I began working in a nursing home in Los Angeles after my only experience was an adult day health care center. After orientation, I began my first day as charge nurse in a 159 bed facility.
I hated it more than anything and I quit after one day. I could not believe how ridiculous and unorganized this facility was. I had 40 patients to care for, 16 diabetics, 4 breathing problem/asthma patients, 2 actively dying hospice patients, a few surgery rehab patients for broken hips, falls etc, and 2 HIV positive patients, the rest were there for reasons I am unsure of because I did not have time to look at the charts. Most of my patients had narcotic pain meds PRN Q4H, except my hospice patients whom were Q2h, and they wanted the pain meds as soon as they could get it. In addition to PRN pain meds, there were PRN sleeping meds, PRN anxiety meds, PRN itching meds, PRN everything meds.
To start my shift, we were called to an inservice meeting, where the DON began to complain about how the dialysis dressings weren't being removed 4 hours after returning from dialysis, and that a patient got an infection and the shunt was now useless and the family is threatening to sue. This went on for about 50 minutes.
Im already behind on my 2 hours to pass meds, so i begin. probably every 5 minutes, a patient bugs the cna for a PRN med. So i must stop what im doing continuously and get it for them. Then I notice there are a lot of ordered meds not even inside the cart, but they're signed for! and the supplement drawer is full of a bunch of empty containers! and some of the meds are in the wrong places. I am already past my 2 hours limit. Also a lot of meds in the cart, but not in the MAR. Many of my patients were not in their rooms and nobody knew where they were, if they were out on pass or what.
I am constantly checking sugars, preparing 2 types on insulin, heparin, some insulins aren't in the cart or in the facility, medications have the wrong bed numbers, and charts have the wrong bed numbers, the patients aren't wearing their identification bands or the bands have no info on them, a ton of orders are hand written in the MAR to the point that I cannot read them, and they have the wrong mcg ordered than what is in the bubble pack. I have quite a few confused patients whom are unsure of what they are to do with the pills i just handed them, and it takes 10 minutes for them to understand they need to swallow their pills, assuming they even agree, and i am required to watch my patients take their pills, as i cant leave the med cup in the room. I had a lot tell me no they didnt want to take their seizure meds, or their insulin, or their digoxin at the moment, and had to waste a lot of time convincing them.
Then one of my patients refuses his seizure medication, and his insulin. HE WILL NOT TAKE IT. So i leave and he disappears, apparently "out on pass" as some of the residents are allowed to leave as they please i guess. So when he comes back, a cna tells me someone fell outside, and i run out there and its him. He is on the ground with an empty bottle of vodka, and is so drunk he cannot walk. He denies that booze is his, and says he fell because he didn't get his medication that day. Then starts cussing out my CNA calling him a snitch. The RN took over because I was so behind.
Then i go back to passing meds, and the cna tells me one of the patients arms feel hard and if I can look at it. I pull back the blanket and this guys arm is FIVE TIMES THE SIZE OF THE OTHER ARM!! I dont know the patients, so I ask if he always has this and the CNA didnt know. So I alert the RN because I dont know the patients, and the RN says no, he has dialysis, and there was a hematoma the day before, and they're going to have to send to the hospital. Then, i learn that for 3-11, im also the Tx nurse, and I have treatments to do. I still haven't finished passing my 5 pm meds, and its almost 11pm, so i had to pass my 5pm and 9pm meds together, and do my insulins and 9pm blood sugars and give the rest of the heparins. Some of my meds were in the fridge, but there was nothing to inform me of the meds being in the fridge. The whole time I have to keep stopping to give pain meds and anxiety meds and breathing treatments, and patients are asking for things they apparently get daily that are not ordered, and i'm supposed to answer phone calls and family members AND do my charting. My patients on thickened liquid had their liquid thickened until it was SOLID as in i could turn the cup upside down and nothing would happen.
The patients constantly tell the cnas that they want to talk to me, and when I enter, its about something insignificant like why can't they have another ensure shake, or if i can leave their prn meds in their room for when they want to take them. Then I have a few rooms that I have to do from the other station, and their meds are in the other cart, so I have to hunt down the nurse with the key to that cart every time I needed to give a PRN, or their routine meds. The charts all say the same thing every shift unless something big happens, and they are illegible. All the nurses clock out for lunch, but keep working, and there are no breaks, and then the nurses clock out and finish working for about another hour and a half. They said it was low census, the day was uneventful, and when the facility is full they stay on average an extra 3 hours unpaid. Now I know why those dialysis dressings are going un changed.
Are all nursing homes like this? I thought I would be ok with working in one, but not if this is how they operate.
