Umm...I will have 47 residence to care for !!!!!

[BigB]

I am oreintating as a new grad for the 3-11pm shift. I have found out that I will be doing all the meds, charting and treatments for all 47 of them. Is this even legal?

The unit manager doesn't help with anything on this unit, and the last two people hired on the station both quit after 2 weeks!!! How in the world can a new grad ( me) that doesn't know any of these patients, or have any prior LTC experience get all this done? Meds I could do. But add treatments, charting, and doing the new admits..NO way! I am starting to think I went into something that I won't be at very long.

After a couple days of orientation I am learning a little about the paperwork but it seems like such an uphill battle. Any advice from TLC works?

[chadash]

Are staffing levels like this a problem with state standards? Would there be problems if the state inspected? I really wonder how places get away with this.

[GLORIAmunchkin72]

Doesn't surprise me a bit. I guess as soon as you accept the position, no matter how crazy it is, you accept responsibility and accountability. You could try to explain in court how much you had to do, that you were the only nurse there, etc., etc., but the bottom line is you accepted the responsibility. You better think very hard before you take on 47 residents!

LTC is very scary for both new grads and experienced nurses. There was some kind of incident at the local LTC here. A patient with an NG tube started vomiting and died before they could get her to the hospital. A new grad was in charge and the newspaper was saying that criminal charges might be filed against the new grad.

[dawnb70]

I currently have 33 residents to care for. I have been responsible for as many as 72 when I was the only night nurse in the building. It is possible, but you are not able to give the care your residents deserve. I'm curious about the laws of nurse to patient ratio. Sometimes I think they don't pertain to LTC facilities. I do know that it's based on the acuity of care. Most of the residents are going to be generally healthy, and you'll only see them during your med pass. Pitiful, but true. If you really like geriatric care, there are always LTC facilities hiring. And I'm sure you will be able to find one with a lower ratio of residents to nurses. Good luck!

[Marylou1102]

My concern would be only one nurse in the building. What happens if there are 2 emergencies at the same time.

[PurpleHairUnicorn]

This was sent to me by the Illinois Office of Health Regulation...

excerpts from the Illinois Skilled and Intermediate Care

Facilities Regulations to define the different classifications for residents.

These can be located in section 300.1230 of the Regulations.

"l) Skilled Nursing Care

Residents needing skilled nursing care may only be cared

for in facilities licensed as Skilled Nursing Facilities. Each resident needing

skilled care shall be provided at least 2.5 hours of nursing-personal care each

day, of which 20% must be licensed nurse time. (A, B)

m) Intermediate Nursing Care * General

Residents needing intermediate care may be cared for in

facilities licensed as either Skilled Nursing Facility or Intermediate Care

Facility. Each resident needing intermediate care shall be provided at least

1.7 hours of nursing/personal care each day, of which at least 20% must be

licensed nurse time. (A, B)

n) Intermediate Nursing Care * Light

A Long-term care resident needing light intermediate

care is one who needs personal care as defined in Section 1-120 of the Act; is

mobile; requires some nursing services; needs a program of social services and

activities directed toward independence in daily living skills; and needs daily

monitoring. Each resident needing light intermediate care shall be provided

with at least one hour of nursing/personal care each day, of which at least 20%

must be licensed nurse time. (A, B) ..."

Medication passes may start up to one hour before the ordered dose time to no

more than one hour beyond the ordered dose time.

We have a regulation that indicates that the facility must have enough staff to

meet the needs of the residents. Are any of the residents not receiving ordered

services because you are unable to get them completed? If you are unable to

complete task/s, how do you chart the inability to provide the service/s?

The facilities get away with understaffing by not classifying residents apropriately. They also turn in staffing sheets with employees listed who no longer work for the facility (Happened to me 7 nights out of 9 in a 2 week period, leaving me and 2 CNAs to care for 62 residents, most of them confused and fall risks) Until the "State" comes in and catches the facilities with inadequate staffing, and actually verify the resident's true level of care, the nurse on duty will be left holding the bag. It is my understanding that if you clock in and take report,if you leave, you have abandoned your residents and are subject to legal action. (Don't know if this is a fact or not, this is just what the "higher ups" have stated.)If you stay, and something happens, you can be held liable also. Darned if you do, darned if you don't.

[jonear2, RN]

wow...i had no idea that such demands were made on ltc nurses. i am a new rn grad (nclex march 1) and i am on orientation to a progressive care unit at a teching hospital where 6 patients seem very daunting. it absolutely seems impossible for you to do your jo the right way. beyond the med pass, charting, etc... how about turning the patients??? i understand that there are cnas but protocol is turn q2 hours, even with 2 aides and yourself that is impossible and dangerous. pressure sores will kill just as quick as anything else. run far far away. but please don't forget the patients. dont just go and get another job and put that terrible place behind you. contact your state inspector. something. does jcaho inspect ltcs like they do hospitals??? maybe its time for a visit.

[dinkymouse]

I am generally charge, 3-11, of 70 residents. We do have 6 aides most of the time and I have at least med tech to pass 1/2 the pills. On a good day I have 2 so I only have to do the tube feedings, insulins, orders, charting, assessments etc. This last weekend staffing was awful, "Superbowl Flu". The on call RN wanted an LPN to be responsible for all 70 patients without a med tech. I told her no and that it wouldn't be safe. She said she thought a lot of facilities had 70 patients and only 1 nurse. I told her that if they asked me to do that Iwould refuse. The LPN did have to be alone for 2 hours.

[donmomofnine]

wow...i had no idea that such demands were made on ltc .... does jcaho inspect ltcs like they do hospitals??? maybe its time for a visit.

we are jcaho accredited for three years now. the accreditation process now involves unannounced visits. it used to be an announced survey, though.

[xmaxiex]

This is not safe ! And any facility who would do this to a new grad is not somewhere you should be working . Your licence is too valuable to put it in jepordy .

[Momto2Boys]

Oh I would be in heaven to have only 22 patients. I just got two more admits so I have 49 patients now!! 4 nurses aids. 5 GT patients. Too many diabetics to count, although I only need to do "finger sticks" on about 11, twice during the shift. I have to answer all the phone calls, pass all the meds, chart on all the daily charting and 3 weekly summaries, do all the treatments (there are about 40 to do ranging from protect barrier cream, to complete hard stage 2 - 3 and 4 decubs. How do the lvn's before me get all this done??? Oh I know.. they dont do it, but chart that they did. I do everything I am suppose to do and have to say at work and extra hour UNPAID!!!!. I have put my two week notice in . The DoN is pissed off cuzz they gave me a 3 week orientation and now I am quiting. Screw this place. I am not losing my license and I am tired of being thier slave.

:yelclap: :yelclap: GOOD FOR YOU!!! :yelclap: :yelclap:

KEEP US POSTED!!!

[yadda_yadda_yadda, LPN, LVN]

Run for your license!

[BrendaLeeRN]

I work in a state that requires 3.0 nursing hours per resident. That would be great if we had meters and once we hit 3.0 hours were done with that resident for the day, but real life doesn't work that way. I too am a new nurse (NCLEX Aug 2005). I oriented for about a month on every shift except 11-7, then started working 11-7. I was responsible for 55 residents, some in a subacute condition. Many just off med surge. That was too much, with treatments, medicare charting, early am med pass, trach care, and multiple g-tubes. Never mind all the other paper work they thought I could do while the residents slept (ha! ha!). So, I explained that as a new nurse I was not comfortable, and then floated 7-3 and 3-11. I had responsiblity for half the patients then, and other nurses to ask advice when in doubt. Much better for me, the facility survived, and I'm now on 7-3 only as charge nurse (55 residents, 6-8 aides, and 2 - 3 other nurses also). Much, much better.