Sub Acute .... LTC

[LPNscottnj]

I currently work at a small mostly private pay facility. We do take Med A pts. more and more actually. They have special rooms set up like a hospital, I start IVs, We have two hospice suits etc. My question is this. Last night I had 12 Sub Acutes and 12 LTC and 1 Hospice pt, *she passed away last night btw* who was on a CAD pump, plus 20mg of morphine every hour, 12mg of ativan every hour( the cancer spread to her brain and was having constant seizures for almost two days) her doctor actually came in and pushed Valium and then vistaril ( i thought that was odd) , Tigan every six hours IM, so every ten minutes I was in the Hopice room taking care of a young lady 55 how had breast ca that mets all over esp in her bones. you could not touch her without her having pain. Oh she was getting Dilaudid 20mg via the CAD pump everyhour to top this off. I was overwhelmed. Does anyone out there have a mix of patients like this. Keep in mind we are only a 120 bed facility. We are building a new 400 bed facility that is under construction as we speak that will have separate units for LTC, Sub Acute, Hospice etc. For now however its seems unfair to my LTC patients that most of my time is spent with my Sub Acutes that need more attention and time. Am I crazy or is this messed up. We do have a third nurse who does all the doctors orders, charting, treatments and so on. So I dont have to be at the desk. I am on the floor at all time with the patients and families. Starting IVs and yes TPN is a new thing now as well. Great experience but alot of bedside care. Any thoughts on this I would appreciate. I really should be a RN I dont think RNs always realize that LPNs are capable of extensive skilled care all the time. Sorry just frustratrated and apparently cant spell well tonight.

[Drysolong]

In my limited exp., sub-acute wings are separate from LTC.

Also, I am an LPN on a med-surg hospital floor doing the same work as RN's,with a few exceptions. Hence, the goal is to become an RN.

[CoffeeRTC, BSN, RN]

Well...kinda. I am in a LTC facility, but at least 10 or so could be sub acute. We get the Hospice pts too and the typical LTC resident. Sounds I have 24 in all and yes....I think I totally get how you felt. We do start our IV (but also have an outside IV nurse), we do TPN etc, do the morphne drips etc..no vents, but have trachs.

I do think this in an unreasonable ratio too. I'm an RN and work the floor. For the most part, the LPNs and RNs are equal except when it comes to the supervision in our facility.

[CapeCodMermaid, RN]

None of the facilities around here do TPN...none of them. The risks are huge and the reimbursement isn't worth it. I'm surprised all y'all do it. None of the facilities around here do morphine drips either. No one does IV narcotics at all....even on a sub acute unit.

[TheCommuter, BSN, RN]

I worked on a subacute unit at a nursing home for the better part of 2 years, but it was structured much like a free-standing rehabilitation hospital. I usually had 15 of these types of patients during day shift, and about 30 at night. My former workplace liked to separate the subacute wing from the LTC wings, because they did not want the fully alert rehab patients to mix with the demented nursing home residents.

On this particular unit, we dealt with many central lines, IV antibiotics, CPM machines, feeding tubes, suture removal, surgical staple removal, complicated wound care, ostomy appliances, diabetic management, casts, braces, splints, cervical halos, and so forth. I once had a patient who was receiving TPN.

Most of my patients had recently underwent surgical procedures such as laminectomies, knee and hip arthroplasties (joint replacements), kyphoplasties, CABGs, hysterectomies, limb amputations, colectomies, thromboembolectomies, and abdominal aortic aneurysm repairs.

The non-surgical patients were typically admitted to our unit for recovery from CVAs, acute MIs, debility, various cancers, fractures, status post pneumonia, deconditioned states, failure to thrive, status post falls, generalized weakness, and other afflictions.

[sharlynn]

Wow! In my opinion, 12 subacutes would be more than enough for one nurse!

[SoggygranolaNurse]

Our subacute unit only had 15 patients to a nurse. We had all the above as well as heparin drips.

[NotFlo]

I really think mixing the LTC with the subactue is not the best way to arrange things. I hope the new construction is finished ASAP.

I work subacute and have 15 patients for all three shifts. That's plenty. Yes, I have had hospice patients in the mix that required very time consuming care, along with the TPN, peritoneal dialysis exchanges,etc. It's crazy.

[Chris81]

Do you have a hospice affilliation c VNA or an official Hospice program? I have worked in a 59 bed LTC that always has an interesting mix-Med A,LTC, respite, younger adults c MS/dystrophy/and the usual-IV ABX/CPM/SCD'S/wanders, sliders, talkers. We staff c 2 med nurses, 1 charge (10 hr) shift, and 8-9 CNA'S day shift. And yes, when we get a highly acute elder the mix changes. In the case of a hospice pt. that is rapidly approaching the end, our hospice nurses, who work c VNA are always available to come into the facility and take their pt 1:1. They have privliges to administer med, contact MD, engage the family, and keep us updated. After the death, they call the MD for pronouncement, can call the family if requested, and do all the documentation. Don't know what we'd do without them