Reality in the LTC

So do you all suggest doing assessments AND meds at the same time? or like give all residents meds THEN assessments and treatments at the same time?

The facility I'm talking about has a unit clerk and then will have a charge nurse that is suppose to "do orders and talk with the doctors". What do you all think of this?

I do assessments with my med pass, since there will be parameters I'm checking, and I am interacting with the patient, so it makes sense. Occasionally, I can squeeze a treatment inbetween, if the CNA's are getting somebody up and tx has to be done in bed. Also have to do weekly skin assessments on bath day, so I stop for that as well. But with meds, I have to be aware of the time, and strive to be in compliance with them. (which seems pretty unrealistic at times!)

I can never count on doing it the same everyday, because stuff happens that will throw that plan to hell! I think you just have to be flexible. You will develop your own routine and way of working after awhile-- I often have to take a deep breath, vent to a friend and try not to get frustrated.

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.

Most skilled facilities here are Joint Commission accredited. Regardless of the accreditation, prepouring meds is not good practice.

NY is only state certified for SNF, not JCAHO. Prepouring is illegal here.

We are not allowed to double dispense either.If caught,the brown stuff hits the fan!When I first started in the Nursing Home all meds were double dispensed into individual trays but ,times change.I have a basic routine but it has to be flexible as no two shifts are ever the same.My aim in the morning is to leave on time as I usually have either a taxi or a lift home and I don't like to keep either of them waiting.I write up C/P report sheets at intervals through the night so that I have the minimum to write before the shift ends and report is given.

Do you all think that one nurse for 30 residents is an "average" number?

And for the nurse taking care of these residents in an 8 hour shift, is it realistic for her to do all meds, all treatments, chart and get out on time at the end of her shift? (a first shift position)

Those of you in long term care do you all usually get out in time or are you still doing things (charting etc.) past your official quitting time?

Just very curious.

NO. In n.california 30 is not normal. I had up to 48 patients and most other LTC have about 35 -37 in this area.

When I work in the nursing home I usually have 42 patients. And yes, you are expected to do treatments and meds and all that other stuff.

Of course, you realize it isn't about "quality" care for the patients and satisfaction for the nurse. It's like an assembly line. Work it work it work it.

Exactly, which is why I left LTC in disgust.

Yes 30 to a nurse is doable as long as ur organized, try bringing all ur supplies with u to avoid running back and forth ,work wit ur head not jumping around aimlessly, always know where ur staff is and delegate whatever u can I also asked to put all patients with ng's or gast-tubs in the same room so I give my feeds at the same time. I always prepare meds in advance and then check new doctor orders befor adm. for changes. WHere ever I can do 2 things at once I try. NEVER waste time complaining ud be surprised how a positive attitude helps get the work done.

I usually take care of between 36-40 residents, depending on which wing I am on. I find that since I am skilled at time management and very organized, it is not a problem. You just have to prioritize, and go from there. Once you get used to it, it isnt so bad!! And you even have some nice time to spend with the resident and or the family members....

This was normal for me. I worked 3-11. I passed out medications, did treatments, ran up and down the halls to answer phones for doctor's calls and calls from family members wanting to know how MOM ate at breakfast. Ran to rooms to check on residents that just didn't feel well or just wanted some one on one time. This was for 30 residents. When I first started, I was in shock for the first week. I cried a lot. I was told by management that it could be done. THAT being said, management freaked if they thought that THEY might have to do the floor themselves.

Yes, I took short cuts, but that being said, I chose my short cuts. Pills in cups? You betcha. Text book nursing is fine, but then reality sets in and.......

I didn't know that LTCs could be JCAHO accreditied...very cool.

We have 30 residents. We staff with a nurse, a med aide, three CNAs, and a bath aide during the day. The med aide takes care of most of the meds and routine treatments...the nurse does injections and narcotics and all treatments on open wounds. The nurse also takes care of all charting, doctor's rounds, calling families, and things like that. The bath aide does all vital signs and passes water and nourishments. It works out pretty well about 75% of the time. I rarely get out on time, but part of that is because the night nurses seem to ask a lot of questions and make a lot of comments during report...LOL.

:)

So once I get my routine down, for a shift that is 6am to 2:30pm, you guys are saying that it is feasible to be out by 3:30pm?