Questions-a-plenty! LPN's in long-term care...

jenac · Dec 25, 2003

Alot of the answers to your questions vary according to the procedure/policy of the facility. Our 2nd shift starts at 2:30 pm, ends at 11 pm. We typically have 22-25 residents to manage, but the number varys by facility. In our facility-we chart by exception. So you only chart on something not ordinary for that resident. On skilled residents-we do assessments (a revised head-to-toe)per shift.

As for blood draws-we contract with a lab who does all of them. Iv cert. is something your facility may or may not choice to do. Some will-some won't. Generally-they send you out for that, if they choose to. In my facility- we only have one certified Lpn-on second shift. We have plenty of Rns on days who can do it. They generally organize the IVs to be done on days. At one time- I was gonna get mine for midnights, but changed shifts, so it wasn't necessary anymore. I've thought about pursuing it myself anyway though. My time- my money.

As for "managing" CNAs-think of more as being part of a team, as team leader. If you try to "boss" them- you'll be in for a tough time. Most CNAs know their jobs-and don't need someone constantly looking over their shoulders and telling them how to do it. Some do- you'll figure out which is which quickly. My advise- any time you need them do to something particular-ask, don't order. And most aides will have alot more respect for a nurse who jumps in to help when they need it. Your residents will respect you more too. They know you have a job to do too-but any good manager knows when to jump in also. Work with them-not against them and you'll do just fine.

Orientation is different at each place, with each person. The first few days, I basiclly got to follow around an nurse who had been there for years. When I did finally get to jump in- she was over my shoulder the entire time untill she felt I was ready to be alone. It can be very overwhelming, and intimidating- it's very, very different than anything you had in school. Take your time- listen carefully and you'll be fine once you get the routine down.

Good luck to you. It takes alot to work in LTC. Alot of compassion and alot of energy! But it is a wonderful thing.

Rane330 · Dec 25, 2003

Dear Steph,

Regarding the CNAs; many of them are well on their way to becomming either LPNs, or RNs, themselves - and possibly your supervisor in the future. Mutual, and well deserved, respect (on both sides) is all that's needed for a good working relationship.

Congratulations and Best Wishes,

Rane

Rane330 · Dec 25, 2003

b-e-c-o-m-i-n-g - "becoming"

I hate it when I do that.....

:imbar

Or, maybe I should work on my perfectionism for the New Year?

-Rane

StephMSeattle · Dec 26, 2003

I didn't know what to expect...being that I'm completely new to this field... I didn't expect to be hired so quickly either! I start orientation on monday!

Thanks again!

ktwlpn, LPN · Jan 5, 2004

Originally posted by Rane330
Dear Steph,

Regarding the CNAs; many of them are well on their way to becomming either LPNs, or RNs, themselves - and possibly your supervisor in the future. Mutual, and well deserved, respect (on both sides) is all that's needed for a good working relationship.

Congratulations and Best Wishes,

Rane

THat is a rarity at my facility...But mutual respect is still number one.The cna's on my unit have seen me feed,toilet and clean up many an incontinent resident.I also will step in and assist them with a resistive or combative resident....They know I will do all I can when I can but they also know that when I am busy I have things I have to get done that they can not do and they respect that....Others I have worked with just had no respect for anyone-themselves,the residents,their co-workers of their supervisors..We worked ourselves to death on that unit and for some it was NEVER ENOUGH....I have learned to never let an instance of insubordination slide-document it because it will escalate .I can't work with staff that will not work WITH me....I try to teach as much as I can and the aides appreciate that.I acknowledge the good staff for their care.I try to make it fun-we are working in the resident's home...I bring music and snax and such for residents and staff.I encourage the aides to spend time just sitting with the residents.That time can be so rewarding....Good cna's are more then worth their weight in gold-a bad one is almost impossible to get rid of if you don't document problems and follow through always.....But they have someone's life in their hands...We owe it to our residents to make sure they are getting the care they deserve....

nursecompassion · Jan 5, 2004

I totally agree with all of the posters with regard to CNA's. I am an STNA in ohio at a LTC facility, I have only been state tested since April, however I do my job better than ppl who have been an aide for years.

It is harder to get rid of the bad ones. I get frustrated when I tell some of the LPN things I find and it does not get documented or reported on.

When I used to work 7p-7a, I once found 3 r put to bed in their clothes, one of them was soaked clear through to the bed pads, sheets, etc. However the although we knew which aide had did it, that nurse did not write her up! THis same aide says she bed checks the R however on third I always come into a mess when she is on my hall.

Yes, if they have been aides they should know how to do their job and do it well, however it is the ones who could care less you have to keep tabs on.

Unfortunately some adults have to be babysat!

p.s. second shift at our facility is the shift where most of the problems occur with resident care. thankfully i work third!

jules

ktwlpn, LPN · Jan 6, 2004

Originally posted by nursecompassion
It is harder to get rid of the bad ones. I get frustrated when I tell some of the LPN things I find and it does not get documented or reported on.

When I used to work 7p-7a, I once found 3 r put to bed in their clothes, one of them was soaked clear through to the bed pads, sheets, etc. However the although we knew which aide had did it, that nurse did not write her up! THis same aide says she bed checks the R however on third I always come into a mess when she is on my hall.

/B]

jules-please come work with me.....You are exactly right-the nurse that can't "be bothered" to follow through with things like that is WRONG...It is passive abuse towards the residents and it really stinks when the good aides like you have to work along side lousy ones and watch them get away with a substandard perfomance day after day...Only your own good work ethic and love for what you do keeps you coming back when you can see that often there is no other reward for it...I work with a nurse that has gotten into shouting matches in the hallways with particular aides-and it is always the same thing,the aide did not put shoes on,teeth in,glasses on etc.....She'll carry on in the hall and then do nothing....maybe bring in donuts the next Sunday morning...what is up with THAT?

nursecompassion · Jan 7, 2004

Originally posted by ktwlpn
jules-please come work with me.....You are exactly right-the nurse that can't "be bothered" to follow through with things like that is WRONG...It is passive abuse towards the residents and it really stinks when the good aides like you have to work along side lousy ones and watch them get away with a substandard perfomance day after day...Only your own good work ethic and love for what you do keeps you coming back when you can see that often there is no other reward for it...I work with a nurse that has gotten into shouting matches in the hallways with particular aides-and it is always the same thing,the aide did not put shoes on,teeth in,glasses on etc.....She'll carry on in the hall and then do nothing....maybe bring in donuts the next Sunday morning...what is up with THAT?

There are no yelling matches at my facility. Luckily I am on third and 90% of the aides on my shift are good aides. Usually I even work with my own mom!

It is what you find after you get there that is disturbing. That's crazy bring in donuts, she must feel bad. Who knows, you run into a few nuts at LTC facility hugh?! Do you say anthing to this other nurse about her behaviour? Just curious.

I have a big mouth at my work, meaning I let ppl know if I am upset, but not in front of the r. I never yell either.

What can you do? It is all or nothing.

jules

sue nurse · Oct 27, 2008

So, I just got this job in a long-term care/rehab facility in my neighborhood. This is my first real job in nursing. (I just graduated this past August) I'll be working 2nd shift. Questions...
What is it like to work 2nd shift in long-term care? How is managing CNA's? (I've never managed anyone before) How much writing and paperwork and how long does it take to do it? What time does evening shift end? (provided that the next shift arrives on time)
How many patients do you typically have? I've heard 20, 30, more... Do you have to fill out paperwork on each and every one?
What is orientation like for new graduates? What is preceptorship like? (do they watch you do each and every procedure/guide you?) Do you have to assess each patient every shift (focused assessment, no assess unless problem present, etc...)?
What type of stuff do you typically do during 2nd shift? Do the facilities certify you to do blood draws & IV's? (or do I have to seek certification elsewhere)
Babble. Babble.
~Steph M

Oh my gosh, but your question is so appropriate-I am also a new grad starting at a LTC facility and I had all similar concerns. Thanks-this thread has helped.

PS-how are you doing now??