'unacceptable' facilities & our duties (long)

[NurseWeasel]

I live in a fairly rural area. The "good" places to work as a nurse all involve a commute of about an hour, and the local places are all pretty pathetic. Our local hospital (although in the process of renovations) is old and outdated and has a reputation of poor care. People in the community would rather drive an hour to a "decent" hospital in all but the most dire circumstances. The local LTC facility is downright gross. You walk in and it stanks - always. The residents don't look particularly happy (then again, who would) to be there, the facility is in major need of updating - it still looks like a 1950's V.A. building (not a stereotype, it fits my limited experience) with ugly furniture, pee yellow or putrid green paint, and nasty carpet... in all but the first 100' or so from the front doors, which are fairly recently decorated and reasonably clean / bright.

I will say that I had my grandma in both these facilities within the last year (so she could be local and quickly accessible to mom and I) and despite the facilities' reputations and appearances, she did receive really good care from the nurses and aides at both places. Obviously if the care was "bad" they'd be shut down, right? Grandma's gone now (through no fault of either facility, lol), and I'm embarking on my 2nd career, with nursing classes starting in January.

Part of me feels a need to go to work at these places and IMPROVE them. I'm a go-getter. I can't stand to see places like that, and low morale just drives me nuts. I do have a business administration degree as well, so one option I've considered is going into the LTC facility as a nurse manager type person (eventually, after I get some experience with the nursing end) and whoopin' it into shape. Another option is to work the local hospital as a nurse in any or all departments that I can, again attempting to change the public perception and be one of those people who makes a difference.

Problem is, I've been in the "real world" long enough to know that beaurocracy from above and low morale / bad attitudes of fellow staff are nearly impossible to overcome. Nothing like being a solitary ray of sunshine in a deep, dark cave. One soon begins to feel less like a ray of sunshine and more like a mini maglight operating on waning AAA batteries, lol.

I figure I have a couple years, lots of clinicals and bookwork, and maybe some volunteer experience to go through before I'm ready to make a decision, but it just weighs on me. I am one of those hopelessly optimistic people who wants to make a difference, yet I'm more than a little fearful of getting into yet another situation in which I just keep beating my head against the wall in frustration because management won't LET things improve and coworkers have been beaten down so far they don't even care any more.

So what do you think? What would you do? Any suggestions?

[cargal]

Have you had med-surge experience? A year in LTC? After that, go for it and make a difference! Some times you just have to settle for small differences, too. But I applaud your goals. I aspire to speaking to my local legislators about LTC staffing ratios, which I feel are outdated to the '70's. Now our elderly live longer, are more frail, are taking more meds and there is an increased dementia factor.l

We need more like you in nursing.

Blessings to you!

[NurseWeasel]

At this point, I have not had LTC or med-surg experience. All my medical experience has been as a medical assistant in doc-in-the-box or physician offices, other than very extensive candystriping (lol, I know that doesn't count) as a teenager.

My long term plans change on a daily basis, which is what I LOVE about nursing. So many options!

Thanks for your kind note! =)

[VivaLasViejas, ASN, RN]

As someone who's "been there, done that", I would suggest that you attack this issue---which is my passion as well---at the legislative level, not the facility level. I have tried for years to force change in my buildings, but I am convinced now that it cannot be accomplished except by making lawmakers sit up and take notice. And you'll need a lot of support from fellow health care practitioners, as well as the ability to speak and write to the powers-that-be. The problem trying to change facilities is, most of them are owned by big corporations which care only about their bottom lines and nothing else. These businesses work employees until they drop, pay them as little as possible, and then chew 'em up and spit 'em out. They do as little for the residents as they can legally get away with, and use staffing levels that were established 25-30 years ago when most nursing home residents were still ambulatory. The insurance companies and Medicare/Medicaid also complicate matters to the point that a resident often has to jump through all kinds of hoops just to get the meds and treatments their doctor has ordered for them, and a lot of times they can't get them at all.

Any kind of long-term care reform will have to come from a grass- roots effort to force those in power to give a damn in the first place, and if you are the one to get the ball rolling, I salute you for it!!

[maggie7]

You can make changes if you want to. I worked 4 1/2 years in a LTC facility that was 150 years old. The walls were painted and papered and the place was remodled but the residents were still the same. Tired and bored. Well cared for, but such a dreary existence. It broke my heart to leave them behind each AM I went home. So during my employ there, with the help of the recreational director, and most all his staff, most of the nursing staff, including administration, I organized 3 yearly parties, to be held in the late afternoon and evening hours,(when they usually have nothing to do). The first was themed " a night out with the stars) and we had more people show up than I ever expected. Staff, family and residents, shared conversation, food and a campfire. (ours was a 450 bed facility and had a huge patio and lawn area). We all cazooed around the fire and the residents talked about it to no end. So I planned a Luau the next year, again a huge success. The final party was a wedding vowel renewal for residents and staff too. Such a boost in morale over the entire facility. Nursing staff made favors, corsages, certificates and food, food, food. And fed the residents and helped them to get dressed (and undressed). And a balloon service decorated the lawn and patio (and stayed to serve) and took the decorations down) and someone made a tiered wedding cake and it was wonderful. It made a difference in the way staff and residents got to know each other. And I believe it was important. I could not hope to change the way the nursing home was managed, althought this one was among the best, but I was able to change the lives of many residents who looked forward to these events and it helped all those involved have a sense of satisfaction too, to see the difference it made. It helped me, too.