Reality in the LTC

TheCommuter, BSN, RN · May 17, 2007

30 patients is an average LTC patient load.

Let me reveal the dirt. You won't get done on time if you choose to do things by the textbook. However, you will get done early if you take a few shortcuts (preparing meds ahead of time in little cups, charting as you go, asking an aide to obtain your vital signs, etc). It might not be safe, but no patient of mine ever was killed or harmed. I hope no one flames me for revealing these things. :uhoh21:

I worked the 3pm-11pm shift in LTC, and was always done with everything by 8pm. I would always set up my meds beforehand, get the treatments done all at once, and chart until the oncoming nurse came to relieve me.

jill48, ASN, RN · May 17, 2007

Yes, that is totally normal. And yes, you can get it all done if you manage your time effectively, not to mention delegating effectively. I prefer to do most of my charting at the end of the shift when I can really concentrate on it and I take my sweet time. I'm not really in a position where I must get out on time, it's cool if I stay. But that is the way I like it. That way I'm not hurrying to get to the charts and chart every little thing I do. I take notes all day and when I can sit down and give it all of my attention (usually after giving report to oncoming nurse) I can take care of it all. And my nurses notes are awesome. I love paperwork and charting. And I really do chart everything. My motto is: IF YOU DIDN'T CHART IT, YOU DIDN'T DO IT. If I was in a position where I had to be home at a certain time or if my kids were little, it would be a different story and it might make it too hectic for me b/c I couldn't stay late or take my time. Good luck to you.

jill48, ASN, RN · May 17, 2007

You won't get done on time if you choose to do things by the textbook. However, you will get done early if you take a few shortcuts (preparing meds ahead of time in little cups

I'm not going to ream you, but you shouldn't be setting up your meds ahead of time. I would think that would be against JCAHO guidelines. And I'm wondering what you mean when you say you don't do things by the textbook. That could be something innocent, but it sounds kind of scary to me. I'm not trying to offend you, I'm just wondering what it is that you don't do by textbook.

TheCommuter, BSN, RN · May 17, 2007

I'm not going to ream you, but you shouldn't be setting up your meds ahead of time. I would think that would be against JCAHO guidelines. And I'm wondering what you mean when you say you don't do things by the textbook. That could be something innocent, but it sounds kind of scary to me. I'm not trying to offend you, I'm just wondering what it is that you don't do by textbook.

Most nursing homes are not JHACO accredited. JHACO accreditation is mandated for hospitals, but not for nursing homes and other LTCFs.

I worked at a psychiatric hospital that was JHACO accredited. However, I have never worked at a JHACO accredited nursing home.

jill48, ASN, RN · May 17, 2007

Most nursing homes are not JHACO accredited. JHACO accreditation is mandated for hospitals, but not for nursing homes and other LTCFs.
I worked at a psychiatric hospital that was JHACO accredited. However, I have never worked at a JHACO accredited nursing home.

OK. Point well taken. This was just my experience then. Thanks for the info.

Dolce, RN · May 17, 2007

Yes, it can be done, but it is not an easy task--especially day shift. I lost weight when I worked LTC because I was running the whole shift. If you stay focused, on task and organize your day well everything can be done, including charting. I don't stay over my shift unless there is an emergency. I know people put down LTC nursing but it is a challenging job that requires expert time management skills and a huge amount of responsibility. Taking care of 30 people, often with little help, can be very difficult.

jill48, ASN, RN · May 17, 2007

Not everybody is made for this, but alot of people really like it. I do. :uhoh3:

catlynLPN · May 17, 2007

I've worked LTC. I did not set up meds ahead of time. I started on time, and got finished on time.

I didn't have to do treatments as we had a TX nurse. So after my 8pm med round was done, I went to my charting. And I charted for several hours on the routine stuff. If anything came up in between I got that in, too.

Then I had my early morning med pass before going off duty, I got that done, charted, gave report and I was out.

But I stayed with it and usually got done on time. I had another job to go to, so I couldn't be slow getting done.

30 people is not a bad load. Some have more than that.

Where I work now I have an average of 45,

but our acuity level is different in this facility than a nursing home.

Raeth · May 17, 2007

Our instructors have consistently encouraged us to chart as we go. Like someone said, if it's not in the chart, it never happened. This has been stressed to us a lot in school. Also, delegating vitals to aides is actually in our textbooks... works if you're using student nurses too!

marjoriemac, LPN · May 17, 2007

I'm in my 1st week of new job, haven't had a break in 12 hr shift yet, (note this could work well if I decide to diet!). 30 residents, medication takes ages, especially if everything was done to the book. I tend to write up charts afterwards or else there is mutiny on the bounty (picture a hoard of grannies screaming at one poor little nurse because their meds are 2.5 minutes late!). Have never worked with any nurse that does everything by the book yet! I do think MAR system can cause complacency though, increasing the chances of one off meds being forgotten as they are not in the popper packs.

jill48, ASN, RN · May 17, 2007

I'm in my 1st week of new job, haven't had a break in 12 hr shift yet

There is no reason why you shouldn't have a break. I'm guessing it's by your choice and not that the facility isn't allowing breaks. You have to take a few minutes away from the stress to re-energize. Even if you take a chart with you to chart in, go sit outside for ten minutes.