Bad day... looks like it's everything I dreamed it would be.

  1. Well, today was my fourth day in my new LTC, still on orientation. My day went something like this.

    1. 3 nurses for 54 residents. Okay. Find out one of those nurses called in. Okay. Are myself and my preceptor (the third one this week) supposed to take two carts and work together, or am I supposed to take one cart and she take the other cart? Myself, my preceptor, and the other nurse would actually make three nurses. How do we do this. NO ONE has a clue. Did I mention that EVERYONE in this joint practically, is either brand spanking new there, or been there about three months?

    2. Finally, myself and my preceptor decide... or more or less I DECIDE, since my preceptor is asking ME what I want to do... I decide to take the cart and the hall that I'm less familiar with, since I thought that I was supposed to take this hall ANYWAY, since the nurse that usually has it called in, and if we did only have two nurses and I was off orientation, I WOULD have that hall along with the hall that I was used to. Confused yet?

    See, if there are three nurses, one nurse has north hall, one nurse has PART of south hall, and one nurse has the OTHER part of south hall, and west hall. I've had that "middle" part all week. When there are only two nurses on day shift, one nurse takes the entire south hall, one nurse takes north and west hall. Since I'm still on orientation, I thought my preceptor and I were supposed to take both north and west hall and work together. So, I decided to take north hall and I thought my preceptor was going to give the meds on west hall.

    3. Alright, so I'm giving meds on north hall thinking "this is easy, this is a short hall, I'll be done in no time".

    Then the call lights started going off. Pretty soon it was like Christmas down that hall. Three, then four lights. There were four aides for 54 residents. The aides have to pass meal trays, change everyone who needs changing, dress everyone who needs dressing. Needless to say, lights are going off left and right and I'm trying to pass meds, answer some of the call lights... one lady had to go to the bathroom, then she wanted me to get her dressed...

    And this one aide kept asking me "Are you DONE giving meds to so and so yet? SHE needs to get up, THIS person needs to get up... etc.. I need YOU to help me!"

    In addition to all of this, I'm expected to help pass meal trays. So basically, I'm supposed to pass meds, answer call lights, help pass meal trays.. help pick UP meal trays, because they get left in the room.

    I am doing my BEST to help this one little aide, but I've had enough of her attitude... she looks at me in the middle of all of this and is like "I'M going to take a break now... we need to get SO AND SO up when I get BACK, she's already complained to STATE". Oh, did I mention state was in the building?? They've been there ALL WEEK. All, of my wonderful orientation week in this wonderful facility.

    When this aide comes back, long story short, she and I have choice words. After that, I pretty much started crying... not out and out bawling, but that soft, crying that you do to yourself. We both apologized to each other later; I understand how hard they have it, I really do. I just didn't appreciate how she was talking to me. Other staff members have complained about her as well. Apparently she put in her two weeks anyway... but I digress...

    SOOO, she apparently went and talked to the unit manager about me, and the unit manager came and talked to me, but that ended up going nowhere. Then, she came up to me later and was like "Stop what you're doing, Mr. Resident Council President is in the dining room hollering about not getting his meds yet, and State has been interviewing him, and please go give him his meds now". Not that I blame the guy.

    THEN later the Unit Manager comes up to me, AGAIN, and was like "So, why did you take the cart of the residents that you weren't used to?"

    HUH???? So apparently, my PRECEPTOR was supposed to take her OWN cart, and do her OWN treatments... and I was supposed to do mine. Why have me on orientation??? Further more, why didn't anyone this morning have a CLUE what to do??????

    The rest of the day went SLIGHTLY smoother... only slightly.

    Is this typical?? I am not used to this!!!!!!!!! I told my manager to put me back on night shift, where I was supposed to go in the first place, but it doesn't sound much better. One nurse for 54 residents, and probably two aides. If you're lucky. I'm not sure how many aides they have on night shift, to be honest, but I'm willing to bet it's two, at the most.

    I feel bad for ANY nurse who ever has this sort of thing, be their first impression of nursing. I kick myself so hard, that I've GIVEN UP jobs better than this one, but I also actually feel fortunate that I KNOW it isn't this bad everywhere.
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  3. by   LFalcon
    This sounds about how my day is every day... I'm sorry your day went like this. :-( It's so disheartening..

    I came searching tonight as I have about 40 residents, it's going up tomorrow by 3.. and 9 BS - AC/HS .. 2 aides - yes, it's ALF - but with an ECC, so 99% are incontinent.. I would feel lucky to have a ratio of 54/3, but then no IV's - trach - nothing crazy for me.

    Such a shame... on the other hand, the fact that everyone is so new is a pretty good indicator something is amiss?? right?
  4. by   laderalis
    We have 4 to 72 beds on first and second shift and 2 on noc. With 7-8 aids on first and second and 5 on noc. It's a mx of ltc and rehab/skilled.
    Something does not seem right about your facility. Most of the nurses have been at mine for >5 yrs.
  5. by   amoLucia
    Also just know that when State survey is in the building, everything, everybody and everywhere is up in arms, upside down, inside out and just mixed up!!! It is a very atypical time and it would be tough to judge your experiences based on this time. It should be more normal after they leave.
    Last edit by amoLucia on Jun 8, '12 : Reason: to finish
  6. by   NurseCard
    Well, I'm going to night shift, but I think I'm also going to go ahead and interview
    for a position at the place where I worked as an agency nurse. It doesn't pay as
    well as this place does, but I like it there a lot. I would have to actually wait about
    three months or more to be able to go work there though, because of the agency's
  7. by   NurseCard
    Quote from amoLucia
    Also just know that when State survey is in the building, everything, everybody and everywhere is up in arms, upside down, inside out and just mixed up!!! It is a very atypical time and it would be tough to judge your experiences based on this time. It should be more normal after they leave.
    Oh I know... but this facility is a "special focus" facility of our state. Meaning, it's had a LOT of problems. Meaning, the State is in the building more than once a year. When I first interviewed, my DON actually told me that the state visits MONTHLY. I've been told by everyone else that they actually visit every six months.
  8. by   caliotter3
    Well at least you know you have an escape route. Hang in there.
  9. by   CapeCodMermaid
    Quote from amoLucia
    Also just know that when State survey is in the building, everything, everybody and everywhere is up in arms, upside down, inside out and just mixed up!!! It is a very atypical time and it would be tough to judge your experiences based on this time. It should be more normal after they leave.
    It's not like this in every facility. I spent probably 2 months talking to all the staff about the survey process. We take great care of the residents every day. We do the right thing every day. Think of survey as just having 4 visitors in the building.We had no extra staff in the building. As the DNS I spend 90% of my time on the units every day so my being there during survey was nothing out of the ordinary.Surveyors arrived and everyone was calm and did their job. The DPH team leader remarked on the calmness of the staff, the team work evident, and how helpful the staff were. She said " even the CNAs who are usually very nervous answered our questions in a straight forward manner. They didn't even look worried!"if you have a good team and always do the right thing whether the state is there or not, you'll be fine.
  10. by   sunflower350
    If and only if, this establishment gets a proper management team, will it care for our precious Geriatric population safely, and with the dignity and respect they deserve. State and Federal Survey's are in place to prevent this kind of care to the patient and staff! This is not okay...
  11. by   JZ_RN
    Our facility counts management staff who do no patient care and most of the time are not even there as "direct care staff" and that is how they get away with 1 nurse to 50+ patients. I want to just give safe patient care, legitimately. I can't wait to leaved this job.
    As a new grad reading this post, I am somewhat scared. So I ask, mostly to the seasoned nurses here who have a lot more experience and wisdom, how is this safe nursing? The nurse patient ratio described sounds so illogical to me, but then again perhaps I still have the perspective of a student. How is it that the state permits this? It is not considered safe nursing, it makes one prone to mistakes that happens when one is overwhelmed and short staffed, and we nurses cannot make these mistakes. Nursing is not easy for what my nurse friends tell me and also for what I could see with my preceptors as I did my clinicals; who emphasized countless time that I stop, check and recheck everything that I am doing to make sure I am doing it right so I am not talking about mistakes one should know better, but certain conditions make you more prone to it.
    I love the profession I have chosen, I want to be a nurse, but working on such conditions is not safe for the patient or the nurse even. It makes me wonder.
    I know budget cuts, health insurance, medicare, etc...cutting makes hospitals, facilities, nursing homes, cut where it should not to make up for it and put the patients at risk.
    Sigh... I am still living in la-la land? Is it too much to expect to work in a properly staffed environment?
    I feel for the nurse who initiated this post and the ones who too replied and working like this.
    It has to get better than this.
  13. by   LpnSocks
    I am new too had my first night alone the other day I almost cried after I ran late with my meds had to give report while they passed meds my narc. Count came off fun because later on we figured out I signed a phen. Bomb out when I was supposed to sign out Ativan don't worry it was just paper I gave the Ativan but ugh I wanted to die then I waited til close to breakfast to give 70/30 an had a nurse say it's long acting so don't worry about it I just sat there red faced feeling dumb( I drug booked later ur supposed to give 15 before meals ugh) an she did this in front of said patient probably dropping his confidence in me to 0. Honestly I wanted to hide my face my night went so very bad 40 residents to 1 nurse an 2 aides. Better than my med passes at my 1st attempt at nursing it was a jail I lasted 1 month an quit I'm not a mean attitude type that I needed to be it was a med pass of 200 with booking people in I wanted to go nuts. But I feel ya I have my 2nd night alone on sun I hope it gets better an states in our window I pray not a day I work I am so scared I won't make my time with proper proper technique
  14. by   litbitblack
    Private pay facilities are sooo much better.