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

[lilaclover]

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???

[NewTexasRN]

The most important thing to consider for you is the safety of your patients and your license! It's hard because some people are telling you to just leave, but in this crazy economy it's not easy to just quit. If I were you I would have a back up plan. I would plan to leave pretty soon. Just give them enough time to find someone else and carefully research other facilities where you can find employment once you have enough experience and get the heck out of there!

[Sparrowhawk]

We have two nurses on day shift..one works from 10a-6p most days, then one charge nurse per shift for 42-44 residents, we just do the HS med pass, most tx are done while the 10-6 nurse is there...what they're doing to you is nuts. Why don't they have a night nurse on the 2nd floor after the 12 hr nurse???

[Midwest4me]

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.

1) it's a ridiculous workload. you need to run from that place. yes, it's common in many ltcs; my experience has usually been 20-40 pts--which is, already, too many. having responsibility for 50 is asinine!

2)you can't just "switch" med times.

[Schmoo1022]

Hi...I think that is too many~We have med techs in my state and I still wouldn't feel comfortable taking care of that many residents. There are way too many small things that you are responsible for that you would never have time to keep up on. I think 20 for one RN/LPN is a challenge, but doable, any more and I would worry

[lilaclover]

Yeah I realize it is far to many... its just there isn't really a lot of full time jobs around here and I really need the money. I am planning on going back to school next fall to take my BSN so was kinda hoping to stick it out till then... just don't know if I can.

[kokosmom]

I would advise you to find alternative employment before you have a huge issue that will leave you wishing you had left earlier. I think I know where you are coming from, the LTC facility I worked at I only had 22-33 patients. I am going to school full time and could not devote the necessary time to the facility, so I quit the PRN job and am focusing on school; only 5 more months to go .

[Scrubby]

My advice-Find another job even if it's not nursing. This place sounds dangerous to the patients and to your liscence. Can your report these concerns to anyone? Is there some sort of state board that looks after ltc residents?