The Cons of Working in Long Term Care - pg.2 | allnurses

The Cons of Working in Long Term Care - page 2

I worked as a floor nurse and supervisor in long term care (a.k.a. LTC, nursing homes, or aged care) on and off for six years. Last year I wrote two articles that placed a mostly positive spin on... Read More

  1. Visit  bluegeegoo2 profile page
    2
    Finally feel rested, so here it goes: The paperwork. The choking piles and file cabinets full of nothing but paperwork. If I had a dollar for every time I have been told "We have a form for that" I could retire already. (And the next time I hear it I can't promise I won't scream. ) I had truly thought that when I got into nursing school that I would one day get to take care of people. Silly me. It didn't take long for me to figure out that my primary purpose is to do paperwork. C my A? You mean C your (corporate) A? Sadly, there are many more times that I care to count that I've had to cut time with a resident in need (not in emergent need, mind you) so that I could get that (expletive) paperwork done in time for shift lest I "go over in hours." In that last few minutes of shift, virtually swamped with (expletive) paperwork there is usually some person who has nothing better to do than to chatter away at me about God-knows-what (I'm not listening) and all I wanna do is throw papers/charts (the Chatter-er seems a good target...) scream and walk out. I am truly sad that all of my residents have been reduced to charts and paperwork. There are really neat residents in LTC. Too bad I can't see them for the paperwork.
    Last edit by bluegeegoo2 on Dec 3, '13 : Reason: Needed editing :)
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  2. Visit  bluegeegoo2 profile page
    2
    Quote from savoytruffle
    Exactly why I left SNFs. This list only scratches the surface of what's wrong with long term care. Working at these places has made me regret ever becoming a nurse. I left feeling defeated and depressed. I will never set foot into these places again. If fate decides to twist cruelly on me in my twilight years, and I become a resident, I will devote my entire wretched existence to eloping.
    I plan to elope as well. I also have a running list of behaviors I can't wait to try out.
    amoLucia and Crispy Critter like this.
  3. Visit  Concerto_in_C profile page
    0
    If you can help it, don't work in long term care because they will work you to death, as evidenced by incredibly high turnover of staff (at the place where I used to work, something like 8 nurses resigned in the same month) and they use deceptive claims of having low acuity. They give you 15 residents claiming "they're low acuity". Untrue.

    I work in a medical surgical unit and most of my patients are low to medium acuity. They may be s/p laparoscopic surgery and have 3 or 4 punctures in the stomach, but they are mostly independent. They can get up with an IV pole, go to the bathroom, ambulate in the hallways, all independently. Many of them are young people.

    Nursing home residents are for most part confined to a wheelchair and many have profound disabilities. A 90 year old person who has lived in a wheelchair for the last 10 years will almost never be low acuity. They poop in their pants, they poop all over their beds (very high rates of C-DIFF make it even harder for the staff) when they eat they have food in their underwear and expect you to change them, they can't do anything for themselves. They drop a book-a call light goes on because you have to stop what you are doing to pick up the book. If they try to be "independent" falls often occur.

    Long term care places tend to be scandalously understaffed, but generally are not held responsible for being understaffed, because government rules are so lenient. In the state of Illinois the laws are so vague a facility with just 1 RN overseeing care is considered "properly staffed".

    Another problem...the public, and to some extent healthcare administrators and recruiters, are conditioned to believe that only helicopter nurses/trauma nurses/ICU are competent. Long term care nursing has a very bad reputation due to under-staffing, sloppy care, etc, which are known to the public at large. This caused me enormous problems when I tried to transition from sub-acute rehab to a hospital. I succeeded, but only by moving to another part of the state. I felt like 3 years of long term experience on my resume was wasted time...
    Last edit by Concerto_in_C on Dec 3, '13
  4. Visit  Concerto_in_C profile page
    3
    Another problem, already mentioned by others. The acuity in long term care, already higher than ever, is bound to increase in the future. For example, a long term facility that never accepted ventilator patients before, now is accepting ventilators. This is because government reimbursement has been drying up steadily, esp. since the Great Recession. This makes administrators increasingly more desperate for resident who "make money" for the facility, including very complex cases that will be difficult to care for in long term care, because staff is lacking expertise, and doctors are rarely seen on the floor.

    A long term nurse can find herself in a unit with acuity the same, or greater, than a general medical unit in a hospital, but with a 15 to 1 patient/nurse ratio. This could be a veritable nightmare of a place to work for...
    mellster, scceda, and HeyHeyitsMaay like this.
  5. Visit  mso819 profile page
    0
    Quote from savoytruffle
    Exactly why I left SNFs. This list only scratches the surface of what's wrong with long term care. Working at these places has made me regret ever becoming a nurse. I left feeling defeated and depressed. I will never set foot into these places again. If fate decides to twist cruelly on me in my twilight years, and I become a resident, I will devote my entire wretched existence to eloping.
    Yes!! I cant wait to leave LTC......its really starting to drain me. And i plan to devote my entire wretched existence not only to eloping but to being the one resident nobody likes. :smiley:
    Last edit by mso819 on Dec 4, '13
  6. Visit  HeyHeyitsMaay profile page
    0
    I work for a privately owned SNF with a regular PPD of 6. Even with a central supply clerk, dedicated unit clerk and incredible corporate support - the acuity and the expectations are so high along with turn over that I regularly want to quit nursing altogether. I worked for an agency as an LVN while pursuing my ADN doing correctional assignments and afterward, at a county jail. I miss it, desperately. I kill myself to be the best DON that I can be and you will never find a better SNF than the one I work for. The quality of care and the work environment we provide is out of this world. We even pay a full time massage therapist for both residents and floor staff. But man. Someone needs to make CMS and DADS come run our facilities the way they require us to. We never, EVER run out of supplies. Abuse from patient family members is absolutely not tolerated - I'll have you arrested without blinking an eye if you even think about being abusive toward my staff. Even with the most optimal conditions and standards, we make a living running for our lives from the government and it's an existence straight from hell.
  7. Visit  Chris81 profile page
    2
    My use of the word incompetence arises from the basic floor- nursing checklist for skills all nurses are expected to perform,sometimes on an hourly basis,sometimes once every 5 years(vital signs to how you hang TPN&lipids,with a long running IV-ABX). I have been assigned RN students who were very enthusiastic and eager to put their hands on a patient,and the equiptment needed to perform a task and it was a joy to watch them deconstruct a task I had long ago integrated. New nurses I elevated to a higher level,as as evidenced by their graduation and passing NCLEX demonstrated their mastery of content,but to my surprise were unprepared to perform those skills that were maybe done once in a nursing lab. At first I thought they were kidding,no-really,I thought they were just trying to blow my mind. After the first few orientees I came to accept the fact that no,they had never inserted a foley catheter into a male pt.,did not know how to obtain a BP on a female c a complete mastectomy on one side and IVs on the other,or how to transfer a pt.c a CVA. Having worked in a facility that liked to "grow our own" nurses,I worked side by side c CNAs who went onto to school with the intention to return to LTC(yay!),so I heard from them throughout school about what they were not being taught. As The Commuter as sagely noted,nurses graduated from school with all kinds of floor experience,volunteering for procedures big and small,embracing any opportunity to DO something. I fear the nurses of the past decade have been educated to pass NCLEX only. Most environments require competencies be demonstrated yearly by staff nurses,and we expect those newly minted nurses to do it best!-no shortcuts,every step textbook. I've reset my expectations and realize that when I'm orientating a new nurse,I'll be showing you HOW to apply everything you've read,studied and tested on. No insult intended,just disappointment expressed.
    bluegeegoo2 and HeyHeyitsMaay like this.
  8. Visit  pinkiepinkPN profile page
    0
    Quote from TheCommuter
    Keep in mind that the particular nurse you're quoting has 35 years of experience. She entered the profession during a time when most nurses graduated from three-year diploma programs. Back in her day, new nurses graduated highly skilled, with thousands of clinical hours under their belts, and were able to hit the floor running at their new jobs without much orientation or training. So in her eyes, today's crop of new grads does seem incompetent compared to the new nurses of 35+ years ago.
    True, but we have to recognize that this is not the fault of the newly graduated nurse. I graduated from a 9 month PN program in May and just started my first job a few weeks ago (I had major surgery in July and had to delay job hunting for awhile)...and yeah. I feel pretty clueless and do wish my program had been longer. Sometimes I honestly feel like I have forgotten everything I killed myself to learn, but I am fortunate to work with several LPNs and RNs who are really encouraging and don't treat me like some imbecile when I ask a question, even if it's something I really 'should' know. But you know what? I'm continuing my education because I want to keep learning and expand my abilities...and if someone were ever to call me incompetent, all I can do is realize they don't know me and how fast I really do pick things up when someone is genuinely interested in teaching me.

    People have a way of living up to other people's expectations. The more experienced nurses we have calling new nurses "incompetent", the more "incompetent" nurses there will be.
  9. Visit  mso819 profile page
    0
    People have a way of living up to other people's expectations. The more experienced nurses we have calling new nurses "incompetent", the more "incompetent" nurses there will be.[/QUOTE]

    Great point and well said. I do also agree that the new grads today are not being taught what needs to be taught, but thatd not to go for ALL new grads. There really are some new grads who are ready to dig in and get there hands dirty. Then again there are some that is not.
  10. Visit  bluegeegoo2 profile page
    0
    Quote from Chris81
    My use of the word incompetence arises from the basic floor- nursing checklist for skills all nurses are expected to perform,sometimes on an hourly basis,sometimes once every 5 years(vital signs to how you hang TPN&lipids,with a long running IV-ABX). I have been assigned RN students who were very enthusiastic and eager to put their hands on a patient,and the equiptment needed to perform a task and it was a joy to watch them deconstruct a task I had long ago integrated. New nurses I elevated to a higher level,as as evidenced by their graduation and passing NCLEX demonstrated their mastery of content,but to my surprise were unprepared to perform those skills that were maybe done once in a nursing lab. At first I thought they were kidding,no-really,I thought they were just trying to blow my mind. After the first few orientees I came to accept the fact that no,they had never inserted a foley catheter into a male pt.,did not know how to obtain a BP on a female c a complete mastectomy on one side and IVs on the other,or how to transfer a pt.c a CVA. Having worked in a facility that liked to "grow our own" nurses,I worked side by side c CNAs who went onto to school with the intention to return to LTC(yay!),so I heard from them throughout school about what they were not being taught. As The Commuter as sagely noted,nurses graduated from school with all kinds of floor experience,volunteering for procedures big and small,embracing any opportunity to DO something. I fear the nurses of the past decade have been educated to pass NCLEX only. Most environments require competencies be demonstrated yearly by staff nurses,and we expect those newly minted nurses to do it best!-no shortcuts,every step textbook. I've reset my expectations and realize that when I'm orientating a new nurse,I'll be showing you HOW to apply everything you've read,studied and tested on. No insult intended,just disappointment expressed.
    In my schooling experience, that was exactly what we were taught: What we needed to pass NCLEX. That's all I heard about. Sure we did "check offs" for skills and such. But who couldn't run a 16f cath into a 24f opening on a dummy? Of course we had to verbalize and at times mime the steps to perform the check off, but c'mon. I graduated without having the opportunity to cath one single human being. Nor did I get to start an IV, or any other handy-dandy nursing skills. I had to learn them on the fly as some poor soul's charge nurse. I felt woefully under prepared to begin to practice nursing. But, hey, I passed the NCLEX. Guess my college gets to add me to their "pass rate" percentage.
  11. Visit  pinkiepinkPN profile page
    0
    Quote from bluegeegoo2
    In my schooling experience, that was exactly what we were taught: What we needed to pass NCLEX. That's all I heard about. Sure we did "check offs" for skills and such. But who couldn't run a 16f cath into a 24f opening on a dummy? Of course we had to verbalize and at times mime the steps to perform the check off, but c'mon. I graduated without having the opportunity to cath one single human being. Nor did I get to start an IV, or any other handy-dandy nursing skills. I had to learn them on the fly as some poor soul's charge nurse. I felt woefully under prepared to begin to practice nursing. But, hey, I passed the NCLEX. Guess my college gets to add me to their "pass rate" percentage.
    I hate to hit quote every time but I can't seem to find just a 'reply' mode on my phone! Oh wells.

    Anyway, what you said about nclex is spot on. My school boasts a 100% pass rate (until his year actually- one of my classmates failed but passed the second time) for all three programs for the last 5 years. It IS all about nclex. Every day, every class, embedded in lecture power points were "nclex style questions" and the school even hired us a specialized nclex consultant that coached us in sessions lasting a week. Yeah, they want you to pass.

    I as well graduated without getting to do many skills in clinical or do them many times. I didn't do a foley until my very LAST clinical day, and that was on a laboring woman with an epidural. In all the nursing homes we went to, only the night shift does them! Only got to start an IV on a classmate in a covert setting, and only got my hands on a whole list of other skills in lab at school. I just did not get a lot of great opportunities in clinical and trust me it wasn't from lack of looking. We has BSN mentor students trolling the halls in search of IVs, catheters, dig stim, ANYTHING! it was just luck of the draw most times. Heck...I had a rotation with hospice once, and was really looking forward to participating in comfort care and learning the flow of hospice. Guess what I did instead? Sat in the social workers office for 8 hours and watched her type on her laptop! She wasn't even going out on visits that day!!!

    But i do refuse to believe that I learned nothing, and when the opportunity comes along at work to do something I only watched once in lab, I'm gonna be honest in saying "I never did that before and need you to show me how" to one of the veteran nurses. No way am I gonna fake my way through something just so I don't look "incompetent." That's advocating for myself AND my patients...a truly incompetent person wouldn't ask for help when they really need it!


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