swimmom

how many patients? sounds normal. the typical medicare unit in my state has about 30. i've got 60. how may cnas. they will make you or break you with the families. say, if there are 15 patients, you, a cma, and one aid, and you get 3 admissions and 2 discharges on your shift, it is not possible. those new patients families will have them discharging an hour after they arrive. new families want 100% attention from someone at all times, plus admission assessments, ordering meds, clarifying orders. they will want you to get bed rails or a tv at that moment, but then they at the same time will want a new order for pain medication for someone who is so recently out of surgery that they just took them off of that morphine drip for a triple bypass but didn't even send with an order for tylenol. they will come to you for toilet paper and malfunctioning heater vents. no matter what you do it will not be good enough. waiting 5 minutes for a call light or a fresh towel or a second roll of toilet paper will translate to a week, and as they tell you that you run this facility so poorly and they have just waited a week for a second roll of toilet paper that they asked for five minutes ago, their family will say i think she's in pain and she needs her oxygen right now, when she has come with no orders for oxygen and her spo2 is 99% with a pulse of 62 and yours is 92% with a pulse of 178 from running around trying to get this stuff these people want that you do not have access to because it sounds like you are on second shift. meanwhile your second admission comes in and the family is there to pick up one of your discharges in which no one has done any paperwork on, but social services told them everything would be ready to go when they got there. so they want you to fill out a complaint form right then and there, but no one has even written discharge orders. and it is all your fault because the nurse is the middle man and gets the blame for everyone. good luck getting an ltc doctor to call you back. god forbid there is an emergency or fall with someone. then when someone is bleeding on the floor with 15 people standing around and no one will do anything without the nurse. then they will be screaming your name to hurry up while you are administering someone's tube feeding or doing cpr and then report to the don that you wouldn't come get this person off of the floor for 2 minutes, and as you are running down the hall to get this person off of the floor a resident will yell after you "will you push me to my room?, i have to go to the bathroom." you yell back i'm sorry i can't i have an emergency, i will tell your aid." they mumble ya right and then report you to state for refusing to take them to the bathroom. your superiors will not back you up, because they were there all along and would not answer your pages for help, but their butts are covered because they had that many people in the building who were supposedly providing direct care. typically in the midst of all of this, they will come yell at you because one of your people has not been moved in their chair for 2 hours and they want you to locate the cna and have you assist in moving them. or "why has this person not had pain meds?" ok sorry, but this is how it is. i had a housekeeping person try to give me their mop today and tell me to go find the other housekeeper they had borrowed it from. this was in the midst of a situation like the above. i paged the other housekeeper who gave this guy a dirty look when she came and he said "it's not my fault. i tried to delegate the responsibility but this girl wouldn't do it. :trout: the nurses are the lowest of the low despite the fact that we are the one's taking care of everything and cooridinating all of the departments. all each department sees is themselves.

I have not worked in a LTC or rehab facility yet in which it was possible to pass your medications at the correct time. As everyone else has said, you have to get to know your patients. I always give the meds that very much have to be on time when they are due and work around the other meds. Obviously, if it is your first time at a facility and you are working through agency, you will not know who gets those meds with important timing. Definately ask during report. I have worked some agency, and have found that facilities that typically use agency are prepared for this and don't have impossible situations for med passes. It is still hard to make it on time, but usually the important stuff in which exact timing matters is in a place that the agency people can easily find it. And there will be people who say so and so usually gives me my meds at this time or complains that no one gave them their meds when it is not even time for them yet. I just always apologize and tell them I will remember next time. Good Luck

Out of LPN school I also didn't want to work in LTC. The first job I applied for and did a 3 days of Orientation for(they had a month long orientation) paid only $11.29 an hour, but I could get day shift. I was making almost twice as much prior to nursing school. I was willing to take it to get the experience, but then was told I had to work every other weekend, after the interviewer had told me I had to work one weekend a month and that they could work with me on which one. As a single parent of pre teens and teens, this was not possible. I left that(without picking up my three days of orientation pay, which now I know was stupid, but I felt guilty for leaving even though they lied to me about schedule). Then for $14 an hour I took care of 120 LTC patients with 2 cnas on night shift as the only nurse. Made several errors with no one to ask what to do and no experience(just paperwork, no one was harmed). 3 months later I took a job for $20 an hour, flexible schedule, with no more than 20 patients at a time, working under an RN. RN did paperwork, LPNs did meds and tx. Next job 9 months later I was nursing supervisor after working there 3 months. I won't continue with the list, but the way to find out about good nursing jobs is by taking what you can get to start. I have always found out from people I worked with. A lot of nurses and cnas work at more than one place at a time, and will recommend you if you work hard. It's not necessarily about knowledge of a knew nurse, but work ethic and kindness to the patients and other employees.

The reason that there is an arguement about it is because of people with attitudes like yourself. I and most of the LPNs I work with have bachelor's or master's degrees and have been working in other fields but became LPNs because they wanted to help people. I am tired of having sent one of my 60 sub acute med A patients to the hospital for very serious situations that we just do not have the equiptment to take care of in a LTC/rehab facility and having them send them back without even getting an x ray on a broken jaw, knee, femur, dislocated hip, ect. We often get in report "yes, they have an abrasion on their nose" They will agree that they have an obvious skull fracture or jaw fracture, are still having seizures every five minutes or whatever we sent them for, but will send them back with orders to wash the abrasion with soap and water. Duh, we can do that ourselves, we just don't have all (or any) of the diagnostic equiptment we need. Often when getting someone back from the hospital who was admitted, the nurse giving report does not even know what they were there for. They will call a knee replacement a fractured femur and when corrected will say they can't find anything about that. So stop treating LPNs like idiots. We have a higher caseload, no equiptment and many of us have more education than the RNs who appear not to take any sort of personal responsibility for their patients.

My facility will not allow those, because they think that people will get lazy and just check what they checked yesterday. We have to write out everything.

It very simple once you get used to it(the medicare charting I mean, not the job). It is just full vitals and head to toe assessment(of which I'm sure you did a hundred of in clinicals). Then you need to know the reason that the patient is being skilled. Did they break a hip? GI bleed? That should be passed on in report, but if it is not be sure to ask. If the previous nurse does not know, you can probably find out in the transfer orders or care plan(if they have been there a little while). Then chart specifically to that problem in addition to the head to toe. Good Luck