what to do.....

I am having a problem similar but not the exact same. I took over MDS et skilled nursing in my facility. I revamped the nurse notes to make them easier, put in charting guidelines so that they will know what to gear their charting towards for each patient et what they are there for, and am constantly in contact with the floor nurses making sure they have what they need et know what is going on with each patient skilling wise. Just the other day, a couple of them told me that they do not understand or see the point of what we are doing et they are just flat out not going to do it. If is very frustrating because our charting is one thing that has come up at state inspection et we have a woman who comes in for chart review who looks at our charting like state does. She also says that we are not sure where we need to be. I am at my wits end with it and it has only been since November since I started!! Very frustrating! Not sure what to do to get everything where it needs to be.

I'm with you. LTC is just increasingly frustrating. I think I am slowly accepting that there is just no hope for our current LTC standards. In my facility anyways, it seems like there are only about 25% of the nurses with any REAL nursing skills. The rest have blinders on and just look to pass meds without using any level of a higher thinking process. Would seem that common sense isn't so common. Example - dementia resident very agitated, constantly trying to get out of chair unassisted, constantly setting off alarms. When I took my turn to redirect, resident tells me I have to poop. Aide and nurse nearby state we've taken her 3 times in last hour and she just sits there. End result... the poor lady has got poop up to her eyballs and no one thought to check if maybe she was constipated. They thought pain in the a$$, but couldn't figure out that it REALLY WAS a pain in the a$$. Of course once she was cleaned out, she was at least more manageable behavior wise.

Couple of months ago I read an article in Readers Digest that basically "slammed" long term care residents. Had example of people dieing of fecal impactions, infected bedsores and all the usual "stuff". My first gut reaction was "Here we go again, more BS about how horrible LTC is", but the reality is - IT IS THAT BAD. Now I think I am fortunate as I work in a facility that physical/mental abuse etc is absolutely not tolerated and rarely to never occurs and for the most part, all the staff (aides, nurses, even housekeepers etc) are a very caring bunch, BUT we need more INTELLIGENT PROFESSIONAL nurses that can think beyond what is in front of their nose.

Another example: I was casually going thru the lab work that was stacked at the station and noted that resident had INR of 7 something. Tracked down the nurse and asked if they had called MD... "No. I'll get to that in a little while". Explained INR of 7 is potentially pretty dang serious and MD needs notified now. Also told this nurse to go assess resident to make sure no bleeding. Nurse stalls and eventually says "Can't. She just left to go to the dentist for teeth extractions" Turns out the nurse HAD actually read the lab report prior to the resident ever leaving the facility and just never occured that this might be a poor decision. WHY WHY WHY?? I could go on and on w/ examples like this.

So, despite all my rambling... what is the solution? How do we obtain and retain a higher class of nursing professionals. Some say it's all about staffing and I agree staffing ratios may help to some point - but I have seen time and time again, when staffing is great for a day everyone seems to goof off just a little more cuz the pressure is off. (Yes, I know there are some of you working under HORRIBLE staffing ratios and more staff would make huge improvements. But I think a 20:1 of relatively stable residents is doable on most days. Been there/done it).

So who has got ideas? Someday we will be old and we will be stuck in our own broken system. Sorry, I'm rarely this long winded, but this topic touches a nerve.

Oh, exactly! I feel your pain. That's why I posted a thread about Legislation in LTC recently. (But no one responded). I am through complaining because the budget of the Nursing Home Owners/Administration is not conducive to bedside care that is needed. It's going to have to come down to LAWS and MORE of them. Yes I also already HATE it when state comes in. I'm the MDS Coordinator and I care what kind of work I produce. I do not stand around gossiping nor do I take smoke breaks. Actually never had taken an actual go outside and breathe break. However, I do eat my granola bar at my desk around 10-11 most days. Just today the interim administrator, who was brought in by Corporate since the NICE female adminis was let go because we got tagged by state on some things, said there is enough hours in the day to do everything she is telling us to do. BUT they only want us to work 7.5 hours/day. I'll tell you what my facility needs: Updated computer hardware that doesn't freeze, lockup, and lose precious, time consuming MDS data; the money to pay decent salaries to LPNs to fill the shifts so the other MDS Coordinator can actually help me instead of being pulled to the floor for numerous things, like: treatments, training a new nurse, working a called-in shift, etc. We also need not to be pulled away from our MDS/Careplan/Medicare duties to do: meal monitoring, inspection action rounds, compliance confirmations, etc. Oh my goodness....it goes on and on....doesn't it. Today in our Stand Up meeting, after the militant administrator told us there are enough hours in the day to do all she demands, I asked her what is my priority: MDS, careplans, or inspection rounds. She said the am rounds. I told her I fear later when we are asked why something is not done, I will be reprimanded. She did not accept that. Treats us like dogs, worse than dogs, so rude and condescending. She leaves no room for negotiation. UGH!

I think one of the keys to successful change, is to have the employees take charge of the changes.

I think that some nice groundwork has been laid by you, that is the reasoning behind the changes.

Now it is time to take it to the next level - for the nurses - how are they going to implement and incorporate these changes.

The realization must be made that these are NOT suggestions, but new standards of practice, and are requirements.

Reward for a job well done, listen and respond to employee concerns during the change process, just because something seems great in theory, it still may need to be tweaked.

And lastly, and also unfortunately, there must be consequences for not performing the duties as expected. There may need to be some pruning of staff who are unwilling to embrace change.

Stress and find a way for the staff to feel as if they have ownership of these changes.

Hope this helps...

Lynn

I am sorry no one replied to the post you refer to. The things that you have suggested have been suggested before by several of us that post on this LTC forum pretty often. Every thing you did bring up in that post is "right on". I have been in contact with nursing home reform people all over this country and the general consensus is that until we get out from under the powerful lobby of the multi billion dollar a year healthcare industry and a new congress NOTHING is going to happen. There are propositions that DO address these issues, but have not been acted upon in the last 6 years, due to this conserative administration. I have HOPE that with the new congress and the possiblility of a new liberal administration in 2008 , these issues will finally be brought in front of a voting body.

I have been in contact with nursing home reform people all over this country and the general consensus is that until we get out from under the powerful lobby of the multi billion dollar a year healthcare industry and a new congress NOTHING is going to happen. There are propositions that DO address these issues, but have not been acted upon in the last 6 years, due to this conserative administration. I have HOPE that with the new congress and the possiblility of a new liberal administration in 2008 , these issues will finally be brought in front of a voting body.

Thanks for the info, Ingelein. Good, re: HOPE with a new congress. I don't understand why the Repub congress did not pass more legislation. Those politicians are also sons and daughters of elderly people (who are the majority of nsg home/rehab residents), so they should realize the problems and should want to correct them or at least TRY. When it comes to money vs. the treatment of your loved ones, where's the difficult decision? It's beyond me.

Yes, sadly to say, some administrators and DONs will keep, shall we say, "not the brightest" bedside nurses and CNAs because they fill the shift slot numbers. It would be great if the people with a conscience and caring hearts ran the individual nursing homes, were district mgrs, were corporate, etc. I agree it is very frustrating. Do your best until it pushes you to resignation, I suppose. God Bless.

Oh man, this IS scary, I can see wards and wards of lobotomized nurses roaming the halls aimlessly...