Struggling in LTC

Lovely_RN, MSN · Feb 26, 2008

My situation is almost identical to yours except that I have 40 patients instead of 29. The state is also supposed to be coming to my facility sometime in March and I feel ambivalent about it. On the one hand I am concerned but on the other it's not my dang fault that this place is run the way that it is. I recommend that you don't make yourself sick over this state survey. Just be calm about it and when the surveyor is observing you take your sweet time and do everything by the book. It's likely that they leave you alone after observing you with a few residents if you do things right and don't act nervous.

As far as the question about why most hospitals are not hiring LPNs anymore I can't say. I think that it stinks but the only option for us LPNs is to continue on with our education because it seems as if this is not a trend that is going to go away anytime soon. If things weren't the way they are now I would likely take my time getting my RN. But since it is the way it is I am going back to school next month because I hate not having options.

It's not that I hate working in LTC because aside from the BS with all the paperwork and being forced to do shortcuts to get the work done it's not a bad place to be. The residents really do need us and I have gotten to know many of my residents personally and I do care for many of them. It's just the lack of options that irritates me because if I leave this job I have no where else to go to except another LTC or maybe a clinic.

crazdmomof4 · Feb 26, 2008

I feel your pain. I am in a very good facility, but am struggling with the lack of training / continuing education being provided. I started working there last May after passing my NCLEX, and was ping pong'd on three different wings, which as a brand new nurse was terrifying. There was very good training at the beginning and we have a wonderful DNS, who is very patient. But this weekend was a killer. We got a call from the local hospital for a sunday admit. Normally those are done by the admissions nurse, but it was for my wing, which is a sub-acute. We got the paperwork during the day shift and the day shift nurse told me in report it looked like a good admission. I mistakenly thought she had actually done her job and read the prog notes from the hospital and pt meds list. OOPS NO SHE DIDN'T.

When social svcs from the hospital called me I was in the middle of my med pass to 22 pts. Quickly glanced at the notes / meds. none were psych, but the pt had been 1:1 on 23rd and 1:1 dc'd in am. According to SS / RN caring for pt, was doing fine, no problems with unassisted ambulation and was managable with her dementia. Now this being my first admit, I go according to the doc's orders for meds who's releasing her. After telling the ADNS about her being 1:1 prior to Sunday and that there were no psych meds, and no fall risk due to confusion, the ADNS agreeded to do the admit. I did most of the paperwork, verified the meds etc. When pt arrives, she's having visual hallucinations and is non-managable, very confused, and kept trying to ambulate...though she can't walk hardly. I get an order for ativan to calm her, it doesn't touch her. So the doc is called back and ups the dose. Pt finally calms down and is ok for night. Next afternoon I go into work and there is major drama regarding the admit.

Pt is total 1:1 care. My hall's nurse manager is upset that pt had order for ativan because its a chemical restraint. Yet the previous night pt is swinging her foot rest around, and at aids. We are short staffed with aids, have 2 very high maintenance pts who think they should be 1:1 are alert and oriented. One of said 2 is 47 with MS and has very manipulative behavior.

With my sunday admit, I not being a mind reader, missed the fact meds doc ordered were not what was on at home (we did not have a list of home meds). Did I mention this pt had not slept since admission? Sometimes I think were are supposed to be mind readers and know everything to do, not do etc. So frustrated over this admission and lack of alternatives being provided to nurses for problem management. I swear I will never do another admission on the weekend. They are always a hospital dump. This weekend is making me question my ability to be a good nurse because of things I missed in the admission. I hate feeling inept, and this weekend did that for me. Sometimes I don't think I am cut out for nursing.

I wish you luck in your survey. If its anything like the ones I have heard about in washington, they are only with you for a couple of pts med passes. Remember they are government worker's and work on an 8-4 schedule normally. Besides you are not the DNS, its her responsibility for adequate staffing. Do your best and let the rest go. Its a lesson I am learning the hard way, though in the above post it doesn't sound like it. Good luck

NurseJosh · Feb 27, 2008

Thanks for the advice. You are right. I'll just go by the book and take my time. I never thought of that-it's not my fault if the pt ratio is too high for me to get meds passed on time. Oh, I would like to add that i got 2 days of training. My first day on the hardest "run" in the facility was spent chasing a nurse trying to get her stuff done on time. The second day she didn't show up so I had to do everything myself. No less than 5 times I wanted to just walk out of the door. The 3rd day she came back and I chased her around again. That was my training. Like I said, I start the RN program in September and at least now I know more about medications and time mgmt. but I also know there is NO WAY I will stay in LTC. I like the residents but the nature of LTC nursing just isn't a fit for me. Thanks again for your input.