppertime. I have already done this with a few.

Up Vote Up Vote ×
Specializes in home health, dialysis, others.

I am wondering 2 things - the simple volume of pts - 50. And the 2 floor issue. It seems strange to me that 1 nurse would be covering 2 floors, regardless of the numbers. Also, check with your state's staffing guidelines. Something seems amiss.

Up Vote Up Vote ×
Specializes in Government.

I'm tired just reading this!

I'm a night RN at a LTC...I cover 2 buildings (not connected, have to go outside to get to each) with 98 residents. I'm everything licensed...no LPN, no other RN. I can't comment on a lot of what you have said but I can tell you this. I couldn't do my job if I had to drop everything anytime a CNA wanted something. I have 2 med pass times, 2 tube feeding times and rounds, tx, charting, primary paperwork etc etc.

I have gotten the staff to understand that I hear their concern and I keep a list of things that I need to do once my med pass/TF pass is done. They have unlimited access to me but have learned to understand that their wish is not my triage priority. If there is just one of YOU, you need to make the best minute to minute decisions you can for the residents in terms of allotting your time.

Up Vote Up Vote ×

In one sentance -- unsafe -- get out -- been there done that -- got bit -- do not look back

Up Vote Up Vote ×

It sounds pretty typical to me.

Why aren't the q day treatments done on day shift when there may be a treatment nurse?

I just resigned (worked through a 2 week notice) from my LTC/snf job that I had for almost 2 years, because most days were like that for me; I worked dayshift. Not only did I pass meds and chart for up to 43 people, but I had to work breakfast and lunch and take all the vital signs myself.

I did excellent work, but it was my home life that suffered because every day, when I came from work, I was exhausted.

It's not way to live, in my opinion.

But, if you are like me, you'll hang in there trying to make it work, until one day you realize that you are leaving parts of your soul at that place, and enough is enough.

Burn out happens fast at places like that.

Up Vote Up Vote ×
Specializes in LTC Family Practice.

Get out if you can, I worked LTC as an LPN for years, we had a 3 floor facility each with 2 wings. On 2nd and 3rd shift we had an LPN on each floor to do treatments, meds, charting etc. and depending on the shift we had at least 2 CNA's per floor - 1st shift had at least 4 CNA's, then we also had one RN per shift for the facility to supervise, eval patients going sour, deal with doc's and lab's, new Rx orders, admits etc. Also, on 1st shift we had a "working" DON as one of the floors was a medicare and had 2 LPN's due to the higher acuity and additional charting needed. Were we busy you betcha, but we had enough licensed people to cover everything and we at least got a 30 min break most days, of course there are always those times that we didn't.

Only you can decide if you feel you and your license are at risk.

Up Vote Up Vote ×
Specializes in Long Term Care.

What to say about LTC!! I could probably write a book with all the things wrong with long term care...but than again there are positive things about LTC if you have the help you need!!! 50:1...I think that is absoutly insane!! Let me ask you how many of those 50 residents need HS meds? And would it be possible to change some of those HS meds to 1700? The facility I currently work at is 240 beds...four wings...with about 26-30 down each hall. I can tell you that there are two LPN's for each wing and four RN's one for each wing during dayshift..I believe second shift has the same excpet there is only One RN supervisor. Night shift has 1 lpn for each wing and one RN...Jeez I thought my place was bad....and the treatments if there is a possible way to have them done by the time the second nurse leaves? Or change them to dayshift? To me it sounds like an unsafe enviornment for you because if something happens you will be held ultimatly responsible...I would find out from your department of health what the staffing requirements are in your state. And I would bring it up to your supervisor/DON. It just sounds shady to me....I think you should get out while you can...not all LTC facilities staff in such a way! :D

Up Vote Up Vote ×
Specializes in Legal, Ortho, Rehab.

I don't like it. When the OP metioned 20:1 I was thinking it's pretty typical. The most residents I've had btw the hours of 7-11p was 30 up from my original 20. Not to bad. But 50??? No, I don't expect anything to get done. Anyone who is a nurse knows that a med pass is MUCH more than passing meds. Two floors is killer! What are you supposed to do? Clone yourself?? I'd leave. I've worked many LTCs and subacutes, I've never gotten that.

Up Vote Up Vote ×

HI, just to comment, Im an LPN and that is very typical here in Michigan. I had one RN but she was NO help, only "supervisor" for three floors. She would come in at 10pm and yell at me why things are left to her nurses to do, I worked afternoon shift. This went on for three years and I almost quit nursing thinking I was not good enough to even be a nurse. Im now in RN school online hoping for a better nursing experience. EVERY tlc I had ever worked at was like that, I always felt so bad leaving my shift............man never again

Up Vote Up Vote ×
+ Join the Discussion