Who Must "Take the Fall?" - page 4

I have wondered for many years about who is ultimatly responsible when a nurse who works in LTC has something tragic happen to her patient. Most nurses who have worked in LTC understand that they are... Read More

  1. by   CapeCodMermaid
    Yikes...this is scary Ingelein...I actually agree with you Things won't change in long term care until consumers make them change. When the people whose taxes pay the bills see what is going on, they will demand change....maybe not until THEY are in the SNF...but I think the day will come when things get better because the patients demand it. I will not be sticking around LTC long enough to see the change.
    I am a better than average nurse...graduated at the top of my class. I know the regulations, know how to take care of really sick people and not so sick people who just want someone,anyone,to sit and talk to them for a few minutes. I've saved lives and greatly improved the lives of the residents in the facilities at which I've worked. But, when the surveyors come in, I get a sinking feeling in the pit of my stomach. It matters not how well we've done things. They, who couldn't do what they expect us to do, base their survey on standards which are practically impossible to follow given the constraints of time, money, and man(woman)power.
    Unfortunately, the best most caring nurses will be forced to leave the LTC business and the residents will be left with uncaring administrators who work for the paycheck and not for the residents.
    Sorry to carry on but after a week of short staffing and 13-14 hour days, I am fried.
  2. by   Simplepleasures
    Quote from CapeCodMermaid
    Yikes...this is scary Ingelein...I actually agree with you Things won't change in long term care until consumers make them change. When the people whose taxes pay the bills see what is going on, they will demand change....maybe not until THEY are in the SNF...but I think the day will come when things get better because the patients demand it. I will not be sticking around LTC long enough to see the change.
    I am a better than average nurse...graduated at the top of my class. I know the regulations, know how to take care of really sick people and not so sick people who just want someone,anyone,to sit and talk to them for a few minutes. I've saved lives and greatly improved the lives of the residents in the facilities at which I've worked. But, when the surveyors come in, I get a sinking feeling in the pit of my stomach. It matters not how well we've done things. They, who couldn't do what they expect us to do, base their survey on standards which are practically impossible to follow given the constraints of time, money, and man(woman)power.
    Unfortunately, the best most caring nurses will be forced to leave the LTC business and the residents will be left with uncaring administrators who work for the paycheck and not for the residents.
    Sorry to carry on but after a week of short staffing and 13-14 hour days, I am fried.
    Cape Cod, I NEVER once thought that you were not a QUALITY person.I too have a deep distrust of the state surveyors, they have their own agenda and it is a mystery to me.Sometimes they pounce when it isnt important and sometimes they totally neglect to address something very wrong.I know I have harped about this book many times, but it really is worth reading, its by Mary Richards Rollins RN BSN titled "Patients, Pain and Politics".Its a true account of a WI state surveyor and the underhanded stuff she saw( much of it by the state itself) she talks about several DONs that are caught between a rock and a hard place.If I have come down on you too hard, I do apologise, I am so passionate about LTC reform I sometimes forget that management really is in a tough spot.
    Last edit by Simplepleasures on Jan 6, '07
  3. by   RobCPhT
    I once read that the nursing home industry is regulated second only to nuclear energy. The common issue is that nurses can't possibly do their job by the books when they are understaffed. I also read that in 10 years the economy won't be able to afford nursing homes. This may be for the better, because when it comes down to the almightly dollar nursing home officials could care less about how many patiens you have or how many call lights are blinking. When is enough enough?
  4. by   banditrn
    Quote from CapeCodMermaid
    Yikes...this is scary Ingelein...I actually agree with you Things won't change in long term care until consumers make them change. When the people whose taxes pay the bills see what is going on, they will demand change....maybe not until THEY are in the SNF...but I think the day will come when things get better because the patients demand it. I will not be sticking around LTC long enough to see the change.
    I am a better than average nurse...graduated at the top of my class. I know the regulations, know how to take care of really sick people and not so sick people who just want someone,anyone,to sit and talk to them for a few minutes. I've saved lives and greatly improved the lives of the residents in the facilities at which I've worked. But, when the surveyors come in, I get a sinking feeling in the pit of my stomach. It matters not how well we've done things. They, who couldn't do what they expect us to do, base their survey on standards which are practically impossible to follow given the constraints of time, money, and man(woman)power.
    Unfortunately, the best most caring nurses will be forced to leave the LTC business and the residents will be left with uncaring administrators who work for the paycheck and not for the residents.
    Sorry to carry on but after a week of short staffing and 13-14 hour days, I am fried.
    Yes, capecod, that is scary. And I understand what you're saying about the surveyors - I used to feel the same way about JCAHO at the hospital! Of all the potential for GOOD they could do - they would come in and get hung up on really stupid things that usually caused us to perform some MORE paperwork.
    I mean, is it really that awful that nurses kept their own coffee cups in the unit kitchen? It seems like they would get totally out of shape about things like that. I used to think they were a bunch of people trying to justify their jobs!!

    I'm getting a sick feeling when I go to work anymore, knowing that the biggest amount of my time will be taken up with paperwork instead of peoplework. And heaven forbid, if I don't have every I, dotted, and T, crossed!
  5. by   VivaLasViejas
    I'm hearing an incredible amount of frustration here, on both sides of the desk.

    What I'm NOT hearing is a sense that all of us---managers, nurses, aides, and ancillary staff---are in this together, and that gives me cause for concern. How can we fight the forces of evil (in this case, bureaucracy, greed, insurance companies, and the government) on behalf of the people we care for, if we're too busy fighting each other?

    For what it's worth, it's not always the floor nurse who gets kicked to the curb after a sentinel event or a bad survey. A few years ago, I myself was fired from a resident-care manager position in one of the state's worst LTCs after only five months on the job. After a disastrous survey in which I was pressured to answer for things that happened two years before I ever went to work there to residents I never met or even heard of, the corporation that owned the facility decided it needed a sacrificial lamb as part of the plan of correction. And since the Medicare and young-adult units I oversaw both received several F- and G-tags apiece, I was it.

    Now, it would have been easy to blame it all on the nurses and aides who "allowed" residents to develop fecal impactions and pressure ulcers while they "sat and did paperwork". The fact is, much of the fault lies with the patchwork mess that America calls a health care system, which puts profits before patients and keeps LTC facilities understaffed, undersupplied, and underpaid. I don't think very many nurses or aides go into elder care thinking, "Let's see, how little work can I possibly get away with? How many hours can I let little 75-pound Nora lie in one position so she'll develop a pressure ulcer? How many residents can I NOT feed so I can do all my charting and get out on time?"

    It's the system that demands more and more paperwork, takes nurses away from the bedside, and directs the flow of money away from resident care. We cannot hope to change it if LTC management and staff are constantly at each other's throats. There is no "us vs. them". There is only us..........and the sooner we learn to ignore labels and remember what brought us into LTC in the first place (hopefully, it's an abiding love for the elderly and not the almighty $$), the more effective we can be in changing the system to make it work for the people it was intended to serve.

    Call me Pollyanna, but that's how I feel. All of this infighting just weakens us and allows the bloated, dysfunctional bureaucracy that is at the heart of all that's wrong with health care in general---and LTC in particular---to keep growing. Let's stop viewing each other as adversaries, and work together in keeping the 'care' in long-term care.
    Last edit by VivaLasViejas on Jan 7, '07
  6. by   banditrn
    mjlrn - Girl - you are right, and your post was great!! But how do you propose we solve it?
  7. by   heamoRN
    once told this by a person who was taught this during orientation at forensic psychiatric unit.

    we as nurses CARE!
    COVER your
    ASS and
    RETAIN
    EMPLOYMENT!!!!!!
  8. by   BoomerRN
    I have worked in LTC for 30 yrs. off and on and the same problems described above existed then as today. It seems to me that the public has been part of the problem. They can't/won't take care of grandma/grandpa and expect miracles from the facility. Also, part of the cause of the mountains of paperwork is the beaucracy which responds to complaints and just adds another piece of paper for the nurse to complete. I've always said that when the surveyors come to a facility, they get some charts go sit in a room with coffee, snacks & socialize. There could be patients rotting in bed and all they are concerned with is that every item on a checklist is checked. It seems that priorities are all mixed up in our society. I used to work my backside off helping the aides complete their work & a don or administrator would chew me out and wonder why I wasn't doing the paperwork instead. I did work for one (God bless them) nursing home that cared for the patients and staff and gave the nurses great support and lots of help. There was a union there. The nurses weren't in it but we received raises and other benefits whenever the cna, housekeepers, etc. did. We had a wonderful facility and I would still be there today but moved out of state. I love the elderly and they are not getting the best care and we that care for them are also getting treated badly. Just had to vent some tonight.
  9. by   gitterbug
    What is happening with you now? Hope you moved on to better things.
  10. by   hecete
    Amen Sister!!!! I Too, Work In Ltc, And It's A Zoo. Corporate Is So Damn Greedy We Don't Have Functioning Equiptment, Under Staffed And Everything That's Wrong Is Nursing's Fault. We All Have Learned The Only Way To Cya Is To Constantly Pile Up The Paper. We Document Everything From A Md Refusing To See A Resident, To Pharm. Not Sending Meds On Time Etc. They , Corporate, Really Don't Care Who's To Blame As Long As They Have A Name To Pin It On. We All Carry Our Own Libality Ins, We Have Each Other's Back All The Time, And I Think That Helps A Great Deal. I Asked For An Ekg Machine, We Have Alot Of Coronary
    Resident, Was Told No, They Would Have To Hire Someone To Teach Us How To Read It. I'm A Former Icu Nurse And Know How To Read It. Corporate Makes Me Sick, They Just Want To Line Thier Pockets At The Expense Of The Residents, And Don't Give A Damn About Their Staff!!!!!!!!!!!
  11. by   imenid37
    I would not work in LTC. I admire those who are patient enough to do it. It all comes down to a lot of greed(IMHO) on the part of LTC owners who don't want to pay for a reasonable # of staff and ridiculous govt. and payor paperwork/computer work requirements that keep nurses away from the bedside,. There is a great shortage of nurse in this area because the working conditions are so poor. Unlike in other countries where a sick person is often at least, partly the responsibility of the family member. We live in a world where people want to have their family member taken care of (a person they often themselves can not or wil not assist in caring for) and then point the finger at the nursing staff if anything goes wrong. God bless you folks who care for these dementia patients. The level of responsibility is ENORMOUS. It is like having a dozen or more 150-200 pound infants or toddlers in your charge. I have often wondered how much $ a facility would lose if the CNA/pt ration was about 1:4 as would be doable. God forbid and to have an RN and LPN for say every 12 patients.
  12. by   Simplepleasures
    Quote from imenid37
    I have often wondered how much $ a facility would lose if the CNA/pt ration was about 1:4 as would be doable. God forbid and to have an RN and LPN for say every 12 patients.
    In a mandatory meeting I once had an Administrator tell a room full of nurses and CNAs that if certain quality care indicators did not improve it would jepordize his vacation fund, he did have a smile on his face, but no one else in the room was smiling , we KNEW it was true.:uhoh21:
  13. by   twotrees2
    Quote from lindarn
    Nurses need to practice what I call, "Defensive Employment". The poster two posts up descrived it right- Bury them in documentation, and write on the bottom:
    CC: my records, board of health, JCAOH, et., and send copies to the above agencies.

    I would also keep copies of staffing sheets in my personal files. I also made copies of any incident reports that I wrote and also kept them in my files. If, and when I was ever called on the carpet for management-caused problems, and they were trying to pin the blame on me, I would have happily informed them of the documentation that I had, and that I would be happy to provide copies to the plaintiff attorneys so that they could sue the appropriate individuals, not me. I rest my case. JMHO, and $0.02.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington
    it is my understanding it is illegal to copy and keep any staffing lists - to do with the other personells privacy breeched - just what i have heard - correct me if im wrong cause ill start copying in a heartbeat of i am wrong

close