Do we expect little of people these days?

Specialties Geriatric

Updated:   Published

I've posted on here enough times with my opinion about a variety of LTC issues. I am at my wits' end now. I've been a DNS for about 4 1/2 months and it seems no matter how hard I try to make things better at my facility, nothing changes. We've had more inservices since I started than they did in 2 years before that....has it made a difference? NOPE...same nurses still doing the same things....maybe one person in the building has stepped up. They all complain that we won't do well at survey time but yet no one seems to think it is up to them to help fix things. Please no one take offense, but in this state LPN school is 11 months and in LTC their scope of practice is almost identical to the RN...with the exception of pronouncing someone dead, and let's face it, THAT's pretty easy...don't need great assessment skills to know when dead is dead.

I had an interview with a brand new RN ... no experience except the little she got in school and she wanted to work on the subacute floor. I told her I didn't want her first nursing job to be horrible and if she took the job with the 20 patients for meds,treatments, labs, orders and everything else that goes with it, she would hate it. My co workers said I should hire anyone who has a license basically...what would all y'all do? I can't lie and tell these nurses it's an easy job.

I'm so discouraged that I wish I never even took the job. I'm leaving next week to go to a different kind of nursing but I feel like a failure. The corporation is telling me what a wonderful job I've done in a short time....wonderful? Nurses still fax labs to MD offices at 3 am...I don't know about all y'all, but MY doctor is NOT in her office at 3 am, and it seems no matter what I say or what classes we provide, they still won't or can't learn. Do we expect so little of people these days that anything is OKAY as long as they show up and pass meds?

I don't really think anyone has an answer, but I feel somewhat better for having spouted off.

Because of the stigma and bad rap LTC has, most of the nurses we have applying are 'not the brightest'. I'd love to fill my facility with smart nurses, but there are none applying. And by the way, having just been a patient in a hospital, I didn't find anyone there was overburdened with brains either.

Capecod - I take exception to this - I'm a very bright girl, lots of experience, etc., etc. But what I've come to realize is this isn't what I was hired for - it's the 'RN' after my name.

Our facility apparently doesn't DO inservices - we recently accepted a patient with a trach - and I came to realize that some of the girls there HAD NO EXPERIENCE with this type of patient. Yet the guy was just brought in one night and dumped on a new LPN! It took me two days to get ahold of the DON and ask her what she planned to do about it? And a policy and procedure manual? I asked her where it was - it's in her office - she's trying to update it.

When they DO get someone new - the older nurses beat them down until they don't know the right way to do things - and again, I think this is a problem with the DON and management. Just having 17 years experience in the same place does NOT a good nurse make - I had an argument with a day LPN the other day about giving a LOL morphine - it gives her hallucinations - I told her that was unacceptable, and she needed to call the doc. She told me morphine was a good drug - well, yes, it is, but there are other things that could be done that would be better.

The management has no real idea what the nurses do - it just seems like they want to cram in more and more people to increase the profits. The unit I work is up to 43 patients, and they're thinking that they could possibly add more.

Specializes in Peds, Geri.

There is hope. If it's like my facility, it may take 2 months or more to get some smart people in there. We FINALLY raised our hourly salary for LPNs to equal the surrounding communities' other nursing homes. The ad just ran. When they fill the 3 LPN bedside positions, then the ADON won't have to work graveyard shift anymore and she can do the ADON job. And the DON won't have to work call-in shifts and she can do her DON job. And the MDS nurse won't have to do treatments. But you know what it took for the "uppers" to realize what we (the "lowers") were saying is true? State Surveyors to come in 3 times within 2 months. FINALLY!

So there is hope for you all out there.

Specializes in Gerontology, Med surg, Home Health.

More money does not make a bad nurse better. Legislation will not make dumb people smarter. You can't legislate good a good work ethic. I'm glad your nurses are getting a raise but more money isn't always the answer....making what we do in skilled facilities valued by the other members of our profession and by the public in general is a bigger part of the answer.

Specializes in Geriatrics, Med-Surg..

I agree with CapeCodmermaid (sp) that as LTC nurses, we are not valued, it is almost like the public just doesn't want to believe just how bad it really is. We as nurses need help in lobbying for better, we really need the public's support. We are all going to get old and need care at some point. I try to tell my parents this with the hope that maybe it will drum up enough interest in their future care, that we as nurses have to fight so hard to provide. Ah, well that is it for my rant. Thanks for reading. :smokin:

Specializes in LTC,Hospice/palliative care,acute care.

We just recently had a clean sweep through administration due to an attactive retirement package.We've looked forward to the changes for years. The 2 nurses that moved into the DON and ADON postions always talked about their "revolution" .Well-we are still waiting! They are so bogged down with the administrative BS that it's the "same -old -same" on the units...We can not seem to deliver very basic nursing care.We can't get medications ordered and delivered on time-we often find pre-poured meds in cups left in the med cart.We can't get dressing changes done,orders are not written correctly.We all know that RN's are highly valued in LTC because they are required-however they keep coming and going..The LPN's with experience are made charge nurses just until a suitable RN rolls through.That's a real morale booster (NOT) Like-I'm "good enough " but not "best" The saddest thing-I agreed to take the position and have worked really,really hard to clean up the mess that was left on that unit for nothing but the satisfaction of a job well done.No monetary compensation.What a sap I am....Of course we have a new RN coming in the end of the month so she'll be "charge" I wonder how long this one will stay? I really think we all have to be inspired to " do good work" but how? I can't even get my co-workers to make sure they order med refills in a timely fashion and follow through to make sure they have been delivered..We have really worked on our attitudes and are trying to be positive and work together as a team on my unit and that has made a difference.But I'm tired...

Specializes in LTC, Hospice, Case Management.

Wow - it seems to be nation wide. The state of LTC is very very sad. And now I hear the Bush wants to cut medicare/medicaid funding, which in turn will cause coorporate to cut costs (ie: staff) even further to protect their profits.

Specializes in Rehab, LTC, Peds, Hospice.

Even if you happen to have a brain in your head, there's little to no time to use it. I work 7a-7p weekends. It is not uncommon for me to get a lousy report (everyones fine) and never even look at a chart until 7p. The med pass alone is daunting. Administration is harping on us leaving on time and harping on charting! I usually stay and finish, because I do know the rationale behind. I find tons of things overlooked, unfinished ie:central lines no orders 5 days post admission, pacemakers not noted, meds not carried over in recaps, coumadin held never restarted. All the things the state wants for the most part are reasonable - if you had more staff!

Specializes in Gerontology, Med surg, Home Health.

I have one more day and then am done with LTC!!! I heard today that the DPH in this state hires nurses straight out of school which means people who have never had to do the job are 'grading' us on how we do it....one more reason I'm glad I'm out. I'll have to make a difference one person at a time in my new job.

Specializes in LTC, Hospice, Case Management.

Good luck w/ your new job. I am jealous as he!!. The powers that be are getting closer to beating me down every day. Hopefully I can escape someday soon too.

Specializes in Geriatrics and Quality Improvement,.

I feel for you all, and I wish I could come work in your facilities so you know what it feels like to have a team member. And I wish I could be there for you DON's as you try to enact change, so I could laugh with you, then for you, as you cry becuase the staff wont change. Then we could both hit the floor and make it happen, in the only way I know how. By example. And someone in these posts was right, if you make the staff part of the changes, the are more apt to agree to them, they thought of it.

I have worked in LTC for 14 years, and I work for the state, so try getting something changed there!! HA! But, except for the people with no brains, its a great job, great atmosphere, and loving facility. Sure, we have our share of "gene-challenged" persons, but all in all, someone is right behind them on another shift to tell them, shape up. Leaving pre-poured meds is a disgrace. Pre-pouring meds is a disgrace! Nobody wants to do another persons work, so you better not leave it for me, and I wont leave it for you. There is no White Wall in nursing(as one nurse told me there should be).

Give the people with organizational skills the proper tools, and you will get the proper job. The ones that need more assist, get those P & P manuals on the unit!!! If not a P & P, then a Moseby or Lippencott!! HELLO! Where do ya think the P & P comes from anyway????

And always remember, you didnt fail if you tried. Sometimes the system fails even with the best of intentions.

Man plans, and God laughs.

Sometimes God turns on the SitcomNurse channel for s**ts & giggles.

Specializes in Gerontology, Med surg, Home Health.

"....you didn't fail if you tried"...nice thought SitCom but tell that to the surveyor or the attorney or anyone else who really doesn't know what we do. P&P manuals? They are on every unit....inservices???at least twice a month. Do the ones that need them come? Nope...we write them up and write them up but as long as they're not a danger to the residents we don't fire them because who knows how bad the next one will be...or if there'll even be a next one.

I used to be like you, but the nurses I know now won't change. They don't want to be in charge of the CNAs let alone work toward a positive change in the facility.

When I turned in my resignation, the VP of Corporate said, "But you're such a great nurse why do you want to leave?" They don't understand either. The way the system is set up the DNS is responsible for everything that goes on in the building 24 hours a day 7 days a week. They don't pay me enough for that AND I can't take the stress of it any more. If all the nurses were like me it'd be easy...everything would get done well and everyone would care about what they do. Unfortunately that's not the case. Patients are getting sicker and the nurses are getting dumber....helloooo...do you need to be told basic nursing after you've gotten a license? ...have you never heard of cleaning an injection site before you inject someone? Nurses hand out medications without a clue of what the med was prescribed for, what the expected benefit is, and what side effect to look for. I know they are busy...I used to be a staff nurse...but what is good practice is good practice no matter how much you have to do.

Zowie! I didn't expect to rant on like this. I really hope the next part of my career brings me more satisfaction than I have now. I'd really hate to think that all the good nurses are bailing from LTC because someday I might be old and sick and need someone who is smart and caring to be MY nurse. .... I'm not holding my breath.

Specializes in Tele/ICU/MedSurg/Peds/SubAcute/LTC/Alz.

Being a staff nurse is very stressful. It is my first nursing job as a RN, and I wonder if all of nursing is like this. I worked on an Alzheimer's Unit for 8 months at my facility. Then, a first shift job opened up on the sub-acute unit at my facility so I asked for it and got it. In the beginning census was low and I was doing quite well. I like being a nurse until it gets overwhelming. I feel like I could do much better, instead of a half-a$$ job. What makes it more difficult is my superiors always get on me for leaving late. With my med pass for up to 30 patients, treatments, documentation, phone calls, labs, admissions, call bells, deligating the aids, showing the per-diem nurses how to do things, or getting things that weren't done from the previous shift, etc... it does get difficult. At times I find myself forgeting things like meal percentages, bm books, and i & o's. Most importantly our log book that the state looks at of course. I hate that!

I have made suggestions like many others, to my superiors about getting more staff, but it never happens. Maybe it will stop them from having too much overtime from the staff nurses on the unit. Some say it really isn't that bad that it is worse at other facilities. Especially the one's where you have 40 or more patients to take care of. Anyone that is capable of that I give them mad props and hope they can give me some well needed tips on how to really get the job done!

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