Last year I returned to LTC PRN after 5 years of working in clinics,, we are a billed as a low acuity LTC w/ 8 beds dedicated to rehab patients. When I first started working, the rehab patients were stable, mainly hip fractures needing PT/OT, and stroke patients that were needing a little extra time before they went home.
The types of rehab patients they have been taken in lately are more sick than they ever been. Because we are supposed to be low acuity, we don't really have the capability in terms of time to take on more critical patients since all 25 of my patients are separated into 3 different halls.
My last shift was a double, I had 17 LTC patients, 6 rehab patients, and two empty beds. My 6 rehab patients consisted of a PICC line w/ ATB for sepsis (he was pretty stable though), patient w/ multiple wounds(one on the coccyx so constantly needed changed because he had many BM in a shift) and patient had c-diff. 3rd patient was pretty much self reliable, 4th was hip fracture w/ low hemoglobin who I was constantly monitoring due to pain and possibility of hemorrhage (she was like 2 days post op and hemoglobin was trending down), 5th patient walkie/talkie but very agitated with no orders for any type of anti anxiety due to family request, and my 6th patient on IV fluids, with hypokalemia/CHF who I was also constantly monitoring to make sure she wasn't filling up with fluid plus I was very concerned about the fluids + already hypokalemic situation so I was in contact w/ on call often. Plus my 17 other LTC patients. I never took a break (which lets get real, who does in LTC) nor never sat down besides to chart for 16 hours.
My boss happened to come in for the other side because no one over was scheduled to work. I ended up calling her at 2100 because one of my aides called to inform me one of my LTC patients was bleeding from the rectum which is the first time this has happened for this patient. I couldn't leave my rehab patient because she was starting to fill up with fluid, I stopped infusion per MD, and was in the middle of getting all of the other orders for her together when this happened.
My boss acted like I was incompetent. Now, I am no LTC expert so I am wondering if from your all's perspective if I may need to change my time management habits or if this is an actual heavy assignment. I am due to graduate with my RN in April and I want to make sure if I am not being efficient enough with my LTC patients to complete all of my tasks that I start figuring out why that's happening before I work in a hospital and have more critical patients than what I have now....
