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75 residents/3 nurses

Has 9 years experience.

Hello fellow Nurses,

I am an LPN who currently works at a Sub-acute LTC facility. We have just about everything a Med-Surg nurse would encounter and more. I work 7p-7a and recently my facility went from using 2 nurses on a unit with 75 residents and 3 carts, to 3 nurses who have their own cart. I will admit things are easier cause when there were only 2 nurses I was often afraid and feared for my residents safety and my license. Last night one of our nurses got sick and we would go down to 2 nurses. We were told that we had no other option. Now we have 2 sometimes 3-4 RN House Supervisors in house for 225 residents in the facility who are supposed to take a cart, but they weren't willing. Myself and my co-worker refused due to the workload and so many critical people on my side. I just didn't feel comfortable. My question is, is it legal for a nurse to work more than 1 cart? Would you as a nurse have taken the keys? Legally if I had taken the keys then I would have taken responsibility for whatever happended.I was told in nursing school that 1 nurse is not to have 2 sets of medication cart keys. I have fear of sharing a cart due to 2 nurses both sharing a narc box. Not that I don't trust her, but many nurses have got into trouble with other nurses who's narcotics are off count and no one wants to claim its their error. If I am going to get into trouble with narcotics being off count its gonna be due to my own error. The RN excuse for not taking a cart: "I don't know these residents cause I am new"! She has been employed with this facility for over 3 months and if anyone should know about each resident it should be her! All you don't know about a resident you can consult a nurse on that unit, a CNA or read your MAR or chart. Thanks for letting me vent

NEVER3

Specializes in LTC, MED SURG.

We have 45 residents with 2 LPNs, 22 for each with a DON thats always there to help and an RN House Sup, she deals with alot of stuff that we cannot help her with being on the carts. We recently stopped switching sides...so I'm always on my 2 halls its nicer. I'm pt and I'm learning quickly this way and feel very safe. I'm switching to 11p till 7am soon because I want to be home more in the day but I have gone in on my days off for 7p till 11p and also 3-11...Ive learned a few things there, I like it. I like the changes. I'm sorry your facility isn't more like ours, you'd feel alot safer and wouldn't need to stress over the key issue. I'm hoping it gets better and you have more help. I feel the facility should maintain adequate staffing so that every person part of the team could do their jobs effectively without so much stress. Good Luck 2 you :redbeathe

pielęgniarka, RN

Specializes in Hem/Onc, LTC, AL, Homecare, Mgmt, Psych.

Ugh This is pretty typical of ltc.

My thoughts exactly. As much as I like working with the residents in LTC (done it for 11 years), after I get my RN I am so outta there. It's too dangerous at those ratios... and adequate staffing is next to impossible either due to budget or call-in's.........

pielęgniarka, RN

Specializes in Hem/Onc, LTC, AL, Homecare, Mgmt, Psych.

Also, house supervisors should have to take a cart in case of emergency.... this frustrates me. "Just let the floor nurses pick up all the slack".... argg!

My thoughts exactly. As much as I like working with the residents in LTC (done it for 11 years), after I get my RN I am so outta there. It's too dangerous at those ratios... and adequate staffing is next to impossible either due to budget or call-in's.........

kstec, LPN

Specializes in Geriatrics/Family Practice. Has 1 years experience.

Welcome to LTC. It's all about the money and you either figure it out or get out. You learn to do your best with what you have. There are days, I know that I've just about went against everything that state would tag us for. When the states came up with the proper techniques for everything, they must of been in a facility that was fully staffed, because reality is much different. My thoughts are, if someone else can do it better with the poor staffing, then do it. I work with some lazy CNA's, who leave the nurse to pick up the slack. Toileting, changing and repositioning is time comsuming along with the rest of my job. But I can't look a frail old person in the eyes and decline them the right of being clean and comfortable. I do my best everyday that I work and pray that I don't hurt anyone. It's scary as heck, but what are my choices. This is my third LTC facility and one may be better in other ways then the others, but all in all, it's about staffing to the the bare minimum. I know that I'm a good nurse, my residents love me and I thoroughly enjoy taking care of them. I wish LTC would run how I would like them to, but that's not going to happen. I figure my options are to do my best and know that I made a small difference or quit nursing all together. Because of the LTC experiences that I've had, I'm going back in Jan to get my RN. I atleast will have more options, and maybe find a job that will not leavie me thinking everyday, what did I possibly do wrong, if anything. It's a heavy weight to carry everyday.

Thornbird

Specializes in A little of this & a little of that.

It's quite common to have two carts or to "split" a cart when short-staffed. If you go to 11-7, you will certainly have more than one cart.

You are right that once you accept the keys and the count, you are responsible. A supervisor should have taken the assignment. What really stinks is that most places count all those worthless supervisors in the staffing ratio.

kstec, LPN

Specializes in Geriatrics/Family Practice. Has 1 years experience.

Supervisors are added into the daily staffing? How can that be when they don't provide patient care? So in that case my facility we are over staffed everyday, due to having to many chiefs and not enough indians. Interesting......

Hello fellow Nurses,

I am an LPN who currently works at a Sub-acute LTC facility. We have just about everything a Med-Surg nurse would encounter and more. I work 7p-7a and recently my facility went from using 2 nurses on a unit with 75 residents and 3 carts, to 3 nurses who have their own cart. I will admit things are easier cause when there were only 2 nurses I was often afraid and feared for my residents safety and my license. Last night one of our nurses got sick and we would go down to 2 nurses. We were told that we had no other option. Now we have 2 sometimes 3-4 RN House Supervisors in house for 225 residents in the facility who are supposed to take a cart, but they weren't willing. Myself and my co-worker refused due to the workload and so many critical people on my side. I just didn't feel comfortable. My question is, is it legal for a nurse to work more than 1 cart? Would you as a nurse have taken the keys? Legally if I had taken the keys then I would have taken responsibility for whatever happended.I was told in nursing school that 1 nurse is not to have 2 sets of medication cart keys. I have fear of sharing a cart due to 2 nurses both sharing a narc box. Not that I don't trust her, but many nurses have got into trouble with other nurses who's narcotics are off count and no one wants to claim its their error. If I am going to get into trouble with narcotics being off count its gonna be due to my own error. The RN excuse for not taking a cart: "I don't know these residents cause I am new"! She has been employed with this facility for over 3 months and if anyone should know about each resident it should be her! All you don't know about a resident you can consult a nurse on that unit, a CNA or read your MAR or chart. Thanks for letting me vent

I am impressed, you are standing your ground. It sounds like that if took those keys you would have been responsible for 50 patients!!:eek::eek:. I would say NO also, and if they gave me a hard time about it I would be writing my resignation. Matter of fact I have done it.

TrickieTam

Has 9 years experience.

Thanks for the replies guys! I am happy to see that we are not alone in this situation. It happened again last night. I was scheduled with a fellow seasoned nurse and a new grad nurse. The seasoned nurse had to leave due to an emergency and I was faced with the same issue. I had to speak up for my new nurse cause I was there and I didn't want her to have to decide on the right choice. The new nurse held ground though because she had told me she just wasn't comfortable and I wasn't gonna let her be thrown to the wolves. I agree, I need to leave asap! I will be re-entering school in Jan 2009 for my RN. I hope when I supervise a facility I actually get my butt out and help and do some actual patient care.

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

I worked in one facility with a subacute floor...very busy. During the day there were 3 nurses and 4 carts. The 'monkey in the middle' had 2 carts all day. Then come 3 o'clock, both nurses had 2 carts. It wasn't a problem. I would be concerned about 'sharing' a cart especially the narcotic drawer with another nurse.

southernbeegirl, BSN, RN

Specializes in Rehab, Infection, LTC. Has 16 years experience.

our nurses have to share a cart on all 3 shifts. we are lucky though that everyone has worked together for a long time and trust each other. but when an agency nurse comes into the mix or in recent history a supervisor with sticky fingers for the narc drawer, its harder on them. they finally came up with only one nurse will keep the keys and pull the narc for the other one and they take turns holdng the keys.

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

You might want to call the DEA or your state BON. This doesn't sound like good practice.

TrickieTam

Has 9 years experience.

our nurses have to share a cart on all 3 shifts. we are lucky though that everyone has worked together for a long time and trust each other. but when an agency nurse comes into the mix or in recent history a supervisor with sticky fingers for the narc drawer, its harder on them. they finally came up with only one nurse will keep the keys and pull the narc for the other one and they take turns holdng the keys.

Sharing a cart during the day? No way, its hard enough to pass meds and complete new orders. I bet that's a nightmare.

TrickieTam

Has 9 years experience.

You might want to call the DEA or your state BON. This doesn't sound like good practice.

My co-worker who refused to share carts told me she may do that. She was involved once before with the same situation.

kstec, LPN

Specializes in Geriatrics/Family Practice. Has 1 years experience.

In two out of the last 3 facilities I've worked at we shared a cart. I thought it was pretty much common practice since you always work short in LTC. Where I'm at now we have 4 med carts but usually only have 3 nurses so there are 2 nurses getting into one cart throughout the shift. LTC is one of those places where a good show is put on for state but the reality is much different. Sad but true.

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