Culture Change In LTC? - page 5

I personally think it is wonderful plan, but understand the fear and concerns direct care staff face while implementing these changes? Is anyone implementing this in there facility?If so what are... Read More

  1. by   PR_Nurse30
    I currently work in a culture change facility in Ohio & I love it!!
    I see that the residents are more in charge of their own lives, it's just as if they were still living at home. There are rules/guidelines of course that have to be followed. And I have asked many of my residents if they like it & most of them definately do!! There are no set times for alot of things & if you work as a team in your households (as we call them) it will run smoothly. Meds are no different than any set times as before, I pass them as rising, lunch & dinner, for specific meds as 9's or every four hours or every 12 hours then thats different you have to follow those orders. But I find it easy this way, there are no med carts on the floors, we do have a nurses station & thats where we give meds out, or bring to their rooms!! I've been working there for a year & I find it beneficial for the residents themselves, they call the shots with in good reasonings of course. And the ones that can't well thats what we are here for!! I know some people don't like change but in my opinion this is a change for the better. If you have any questions more about culture change ask me I will try to answer at least what I know from my facility...Oh one more thing anyone know of culture change in Houston or Dallas, please let me know..

    Thanks Jovi

    :tinkbll:
  2. by   JohnBearPA
    Quote from ingelein
    You dont owe anything to the nursing home, you owe it to the patients and your self respect to tell the ugly truth, hopefully the "state" will do the right thing and correct the situation.Management is NOT there to work with you, dont be fooled.If they are the rare breed who does have some ethics, they dont last too long and are soon gotton rid of. THAT is the ugly truth also.

    Actually, I think you DO owe something to the nursing home, they're the people that give you money for your services, and allow you to live with a roof over your head and eat, pay bills, put your kids thru school, and not be on the street.
    I agree that some management is just looking out for the bottom line, and may not be AS concerned with pt advocacy as they should be, but I don't by any means feel that they all are like this.
    I work at a facility that's advocating culture change, and it's a slow process, but believe me when I tell you, our DON is all about pt advocacy, and also defends her nurses as long as they're in the right.
    There are alot of other agencies that you can go to to blow the whistle other than directly to the state during a survey. That's kinda' like cutting off your nose to spite your face.
    Last edit by sirI on Jan 16, '08 : Reason: TOS
  3. by   Simplepleasures
    Quote from JohnBearPA
    Actually, I think you DO owe something to the nursing home, they're the people that give you money for your services, and allow you to live with a roof over your head and eat, pay bills, put your kids thru school, and not be on the street.
    I agree that some management is just looking out for the bottom line, and may not be AS concerned with pt advocacy as they should be, but I don't by any means feel that they all are like this.
    I work at a facility that's advocating culture change, and it's a slow process, but believe me when I tell you, our DON is all about pt advocacy, and also defends her nurses as long as they're in the right.
    There are alot of other agencies that you can go to to blow the whistle other than directly to the state during a survey. That's kinda' like cutting off your nose to spite your face.
    That is my sentiment and unfortunately it is REAL. I am well aware that there are agencies who take complaints and reports from nurses, the surveyors belong to one of these agencies,it is called the BQA in my state. Why would an employee NOT want to tell then something if the opportunity arose? We are there to ensure the patient given care, we are not there to hide and lie to protect the interests of the facility, when they are engaging in illegal/ unethical behavior.

    I stated that there were some management people with scruples, did I not? I am a nurse who has been around the block so to speak , in LTC and I don't mindlessly buy the management's spiel of put your loyalties to the facility first, my first loyalty as a nurse is to my patient. LTC will never improve as long as nurses have MISPLACED loyalties, or loyalties born out of fear of retaliation.
    Last edit by sirI on Jan 16, '08 : Reason: quoted and referred to edited post
  4. by   facetiousgoddess
    Quote from JohnBearPA
    Actually, I think you DO owe something to the nursing home, they're the people that give you money for your services, and allow you to live with a roof over your head and eat, pay bills, put your kids thru school, and not be on the street.
    Lets see the majority of my residents are on medicare or
    medicaid.....yes they have paid into "the system". However it is my current tax dollars that allow for their continuing care....so not only am I paying for my residents....but by default am paying my own salary....

    sorry to be OT

    as to the original topic....I would love to see that be our care modality..

    Tres

    heaven forfend, when I am in ltc some poor aide trying to wake this night owl at 8am with a breakfast tray....tray will go flying and I will be labeled and prolly medicated for other's protection...(said in a not so facetious manner)
    Last edit by sirI on Jan 16, '08 : Reason: quoted and referred to edited post
  5. by   JohnBearPA
    Quote from ingelein
    That is my sentiment and unfortunately it is REAL. I am well aware that there are agencies who take complaints and reports from nurses, the surveyors belong to one of these agencies,it is called the BQA in my state. Why would an employee NOT want to tell then something if the opportunity arose? We are there to ensure the patient given care, we are not there to hide and lie to protect the interests of the facility, when they are engaging in illegal/ unethical behavior.
    If a facility is engaged in illegal activity, it surely needs to be reported to state, but most facilities are NOT engaging in illegal or unethical activity, other than the short-staffing that is prevalent in our profession. The facilities that are engaged in anything illegal are caught by regulatory agencies and closed down, as they should be. I'd be willing to bet that if you polled most nurses on this forum, most would say that their facility works above board. To make a blanket statement is a disservice to the profession, as it makes it seem as the nurses are part of the problem, because they have no choice but to go running to the state surveyors because there are no facilities that are good out there, and we're forced to work in lousy facilities that are working illegally and unethically. That makes us as nurses part of the problem.

    Quote from ingelein
    I stated that there were some management people with scruples, did I not? I am a nurse who has been around the block so to speak , in LTC and I don't mindlessly buy the management's spiel of put your loyalties to the facility first, my first loyalty as a nurse is to my patient. LTC will never improve as long as nurses have MISPLACED loyalties, or loyalties born out of fear of retaliation.
    You did state that there were some management people with scruples, but in the same sentence, you stated that they're soon run off out of the business. I also didn't state that the employee was incorrect to report, just that there are other avenues that carry less of a punch financially to the facility that signs our paychecks.

    I've been around the block a few times myself, having been in this field one way or another since I was 16 working as an orderly for the summers in a state hospital. I'm well aware there are instances where management turns a blind eye to anything but profits, but believe me, in my experience that's not the norm you are trying to portray.
    I'm truly sorry for your bad experiences. My loyalties are also to my pt's, as are my DON's, and my administrators. Staff that doesn't feel this way doesn't last long at my place. My loyalty lies in the fact that my facility lets me do my job, advocate for my pts, and pays me well to boot.

    Have a great day, and may you someday find a facility as pleasant as mine to work at.
    Last edit by sirI on Jan 16, '08 : Reason: TOS
  6. by   JohnBearPA
    Quote from facetiousgoddess
    Lets see the majority of my residents are on medicare or
    medicaid.....yes they have paid into "the system". However it is my current tax dollars that allow for their continuing care....so not only am I paying for my residents....but by default am paying my own salary....
    You have a point. but if it wasn't for the facility being open and getting paid for it's residents by your tax dollars, they wouldn't have the money to pay you, creating those tax dollars that you're paying to take care of those residents, now would they?
    As for culture change, which is what I originally wanted to post on, our place is going thru this now, and it seems a success, except for the fact that overhead paging is no longer allowed. MD's have to wait longer on the phone, but that seems the only drawback so far. Then again, we're VERY early in the change, so it'll be interesting to see where it goes.
    Last edit by sirI on Jan 16, '08 : Reason: quoted edited post
  7. by   Simplepleasures
    Quote from johnbearpa
    i'd be willing to bet that if you polled most nurses on this forum, most would say that their facility works above board. i encourage you to do so.

    to make a blanket statement is a disservice to the profession, as it makes it seem as the nurses are part of the problem, because they have no choice but to go running to the state surveyors because there are no facilities that are good out there, and we're forced to work in lousy facilities that are working illegally and unethically. that makes us as nurses part of the problem.nurses are not part of the problem, nurses whose loyalties are to the employer, instead of to the patient are part of the problem.i do not fault nurses for being afraid of retaliation for reporting, it is a very real thing.

    you did state that there were some management people with scruples, but in the same sentence, you stated that they're soon run off out of the business.i stand by my statement.

    i also didn't state that the employee was incorrect to report, just that there are other avenues that carry less of a punch financially to the facility that signs our paychecks.you must do whatever you feel is correct for your own situation, but there are nurses out there, who do not feel the employer has their or the patients best interests at heart.

    i've been around the block a few times myself, having been in this field one way or another since i was 16 working as an orderly for the summers in a state hospital. i'm well aware there are instances where management turns a blind eye to anything but profits, but believe me, in my experience that's not the norm you are trying to portray.
    i'm truly sorry for your bad experiences. there are very good facilities out there, and you're giving them a bad name by association with the absolutes you're using in your posting. you are entitled to your opinion and i to mine, i have my fellow nurses and patients in my best interests.

    my loyalties are also to my pt's, as are my don's, and my administrators. staff that doesn't feel this way doesn't last long at my place. my loyalty lies in the fact that my facility lets me do my job, advocate for my pts, and pays me well to boot. again, you are fortunate, but to state that most ltcs are as you describe, is simply inaccurate.
    have a good evening.
    Last edit by sirI on Jan 16, '08 : Reason: quoted/referred to edited post
  8. by   JohnBearPA
    We'll just have to agree to disagree. Again, my sincere wishes for you to have a great day, and be happy in what you do, whatever that may be.
    Last edit by sirI on Jan 16, '08 : Reason: TOS
  9. by   Valerie Salva
    Quote from JohnBearPA
    most facilities are NOT engaging in illegal or unethical activity, other than the short-staffing that is prevalent in our profession. The facilities that are engaged in anything illegal are caught by regulatory agencies and closed down, as they should be.
    I have worked in a number of LTCs, hospitals, clinics, etc. I find that there are illegal and unethical practices going on daily as part of their normal routines. If every place that engaged in illegal activities really were shut down, we'd probably have at least 50% fewer facilities of any kind in this country.
  10. by   VivaLasViejas
    Moved to Staff Review for further discussion.
    Last edit by sirI on Jan 16, '08
  11. by   sirI
    Thread replaced back in view and now open for discussion.

    Please, let's keep the debate on topic: Culture Change in LTC?

    We respectfully request that you debate the topic and keep off-topic and/or inflammatory reponses out of the discussion.

    Making comments personal usually does nothing for the topic and serves to derail the thread. Please report posts that you think are against Terms of Service by utilizing the report icon and our staff will address the report(s).

    Thank you,
    sirI and the admin team
  12. by   Simplepleasures
    Thank you moderators for editing the previous posts, you kept the pertinenance of the discussion intact and removed the parts that distracted from the true message of the statements. I am glad that you saw fit to bring this thread back as it speaks to the heart of a major aspect of LTC nursing.

    My opinion is that culture change begins with facility and its owners. Many seasoned nurses are a bit cynical and tend to see through the smoke screen of false promises of culture change by the facility owners. We have been promised such changes before only to realize it was not a true change, only a ruse.Perhaps this is changing, maybe it can only happen in baby steps.

    LTC nurses are sometimes overwhelmed with the enormity of their everyday tasks and just don't have the physical and emotional energy to change one more Depend, much less the culture.

    One step in the right direction is to unionize, I know , I know , I am guilty of shouting "UNION" in a burning theater so to speak. Well, its not the theater that burning , its the LTCs of this country and the nurses who are getting burnt out with the untenable patient load and the fear of retaliation if reporting or complaining about patient care issues, etc.

    I know that we as nurses are often disheartened by what we have to see and face at work, I know it takes a toll on us as human beings and nurses. GOOD unions help nurses get the laws passed that are needed to change nurse/patient ratios, to help pass legislation that gives the nurse legal recourse ,when retaliated against for reporting to a regulating body, or even just discussing issues in house. I do believe when the time is right, meaning when the LTC nurse feels secure in her job and has been empowered, culture change will happen. This is my fervent HOPE.

    For those of you fortunate nurses who are lucky enough to be working in a LTC that has TRULY embraced culture change, hoorah, I hope this will sweep the nation and be the TRUE change we need in LTC.
    Last edit by Simplepleasures on Jan 17, '08
  13. by   CapeCodMermaid
    Hmmm..interesting you want to stay on the topic and then bring up unions.....
    Culture change in LTC is a huge undertaking. I would say 95% of the residents in my building have a better, safer, more activity filled life than they did when they lived at home. Perhaps it is because we, management and line staff alike, actually care about the residents. As a manager I also have to care about the budget. As culture change grows, I hope many of the useless unneeded tasks we were once so concerned about go the way of reusing needles. No long term resident really needs their blood pressure checked 4 times a day. No one in their late 90's is going to benefit from taking 23 medications at 9am. Did these people bathe 2x/day at home? No...more like once a week and they didn't smell and didn't have dried skin. The issue of quality care and culture change AND a good quality of life is too huge an issue for one thread.


    PATRIOTS...the next Super Bowl Champions....AGAIN!

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