Cry or scream.. venting thread

[Nascar nurse, ASN, RN]

Please, I just need to rant a bit. I work in LTC facility with 84 residents, approx 18 medicare currently. I am the MDS coordinator and considered part of nursing management. We recently had state survey, and had the WORST survey we have ever had (total 19 tags - at least 14 related to nursing). We had tags out for B&B assessments not matching MDS, Dietary marking wrong weights on MDS, medical appointment not being scheduled/followed thru, nursing not updating the careplans w/ order changes between MDS cycles, social service and activity careplans, on and on and on.

My frustration.. after NUMEROUS INSERVICES, nurses still not following up to schedule appointments, alert INR not called to the dr. til the following day, B&B assessments state "Res. incontinent", but the nursing summary &/or narrative note states "continent" (often documented by the exact same nurse!) (No chance the MDS will match, cuz the stinking documentation doesn't match - happens at least 3/4 of the time SINCE we've done the inservices), new admit with drawings on admit nsg assessment to indicate open areas with no assessment of actual size, color, drainage, depth, etc., nurses notes that state new order received and noted - but not actually carried thru with - do you get the point. could go on and on.

We have, as stated, done plenty of group inservices. Than I decided to try 1:1 inservices w/ specific points to emphasize (non-confrontational), ADON and DON have been doing "teachable momements", which is a written notice that you're pretty much not doing something correct and you have been instructed HOW to do it right in the future. Now they have started writing nurses up because they just don't seem to care. I hear them talking aboutabout us (management). "All they do is ride our a$$. If they think it is so easy, they otta come do it". Well I did it for years, I WORKED my way into the position I've got. I couldn't possibly go help them. I am spending all day doing my own job and re-writing 3/4 of their job so we can pass state on re-visit. Of course this is causing a great divide in our work place and making it out right miserable for all. Dietary supervisor is still putting wrong weights on MDS even after corporate consultant called in to inservice her. They hired an Activities direction with absolutely no experience - so I gotta re-do a bunch of her stuff too.

I just want to know, why are so many (at least at my place) willing to just get by. What happened to having pride in your work?

I just want to fall down in the hall, kick and scream and yell "what the heck is the problem here. Get it together or get out!" Unfortunately, I'm not the boss.

Please don't turn this into a management vs floor nurse attack. I know there are many hard working floor nurses out there in long term care and I have been one of them for years.

[LisaRn21]

Can I rant too? If I hear one more time already this season, "You don't have kids why can't you work xmas" I am gonna shoot myself! Really! Like Idon't have a family and then for the nurse to say "Well in 15 years come talk to me" I don't care how long you have worked there your holiday is your holiday geez. ok I'm done :)

[rehab nurse]

vent away...lord knows this is needed thing to stay sane!!!

is it just me, or does the number of people having really rough times at school and work seem to be really high recently???

nascar, i worked subacute/rehab/skilled LTC more 8 years. i did the transition care too. i don't know what it is about nursing homes, but the management lately (the new mgmt) is lacking basic managerial skills. they pick favorites, don't address very real problems that can and HAVE resulted in pt issues. lack of care is astounding. the documentation (if it's even done at all) is often lacking, contradictory, and will never hold up in court. i remember one month we were denied payments by the ins companies because when they reviewed the charting, it didn't cover any of the things people were there for.

i have also seem droves of experienced RN and LPN who were there for years and years, driven out by management one by one. for dumb things. the things that matter (say, a pt c/o CP, being sent to ER with EKG changes, and admitted) not charted on AT ALL. no one knew why the person left the facility. the chart was in the rack for over a day before it was realized the person was admitted in the hospital. the things that don't matter (the TED hose audit chart, for example) was missed for one day by one shift, and that nurse was disciplined. i don't know what it is. this environment is demanding and short-staffed every day (i know it prob is like that in the hospitals too...) and it's sad. these poor residents are being neglected and the care is poor. i really believe the staff that IS still left there, doesn't care. they are all buddies with the new managers, and the survey has a lot of nursing tags, lots of legit complaints from family and patients, etc. i don't know how the place stays open. it's like this all over the area right now. the new management has repeatedly LIED right to peoples faces. they've done it to me, and they've done it to a dozen other people (even their own managers!!).

i don't know how to fix it. i tried to help, but i was not liked when i spoke out about the lack of care. if i offered suggestions, they were shot down. i finally had to leave due to health issues, but a lot of my friends from there have moved on. they are all stressed to the max, having CP themselves and anxiety when at work, etc. and these were GREAT nurses. nurses i'd want taking care of me and my family, that's for sure. now, the nurses there either don't care, or don't want to work hard. they do what they gotta do to get through the shift. minimal. i truly feel for those residents, and i feel for all the nurses who have to work in such a toxic work environment.

i hope you feel better, nascar. vent away!!!

[Nascar nurse, ASN, RN]

Thanks for the support. No I really don't feel better. I gotta get out of this. I have been doing this for 20 years and I just can't stand it anymore. Seems to be a no-win situation and I'm sure it's not just my facility. I just don't understand why some people even bother coming to work if their only going to give half a$$ effort. Ya can't fire em all - god only knows no one is pounding on the doors begging for a job in LTC. I'm looking for a job now, but so far haven't found what fits into my family life schedule. Everyone talks about these insurance jobs.. anyone know how to actually get one?

But again, the support helps. THANKS

[bargainhound, RN]

I think you have made the right decision. It will drive you crazy

going through those inspections and trying to fix everyone's

documentation. Been there. Done that. It's not worth it.

http://www.corvel.com is one of the insurance jobs that pays well

and has good benefits.........workman's compensation cases

that you work on over the phones.

[anne74]

Just some other things to think about - what is your charting system like? The computerized charting system we use is ridiculous - it's so time consuming and cumbersome - I know I could do a much better job documenting things if the system was more user-friendly. Do you chart by exception? Paper chart? Are the charts in the pt rooms or at the nurse's station?

Also, what else is going on there? What's your nurse to pt ratio? Do the nurses have a managable workload? Good support from CNA's etc? Are other tasks keeping them from charting? Often these problems arrise from a combination of factors. And the demands of nursing can burn you out so badly, you lose the enthusiasm you started out with. And it seems like every day managers have new demands for you.

The biggest problem between managers and staff nurses is that each group has different priorities and different things important to their lindividual world. To you, accurate charting is huge because your job focuses on that. To them, charting is yet another painstaking task, keeping them from going home on time. You have to find a way to make your priorities meaningful to them too.

It sounds like the solutions your management has come up with have been negative and punitive (writing people up, etc.) How can you positively motivate them? What's in it for them - what's their incentive? How will charting like you want improve their daily lives?

I'm not trying to make excuses for poor employees, but just some other things to consider. Before I became a nurse, I was a PR consultant. I learned if you want to motivate or persuade people, you have to first get inside their heads and find out what matters to them. Then base your interventions off of that. Forcing them to have the same passion for your agenda won't work. Maybe pass out a survey to find out what they're thinking, what the barriers are, ask for their suggestions - ask them what they care about, and what they value, and then focus on that.

Good luck!

[Nascar nurse, ASN, RN]

The biggest problem between managers and staff nurses is that each group has different priorities and different things important to their lindividual world.

These are not MY/OUR priorities. These are issues related to STATE and FEDERAL GUIDELINES

It sounds like the solutions your management has come up with have been negative and punitive (writing people up, etc.)

We started with inservices and asking for feedback from this. More often than not, they didn't even show up for the mandatory inservice, then say "Well I didn't know, no one told me".

I appreciate your opinion and you raise some valid points, but like I said, I HAVE been on both sides of the fence. Many are not even providing basic nursing care, have an "I don't care" attitude, and are very likely to cause actual harm to a resident. Not only does this affect all of us in my facility as far as government regulations, but it could also potentially affect their license!

[banditrn]

Nascar - I can't speak for the nurses at your facility, but I wish someone would have spent some 1:1 time with me. I knew so little about LTC when I started, and only got 3 days orientation.

The charting is so different from the hospital, where we used a lot of flow sheets. I had no idea what was expected, and no one told me - until the middle of a nurses meeting a month later. A lot of the time I have felt that I'm wandering around in the dark.

Another thing I'm finding is that the residents are becoming more critical. And, frankly, some nites I have little time to chart, because I spend so much time doing direct care. And now we've been told we're not allowed to have overtime.

I know the feeling of wanting to lay down on the floor and kick and scream, but I just don't have time.

[Dorito, ASN, RN]

I find a lot of times it boils down to accountability. I work in staff development and I go through a lot of the same issues. For some reason the LTC facility seems to be the biggest challenge. I know there is enough paperwork but maybe you could draft an algorhythm for them to follow, or some type of check off sheet that they need to address at specific intervals to make sure that duties are carried through. I feel your pain....sometimes it seems like a thankless job where you just spin your wheels. Good luck!

[CapeCodMermaid, RN]

It sounds like the solutions your management has come up with have been negative and punitive (writing people up, etc.) How can you positively motivate them? What's in it for them - what's their incentive? How will charting like you want improve their daily lives? "

Hello....?!?!?! How will it improve the daily lives of the staff??? Cripes! You don't come to work with the intention of improving YOUR life..you are paid to do a job and hope to improve the daily lives of the residents. In no other industry are the workers so coddled. I know it's hard...I've done it all and gave it my all no matter what the job because I was brought up that way. Seems to me some nurses think they are owed something other than a pay check. I bend over backwards to help,teach,train,and support my nurses and some of them still won't comply with the regs. The last DNS did everything for them so it would be done right. That would be the easy way, although I'd end up in a home somewhere...it's much more difficult to show them the right way and have expectations for them to do it.

[banditrn]

Capecod - would you please come work with us!! :) I'd love to be coddled.

[brendamyheart]

My goodness. You described my LTC to a tee.