[MegRyanGirl]

I am writing for some advice from people with experience. I am a new grad and I have been working in a LTC for the last 3 months. The facility is sponsoring my green card and they made me promiss to work for them for 2 years, although they haven't made me sign any agreement yet.

The problem is that the management is so horrible that I am dying to leave the place, but I can't until my green card is approved.

For example, I didn't get the basic fire safety in-service the first 2 months. The first week the DON and the assistant DON told me to spy on all the floors and tell them what I found the nurses do wrong. When I came back with a list of things that were wrong, after a while they didn't want to hear it any more and labeled me as a complainer. Then the nurses on the floors where things are done wrong, they don't want to work with me because I want to do things the right way, and it makes them look bad.

A nursing supervisor complaind about me to DON that I was annoying because I requested a drug book (which every unit is supposed to have) a couple of times.

We have to punch in and out every day and the time clock is unfair and inconsistant. I always get paid anywhere from 15minutes to 1 hour less than I am supposed to. Lunches are not paid, and over time is not paid.

The DON told me not to take BP on cardiac meds because "it takes too long and you won't finish all the meds if you do BPs." She says "you sort of have an idea of your residents' ranges" although the MD order read that BP ranges had to be 60-100 and that MD had to be notified if it wasn't within the range. In fact, when I took the BP like I was supposed to, it was so low that I had to hold 3 medications and call the MD. Imagine what would have happened if I had given the meds??? The DON laughed when I insisted on taking the BP saying that I was young and inexperienced.

Then, a family complained about me that I "ask too many questions when the patient wants a pain med (which is actually an anti-anxiety med)." The DON asked me what happened, and I said I normally go through the standard protocol when a patient asks for a PRN med. Typically, when the family comes, the patient says "can I have my tranquilizer?" I say "what's going on? how are you feeling?" pt says "I am feeling anxious" and shakes her hands to make herself look anxious. Meanwhile, pt's hands are shaky all day long and I ask her if she is aware that her hands shake all day. She says she didn't know that. I go and get her ativan. So the DON and the assistant DON told me that I should not ask any questions and just give the PT the med. I explain to her that as per protocol, I have to document why I am giving a controled substance and I have to ask why the pt needs the med. IT's not a tylenol or a vitamin we are talking about here. It is a double locked controlled substances that each shift counts to make sure no pill went missing. And the DON tells me "just give it without asking questions" ??? I told the DON maybe she could explain to the family that I am just following the protocol to give the pt the best care, but she didn't want to do that. Her and the assistant DON both said "We don't side with the nurses. With side with the families because that's who brings the money! There is so much competition among nursing homes and we have to make the family happy so that they stay with us!" They told me that I was impossible to work with and that they are going to write me up for insubordination.

I like caring for patients and always want to do the best I can. I don't think I did anything wrong. I would like any advice on how I can handle the situation while I am stuck at this place for another 1 year and 9 months (unless I get a greencard fast or they somehow decide to terminate the verbal contract ). Leaving the place is not an option. I just would like to figure out how I should behave to make the situation somewhat bearble. By the way, there are some nurses that feel sorry for me and side with me, but they are scared to say something for their own sake...

Any advice will be appreciated!!

[letina]

And you trust this employer to sponsor your green card?

[MegRyanGirl]

Originally Posted by letina

And you trust this employer to sponsor your green card?

It's not that I trust them....I don't have a choice. So far they've signed some papers for my work visa that allows me to work for them. Now i have to ask them to sign the other papers.. for the green card. *sigh*

[racing-mom4]

Do the best that you can, do what you think is right for your patients--take their BP before giving the meds!!

Stop being a tattle tale no one likes that not the ones you tattle on and not the ones you tattle too. Even if they did tell you, dont.

I dont know how the whole green card things works, you seem like you do, so it sounds like you have to stick it out, try and make the best of it and chart chart chart!!!

[nightmare]

Move to International for more expert advice.

[Alexk49]

What country are you from, it sounds like their are some communication issues ongoing.


In long term care, you don't have to take BP before adminstering cardiac medications. This is the residents home, you would not advise a home care patient to check meds before taking the pills. If the resident is unstable and needs more nursing management they belong in a different level of care, ask the doctor to change the order OR move the patient to the right level of care. Some docs are not aware of what resources are available, for example....in home care we would get order for four times a day glucose checks, we would call the doctor and say if they need that intense monitoring by a nurse they should be in SNF.

Secondly the time clock, if it happening to you, it is happening to all employees, call the local labor board, they need to certify the clock.

Third, you came to the USA as a professional, buy your own drug book, I buy my own and expect my student to have one.

As far as assessment, you can do an assessment without all the red flags coming up. Ask a season nurse to assist with this.

You are tied to a contract if you leave you are in breech and will have to suffer the consquences.

[suzanne4]

Not sure if you are aware of the fact that the US is still under a retrogression; and we do not expect the AOS to open again for several years at the earliest because of the numb.er of petitions that were submitted last summer.

Are you willing to remain in this facility for the next three years? It is not as easy as just signing some papers. Remaining there for the two years and if no green card is available then for you, and you are going to be there longer or you will have thrown all of this time away. You would no longer be their employee, so they will not be continuing on with your petition.

And for others that are reading this thread and wondering how she got the working visa, it is because she had an H1-B in another capacity earlier or it would not be possible for her to do.

---------------------------------
LTC has completely different requirements than the hospital setting or even doing private duty nursing. When you have 50 plus patients that you are legally responsible for, then the rules change. And you usually do not see the RN administering meds in LTC either.

[MegRyanGirl]

Originally Posted by racing-mom4

Do the best that you can, do what you think is right for your patients--take their BP before giving the meds!!

Stop being a tattle tale no one likes that not the ones you tattle on and not the ones you tattle too. Even if they did tell you, dont.

I dont know how the whole green card things works, you seem like you do, so it sounds like you have to stick it out, try and make the best of it and chart chart chart!!!

Thank you for your advice!! I definately won't be a tattle tale. I wasn't trying to be one. I was just doing what the DON and the assistant DON told me to do.. but they turned around and decided to use it against me.... something I call "back stabbers." Oh well, what can I do.... I am stuck here until the green card is approved.

[MegRyanGirl]

Originally Posted by Alexk49

What country are you from, it sounds like their are some communication issues ongoing.


In long term care, you don't have to take BP before adminstering cardiac medications. This is the residents home, you would not advise a home care patient to check meds before taking the pills. If the resident is unstable and needs more nursing management they belong in a different level of care, ask the doctor to change the order OR move the patient to the right level of care. Some docs are not aware of what resources are available, for example....in home care we would get order for four times a day glucose checks, we would call the doctor and say if they need that intense monitoring by a nurse they should be in SNF.

Secondly the time clock, if it happening to you, it is happening to all employees, call the local labor board, they need to certify the clock.

Third, you came to the USA as a professional, buy your own drug book, I buy my own and expect my student to have one.

As far as assessment, you can do an assessment without all the red flags coming up. Ask a season nurse to assist with this.

You are tied to a contract if you leave you are in breech and will have to suffer the consquences.

I am from an English speaking country. Why do you think there is a communication problem?

I work on a sub-acute floor with people on vent machines. Are you saying that I don't have to take BP even if the MD order says that the BP has to be within a certain range and that the med should only be given within that range? The order sometimes even says that I have to call the MD if the BP is out of range.. This is mostly for people that have cardiac issues. But the other stuff about the glucose makes sense. We do ask the MD to cut down on the glucose monitoring if the pt is fairly stable.

What do you mean by "certifying the clock"? - I can definately call the labor department, but then I am sure the management will figure out that I am the one that called since I have been asking questions about it. I am afraid that I will make a high profile by doing that and possibily jeapoerdize my job...

I have been in the US for 13 years and I got my nursing degree here in the US. I have my own drug book. I can bring my own to work, but then it will disappear... like many other things that have disappeared. The DON claims that each floor is supposed to have one. Is it wrong of me to request one if it's supposed to be there? I would rather hear the truth....

The funny thing is, the facility hasn't made me sign any agreement althought they said I have to work for them for 2 years if they support my green card. It goes to show how disorganized they are, IMHO.

I appreciate your advice and I will defiantely ask a seasoned nurse on how to assess without the red flags coming up.
Have a great weekend!!

[MegRyanGirl]

Originally Posted by suzanne4

Not sure if you are aware of the fact that the US is still under a retrogression; and we do not expect the AOS to open again for several years at the earliest because of the numb.er of petitions that were submitted last summer.

Are you willing to remain in this facility for the next three years? It is not as easy as just signing some papers. Remaining there for the two years and if no green card is available then for you, and you are going to be there longer or you will have thrown all of this time away. You would no longer be their employee, so they will not be continuing on with your petition.

And for others that are reading this thread and wondering how she got the working visa, it is because she had an H1-B in another capacity earlier or it would not be possible for her to do.

---------------------------------
LTC has completely different requirements than the hospital setting or even doing private duty nursing. When you have 50 plus patients that you are legally responsible for, then the rules change. And you usually do not see the RN administering meds in LTC either.

Yes, I am aware of the "pain in the neck" retrogression :-) Whatever happens happens. I don't know when the immigration will open the window and no one really knows. All I can do is file what I can file now such as I-140 and wait to file the rest when it is possible.

Of course I would rather not stay in this facility for 3 years. I don't even want to stay there for 2 years. But if push comes to shove and they actually make me sign a contract, which they haven't yet, I will have to sign it. I don't have much of a choice.

What I really would like advice on is how to handle myself at work while all of the stuff I mentioned in my first thread is going on. I don't want to antagonize anyone and continue working there (I do like working with the patients and some of the nurses... they save my day) until I get what I need to get.... Then I will move on to the fancy hospitals that offered me jobs without the sponsorship.