RN accountability in long-term care facilities?

[LydiaGreen]

Hello. I am a student who will be graduating in May and am from a smaller "city" (less than 9,000 population) with only one long term care facility. Yesterday, a representative came to speak with my class of eleven about working there as RN's after we graduate. The addition of another unit should be completed by the time we graduate and have written our registration exam. The rep stated that they will then have over 90 beds. The way that this facility works is one RN overseeing one RPN per unit (three units) with an average of three professional service workers (what you would call CNA's I guess) per unit. This is during the week. On the weekends, there are only two RPN's for the facility.

We asked about the accountability of one RN being responsible for the care of greater than 90 patients in a shift. This is the norm in LTC in Ontario, apparently. The rep stated that we would not be accountable if something happened to a "resident" unless we knew of the situation and did not act. I have heard from others that an RN would in fact be the one accountable.

I know several of the RPNs who work at this facility and do trust them and their skills. But an RPN is responsible for approximately 30 residents and the RN relies on them.

I have learned a lot in nursing school but I am certainly not foolhardy enough to believe that I am experienced. This facility would give us three months of working on the floor (one month in each unit) with an RPN before assuming the role of the RN (that is the role of the RN in this facility).

I have not received any type of management training through my nursing program either. Just wondering what your opinions would be on the safety of a new grad taking such a position. All of my classmates (with the exception of two who have worked in this facility as aides) believe that this job would be overwhelming for any new grad and that we would all be better off gaining experience in Med/Surg (averages 8 patients in a shift) before assuming a role as demanding as that of an LTC RN.

Thank you for any responses in advance. :)

[jkaee]

First and foremost, good luck as you finish nursing school. It's and exciting and stressful time, but well worth all the work!

Also, thank you for recognizing that geriatric nursing is a demanding field to be in. Too many hospital nurses think that LTC nurses lack skills, when in fact, our skills have to be sharp, if not sharper, than most areas because we aren't relying on machines to tell us when something is wrong with our patient, and we don't have a doctor around at all times. But, I digress.....

You are wise to be weary of taking on such a big responsibility right out of nursing school. If this RN position will entail supervising staff and handling any staff problems or issues, I would definitely wait and gain more experience first. It is so important to concentrate on building your assessment skills and time management skills (as well as staff management skills) before you take on a position like that. While you are working as a nurse, if you are lucky, you will have a good manager or supervisor that you can learn from, and see how to handle difficult situations that RN's are put in when they are responsible for all staff.

Regarding RN accountability, I work in a LTC facility and sometimes I am house supervisor on the night shift. That means I am the only RN for 140 LTC beds and the same number of Assisted Living residents. LPN's staff all the units. If something does occur with a resident, I am the one they call. I have to act accordingly and decide what the resident needs. Ultimately, the accountability falls on me, but it is my staff's responsibility to tell me when a resident's condition changes. It can be a very complex situation, but if you have a good staff working with you, it can go smoothly.

My advice? Get more experience first, so you can learn how to respond to emergency situations, staff situations and feel more confident as a professional nurse. Supervising staff can be very difficult...wait a couple of years before taking on that responsibility.

[sixes]

Congradulations

Iagree with jkaee

I am also an RN in a LTC

On Night and evening shift I am also the Supervisor and am responsible for 150 residents as well as nursing staff. I am also considered the quailfied first aider therefor responsible for all support staff.

I had 10 years experience in home nursing before taking on this job.

I thank god every shift that I have great nursing staff. I depend on them to inform me if a residents condition has changed or something new has popped up.

On evenings I have 3 wonderful RPN's and on Night's 1 RPN

On evenings I have 5 PSW's per floor and Nights I have 5 PSW in the building.

I am accountable for ever thing that happens in the building. I guess if I don't know I could still be held responsible. I am the luckiest rn in the world in my opionion. there isn't one staff member that isn't there for the well being of our residents.

I also have the greatest DON as well as Administartator. I can call anytime day or night.

Our doctors are also great stuff. they can be reached night or day

they both have general knowledge of each others residents.

We have Advance directives which helps alot and if in doubt ship them out.

Some shifts are more hectic then others as it will be any where you work.

Even with 10 years experience my 1st shift was one straight from HE**. Had to call in the DON at 0300. I figured it was my first and last shift as a supervisor. to my surprise she said this is an unusal occurrence you'll be just fine. You did a great job.

I've been there 6 mths and I learn something new everyday.

If they could only teach me to spell

:roll :roll

Best of Luck what ever you decide to do with your new found career. follow your heart

[LydiaGreen]

Thank you for your responses. I agree that neither I, nor my classmates, are capable of assuming this type of responsibility straight out of school. It would be easy to fool ourselves in to believing that we could handle it (a high position for a grad fresh out of school could seem prestigious to some).

I do not believe that this would be responsible, even if it was an ideal LTC. Don't get me wrong... I have visited four LTC's and done placement in one. This LTC is by far the best. But, matters are complicated in that 35 of the current residents are physician orphans (we have a chronic shortage of docs in our community). We now have PSW requirements (implemented recently) but prior to that I believe the only training was something like two weeks for anyone who walked in off of the street and got through the interview. I have friends who are currently taking the PSW course and am very impressed with the curriculum and the texts. Their skills text is much more understandable and comprehensive than the one that we were provided with for our nursing resource centre courses (as to general assessment, transfering, feeding, etc). But, I do understand that nursing requires additional skills that are not covered in the PSW text.

On the weekend evenings there would be one unit without an RPN. I understand that experience is a greater teacher than theory however, I believe that it is necessary to have the theory behind you to adequately perform any healthcare occupation responsibly. I would be concerned about my accountability in a situation where the staff were entirely pre-PSW-training, (staff that were in place prior to the new requirements are exempt from them).

Thank you for your input, it has reinforced my thoughts that I would require a mininum of two years in the hospital med/surg unit to hone my skills before moving into a position that requires more accountability and responsibility. To be honest, I will likely be overwhelmed with eight patients when I graduate (our hospital does a lot of TKA's and gyne surgeries and serves as the operative hospital for the area one week per month - for emergency appy's, choley's, obstructions, etc.). I think that these clients will be of a high enough acuity for a fresh grad with the backup and knowledge of an experienced DON and nursing staff.

The three classmates who have worked in the facility as aides will likely pursue the position. Perhaps that is an entirely different situation and they will have no trouble adapting to the RN role. But, I know that I would.

Thanks again for your input.

[purplemania, BSN, RN]

If you are anxious now I doubt you will feel more comfortable later. How can someone who is not an RN train you to your job? How can one person possibly know what is going on with 30 people, much less 90??? Sounds like a problem waiting to happen. All new RN's need a foundation in what RN responsibility and accountability is, including leadership.

That said, I will add congratulations for getting this far in your career. You sound like you have your head on your shoulders and that is a definite plus!