Sorry To Upset You, But....

  1. I worked in a LTC facility for a short period of time before getting a position in a hospital (med surg). While there were a lot of great things in LTC, my dealings with many LTC staff now isn't a pleasant experience. I actually get the feeling the LTC staff try to act better than hospital nurses!! I called to give report on a patient and the LTC RN was all upset she didn't get more of a notice the patient was being transferred (she was getting a 90 minute notice, I received a 15 minute notice the ambulance was arriving). She knew the patient was returning that day, but apparently wanted hours of notice!! Gosh, I'm lucky if I can get a 20 minute notice on patients being admitted now. She was so huffy it was unbelievable. I stated "do you want report or not" and she didn't even listen to it. It was pretty pathetic. Often doctors want to discharge patients and LTC staff expect the patients to return "perfect" not taking into account they might be 90 and any illness could end their lives. LTC staff should be able to give po antibiotics for a UTI, give Tylenol for low grade temps, etc. A UTI or common cold shouldn't close down a facility if proper handwashing is followed as well as some common sense to prevent spreading germs. While I'd love to see everyone leaving the hospital in perfect care, it just isn't the way things are done today.

    Many of you sound like great nurses posting threads. Do you find some of your coworkers sound like the above? Truthfully I don't care for hospital nursing, but when I get the attitudes noted above, it makes me wonder if I want to focus on LTC again which I have been thinking about. Thanks for your thoughts.
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  2. 21 Comments

  3. by   Super_RN
    I think that attitudes are from individuals, not departments. Some people are just like that and no matter what you do to try and make things smooth...well, I think they wouldn't know what to do if they didn't stir things up!
  4. by   CoffeeRTC
    :yeahthat: Attitudes are every where. Not sure what to suggest. If you routinely get an attitude from nurses when giving report, I would take it higher. That facility/ nurse is gernerating alot of bad PR. I'm sure the higher ups would like to know about it.

    As far as the notice thing. I like to be notified at the start of my shift of any returns or new admits so that I can make sure we have the room ready, paper work ready (esp the CPR signed by respons family) equiptment or pumps ready etc. Ideally this should have been done already by the admit coordinator or SS. In the real world, I'm mostly just happy to be notified before the admit comes to the facility. Maybe this nurse is just super anal like me, but less flexable?
  5. by   geekgolightly
    never had a problem with any LTC nurse and I give report to many facilities.
  6. by   lisa41rn
    Crabby people are everywhere. Guess we're never going to change that. If you haven't experienced this from LTC, consider yourself lucky. I got off the phone that one time and the social service person who asked me to call was next to me doing paperwork and I mentioned it to him. He said they were rude to him too when he was setting things up. It's weird and yes, LTC management probably should have been informed. It was a weekend and nothing was ever done about it. I agree with getting as much notice as possible. Apparently she knew the patient was coming so she could have worked on getting things done early on, but chose to wait for my call and be rude. Go figure!! That's time issue is part of why I don't like the job I'm at now. There's little to no notice for anything and I hate that!! We all have stress, but the floor I'm on is terrible. I tend to be someone who is a perfectionist and I worry about everything!! I have too many things that can go wrong in the hospital setting and would like LTC more if I find the right place. I'm considering it for sure. Thanks to all you great LTC nurses for your responses.
  7. by   ktwlpn
    ........................Actually I see the opposite-I now work in LTC and almost every interaction I've had with acute care nurses has been negative.If you worked in LTC you know that the charge nurse may be responsible for up to 40 residents-it is nice to get some notice regarding a hospital return-we like to at least get the room ready (o2 set up and the like) The nurse you were speaking with is either always miserable and happy to share that or was just having a bad day....Why are you taking her attitude personally? You did the right thing-you sent a good transfer sheet didn't you? That is all I get-we don't get a nurse to nurse report form any of our local hospitals now....I don't know what you mean by sending LTC residents back "perfect" We know that things like wt loss are inevitable after a hosptilization.However when I get a resident back with a whopping big pressure ulcer I consider that unacceptable......When I call the ER to give report I hate hearing things like" Is he(she) a DNR? Why are you sending them in?" DNR does not mean do not treat....I also hate to see a resident with explicit advance directives end up with a tube feeding against their wishes because some nurses and doctors in the ER told the family they would "starve to death" without it.. We do not have a radiology dept. or a lab on -site-most LTC's don't.....We are perfectly capable of giving antibiotics,tylenol etc...But you must know how fragile the elderly can be and how quickly they can deteriorate.Often we have to send them in for a quick eval........It does NOT matter if they are 19 or 90-they still deserve the best care....I also often have to run interference with families after a hospital return-I take the time to explain that patients are so sick in the hopsitals these days that things like shaving and cleaning fingernails often can not be done.......I don't know what you mean by leaving the hospital in "perfect care" I do expect to see they have received basic nursing care......As for shutting down an LTC do to the common cold or UTI I don't understand what you mean by that either......The staff can wash their hands until their skin comes off but when you work with dementia residents you know that body fluids are going to travel and hope for the best.As I said before we can try to treat them at the home with PO or IM antibiotics,mini-nebs,tylenol,etc) but often they end up going out......We can educate families until we are blue in the face but ultimatly the decision to treat a resident aggressively belongs to the family and we have to carry out their wishes....I think you need to be alittle more assertive and not take others behaviors so personally...You know there are miserable people everywhere....Stick up for yourself and move on.....Be the best nurse YOU can be-----do what ever makes you happy.....
  8. by   lisa41rn
    WOW, you took a lot of time to work on nearly every sentence I wrote. Thanks for sharing your thoughts, but please I don't want YOU to take it personally!! I don't even know you obviously. I don't doubt you have experienced some rude hospital RNs. My concern is that I'm looking to change into LTC and want ideas from others due to the problems I've experienced. There are good and bad nurses everywhere. Even the ambulance transporters made a comment about how some of the LTC facilities don't want the patients back "too sick." What is too sick? Sometimes it is ANYTHING less than their baseline. The short time I was in LTC an RN watched (for two days + I was told) a patient vomit bile and had no clue to call a doctor. THAT LTC nurse was lacking basic nursing skills!! Yet I'll be the first to admit there are some great LTC RNs. Thus I didn't take the crabby RNs personally, but I don't want to be too quick to switch over if this is the "norm" for LTC. Again, sorry if my post upset you!! Keep smilin'
  9. by   UM Review RN
    LTC nurses are unbelievably stressed due to unrealistic workloads from management, in addition to typically being micromanaged by an administration that has no idea what nurses do all day (or night).

    Things work differently in LTC. The admission that's streamlined and takes about 45 minutes in a hospital will take a LTC nurse about 3 hours. No kidding. It's about 30 pages of paperwork and complicated assessments because the liability in NHs nowadays is so great that they're CYA'ing to the point of ludicrousness (is that a word?). That's done in between med passes (3 hours apiece) and Medicaid charting (another few hours), treatments and dressings (about 2 more hours). Oh, and it could take DAYS for the attending to call back to verify or change orders, especially for patients transferring on weekends.

    Add to the mix that there are frequently nonstop phone calls from disgruntled relatives, emergencies in which the doc doesn't call back for days, stat labs that take 36-48 hours to get results....

    well, you get the picture.

    I'm thinking that the nurse you spoke with was burned beyond recognition and probably needs to quit LTC but can't because hospitals won't take LPNs and HHC is not much better.

    Next time, you might include a short written report and let all that other stuff just slide right off.:icon_hug:
  10. by   ktwlpn
    quote>I'm thinking that the nurse you spoke with was burned beyond recognition and probably needs to quit LTC but can't because hospitals won't take LPNs and HHC is not much better.>quote---The nurse in the first post was an RN....and I've seen that trend come and go and come again....
    quote>WOW, you took a lot of time to work on nearly every sentence I wrote. Thanks for sharing your thoughts, but please I don't want YOU to take it personally!! I don't even know you obviously. I don't doubt you have experienced some rude hospital RNs. My concern is that I'm looking to change into LTC and want ideas from others due to the problems I've experienced. There are good and bad nurses everywhere. Even the ambulance transporters made a comment about how some of the LTC facilities don't want the patients back "too sick." What is too sick? Sometimes it is ANYTHING less than their baseline. The short time I was in LTC an RN watched (for two days + I was told) a patient vomit bile and had no clue to call a doctor. THAT LTC nurse was lacking basic nursing skills!! Yet I'll be the first to admit there are some great LTC RNs. Thus I didn't take the crabby RNs personally, but I don't want to be too quick to switch over if this is the "norm" for LTC. Again, sorry if my post upset you!! Keep smilin'>>>>>>>>> No upset here.I'm.truly happy in my present postion and enjoy the elderly.I especially like the challenges presented by those with dementia....It really ticks me off when any nurse acts like she is being inconvenienced by the needs of her patients...I also take the remarks made by the ambulance crews with a large dose of salt-most of them around here think all of our residents should just be left to die...Residents in LTC are living longer with more and more complex problems and it can get overwhelming especially when you have meds to give to 22 others and 7 fingersticks with sliding scale coverage before breakfast....Sadly the "not too sharp" nurses can hide their shortcomings longer in LTC then they can in a hospital.....Where was the supervisor while this resident was spewing bile? The other shift nurses? See-we need YOU in LTC (PS-I did team nursing in a small community hospital and worked for a short time with an RN that used to run the opposite direction from the crash cart-she now works in maternity in a large hospital-I can tell you some stories about scary incompetent nurses ) .......anywhoooo.....I think I understand now what you are asking-many many things go wrong in LTC too and throw the rest of the shift into chaos-It's just a slightly different focus then acute care..We deal with such ridiculous crap-from the family complaining about "mother's missing pink socks " to "daddy did not get his warm milk at bedtime last night" These people think that type of issue is just as important as another resident's PT/INR.....It's up to us to make them think we agree......with a smile and " I'll look into that for you" These elderly people are important and deserve the best.....
    Last edit by ktwlpn on Oct 1, '05
  11. by   texas_lvn
    I would like to go further that the nurse (with the vomiting) may have initated a call to the Dr, but he/she did not bother to call back. Although there are ways around this (notifiy family and have them insist family go to ER), we in LTC have our hands more bound b/c when we do see a problem, we do not have the immediate number of the Doc, we have to wait for a call back.

    To the OP- if you are looking to move to LTC, take a long hard look at the facility. Go in several times, at different times. See how your CNA's interact with the staff/residents. Is everyone burnt out? If you had to call in for any reason, would there be coverage or would it take an act of congress? How do your LVNs respect the higher ups? Do they speak badly of them, or is there respect? What has state/medicad/medicare reports state? During your interview, does the DON have great things to say about the staff (without hesitation!) (ASK). I work in both hospital and LTC (and HH PRN), and LOVE LTC. You are going to find people with bad days everywhere, just be sure not to apply at that facility! Or You could be the one that makes a difference in the lives of your co-workers. I am not saying belittle them or let them step on you, I am saying, when I am having a bad day, (for whatever reason) I know I can count on my co-workers and they can count on me. My aDON stepped in yesterday and did most of the work for a new admit for me (our paperwork does take over 3 hours for new admits plus follow ups X 7 days q 4 hours.) In the long run, how is the facility/workers. Sorry for the lenght I am passionate.
  12. by   Cubby
    I HAVE HAD MORE THAN MY SHARE OF BEING AN ACUTE CARE NURSE-BUT I PREFER LTC. I LIKE KNOWING THE IDIOSYNCRACIES OF WHO I AM TAKING CARE OF. BUT I WOULD LIKE TO KNOW WHY IS IT THAT I CAN SEND A 90+ YEAR OLD TO THE ER (99.9% OF THE TIME IT IS A FAMILIES REQUEST, YEP, YOUR DAD WILL BE THE ONLY PERSON ON RECORD TO NEVER DIE) WITH THEIR SKIN INTACT. WHEN HE COMES BACK, WE HAVE DECUBITUS ULCERS ON FEET, HIPS, BUTTS. WHY? I KNOW THAT ACUTE CARE NURSES TAKE GOOD CARE OF THESE FOLKS. I JUST DON'T GET IT! INPUT PLEASE
  13. by   suebird3
    Quote from michelle126
    :yeahthat: Attitudes are every where. Not sure what to suggest. If you routinely get an attitude from nurses when giving report, I would take it higher. That facility/ nurse is gernerating alot of bad PR. I'm sure the higher ups would like to know about it.

    As far as the notice thing. I like to be notified at the start of my shift of any returns or new admits so that I can make sure we have the room ready, paper work ready (esp the CPR signed by respons family) equiptment or pumps ready etc. Ideally this should have been done already by the admit coordinator or SS. In the real world, I'm mostly just happy to be notified before the admit comes to the facility. Maybe this nurse is just super anal like me, but less flexable?
    Michelle....you and Angie hit it on the head. I am sure things get really crazy in acute care.....I can attest to the LTC side.

    I try to give a good report to the hospital, if I need to send someone out....but it is not always possible, on my side OR theirs. I am sorry, Hospital nurses!!!! I give you credit.

    Oh, yeah, I have given our admissions lady unending grief about people who come back w/o "advance notice", but this is a running joke between us. I have realized that "stuff happens" in the hospital, and if the bed is needed and the person can be transfered.....
  14. by   suebird3
    Quote from Angie O'Plasty, RN
    LTC nurses are unbelievably stressed due to unrealistic workloads from management, in addition to typically being micromanaged by an administration that has no idea what nurses do all day (or night).

    Things work differently in LTC. The admission that's streamlined and takes about 45 minutes in a hospital will take a LTC nurse about 3 hours. No kidding. It's about 30 pages of paperwork and complicated assessments because the liability in NHs nowadays is so great that they're CYA'ing to the point of ludicrousness (is that a word?). That's done in between med passes (3 hours apiece) and Medicaid charting (another few hours), treatments and dressings (about 2 more hours). Oh, and it could take DAYS for the attending to call back to verify or change orders, especially for patients transferring on weekends.

    Add to the mix that there are frequently nonstop phone calls from disgruntled relatives, emergencies in which the doc doesn't call back for days, stat labs that take 36-48 hours to get results....

    well, you get the picture.

    I'm thinking that the nurse you spoke with was burned beyond recognition and probably needs to quit LTC but can't because hospitals won't take LPNs and HHC is not much better.

    Next time, you might include a short written report and let all that other stuff just slide right off.:icon_hug:

    Angie.....I always remember that "This, too, shall pass." You have written exactly what I have seen, and I do what I can when I can.

    When I went onto the present round of 11-7's, I collared the one "hard to get ahold of" MD's, and negotiated for some ground rules. :chuckle He was pretty cool about it.

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