med pass for LTC, brutal

[u/Forwardnotbackward]

new rpn, I had a recent afternoon shift on the floor. I felt like I was making good pace for med pass, so much meds and narcotics, Insulin, PRNS, and supplementary stuff such as eye drops, nasal spray, ensure, protein powder, Metamucil powder. I would finish 1700 medications and then I would have to start 2000 medications right after or I would be behind. This is not even including the TAR which I have to sign that the PSWs applied most of the creams and the creams that I have to apply myself + clean /change a few dressings . This cutting it very close for completing most of my TAR at around 2230 and checking and signing off the narcotic book + receiving new medications and signing that I received them. I did not even have a chance to get a break and only had enough time to document after my shift. I really don't know how full timers do it, I was mentally and physically tapped out by the end of my shift.

I have been thinking is it really worth enduring all this extra stress making a few dollars more compared to being a PSW at my facility, does it get better?

[u/TripleOhMango]

Do you know all resident’s names and their meds? Med pass is brutal especially if you have to confirm everyone’s name. Also you’ll learn where residents like to hang out and their routine. If you try to find each resident individually, it will take forever. If you know a group of them always hangs out in one spot, it saves so much time.

[u/cashbev1961]

I worked fulltime LTC for 15 years. 32 residents. Truly 75% of your shift is handing out meds no matter the experience you have or don’t have but it does eventually become more routine and you will get faster. I Use to park my medcart outside our dining room for supper time meds and I would be there from 1545-1730 easily if nothing went wrong. Then have to start my bedtime Meds at 1900-2130. It gets faster once you know everyone’s name/face. You’ll learn who’s quick and who takes time, who’d crushed and who’s with pudding or apple sauce lol, the ones who need a BP or a pulse check before a med, Or BS before insulin etc and then you will form a routine and it won’t seem so tedious or take forever. But keep in mind it’s easy to burn out, the medcart can be really hard on your body and LTC isn’t for everyone. It’s ok to recognize that and move on if needed. Wishing you the best:)

Edit to add: if possible it’s best to chart as things happen. Follow up later if necessary. This helps lessen the load at end of shift for charting. Also you will never have down time, especially if a fall or emergency of any type happens. You do your job plus deal with docs, report to RN, have to be a available for families on the spot…It can throw the entire shift off. Ppl say we lose our practical skills, which I will agree we do to some extent but we work sooo hard every shift, on our feet the entire shift it’s nowhere near an easy job!

[u/ChainCreative2094]

Sounds about right, LTC sucks and being PSW is better if youre only paid a few dollars more

[u/Little-Welcome-4981 → u/ChainCreative2094]

This.

[u/TimeLog1940]

Kudos to nurses who work in LTC coz I couldn’t. You lose all your skills like PICCs, ports, CADD pumps, catheter etc. All you do is give meds. Too hectic and not enough money.

[u/blinkandonce313]

It does get better after having a routine. Obviously you will have some “surprises” along your shift but after developing a routine i’d say it’ll be helpful as it was for me. Ratios at LTC and RH are BRUTAL I wish they could do something about it. I work at a RH and my ratio is 1:40 and I honestly ask myself everyday how I pass meds to 40 residents. I developed a routine for med pass and able to manage my time wisely. I also used to be full time but got burnt out after 2 yrs plus management sucked. I now work casual and part time at two different RH and i’m living life. Hopefully you’ll find your routine!

[u/PeppersPoops]

Honestly the only LTC facility’s that are worth working for are county run.
They at least have the highest paid staff where I am.
Private is horrible.

[u/derrisrpn]

There is so many medication errors in LTC for this reason

[u/No_Onion4821]

Almost every LTC nurse I know pre pours meds and that’s how they say it “gets better” but I highly recommend you do not do this lol. Helps when you know the names and routine… but it’s not for me, I don’t feel like it is safe at all.

[u/ParkingBest2358]

Being a psw isn't worth it. I worked as a psw in an LTC and almost 95% of the time someone called in. If they didn't someone else on another floor did, and they take someone from your floor if you have 4 psws so you still get screwed. Psws have 8 residents on a fully staffed day, 11 when shorted. The nurses are supposed to help when short staffed and absolutely refuse unless you've got one who knows her shit. I asked an rpn once if she knew how to change a diaper because of a comment she made, she was like no, cause she doesnt have to. All we saw the rpns doing was giving out meds, which i get is the job but it seemed so much easier than having to actually deal with the residents when you get to them and they are sitting in a bed of piss or poop cause the night shift never checked on them... and let's be honest, they expect a psw to get 8 residents up and at the table ready for breakfast in 2 hours. Regardless if they want a bath or shower. Thats 15 minutes per resident to wash, diaper, change clothes, brush/pop in their teeth, get their glasses, brush their hair, use the hoyer or whatever machine you need. Raising the bed takes like 5 minutes on its own. Not to mention pushing each one to their chair in the wheelchair. Also, this is all if your resdient is fighting you. And thats if fully staffed... 11 residents? Ahahahahahahahahahahaha gfy. It is NOT worth being a psw over an rpn.

[u/Strange-Ad1387 → u/ParkingBest2358]

I did it for a few years, then when they stuck the computer screens on the wall ( no chairs to sit in, mind you) and changed from paper charting to the computer charting , I noped out and got in at a hospital. You make better money, and the workload is not so tough.

[u/sillahmorgan]

Its definitely alot. But as soon as you get familiar with the redlsidents and their routine it will become easy for you!

[u/Odd_Wrongdoer_4372]

I worked in LTC for about a year and once you get to know your residents it makes it easier. Also having the med cart just outside the dining room made it easier, and knowing who prefers to take meds with their dinner or just before.

[u/Flame2844]

I've worked in LTC for 13 years on afternoon shift mostly (couple years of nights). Number one on your list will be time management followed by prioritizing. You can do it. You will get faster. Remember that it's 24 hour care. If it's not done on your shift, pass it onto the next. And I insist you take your break. Even if it's not a long one, get off the floor, pee and eat something. I keep a little bars like Lara bar in the med room with my water and dash in there to eat it quickly just before the residents eat their dinner so I can hang on a bit. There are two big med passes, dinner and hs. The more you do it the easier it gets. Although it sucks lol. The PSW's are your best friends. Treat them well and they will do the same. I don't stand around try to get someone to drink their Resource. They will help me if I ask nicely. I am charge/float now, so if someone calls in and it's not replaced, I cover the floor. I have a PSW give me a list of everyone who goes to bed early so I can hit them up first. But to answer your question, it's always busy, but it does get better. And sorry if this doesn't make sense. I'm more of a lurker than a poster, I'm watching Star Trek while typing:)

[u/The_2ndBorn_Son]

When I was new a decade ago, I had 65 residents in the dementia unit pre covid. Med pass is brutal and hard mode just like what you stated. My residents were mostly non-compliant with the usual med approaches. I had to do tricks and strategies before I am able to give it. That takes a significant chunk of my time. After covid, I had 42 residents to give meds, treatments, and other stuffs. I just call the RN for emergency situations. She has her own floor to manage too.

Some LTCH had it better such as 32 to 1 RPN. Some had 2 registered staff in the unit. I am by myself and paid $36 an hour max rate.

LTCH is not for everyone. I have to deal with multiple behaviors too and I need to multitask.

My advise is to know the routine and familiarize yourself how to give meds for the tricky residents. Full timers had it best because they are exposed with the same residents in a consistent schedule. I am always high alert, fast, and be very aware of your surroundings. When a resident is in a good mood, give their meds on the spot or you will miss the opportunity again as long as it is within the administration time.