nightstalkerRN

LTC is not for everyone. I disagree with the babysitting assessment in reference to my 10 years in LTC. I also disagree with the thought of losing skills. Yes LTC is often understaffed. Yes management is often apathetic or has their hands virtually tied by owners. LTC is never boring. I have cared for up to 47 patients as the only nurse at my current job, and more than that in times of staffing crises at my previous job. My current facility has everything from skilled Medicare patients receiving therapy to Hospice patients to patients that should be in psych care facilities (due to my geographical area closing many inpatient psych facilities). Full codes and DNR's, and yes I have participated in CPR more than one time on a Full code patient. Dementia and fully alert. Hoyers and independently able to walk. All on the same unit. PEG tubes, PICC's, Stage 4 decubs, fresh surgical sites, Foley's, Suprapubics etc. My facility also does in house dialysis which is contracted out to a private company. Management of those patients takes a skill set. You name the diagnosis and I have had a patient with it. It takes skills to be able to monitor all the conditions. It takes good pharmacology skills to understand all the meds they take. It takes skills to understand all the labs drawn for all the different diagnoses. You get to know your patients and you know when something is not right. Yes there is a chronic shortage of CNA's in my area. Yes many CNA's feel entitled and unable to be fired because of that. Most are your eyes and ears and are dedicated. You do the best you can. Until wages for CNA's go up that's where we are. LTC is a challenge and every day that challenge is different. Some of us love that aspect of the job.

Heck, where I work I wouldn't have time to pray with a patient or to be silently respectful of prayer if I wanted to. Too many patients and too little staff. I call their family or listed clergy on the fly if necessary (no chaplain here).

The facility where I work has 3 shifts 8 hours each. I have been on noc shift for 5 years now. My shift starts with report, then narc count. We often sign for Pharmacy delivery and we always have to go through the manifests and then put the medications away. We print the nightly census and nursing and CNA coverage sheet for the day as well as the schedule for the next day with all hall/unit assignments. We have a lab service that comes and draws blood around 5 am so we have to print out the list of the day's lab draws and make sure the lab reqs are filled out and ready. All new orders that come in during the day are checked by noc shift. When there are admissions all of the admission orders and paperwork are also checked by noc shift. If anything is incomplete or wrong with these things we are expected to correct or finish them. Which happens more often than I would like. We have a few midnight meds to give but mostly give PRN meds through the night until 4am when our med pass begins. We have treatments, generally skin treatments that would be difficult to do after residents are up and dressed. We also must make sure all O2 portables are full for the coming day. If we have resident's with PICC lines that need blood drawn I have to do that rather than our lab service because I am the only RN, working with LPN's and our facility requires that an RN do this. I am also the only nurse on nights that can run IV meds @ noc through PICC lines for the same reason. I have had anywhere from 18 to 103 patients to myself depending on staffing and census. Our facility has a 28 bed Dementia locked unit, a 27 bed Long term hall (90 % of which also have dementia but need too much care to qualify for the locked unit), one 15 bed private room hall that is equally long term and Medicare, one 20 bed hall that is exclusively Medicare and another 27 bed hall that is half long term and half Medicare. All halls but the exclusively Medicare hall currently have Hospice patients. The nights I dislike are when there are 5 Medicare admissions on one hall and the admissions were done by a new or lazy nurse, all my Hospice patients are crawling out of bed despite Haldol, Ativan and Morphine. Dementia gentlemen are pulling out their Foley's fully inflated, wound vacs won't keep suction, PEG tubes are clogged, JP drains are leaking, I have to stop my AM med pass to draw blood from 3 PICC lines, and I have several falls or skin tears. The new admissions don't have any medications so I have to call the backup pharmacy and wait 4-6 hours for delivery. And in the middle of all this somewhere I have event charting, Medicare charting, patient observations, skin checks, monthly summaries. Heaven forbid we have to call an on-call doctor and wake them up in the middle of the night. Our facility also has an assisted living facility next door with a connecting corridor. Only CNA's work the night shift there. If anything happens there on noc shift (for example- fall, change of condition, signing for meds and putting narcotics away, new orders, sending resident's to ER or accepting returns from ER) it is our responsibility to got over to their building. I have worked 1st, 2nd and 3rd shift and none of them are "easy", they all have their different challenges.

I work in skilled/LTC and we got a text from our DON. One of the local Hospice organizations we do business with brought us huge tubs of pretzels and a few families of the long term patients gave us cards, flower arrangements and snacks and candy. What a nice thing to know the families appreciate us!

I began my adult life in biochemistry and found I hated being in a lab all the time with little human interaction. I went from that to being a radio station disc jockey! When I had young children I actually waited tables for 7 years and then was a stay at home mom for a few years. I decided I really wanted to go back to something science based which is my first love but with human interaction. At 40 I was not the oldest person in my nursing class, which surprised me. We had students from 17 to 52. I believe my life experience makes me a better nurse than I would have been when I was younger. I made the right decision for me and I love my job.

Nursing school teaches you the minimum to be "safe" and nowhere near what you need to know for actual nursing practice. This does not minimize the accomplishment of finishing nursing school. Every nurse has had to learn on the job the real everyday nursing skills they need. Nursing is a lifelong commitment to learning about your practice and profession.

I can sympathize. I work in a SNF on noc shift. We have varying kinds of patients: Dementia/Alzheimer's, fresh from hospital post surgical, long term skilled care, and Hospice. I normally am responsible for the care of 50-55 patients in the locked down Dementia unit and the Medicare rehab unit. At times I am responsible for 90-100 patients (the whole facility) when an LPN calls in sick with no replacement. Our patient medical records are all computerized. We have one computer terminal that is able to print out paper copies of medication administration records even when "the system" is down. We also have a three ring binder "Nurses Manual" that details procedures for death of a patient, admission, discharge, etc. It sounds like your facility has chosen not to take some very simple steps to cover all situations. My DON is not easy to contact on the phone at night either but when she does not answer I call the Assistant Administration of the facility, and then the Administrator if necessary. Trust me, they do not like being awakened and usually there will be some sort of change in procedure and policy following. I have also been known to call a 1st shift nurse and ask her if she would come in an hour or two early to help. It never hurts to ask and sometimes they say yes. If management wants to know why the extra hours then very frankly explain.

I regularly have 51 patients every night but have had as much as 103 all to myself for the greater part of month. Its very manageable when most are sleeping. But when you have dementia patients that are up and are a danger to themselves and/or elopment risks, hospice patients at the very end of their journey, fresh surgeries out of the local hospital that no longer has a post surgical skilled unit of their own... it can be interesting. Don't ever let anyone tell you night shift doesn't work as hard as any other shift. Besides, in my facility night shift gets all the paperwork that no other shift wants and all the follow up on physician's orders and pharmacy issues, even though no one is awake to respond to our faxes. Also don't ever believe that LTC nurses don't use just as much "critical thinking" and assessment skills as any other area. I think it takes a special kind of nurse and a specially developed skill set to truly excel at LTC.