Originally posted by RainbowSkye
.......Do any of you nurses who work in long term care have any suggestions?
I used to work LTC, did it for years. But I gave up. I will never go back. As the only nurse for 65 pts (9 tube feeders, two trachs w/ MRSA, all the rest demented, frequent falls, total care, etc). I had 3 aides usually, sometimes 2.
Many of the charts do not even contain the residents' code statuses, or even their allergies.
Many times, I've called res' "next of kin" or "responsible party" as listed on face sheets to find that the phone #s are disconnected, or are incorrect.
Many charts do not have an H&P.
I once had pt who had a clogged G-tube. I removed it and inserted a foley, it worked fine. However, I was written up. I was told this was against policy, and that I should have sent the pt to the ER.
As for FOS pts- Often CNAs will lie, and falsey document, saying a res had been having daily BMs, when they have not.
Because if I give a laxative, Fleets or whatever, the pt will then really be having BMs, and the CNA might actually have to be involved in cleaning it up. So, they tell me the pt is not constipated. Some elderly pts always have hyoactive BS and distended abds. That's usual for them. You may not feel any stool when you check for impaction, either.
Some CNAs also do not want to be bothered with actually taking V/S. So, they just write in fake ones.
Also, many res are so combative that it is nearly impossible to get a decent assessment on them. These factors combined with the huge number of pts LTC nurses have to take care of, and you can see how problems w/ some pts are often overlooked until they are rather far along.
I've had a few pts fall and break hips. Restraints (chemical and physical) are not permitted in most nursing homes. Adm feels that the nurse w/ 65 or so pts should be able to keep close enough tabs on all of them to prevent any falls/injuries.
Yes, I've sent pts w/ hip fx to the ER. Even though I knew they were too old and frail for a surgical repair, I will not be able to get any pain med orders for the pt unless I have proof in the form of X-rays and documentation (from the ER) that the hip is really fx.
I will also not be able to prevent adm from ordering the pt up and dressed in their w/c by 4am (w/ all the other poor souls) unless I have proof of the fx.
Adm in LTC does not recognize nursing judgment. If you try to keep a pt in bed because they are ill or injured, adm sees it as you trying to get out of doing the work of getting the pt up and dressed.
I have had pts returned from hospitals (many times) with bed sores that they did not have when we sent them out. I've also had an ER D/C a res back to me at 2am, w/ a temp of 102. This pt had hx of sz disorder and craniotomy.
Even though I worked at one LTC for almost 3 years, I was unfamiliar w/ the baselines for many of my pts. Why?
Because when you have such overwhelming numbers of people to care for, there some that always have something going on and take all your time. These especially needy and demanding ones prevent you from ever getting to know much about some of the other residents.
I worked at one LTC where phone service was cut off as someone had "forgotten" to pay the bill. One of the CNAs lent me her cell phone so I could call 911 and call the ER to give report.
Most LTC "medical directors" are a joke. Some have been the "provider" for years to residents that they've never even laid eyes on. They just come in, read the nurses' notes, write a progress note of their own, and leave.
As for pt "dumps", often hospital attendings will D/C LTC pts from the hospital back to the nursing home on Fri afternoons, even if the pt is still acutely ill. This is because they will have fewer pts to round on over the weekend if all their nursing home pts are D/C.
I have worked in a hospital, in med/surg. It was an awful hospital, and working conditions weren't much better there.
My closest friend has been an RN for 25 years. Mostly in hospice and psych. She recently quit a job in LTC. She was the only nurse for 120 residents on nocs. She had 3 CNAs and one med aide.
I worked with her in inpt hospice, and I know she is a fabulous nurse. However, she told me the LTC position made her feel "so inadequate and incompetent" because she struggled and struggled, but could not possibly provide good care for her 120 pts.
I really enjoy elderly people, but I couldn't do it anymore. Trying to provide good nursing care in a nursing home is like trying to bail out a lake with a teaspoon.
Leaving LTC really lifted an unbearable burdon off of my shoulders.
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