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Discussion

RN LTC

Have started a job in LTC recently coming form a hospital and travel nurse backgroud. The facility has two floors with acute rehab on the first and long term care on the second. Each nurse has 15 patients on the first floor consisting of dialysis, wounds, knee and hip surgery etc. The second floor has pts on 02, foleys, trachs, and wounds. The night shift nurse on the second floor has all 58 patients to give medications, chart checks, treatments, accu checks, charting on specific patients, those on anitbotics, etc. Is this a norm for LTC facilities?. I was told Virginia states an RN or LPN can have up to 60 patients a shift. But does that include all that she has to do...Have done this only once and did not get done until 09:30 am...Woulld like some input on other night nurses in LTC.

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    I live in NJ and have worked on a LTC floor on 11p-7a in the past and had up to 60 patients. It was very hectic as the patients had wound care treatments, tube feedings, O2, breathing tx, AM blood sugar checks, to name a few of the responsibilities. I often found myself staying at work until 8:30 am or later to complete charting. Even though it was night shift it was still very busy, not a lot of down time. Sub - acute units usually get 2 nurses.

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    On a LTC unit, routine wound care, treatments and baths and the like should NOT be scheduled for the 11-7 shift. This is the residents' home and they should not be woken up at all hours for staff convenience.

    With that said, I have never seen a LTC facility that doesn't schedule a large chunk of its wound care, baths, Foley catheter changes, etc. on third shift. The prevailing logic seems to be that its only fair to spread the work out over all three shifts, regardless of whether or not people are sleeping.

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    I had up to 68 residents when I worked the midnight shift in LTC. My shift ended at 6:30am but I wouldn't leave until 7:30am, mostly because I was waiting around for the day shift stragglers to clock in and receive report.

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    • Experts

    In LTC, I have had as many as 80 patients. When personnel did not show up for work on Christmas Eve, but instead went to their big Christmas party, the only nurse in the building was responsible for all 165 or so residents. He knew not to call authorities on his friend the DON because it would have meant his own job.

    Some facilities schedule stuff for night shift, "to be fair", but most do not. Most DON's/administrators realize that people need to sleep at night and thus procedures are scheduled for earlier than 9 pm.

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    I am sorry but LTC needs better oversight and the same expectations as hospitals. Medicare expects facilities to reduce readmissions. How can that be when staffing is poor expects nurses to be anything but pill pushers. When are we as Americans expect no demand better care for LTC and subacutes.

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    • Experts
    When are we as Americans expect no demand better care for LTC and subacutes.
    As long as Medicaid is reimbursing nursing home care at the paltry rate of $100 per day, nothing about the LTC industry is going to improve.

    Money makes the world go 'round, and there isn't enough of it in LTC.

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