How to Fix a Broken Nursing Home

[jayni87]

I think we all know that LTC is no joke. Some places are better than others, and some are struggling to get by. In the end, it's always the residents who suffer.

I'm a new nurse, one month into my new job. I absolutely adore the residents. I'm on the dementia floor, and some of the personalities we have make me laugh out loud. Others are very combative, but even they need someone looking out for them. The facility I work for does not screen their residents at all, they basically accept anyone. It's actually something I somewhat admire about the facility: everyone receives care, no one is turned away.

At the same time, if our census is down more than 5 or so (out of 189 beds), management takes a nurse off each floor. Normally we have 3 nurses on my floor, each with 24 patients. When we have 2 nurses, we're looking at 36 residents each. It's doable with 2 nurses, and I feel like I'm providing good patient care. With two, it's a mad-house. First shift is angry at the night shift for not finishing all the orders, second shift is angry at first shift for the mess at the nurses' station and the 6 orders still up, and night shift is angry at second shift for the 2 orders we couldn't get to. Heaven forbid a fall or a new admission should come through. It's a revolving circle of bitterness and frustration.

The nurses are responsible for passing all meds, doing all treatments, ensuring that tube feedings are up on time, changing colostomies (on occasion several times a shift...as I said, dementia unit so they don't always stay on), completing nurses notes, 24-hour report, our "adopt" program paperwork, 15-minute checks, re-ordering meds, as well as anything else that may happen throughout the day. A fall report takes a good 40 minutes to complete properly, an admission takes a good hour and a half to do properly, and we are constantly running down the hallways towards a chair beeping to make sure no one has fallen.

Next: whether there are three nurses or two, we are expected to clock out at the end of shift exactly. There is no lee-way, we will get written up if we stay late to finish our paperwork. As a new nurse (both to the facility and nursing in general), I did end up staying 45 minutes or an hour late on the days that we only had two nurses so that I could complete all my paperwork. Even the seasoned nurses couldn't get it all done in time.

This is adding to our cycle of bitterness and anger. I've heard around the rumor mill that they will be losing a significant number of their staff. People are fed up. I actually had to take five minutes the other night, walk outside, and repeat to myself "Don't quit, don't quit, don't quit" in order to get through the night. So, while I am certainly frustrated, I'm not ready to throw in the towel.

There are probably many people out there who have been through similar situations. Are there any solutions that could be instituted? I have this insane idea that if I bring management both a problem and a solution, I could make a difference. Am I crazy? As I said, I adore the residents here. Some of them don't seem to hear or understand a word I'm saying, but I chat with them as I give them their meds nonetheless. Others understand me, but think I'm their granddaughter. Others give me suspicious looks as I coax them into eating their applesauce. I adore each and every one of them, and I want to try to help making their lives better.

Please leave comments with ideas on how we can fix this. I'm completely flustered, and look forward to hearing from you all.

-Jayni

[JBMmom, MSN, NP]

I hope that someone else might have some advice for you, I just want to wish you good luck. I hit the jackpot of LTC jobs with my first one. I have great coworkers and while I may never understand the whole corporate/staffing side of things, I don't think that I've been in a situation where anyone was unsafe because of staffing issues. Very proactive of you to try to have a constructive argument with management. I have no idea how successful that could be, but it can't hurt to try. Be prepared to leave if you have to, but know that you're doing your best for the residents. Good luck.

[sunshyne17]

I understand your pain - to a point. We have to ask for approval to finish work after our shift and they will say whether or not we will get paid for the time but we don't get written up.

I can't imagine being on a rehab unit and having to do treatments and med pass and charting and assessments... We usually have someone come and do treatments. And I STILL have to stay pass my 3-11p shift sometimes to chart!!

I'm with JBMmommy - I hope talking to management changes something. Maybe tailor it to something that would be in their best interest (savings, less falls, etc) as opposed to nurse burnout.

GL!

[CapeCodMermaid, RN]

These days it's all about customer satisfaction. If you can show the residents(customers) or their families(customers) have complaints because of poor staffing, you might have a chance. I've been told in my past lives to staff to census...I usually refuse based on acuity or behaviors of the residents on a particular unit. The company I'm with now is wonderful. We have to be down more than 10 beds to call off a CNA but we never call off a licensed person.

[NanikRN]

I don't have anything of value to add to prior advice given but-- you sound like a delightful nurse and I think your residents are fortunate to have you.