Rivalicious

I've once forgotten to document a PRN narc in the EMR but had signed it out on the paper sheet- no biggie, I just did it once I realized my error on the next shift. I'll be honest that when it comes to non narcotic PRN's I've forgotten to document giving them a few times, because I have a heavy med pass and I am pretty liberal about giving them. A lot of my patients are non-verbal and can't communicate that they are in pain so if I see any sign of discomfort I'm throwing in some ibuprofen with their regular meds. I also pre-medicate my dressing changes and other potentially painful procedures. I have 48 patients to chart on every shift and I don't always have time to do the MAR as I go and will chart it after the fact, and occasionally forget. And yet I always somehow remember to pass on the info.to oncoming shift. Go figure.

Honestly, it's the new grads who DON'T have the occasional freak out who make me nervous! It's totally normal and good on you for being so open about it with your peers.

No problem, if you have any questions about it feel free to ask! There's also a developmental disabilities nursing forum here, and the National Developmental Disabilities Nursing Association (NDAA) has some great resources as well.

I've actually never worked in a hospital (they don't really utilize LPN's anymore) but I've heard from others that it can be a special kind of hell. Since you have a child with ASD have you considered IDD nursing? That's where I'm working currently- I do weekend overnights in an intermediate care facility for adults with developmental disabilities and per diem home care for pediatric cases. There are a lot of options in this field and a real need for nurses with the background and passion for it. I just happened to end up here and found I loved working with this population, but a lot of the nurses I work with have family members with special needs (usually siblings or children) who inspired them to go into this area, and the experience and empathy they bring to the table is invaluble. Eta- I meant to add that although these are nursing roles, the role we play is quite different from other specialties. You have a lot more autonomy, but the pay is not as good and the workload can be intense in the more institutional settings. In my ICF I have a 48:1 ratio with as little as 2 direct support professionals (similar to NA's) on overnights!

A newer doc rounding on one of my patients while I was hooking up his tube feed "And what is patient x recieving an IV for?"

OK, hold up though...it's not a for profit. It's a non-profit (run by monks actually) that has been in existence since the 70's. Maybe I'm niave but I'm pretty sure no one is getting rich here. The majority of their funding comes from fundraising and the administrators often pay for supplies out of their own pockets because insurance for DD is so bare bones. Not to mention they are salaried and regularly pull 100+ hours a week to keep the facility running. I agree there is an issue with staffing ratios and safety, that's why I made the post, but the issure isnt one of a greedy corporation milking the system for a buck. If that was the case I would have been out the door already. The issue is funding (state funds have been slashed) as well as poor management and high turnover. But the core staff there are genuinely good, dedicated people who love these guys and genuinely care about them. And the reality is, this is the only home many of these residents know- they have been here for 30+ years and have formed bonds with staff and other residents. They are particularly sensitive to changes in routine and would not be well served by the facility shutting down imo. But they DO deserve better care as an aging and increasingly Ill population. The problem is we don't get funded to support those needs, so I'm caught in a catch 22. I don't want to enable sub-par conditions or put my license at risk, but I genuinely care about the facility and the men who lI've there and want to help improve their lives in whatever small way I can.

I'm a LPN currently working on my ADN. Pretty much as soon as I finish that I'll have to start working on my BSN, as it's the only way I can have the career I want. You can get a job as an ADN or even a LPN in most areas, but you will have lower pay and less job security. Hospitals are increasingly requiring BSN'so in order to obtain magnet status and I expect this trend to continue. If I could do it over again I would go straight BSN. I do feel working as a LPN for 7 years has given me valuable experience that can't be taught in the classroom and there is an aspect of rising through the ranks (from CNA to LPN to RN to BSN) that I feel particularly proud of... but when all is said and done I will have been in school for 5 years by the time I get my associates (18 months for LPN + 2 years pre-req + 1.5 years RN) and I could have earned my BSN in that same time frame. Waste of time and money.

I think part of the problem is my facility is licensed to be a residential center, similar to a group home, but the reality is it operates as more of a subacute facility. It's because the original resisent population (lots of guys have been living there since the 70's!) are aging, and experiencing the co-morbidities that come with it, plus the existing issues they had to begin with. When the facility opened the average lifespan of a DD person was very short-around 35 from what I've read. Now it's much longer, and there are a lot of medical and psych issues that are coming up which hadn't been prepared for. I think we should be designated as at least sub-acute and have a patient ratio similar to yours (although I'm sure that is still high especially when you have other responsibilities dumped on you) but for whatever reason that isn't happening. I'm sure 15:1 + phone duty on dayshift is no picnic either.

I work as a LPN in a LTC facility for developmentally disabled men. I'm relatively new (2 months) and it's the first time working in a LTC environment so I don't have a lot of context, but I feel like my workload and responsibilities are excessive and putting myself and my patients in a situation that is unsafe. There are 100 residents total at this facility. I work the overnight shift 6pm-6:30 although I rarely leave before 7. On a standard shift I work with one other nurse, and we each take 2 hallways-so I'm in charge of on average 48 patients. There are varying degrees of acuity but since I'm usually stuck on the higher needs side I'll describe a typical shift there. Almosy all of my patients get HS meds, and about half get 5 or more. All are classified as severely disabled. About half are wheelchair bound, quite a few are blind, and 25% have major underlying health conditions like CHF, renal failure or cancer. Almost all of them have psychiatric co-morbidities- schizophrenia and intermittent explosive disorder, psychosis and major depression are the most common. Early onset Alzheimers is also very common. Lots of sensory issues and seizure disorders as well. 4 are on tube feeds. 5 are diabetic and need varying degrees of blood sugar monitoring. Many ostomies and caths, too many to count. Since it's DD you can imagine it's tough to get a lot of these guys to take their meds. Many are spastic and have difficulty swallowing, so they need to be given tiny amounts at a time. Others are just uncooperative-they run away, get combative, spit them out, or throw them . Others require constant coaxing and coaching. I'd say about 40% fall into the category of being extremely difficult to get meds into. There is never a shift that goes by without some kind of incident- whether it's a fight between residents, a fall, grand mals, or elopement. There have been several times I've been physically attacked and other nurses and care attendants have been seriously injured. On a good night ill finish med pass by 11:30, although it's not uncommon to still be passing well after midnight. As soon as I finish the meds I have about half an hour to chart and then I start doing treatments. We have several that need pretty extensive dressing changes (pressure ulcers are unfortunately pretty common since so many are wheelchair bound, can't communicate pain, etc.) There are the tube feeds and flushes, BIPAPs and nebs, a few who have psoriasis or other skin conditions and need topicals. I also need to get vitals most of the time because the facility doesn't hire CNA's- we do have care attendants but they have no real medical training and the turnover is ridiculous, so there are few who stick around long enough to learn skills like that. Because of the staffing issues it's not uncommon for me to have to change or clean a patient myself because if I don't they would sit there for hours in their own urine and feces. I've gotten to the point where I just empty the bags of my urostomy patients myself since at least once a shift one of them would overfill to the point of bursting and I'd have to change the entire setup. By the time I'm done with all this, usually around 3, it's time to start my 6am pass. Oh, and we do in house hospice. Thankfully that isn't too common but when that happens, on top of everything I just described we are additionally responsible for pain control and end of life care for an actively dying person. I feel like this is just too much work for one person and I'm starting to get burned out. Even with a 12 hour shift, on graveyard, I can barely get everything done. I chalk some of that up to me being new but in reality the other nurses who have been there longer, some even for years, don't fare any better. I don't have a moment of downtime during my shift, and I usually don't have enough time to finish charting. My manager is very understanding and I haven't ever gotten in trouble for this but I always leave there feeling like I have left so much work undone. I know that I'm not the only nurse who has a heavy workload and to an extent that just comes with the territory, but at what point is it beyond what's acceptable? Am I risking my license by working here? We had the state come in recently and I know there were citations and fines, but I didn't hear any of the details. I guess my question is does this within the realm of normal or is it time to find a new job?

I work in LTC for developmentally disabled. 48 patients. My evening med pass is typically 7 hours long.

Of course I've been disgusted at work. The areas I mentioned (case management, informatics) can pay just as much as bedside nursing, if not more. I'm not trying to "pitch" anything to the OP, just putting some options out there that she could consider. I've taken care of plenty of obese people. I've cleaned up a 400+ lb patient covered in C-diff BM who couldn't fit in a shower, done the teamwork foley insertion, treated macerated, MRSA infected pressure ulcers within fat folds, once tried to move a bed-bound obese patient who was too big for the Hoyer lift and wrenched my back in the process. Etc. I've also had a TBI patient who weighed 90 lbs soaking wet rip out her ostomy bag and fling liquid feces at me, and a sundowning little old lady spit in my face. Etc. Disgusting things happen in the nursing profession. Disgusting things come out of the human body, and illness (mental and physical) can do wretched things and create very unpleasant behavior. I have called aspects of my job disgusting, but I've honestly never called a patient-an individual human being- disgusting. The disgusting things that come out of their body are not something they really have much control over. Even when it's a hygiene issue that is often the result of impaired mobility, physical limitations (a very obese person is going to have a hard time washing every fold of their body for obvious reasons) or depression. It is not my place to judge them for how they got into that state, and I don't write people off as simply "disgusting" because of the way they smell or how difficult it is to work on them. Similarly, I have had patients with dementia, but I don't call them "demented" like that is the sum of all of their parts and the definition of who they are. The moment I start seeing people in such a one dimensional way is the moment I'll know I'm burnt out and it's time to take a break from nursing. We all give advice according to our personal perspectives, and this happens to be mine. You are obviously free to disagree. I doubt my advice is going to make or break her career anyways.

Nowhere in my post did I say she had to "like" all of her patients-miserable, obese or otherwise. We all have to take care of patients we aren't fond of, and I have had days where I've been pushed to my breaking point too. But when you start saying things like your patients are "demented" and "disgusting", those are dehumanizing terms and I think it's a sign that something is seriously off. Maybe some professional help or peer counseling would help, maybe a different job would do the trick, or maybe bedside nursing just isn't a good fit for the OP. I tend to think it's the latter, others may disagree. Bedside nursing is a hard, often thankless job and you have to really have a passion for it to survive and not get burnt out. And By OP's own admission nursing wasn't even her first choice, so why stay on the floor when there are so many other things you can do with a BSN?I also don't see what being obese has to do with a patients likeability, it's not a character defect

Putting the issues with co-workers, managers and docs aside for a moment-The way you refer to your patients does indeed make me think you chose the wrong field. You complain that they are old, sick, demented, indigent, obese...who did you think you would be taking care of, the young, sane, wealthy and attractive? Illness can do funny things to people-it renders them helpless, fearful, vulnerable. Same with family members. Often those feelings get channeled into anger and resentment, which are then hurled at you because you are the convenient target. It is hard not to take it personally. It is hard not to get burnt out. But if you have only been doing it for a little over a year, and you're already burnt out to the point where you are dreading waking up in the morning, where you have no compassion or empathy (with the exception of those patients you deem as both "truly sick" AND appreciative of your help) , then yes, it's a good possibility you are in the wrong field. And that's OK! The great thing about nursing though is that there are many things you can do with your BSN that don't require you to be at the bedside. You might consider case management, informatics, or another specialty that doesn't involve direct patient care. With your interest in nutrition, perhaps becoming a diabetes nurse educator would be a good fit. Moving to another floor or hospital isn't going to solve your problem-there is no specialty in nursing where you aren't going to have to deal with ungrateful, unmotivated patients and you don't seem well equipped to handle them. Better to learn that about yourself now, early on in your career, and go find something that makes you happy. Best of luck to you!

You also don't need to be a RN to work in ambulatory care nursing. There are quite a few of us LPN's who work in ambulatory care, especially now that LPN's are being phased out of hospitals in many states. This article made it seem like we don't even exist!

Sorry for the late response, I couldn't find this thread for some odd reason. "I was in a similar situation, but on the other end, as a MA in a busy surgical practice. Myself and the other MA trained the RN, and resentments built up over the years. Being that we were there for a longer time and went above and beyond, the docs often came to us first, which worsened the situation. I was also in nursing school at the time, so that too blurred the line. It was difficult for our RN, but she wasn't the best communicator and on the downside of her career. My advice to you would to be constantly communicating with your manager and the docs, and looking for opportunities. As the newer person, you may have a fresh set of eyes and be able to critically think about how to approach aspects of patient care and policies better. In a clinic, there aren't as many oversights and regulations, and perhaps you can help create some to promote safety and improve patient care. Identifying needs and then acting on them will help set you apart. Educating and helping your MAs will help them to see you as a valuable resource, and not an overpaid MA. Anything you can do to be proactive will help, just be careful to not make the MAs feel like you think you are superior to them. (Not that I think you would do that; I'm sure you are a fabulous person! I just know from experience that it can be a sticky situation!). Good luck!" Thank you so much for you reply! This is great advice, and very valuable to hear from the "other side". I have been trying to get more proactive about taking on as much responsibility as I can, and it's gotten better in some areas but worse in others. This week has been especially frustrating, so be warned, I am about to vent! So in order to clear up some of my confusion over my role at the clinic vs. theirs, I read up on my facilities job descriptions (which are very detailed, almost like a mini scope of practice) to better understand the differences between what a MA and LPN are supposed to do. In a nutshell, the MA's are supposed to be responsible for doing minor patient procedures (injections, vitals, suture removal etc.) as ordered by the MD, but the majority of their job description is clerical-doing pre-authorizations, transcribing orders, calling in prescriptions, that sort of thing. The LPN's job description includes more advanced office procedures, including assisting in surgeries (we perform excisions in our office) and sterile dressing changes, as well as doing patient assessment, phone triage, and answering patients questions/giving medical advice either directly or after consulting with the physician. It of course also says that we may do the "office" work as well, but there is much less of an emphasis on it. However, what is on paper isn't what it is in reality. Not even close. Like I said, our MA's do everything that is included in my job description, including things that are excluded in their own. Including things that would seem to be outside their scope of practice and beyond what they are trained or qualified to do. For example-taking patients questions and dispensing medical advice, directly, without consulting with the physician. Often while presenting themselves as nurses-or at the very least not correcting the patient when they are called one. And while it's usually accurate information, sometimes it isn't, and there have been a couple cases where I've overheard one MA in particular telling patients things that are downright dangerous. For example, she recently told a patient to d/c an antibiotic before therapy was complete because of a yeast infection, without even consulting the doctor. Tried to explain that yeast infections can be treated, drug resistant infections not so much, and that in any case it was the MD's call-and she just rolled her eyes and said "oh well, I'm sure she will live" I want to get along with my co-workers and have a respectful professional relationship with them, but it's obvious they have very little respect for me, or nursing as a profession. And it sucks because we are all on the same team, and should have the same goals- to give our patients the best care possible. I'm certainly not above doing any of the "dirty work" of a MA, or a CNA-Heck when I worked in a SNF I was everyone's favorite nurse because I would always help the CNA's with their assignments once I was done with my own work. And I don't have a problem with "sharing" the clinical duties either, especially if it helps us get our work done on time. But when we take the office tasks and divide them up equally like this, it means that MA's are taking on nursing responsibilities while I'm being taken away from them because I'm doing work that they are not only capable of doing, but have the specialized training and knowledge perform. I know I can't delegate to them, nor do I want to, but I would like a division of labor based on what our roles are supposed to be and what is in the best interests of our patients. Unfortunately it seems like they are not open to the idea of changing anything because "that's just the way we have always done it". And much like your experience, I'm up against a brick wall when it comes to the doctor because she has been working with her MA's for so long and she has built up a relationship with them, while she is still getting to know me. Anyways, I am sorry for rambling-it's been a rough week! I will definitely take your advice to heart. I have a meeting with my supervisor next week and I will talk to her about this, so hopefully she can help me address this with them and come up with a solution. I just hope it doesn't come with too much drama