LTC is making me hate nursing!!!

Specialties Geriatric

Published

I'm a new grad charge nurse in a LTC facility. I've been there for almost 2 months and I'm at the point where I'm literally scared to go to work. At first I floated, and that was ok, but I just became a regular on a dementia/psych floor. The paperwork and charting is sooo heavy, and I'm the only nurse on a 40-bed unit. I know I have to "manage my time" more effectively, but there's not enough time in one 8 hr shift to do everything that is required of me.. and i don't take lunch.

I have to pass meds (and the time schedules of the meds are so crazy), start tube feedings, supervise CNAs, chart, pick up orders, check orders, treatments, and various other paper work that come in books.. and the worst of all is getting an admission.. i always fear that i'll get an admission :confused:.. and on top of all that, i JUST learned that i'm required to re-do the whole treatment book for the new month.. and my god, the daily interruptions i get.. supervisors coming every 5 mins to check the medex while i'm giving meds, CNAs calling me for this and that, residents not wanting to take their meds (i have to spend so much time just to encourage them to do so).

I don't want to quit because I want to be able to handle everything, and I've floated to every floor to know that other floors are easier to handle; still hard, but a little easier. I just don't believe one nurse can do it all safely.

Specializes in LTC/Dementia/Woundcare.

Leave while you still can and go to another LTC. When you interview, ask what the nurse/resident ratio is. If you don't like it try another one.

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Specializes in Med.Surg/ Psychiatry.

I feel your pain. I am desperately looking for a way out of my LTC job. Its so crazy out there that we nurses have a slogan "i can't believe i work here". People call out everyday, you are stuck by yourself and you have admissions, falls, med pass, treatments and so many interruptions both with the phone ringing and omg let's not talk about family members. Its ridiculous...I need a way out fast before i lose my mind. My job has a high turn-over rate and i've only been there for a couple of months. The problem is, even as a RN, its almost impossible to find a job in Iowa. Too bad i found out the hard way but i would love a referral if anyone has any home health/psych jobs they know of around the quad city area. Phewwww!!!

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Specializes in LTC.

I have done this for 18 years, and I am done.

It is plain crazy what is expected of a LTC nurse.

The charting, pt/res load, the shift wars, the catty petty crap, the short staffing, the new rules/guidelines/policy that adds more to your shift, and ieffective management that hasn't a clue what floor work is like because they won't do it.

It will be easier to care for 5, 6, 7 patients to me because a typical ratio is more like 23-48 and I do believe that it is enough of a difference that a functioning moron will see just how easy it is. Hospital RNs come into LTC for the money, thinking it will be easier and find out the truth. They run right back to the hospital here, and don't look back. We have lost many, many hospital RNs for the reason of an 'unsafe workload/environment' but LPNs here have no choice but do this job. We learn to 'make that shift work' and manage time. Or we get fired from one job to the next.

Like I said, I have done 18 years of LTC it gets worse every year. The sad part is that the work and residents aren't the issue; its the job. So many unnecessary demands have turned the job into a nightmare.

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Specializes in LTC.
I have done this for 18 years, and I am done.

It is plain crazy what is expected of a LTC nurse.

The charting, pt/res load, the shift wars, the catty petty crap, the short staffing, the new rules/guidelines/policy that adds more to your shift, and ieffective management that hasn't a clue what floor work is like because they won't do it.

It will be easier to care for 5, 6, 7 patients to me because a typical ratio is more like 23-48 and I do believe that it is enough of a difference that a functioning moron will see just how easy it is. Hospital RNs come into LTC for the money, thinking it will be easier and find out the truth. They run right back to the hospital here, and don't look back. We have lost many, many hospital RNs for the reason of an 'unsafe workload/environment' but LPNs here have no choice but do this job. We learn to 'make that shift work' and manage time. Or we get fired from one job to the next.

Like I said, I have done 18 years of LTC it gets worse every year. The sad part is that the work and residents aren't the issue; its the job. So many unnecessary demands have turned the job into a nightmare.

But on any given night we have those 5-7 patients who really should be in the hospital or were just admitted from the hospital and going south because the hospital wanted them out.

Plus we have the other 20-30 patients on top of that.

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Specializes in Geriatrics, Ambulatory Care.

LTC is very stressful and hard but it is also very rewarding. I have been at my current position for 5 years. I work with some of the most amazing nurses and CNAs and CMAs. I do not think staffing ratios are the answer. Nor do I believe that unions would help. Learn to speak up for yourself. If your administrator or DON do not have an open door policy, find a new facility. If your med pass is too heavy at a specific time meet with your DON to discuss moving meds to different times. As nurse managers our goals are the same as yours, we want to provide the best care possible to the residents. Some nurse managers only know how to put out fires but do not know how to put prosesses in place to stop the fires to begin with. If you have suggestions, voice them. LTC is the most highly regulated industry in the United States. If you truly want change in LTC please please please write your congressman. The daily rate provided to most nursing homes is less than the cost of a good hotel. Yet with that money we are expected to provide nursing care, wound care, food, housing, personal care, etc.

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Specializes in LTC.
But on any given night we have those 5-7 patients who really should be in the hospital or were just admitted from the hospital and going south because the hospital wanted them out.

Plus we have the other 20-30 patients on top of that.

Exactly! :eek:

And of those extra 20-30 any one or possibly more, can also go south and crash on you.

I have worked a lot of units; TBI, skilled, trachs, IVs, ostomys, decubs/stage IV or worse wound vacs too, and high acuity needs but with that I've always, always, always had at least 15 more pts on top of that.

I am a dinosaur, I had this type of a pt load as a GPN before I was licensed, in 1993 you could work under a RN as a graduate nurse on the floor- if I can handle this as a new grad before I was licensed....Please, the hospitals with the 5-7 pt ratio will in fact be easy to handle. The work itself will still be a challenge but the load will not.

My SIL is a new grad RN and so is my niece and they were shocked to learn how many pts I care for, their first question was, 'how do you do that? and get done?' Both of them have a 5-7 pt load where they work.

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Specializes in LTC.

All I can say is that I am praying for you. I am at the point where you are except this is the end of my first week after an "8 week" orientation. Yesterday I almost quit right in the middle of my shift but I thought how much danger the patients would be in if I did so, so I stuck it out and as usual didn't pee, inhaled half my avocado (first "break" of 5 mins to eat all week) standing up and hiding from patients in a corner. This was after I was told that I was staying too late and that I had to manage my time more effectively. Mind you I was pulled out of med pass for this meeting that lasted 20 mins which I could have used to be done on time.:uhoh3: Between peg tubes, unruly patients, massive narcs and meds, demented patients who keep unplugging equipment so they complain it doesn't work, O2 sat patients, other demanding mess left and right I always feel in over my head. Couple this with a nurse manager who thinks I am dingbat for asking necessary questions, I feel as though my cup runeth over. I go back in today but I am hoping to speak with someone before my shift because no matter what they tell me of "it will get better" I'm not to sure of this. All I can say is be encouraged, start looking for another job like I've been since my second week in a place like this, and PRAY!

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Specializes in drug seekers and the incurably insane..
LTC is very stressful and hard but it is also very rewarding. I have been at my current position for 5 years. I work with some of the most amazing nurses and CNAs and CMAs. I do not think staffing ratios are the answer. Nor do I believe that unions would help. Learn to speak up for yourself. If your administrator or DON do not have an open door policy, find a new facility. If your med pass is too heavy at a specific time meet with your DON to discuss moving meds to different times. As nurse managers our goals are the same as yours, we want to provide the best care possible to the residents. Some nurse managers only know how to put out fires but do not know how to put prosesses in place to stop the fires to begin with. If you have suggestions, voice them. LTC is the most highly regulated industry in the United States. If you truly want change in LTC please please please write your congressman. The daily rate provided to most nursing homes is less than the cost of a good hotel. Yet with that money we are expected to provide nursing care, wound care, food, housing, personal care, etc.

You definitely are in management.

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Specializes in ltc, rehab, home health.

I've been working in LTC for 14 years 7 as a CNA and 7 as an LPN, it does'nt get any better believe me, it only gets worse. I'm only working per diem no more than 3 days a week because thats all that I can handle nowadays. I'm trying to find something in home-health. LTC needs a change!!!

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Specializes in Geriatrics.

This is sooooo common in LTC. As an LPN, I have very few choises as to where I can go. You may have noticed the turn-over rate is very high in LTC. Burn-out is an everyday thing, and getting fired for family complaints are the norm. If you manage to manage your time to accomplish all the job requires, they WILL add more to your job. Basically it is a job where you are set up to fail and your constantly doing your best not to. If you succeed in all you do, you will be seen as trying to advance and that will scare someone, then you probably will have charges falsely placed against you, so you either quit or get fired, this too is common. Which is one of the reasons for the high turnover! LTC rarely treats thier Staff properly. Why do I stay with it?? Because I love my patients, and because as stated in the begining, there really are very few choises for me.

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Specializes in Gerontology, Med surg, Home Health.

I don't fire staff for made up complaints. No one has anything made up about them...it's not tolerated. Not all LTCs are horrible.

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Specializes in Mental Health Nursing.

Hey all,

I have my 6+ months of experience and work has gotten better in the sense of getting to know the residents; residents who wouldn't take a single med now trust me and no encouragement is needed :).. But as for the job getting better... Nope. It's actually worse because now I'm dealing with MORE paperwork, new arrogant supervisors, and this crazy habit of management calling all nursing staff for inservice in the middle of our shift (one time inservice went on for an hr and a half, right in the middle of evening fingersticks and insulin coverage).. Also, it seems like the better I get, the more I get new paperwork and responsibilities shoved at me.. I still stay 2 hours after my shift sometimes (you know those days when you get an admission, a fall and have to transfer a resident all on the same shift.. or the ultimate terror.. two admissions OMG) but i feel better because I understand everything I'm doing now.. I still wish I had another nurse with me instead of having to do everything lol, but knowledge does lead to confidence :)..

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