What are all of the duties of LPNs at LTC Facilities?

Forever Sunshine, ASN, RN · Mar 6, 2010

What are all of the duties of LPNs at LTC facilities?
I work in the LTC areas of the hospital where I work for two of the four hours I am there and I have been observing what the LPNs do.
Most of the "dirty work" (diapers, changing the patients) is done by the CNAs (most of the nursing staff here are CNAs) as well as making beds, laundry, feeding, bathing, and assisting the patients. I have observed the LPNs only distributing meds and testing blood sugar, but I am sure they do more than that.
I am interested in learning what they do because I hope to be doing the same thing one day.
Thank you. :)

I just started my first job in LTC as an LPN. I can only speak for about a months work, for the most part so far I am giving meds(which takes up more time than you would think lol), testing blood sugar, skin treatments like wound care, tube feedings.

Theres also things to be done at the desk but I am not too familiar with that yet such Entering md orders, updating mar/tar for the month, nurses notes, medicare charting, cna assignments, im sure theres more but I only shadowed at the desk a couple times so I don't really know all the things they have to do.

josh1974, LPN · Mar 6, 2010

To continue on Dajulieness' post. Intakes, discharges, trach care, suctioning, I n O catheters, replacing a g-tube with my don, helping your cna's, moving tv's for residents, lots of documentation, IV's, hmm, trying to think of what else I did today. Oh yeah, colostomies and urostomies. Answering lights, getting ice, trying to ignore the dementia resident that sits at your med cart mumbling about stuff. Don't get me started on the prn narcs! lol. But my facility is very high acuity, so may not be like that everywhere. Its a wonderful way to start as a nurse. You learn a lot really quick! Good luck to you, hope this helps and doesnt harm.

dhinson45 · Mar 6, 2010

I have worked in LTC for around 36 years and there are different areas that nurses work in, such as custodial, skilled. locked down units,etc. Different areas have different responsibilities. In general the most commom task involve; having a secure facility,taking care of all patient needs, mental or phy, satifiging family members ( when they ask " where is mothers' red sweater!!!!" you are expected to stop what you are doing and deligate or track it down yourself) .There are too many resp. to list here but here are a few.

You have meds to pass and each shift is different,treatments to do,blood sugars to get and may be twice on your shift, work the dining room passing trays, making sure each resident gets the appropiate tray with only their things on it allowed, feeding patients, cleaning up spilled food, dealing with angry relatives when thing are not perfect, picking up trays, moving residents out of the diningroom, and deligating what you can as you have more meds to pass now and the phone is ringing and you have a new patient to admit= at least 2-3 hours to tend to the family and patient then all the assessment that need to be done on them, that's psy, physical, skin, and all other areas. Finding out where your CNA's are and not answering the lights per family member and " she has rang for 30 minutes-WHERE ARE YOUR AIDS!!!!!!!!! You have just been informed that one was sent home and now have only 2 to assisst 18-20 patients and the maj. are bed ridden and total care.

THEN there is an ALARM going off in 310 and you know the GT is tangled up.

The paper work. Well there are the weekly assessments, monthly assessments, wts that need to be done and documentated, V/S taken and documentated.( follow up if any adnormal) posting of each BM and follow up of meds if needed, showers taken, any skin breakdown, and if so, needs incident report with call to MD,family and after orders documentation of all and if pt fell and not observed, have to do incident report and v/s every 15 minutes WITH assessment of all neuro signs. Then the MD shows up and wants you to make rounds with him= each of his patients and every concern that they have and/or their relative has. Orders to take off, labs to order, meds to order, transcribe to med sheet, initial nurses notes to include entire phsical assessment. All this time buzzers going off,people coming to you and asking " Where is Joe Blow, what room? well he was not there so where do I find him? Where is my mother/father/etc, why is that person wearing my mothers blouse? Then there are the fights between the patients, she stole my _______. Then the dining room doesn not deliver the pm snacks and they are gone before you know it, what to do with your Diabetics? Mary is yelling down the hall wanting her 2 oz of wine NOW. OMG- here comes ____ ____'s daughter and she looks mad as usual. (SIGH). Who ate all of my mothers pudding??

Medicare charting= skilled documentation= see,hear,what degree of asst needed, able to assist nurse?? the pages go on.

Well that is about 3 hours worth on your shift. Each shift is different. With the evening shift= after 5 so family members come in and can really raddle your cage, also time for all meds to be delivered, accouted for, passed to carts, transcribed as rec, and administered. There are the sleeping and pain meds given, signed out, and control log count done. Oh!! did your remember that that red sweater is still missing and he is back at the nurses station wanting to know what you have done about it? NOW

THEN the State walks in.

I suggest you go take potty break now as things are going to get sorta busy:nurse:

TonyaM73, ASN, RN · Mar 6, 2010

dhinson45 , wow i didn't know you were following me around yesterday???!!! by the way you forgot about the pt that fell and hour before your shift and you were told that they had a skin tear, but when you checked her out she has two skin tears: one 12cm in length and 1/2 cen in width and the other 7 1/2 cm in length and 1 1/2 cm in width both are bleeding through the thick bandage that was just applied about an hour before and her foot now looks like an over inflated football. of course you have to send her out for an xray, but dang do you have to fill out allllll of that paperwork while you are still trying to get your morning meds?????? yes

rdop5388 · Mar 6, 2010

Wait a minute. You forgot the new admit. paperwork paperwork

lisamc1RN, LPN · Mar 6, 2010

Excellent post dhinson45. Don't forget that one STNA who can never be found and every time you need to ask her a question, you need to track her down first. Oh, and when the big bosses decide to do a walk through, and your administrator wants to make sure that all the closets are organized, as we never know what they will want to look at. Not to mention, the little old lady who steals coffee cups and spoons and stores them in very creative places all over her room, so you are constantly doing room checks on her. And the med room that needs to be organized AGAIN because a few nurses just throw things anywhere and now you can't find what you need quickly. Oy. LOL.

kcochrane · Mar 6, 2010

All of the above and in my facility we did patient assignments once or twice per week.

scoutsmom · Mar 7, 2010

dhinson45 hit it so well in telling what her day is like as an LPN in LTC, I could of wrote it too, now working in a state place though it is a little better, the RN's do the admits, and ect.. LPNs to the treatment cart or meds, we take turns , one day the meds , one day the treatment cart, treatment cart nurse does neb treatments, accu checks, -( 16 accu checks on some days at 1600)! insulins, drsg changes, the Med LPN, handles the meds and report, and bowel interventions.

tiredstudentmom · Mar 7, 2010

To continue on Dajulieness' post. Intakes, discharges, trach care, suctioning, I n O catheters, replacing a g-tube with my don, helping your cna's, moving tv's for residents, lots of documentation, IV's, hmm, trying to think of what else I did today. Oh yeah, colostomies and urostomies. Answering lights, getting ice, trying to ignore the dementia resident that sits at your med cart mumbling about stuff. Don't get me started on the prn narcs! lol. But my facility is very high acuity, so may not be like that everywhere. Its a wonderful way to start as a nurse. You learn a lot really quick! Good luck to you, hope this helps and doesnt harm.

Thanks for your post! I now have some hope...I'm pre-nursing and getting a lil down about getting a job when it's all over with; however, by the time I even finish school...maybe there will be some jobs available. I worked as a cna in a LTC almost 10 years ago (where did the time go?!) and work currently as a medical asst. I know this experience won't get me into nursing school, but I think it will help when it comes time for clinicals and being on the job. I know how to do vitals, take histories, venipuncture, etc. I love working w/ the older folks, there's just something about the older generations. I adore the patients we have at our office. It's so easy to get to know them. off subj,...sry! But I'm just glad that there is hope for us future nurses! :rolleyes:

Fngrpntsnotasin · Mar 7, 2010

Don't forget about the high strung, order-happy, weekend supervisor (that only works one wkend a month) that will not stay away from your med cart/tx cart/MAR!

~Mi Vida Loca~RN, ASN, RN · Mar 7, 2010

What are all of the duties of LPNs at LTC facilities?
I work in the LTC areas of the hospital where I work for two of the four hours I am there and I have been observing what the LPNs do.
Most of the "dirty work" (diapers, changing the patients) is done by the CNAs (most of the nursing staff here are CNAs) as well as making beds, laundry, feeding, bathing, and assisting the patients. I have observed the LPNs only distributing meds and testing blood sugar, but I am sure they do more than that.
I am interested in learning what they do because I hope to be doing the same thing one day.
Thank you. :)

I haven't read the replies yet but I did do my first semester clinical at a LTC. I first have to say, I cringe at the saying diapers in regards to adults. Anyway, I gained a lot of respect for CNA's and Nurses from these clinicals. While the CNA's did most of the "manual work" in regards to the tasks you mentioned, I could certainly see why. The whole place was considered one of the GOOD nursing homes, but if that is the case then I would hate to see a bad one. Anyway, their needed to be a lot more CNA's these poor CNA's were overworked and it would "appear" they did everything. But actually shadowing the LPN/LVN during my stay, I could see that although it appeared they did nothing more then pass meds, their was a lot more to it and no time for much else.

On a good day, where their were no pt. emergency, there was 4 halls on each wing and ONE nurse per 2 halls. She started her shift with report and started her MED pass. Which that system alone was very outdated, confusing and time consuming, the med carts were also very small and packed and unorganized. Each patient had TONS of medication, most of the patients had trouble taking it. So just giving them their meds was time consuming. While giving meds the nurse did an assessment and addressed any wounds(which seems their were a lot of them) and doing the dressing changes. They had to do the blood sugars which seemed was every other patient. Then they had to quickly move on to the next patient. It seemed by the time they were done passing meds, they tried to grab 30 mins to chart on ALL of the patients. There were no portable computers and charting had to be done on all patients at the end of the med pass. No sooner then when they were done with charting, was it time for the next round of med passes, and being that it was a nursing home with an elderly population it seemed that never a day went buy without someone having extra medical problems that took a lot of time as well.

These nurses wouldn't have had time to do anything other then Meds and Charting and assesments, but they also had to do all kinds of paperwork for Insurance and Medicare, I can't remember the names of all the strict assessment they had to do. It was terrible. Terrible because for the amount these places charge, they can afford to staff a few more RN's and CNA's

The CNA's were pretty much the same, by the time they were done with round one, it was time to start again.

My first day, I noticed I went home with a lot of judgments, I felt a lot of anger towards both the CNA's and the Nurses, I felt these patients were so neglected, handled with a cold touch, and a hearding type mentality. Meaning, they were nothing more then a number, or a task that had to be done, rather then a real person with emotions and such. In my new student mind I felt like their were no excuses for such things. After really observing more, as much as I hated seeing it being that way, I saw their was no way around it on the Nurse and CNA end. It was a management thing. The nurses and aides were doing the best they could with what they had to work with.

I shadowed at the local jail to, and hands down. I would work their over the nursing home anyday. The staff and population were treated MUCH better. As sad as that is to say.

Anyway, you say you work in a facility so I am sure you are very much aware of these things (the problems I mentioned). But as far as what the nurses do, it may not seem like they are doing much but they really are, in fact they expectations placed on them isn't right. I really hope someday it changes but I am not hopeful from what I have heard and saw.

All in my opinion of course and I am sure not every place is like this. I was just shocked to hear I was lucky to be doing clinicals at one of the good places. Best of luck to you on nursing school :)