[bluegeegoo2]

Have you ever had that "bad feeling" in your gut about an upcoming event? Well, my facility has decided to "switch" 2 units. Alzheimer's to the 30 bed, formerly skilled unit, and the skilled unit to the 60 bed, formerly Alzheimer's unit. While I feel that our dementia pts will greatly benefit from a smaller, quieter unit, I can't help but wonder what kind of mess the "skilled" unit will become. They plan on having Medicare, GIP, regular hospice, and non-skilled pts on this unit. Eeek. At the moment, they are only planning on 2 nurses per shift to handle this load. While shooing away flies from my jaw agape, I couldn't help but wonder what the h*** were they thinking? At the moment the skilled unit has some pretty sick people on it who require quite a bit of care by themselves, never mind the other 40-50 people to take care of. Oh, I feel nauseous...Anyone else had experience with a situation like this? How did it work out? (Or not?) Any words of wisdom other than run for the hills? (I came up with that thought all by myself! ) Anyway, please let me know what you think. FYI: I'm on the skilled unit. (Naturally).

[SillyStudent]

They want 2 RN's on a skilled unit?

Run away. Run FAR away.

[husker_rn]

I've learned to listen to my gut. It's seldom wrong. I agree with Silly Student. Start looking around for other options.

[oramar]

Everyone knows what they are thinking here. They are thinking about money most likely.

[NRSKarenRN]

High intensity skilled unit need ratio 1 nurse /20 pts for quality care be provided when hspice/IV's/ extensive wd care/ Medicare thrown into the mix or community members will become savvy and avoid facility like the plague..... something I'm seeing in my own back yard.

[bluegeegoo2]

Originally Posted by oramar

Everyone knows what they are thinking here. They are thinking about money most likely.

Side bar: I LOVE the Holy Grail! And you're right: It's always the money. However, the more they stretch us to increase profit margins, the lower quality of care our residents receive, the word gets around. Empty beds= money lost. Duh! But, "they" seem to think we are super people who can pass meds, do accuchecks et cover, do tx's, call MD's, call families, chart, take et process phone orders, deal with families in the facility, monitor unstable pts, plus deal with surprises all in an 8 hr shift WITHOUT going into overtime. All that and more for only $15.25 an hour! But wait! If you act now, you can throw in MDS charting, skin tears AND falls for NOT A PENNY MORE!!!! If you order within the next 10 min., we'll also throw in hard-headed management who have forgotten what it's like to work the floor! (Included are stories about how EASY you have it compared to when THEY were on the floor). I apologize for the sarcasm and rant. If I don't laugh I'll cry. I realize I'm a new nurse and am still trying to adjust to what is LTC, but I became a nurse because I truly, genuinely care how people are, and want to help them get as "better" as they can. The politics in healthcare just make me sad. So much more could be done for my people. But, the shareholders have a yacht to buy, I guess.

[TheCommuter]

In my personal experience, mixed units have been hellholes on earth.

It simply does not work out when management attempts to mix the higher-acuity short term skilled patients in with the long-term hospice residents and non-skilled residents.

Stressful situations arise when the short-term Medicare patient's abdominal incision suddenly eviscerates and she's bleeding profusely. You need to send this lady to the nearest emergency department as soon as possible, but you're being delayed by the long-term resident's family members who scream obscenities at you because they cannot seem to locate Grandma's polyester trousers in the facility's laundry room.

[bluegeegoo2]

Originally Posted by TheCommuter

In my personal experience, mixed units have been hellholes on earth.

It simply does not work out when management attempts to mix the higher-acuity short term skilled patients in with the long-term hospice residents and non-skilled residents.

Stressful situations arise when the short-term Medicare patient's abdominal incision suddenly eviscerates and she's bleeding profusely. You need to send this lady to the nearest emergency department as soon as possible, but you're being delayed by the long-term resident's family members who scream obscenities at you because they cannot seem to locate Grandma's polyester trousers in the facility's laundry room.

Now that I have put some time into this "new" unit, you're absolutely right. It IS hell. All day, every day. I worked a "double" today, (it seems I have "dumbass" taped to me somewhere...) and it took most of the 16 hrs to complete what management expects to be done in 8. Which brings another question/observation: I bust my butt all day long, and never, EVER get done in 8 hrs. EVER. The other day shift nurses breeze through the day and almost always leave on time. My question is, what I am doing wrong? Are the other nurses possibly skipping certain things to get done and leave? I don't want to think that they are overlooking skin issues, cond changes, etc., but I'm not naive either. I have tons of orders everyday, as I am always assessing my pts to make sure they are as good as they can get. I'm truly not trying to toot my own horn, I just do what I think needs to be done. I am at a loss to explain how they leave on time and I never do, try as I might. Just confused is all.

[psalm]

Originally Posted by bluegeegoo2

Side bar: I LOVE the Holy Grail! And you're right: It's always the money. However, the more they stretch us to increase profit margins, the lower quality of care our residents receive, the word gets around. Empty beds= money lost. Duh! But, "they" seem to think we are super people who can pass meds, do accuchecks et cover, do tx's, call MD's, call families, chart, take et process phone orders, deal with families in the facility, monitor unstable pts, plus deal with surprises all in an 8 hr shift WITHOUT going into overtime. All that and more for only $15.25 an hour! But wait! If you act now, you can throw in MDS charting, skin tears AND falls for NOT A PENNY MORE!!!! If you order within the next 10 min., we'll also throw in hard-headed management who have forgotten what it's like to work the floor! (Included are stories about how EASY you have it compared to when THEY were on the floor). I apologize for the sarcasm and rant. If I don't laugh I'll cry. I realize I'm a new nurse and am still trying to adjust to what is LTC, but I became a nurse because I truly, genuinely care how people are, and want to help them get as "better" as they can. The politics in healthcare just make me sad. So much more could be done for my people. But, the shareholders have a yacht to buy, I guess.

You forgot nightly chart reviews and monthly complete assessments, 2-3 a night (night shift job). BUT WAIT, THERE'S STILL MORE! You take the call-ins, for the whole facility, not just nursing personnel, AND AS AN ADDED BONUS, get to call people to fill the slots, taking time away from the 5 am med pass!!

[eldragon]

Originally Posted by bluegeegoo2

Now that I have put some time into this "new" unit, you're absolutely right. It IS hell. All day, every day. I worked a "double" today, (it seems I have "dumbass" taped to me somewhere...) and it took most of the 16 hrs to complete what management expects to be done in 8. Which brings another question/observation: I bust my butt all day long, and never, EVER get done in 8 hrs. EVER. The other day shift nurses breeze through the day and almost always leave on time. My question is, what I am doing wrong? Are the other nurses possibly skipping certain things to get done and leave? I don't want to think that they are overlooking skin issues, cond changes, etc., but I'm not naive either. I have tons of orders everyday, as I am always assessing my pts to make sure they are as good as they can get. I'm truly not trying to toot my own horn, I just do what I think needs to be done. I am at a loss to explain how they leave on time and I never do, try as I might. Just confused is all.

Of course.

If it walks like a duck and all that.

A nurse with a work ethic and compassion can work twice as hard as a nurse who has neither of those two things. The only thing in common between the two is their license, their paychecks and the fact that both see themselves as working their butts off.

I am only a nurse for five months and already I am getting burned out. The first time I volunteer to do something, it becomes part of my job forever. (Rather than listen to the feeding pump beep because it's empty - several times a day - I started putting in the food - even though it wasn't my job. Now it is my job. If I don't put it in, it doesn't get done.)

ETC.