Questions about LPN duties in nursing home

KaroSnowQueen, RN · Mar 2, 2005

Usually the QMA (CMA in your area) and I would split the hall and each pass meds. There is a good bit of charting in LTC. You have to do weekly summaries on a certain number of pts daily as well as your pertinent charting - such as pts who have temp, on ABT, have had recent falls, etc. Then you would have to do all the meds for any tube feeding pts, do your dressing changes, etc. When I worked 2nd shift, if it got quiet the CMA and I would do half the hall when it was time to make rounds and change the pts.

Antikigirl, ASN, RN · Mar 2, 2005

Paperwork..heck yes...or at least at my facilty there is!!!!!!

I work in an assisted living home that has 160 patients, a CNA that does all direct care and med pass for 12 patients each, and ONE floor nurse!!!! (which can be a LPN or RN).

All of us have to chart, and with how scared my facility is about liablity...we chart in excess (I didn't believe there was such a thing till this place!!!!!!!!). CNA's chart on patients as directed by the floor nurse dependant on situation (called alert charting), then if I do anything...I have to chart in the chart, fax the MD (this is a given..anything we do must be faxed to the MD..yes even a bandaid or just to alert the MD of a 2cm yellowing ecchymosis!!! It really bites!), chart again in the 24 hour communication books for the CNA's then another one for the Nurses, then if it was a skin issue or fall...more paperwork for incident reports, and perhaps a write up or two!

Then on certain days of the month, I was hired to check over to make sure there are no gaps in documentation, and if so, I must fix it, or write people up for documentation ommissions!

SO for me, an RN here...I am doing more documentation and double checks than seeing a single patient! You get to the point of just going in a room, quick assessment because you know you have about 30 mins minimum of documentation to do afterwards (for a simple probelm). Or heaven forbid you have to send them out..then it is 10 fold!!!!!

I find this to be a very seriously depressing trend, and one that takes nursing out of nursing! Because of medicare/medicaid wanting full documentation of treatments, in documention sent to them ASAP if they wish, in order to cover them (so must be documented or tx can be placed back to patient pay), and fear of being sued by family members for any reason under the sun...I can't be the bedside nurse, only the one that pops in, looks, says something, and off to do all the paperwork necessary to initiate any type of help...and hope that one time will do it, and not several cases of documentation and faxing!

So paperwork...for us HECK YES...so much that the patient has become just a small piece of the bunch of hoops to jump through...and that is very sad indeed! I don't really see my patients anymore...just the tip of my pen writing as fast as I can so I can move on to the next probelm (and one nurse to 160 geri patients! Okay there is always 3-6 probelms waiting for you when you initiate one!)....

JHUBRAIN · Mar 2, 2005

Hi......I'm an LPN who is thinking of working in a wonderful nursing home------My main question is----I will have a CMA and 2 CNA's with me.....I can't imagine not passing meds, since it was such a huge part of my hospital work.
Therein lies my question-----besides the obvious things like checking labs, calling doctors, caths, tube feedings (we don't have many), dressing changes, and supervising the aides, is there usually a lot of paperwork? With a CMA and the 2 CNAs, it doesn't seem like I'll spend much time with the patient......???

My Hospital in Oklahoma allows the LPNs to draw blood, start IVs, Do IV Push (with training class) and carry a patient team. However, due to the oklahoma law - they must have their assessments sign off on by RN

tracytoon · Mar 2, 2005

My Hospital in Oklahoma allows the LPNs to draw blood, start IVs, Do IV Push (with training class) and carry a patient team. However, due to the oklahoma law - they must have their assessments sign off on by RN

Sometimes the old 80/20 rule comes into effect--I spend 80 percent of my time with 20 percent of the patients.

Nurse Hatchett · Mar 3, 2005

Hi......I'm an LPN who is thinking of working in a wonderful nursing home------My main question is----I will have a CMA and 2 CNA's with me.....I can't imagine not passing meds, since it was such a huge part of my hospital work.
Therein lies my question-----besides the obvious things like checking labs, calling doctors, caths, tube feedings (we don't have many), dressing changes, and supervising the aides, is there usually a lot of paperwork? With a CMA and the 2 CNAs, it doesn't seem like I'll spend much time with the patient......???[/quote
I work in LTC and often say I went to nursing school to be a secretary, waitress, beutician, and punching bag for guilty feeling family members!! LOL At my facility there is a ton of paperwork. I have from 45-52 res and being the only nurse, it keeps me very busy. QMA's are only allowed to pass meds. It is up to LN to do tubes, treatments (except creams, any staged O/A we have to do) Iv's, falls, doctors, and family members, just to mention some of our job duties

shelynch · Mar 9, 2005

Hi......I'm an LPN who is thinking of working in a wonderful nursing home------My main question is----I will have a CMA and 2 CNA's with me.....I can't imagine not passing meds, since it was such a huge part of my hospital work.
Therein lies my question-----besides the obvious things like checking labs, calling doctors, caths, tube feedings (we don't have many), dressing changes, and supervising the aides, is there usually a lot of paperwork? With a CMA and the 2 CNAs, it doesn't seem like I'll spend much time with the patient......???[/quote
I work in LTC and often say I went to nursing school to be a secretary, waitress, beutician, and punching bag for guilty feeling family members!! LOL At my facility there is a ton of paperwork. I have from 45-52 res and being the only nurse, it keeps me very busy. QMA's are only allowed to pass meds. It is up to LN to do tubes, treatments (except creams, any staged O/A we have to do) Iv's, falls, doctors, and family members, just to mention some of our job duties
this is in reply to the nurse who is a waitress, secretary and beautician...when do you find time to do the admissions that come often without warning! don't tell me you have an RN that does it, they are few and far between. mostly in management positions in LTC because budget and census rule. not patient needs.

Nurse Hatchett · Mar 9, 2005

Shelynch -

Like you, those unexpected admits absolutely kill me. I love it when the ambulance drivers come in and ask where so and so goes, I call admissions and they say on your hall. Gee thanks for the warning. :stone No we do not have an RN to do our admissions, we just deal with them, and do the best we can. What I meant as far as beautician, etc. Family members coming in and having a cow because mother has a curl that came uncurled, or instances like this. :)

arc25 · Sep 28, 2009

as a new nurse in a long term care facility, i havent had to do admission papers ect. can someone explain the process to me...

cori40 · Sep 28, 2009

I live in Los Angeles with LVN would like to move to Colorado or Las Vegas which hires LPN. How could I change LVN to LPN?

tiroka03, LPN · Sep 28, 2009

I think working in LTC, is the same as working in a hospital, except you have more patients, and less people around in case something goes wrong.

You just keep going out and checking your patients. There are always going to be the ones that need more care, ie trachs, feeding tubes, IV's ect, and also the emotionally unstable pts.

You get more patients at night than the day or pm shift, and you get additional paperwork and duties. You also get the responsiblity of the MARS/TARS.

You get the attitudes from other shifts who believe you sit around and do nothing all night.

Personally the only reason I work nights is to keep away from management. Management in LTC usually is very demanding. I choose not to be involved in that. Days/PM's also have to deal with State Inspectors. I choose also to steer clear of that.

I have a healthy respect for AM/PM nurses. But, I have worked both shifts, and understand the good and bad of thoses shifts. The main difference is you have a protocal to follow, but you are your own boss, you make your own schedule, (within limits of course), and you just work until you think you can't take another step, then you do-take another step, and just keep going.

You sigh with relief when you get into your car.

Of course then there is waking up at 4pm and finding kids starving. Try making dinner when you first wake up. I think personal life can be more hetic for the night nurse. But, I am a single mom, and life is hetic anyway. You will be able to go to school meetings and bring your kids to the doctors, but that is like waking up at 3am and doing it, you will have to work hard on getting your rest and finding the proper balance.