Seriously overworked

LPNtoRNin2016OH, LPN · Nov 20, 2015

I would like some advice from other nurses. I work in LTC and have 30 to 32 patients daily. The patients are on a lot of meds and it takes the whole 12 hour shift to do the medications. There are also a lot of treatments, and all but 3 patients have treatments. I can not do it in the 12 hours. Before I am done giving 9 am meds, I'm taking lunch blood sugars. I finish the AM and turn around back around the hall to do 11 and noon meds. I do not get a break at all until after 1 pm and start at 7 a.m. -- and that is if I get a break at all. I tell every supervisor that comes on the floor that it is too much. The last 3 nurses assigned to this hall have quit and the one before that died of a brain anurism and heart attack. I can't get charting done at all and administration keeps yelling at me and all the other nurses on that floor that we don't get it done because we are insufficient. I was on a different hall, but had the ignorance to stand up for myself once and this is my punishment. I spoke to the administrator and was straight up told it wasn't going to change. Tuesday I was eating lunch in the staff lounge when a pt's wife came in and had a fit because his tube feed was empty.
I am at my wit's end.
What would any of you do in my situation? I am talking specifically about what to leave undone and how to cover my ass.

You need to move on a find a new job. You have been told it won't change AKA they do not care your running ragged the whole shift. 31 shifts is TOO many. I have 25 in LTC, 10 of those skilled. My DON knows, anything over that, she will be short one less dependable PRN nurse. I asked on interviews what ratios are because at 25 I never take a break, with 31, how do you even pee??

Defintely start scouting out places. My current position allowed me to interview with nurses who already worked there. That way I got the REAL scoop on patient to nurse rations. Not every SNF will do this so I knew it was a gem since the DON enthuastically let me talk with her staff before accepting a position.

toomuchbaloney · Nov 21, 2015

I agree.

Do not stay in this unforgiving and unsupportive work environment.

They have told you that they don't care enough about either their patients or their professional staff to change anything.

Find another job pronto.

StrawberryEssence81 · Nov 21, 2015

I would leave. That's about how many I have on nights, but it's not as stressful as your job. Another thing that helped me is that I only have that many residents 2 nights out of the week because my schedule changed to night shift Baylor.

Good luck with whatever you decide.

AngelicDarkness · Nov 22, 2015

LTC/RHs get so busy. It's hard to keep organized. I've seen many nurses that don't work out well in the environment. It might be time to try a different nursing field.

ambr46 · Dec 2, 2015

Honestly, I would quit. The working conditions of LTC aren't going to change anytime soon. Life is too short to be this overworked and stressed.

caliotter3 · Dec 2, 2015

You need to get another job. Serious consideration to be given to whether you should resign now, or when you get another job lined up.

OldGrayNurse · Dec 6, 2015

I would like some advice from other nurses. I work in LTC and have 30 to 32 patients daily. The patients are on a lot of meds and it takes the whole 12 hour shift to do the medications. There are also a lot of treatments, and all but 3 patients have treatments. I can not do it in the 12 hours. Before I am done giving 9 am meds, I'm taking lunch blood sugars. I finish the AM and turn around back around the hall to do 11 and noon meds. I do not get a break at all until after 1 pm and start at 7 a.m. -- and that is if I get a break at all. I tell every supervisor that comes on the floor that it is too much. The last 3 nurses assigned to this hall have quit and the one before that died of a brain anurism and heart attack. I can't get charting done at all and administration keeps yelling at me and all the other nurses on that floor that we don't get it done because we are insufficient. I was on a different hall, but had the ignorance to stand up for myself once and this is my punishment. I spoke to the administrator and was straight up told it wasn't going to change. Tuesday I was eating lunch in the staff lounge when a pt's wife came in and had a fit because his tube feed was empty.
I am at my wit's end.
What would any of you do in my situation? I am talking specifically about what to leave undone and how to cover my ass.

I don't know what state you work in, but be careful following the advice to quit and find another job.

In my state, hospital are attempting to gain magnet status and no LPNs are being hired, period. Most I know are relegated to either LTC (good pay but higher stress) or physicians offices (lower stress, better hours, but also lower pay).

There are no regulations as to specific nurse to patient ratio in LTCs, only recommendations put forth by DHEC. They do exist for direct care (in the LTC, that's the CNA).

There are regulations as to overall staff ratio (CNAs, RNs, LPNs, RN Supervisors) per number of filled beds, but admins are great at fudging the numbers in paper. For instance, if your grooming techs, who only work in the beauty shop doing hair are licensed CNAs, they can be counted in the ratio and the SNF would still be in compliance, despite being short on the hall. I am the Care Plan Coordinator, but my DON won't bat an eye at counting me in the hall staff nursing ratio.

I said all to say, it's not unusual to be assigned that many (32 for one nurse) residents in my state. Normally, we try to stay 1:22 during the day, but legally it can go as high as 1:44. That's too much to provide good quality of care, and although the state recommends but does not mandate a lower ratio, they will be quick to cite your SNF under that tag anyway. They get away with not having to enforce it, but get to tag you for it if they find any care issues during inspection.

I agree with you that it is too many, and it does suck big time that SNFs are allowed to get away with it, but I'm just warning you, you may find yourself in that same situation wherever you go, depending on your state mandates.

Could you perhaps, do some quick research and pull together some care issues that may get tagged during an inspection that would be a direct result of high ratios?

Skin issues, poorly controlled blood sugars, weight loss, UTIs, are things that are consider a result of poor quality of care if they show a "trend". Also, could you suggest hiring a staff member who might like to work alongside you and split the hall for the first eight hours only? Some older nurses like the idea of the eight hour shift. Might be worth a shot at permanently getting some help. Good luck!

Neural · Dec 8, 2015

I'd say start looking for another job, but patiently. Don't do anything rash. Be confident that you're actually improving your conditions, and (try to) make sure you'll get a good reference from that place.

NurseQT · Jan 5, 2016

I feel ya! I wish I had some suggestions for you...

My work day almost sounds like yours! I actually bawled through most of my morning today after I finding out that, despite me literally begging the "higher ups" to reconsider moving a very difficult patient to my hall it was being done anyways. It didn't matter to any of them when I tried explaining that the hall is already unmanageable and the addition of this patient would make it physically impossible for one nurse to handle. Right now I spend my morning med pass running like a maniac trying to get all the meds done, it's to the point where it's not even safe! If anything goes awry well then I'm screwed! My next shift on will be in a couple days and this resident will already be moved to the hall... My a.m. med pass will take until 10, BUT I have multiple care conferences starting at 0930.. And a committee meeting (for which I was selected to partake in without anyone asking if I wanted to be on this committee!) starting at 10! Then more care conferences immediately after the residents' lunch is over (I also have to supervise the dining rooms at each meal)!! How I'm expected to complete meds, treatments, Doctor rounds (because that happens on my shift too), multiple care cobferences, meetings, charting, and multiple tube feedings is beyond me. I already want to cry just thinking about it!

greysfan_LPN2RN, ASN, RN · Jan 8, 2016

At my LTC facility where I work, I have 36 residents on a hall. With TWO CNAs... :dead:

Tired nurse · Dec 18, 2022

I have taken care of 60 residents so get out as fast as you can! I had a DON who thought 30 skilled residents was a easy load for 1 LPN that *** didn't have a clue. I decided that as an LPN you never get respect in LTC so I travel and make them pay for their disrespect! Will never work staff again.