Worst SNF ever!

CapeCodMermaid, RN · Nov 27, 2015

There are good SNFs and rotten ones. Find one you're comfortable with. I've been at my current place for a month....quit already. They cut staffing 4 times in 4 weeks. I've been in the business for years and this is the 1st time I'm in fear of losing my license.

snfnurse · Nov 27, 2015

Were you hired as the DON? Did you give a notice? I've seen this place doing underhanded things, no way was I going to risk having them do that in retaliation while I worked a notice.

LPNtoRNin2016OH, LPN · Nov 28, 2015

I would have done the same, that sounds ridiculous. To find a quality SNF is actually the exception and not the rule.

snfnurse · Nov 28, 2015

Thanks for the support. I was raised not to quit jobs and to give adequate notice and I know from experience how health care workers DO run into each other again, so I agonized about the decision to the point that I was having stomach pain and couldn't eat. My Dr. wanted to do an upper GI series to make sure I don't have an ulcer. That little 20 something LPN told me I have a "****** attitude" just because I didn't agree with her assessment of the CNA situation!!! I'm not the one coming in 45 minutes late in the morning! She told me I had to make my night shift CNA stay past 7am to help get people up. Um, no. If Administration is going to put one CNA on a hall at night where most people are two person assist for transfers, it's not my CNA's problem. My CNA doesn't want to risk her license transferring someone alone that is two person assist much less risk injuring a patient. She is a skinny 60 some year old woman!! She is free to go at the end of her shift UNLESS she prefers to stay. It would have gone a long way with her if someone had asked her nicely. Frankly, I thought my CNA was terrific. No one ever had a low blood sugar because she kept a close eye on them and made sure they had a snack. My dementia patients that take off their nasal cannula during the night were never at risk of low O2Sats while she was on duty. My dementia patients who can get out of bed never fell while she was the CNA-she kept an ear out for those patients. She would tell me when someone was restless and not sleeping. She told me immediately when my cancer patients wanted pain medication. I was always relieved when she was on duty vs one of the younger cna's. I'm so relieved I am out of there. I asked if I could have the day before Thanksgiving off or the day after and never even got an answer.

kbrn2002, ADN, RN · Nov 29, 2015

I work in LTC and I am appalled at this. As much as I can [and do] complain about my job it's nothing like the the horror of a place you are describing.

Yes, we are horribly short staffed, but not for lack of trying to hire new staff. There is just nobody applying. Every time we hire two new CNA's three are leaving so we just can't get ahead. One recent shift our DON and nurse managers were working as CNA's because there just wasn't' anybody else to work. The nurse managers are pulled to work the floor as nurses at least 2-3 times a week. But everybody is pitching in and doing what we can to help. Our residents have never been and will never be given less than the best care we can provide.

No blame here for running far and fast. Those poor people! Both staff and residents. It sounds like that place is horribly managed. At least the one CNA you regularly worked with seems to care. Too bad she is only one person.

I can't imagine not addressing skin concerns. Double shady to not have any sort of paper trail like assessments sheets. I don't want to assume here but it sounds like maybe they are thinking if pressure areas don't exist on paper they don't exist at all as far as state will be concerned. Did you ever document skin issues in the charting? If so, there is a paper trail of these pressure ulcers somewhere and a call to state alerting them of this practice is in order.

Don't any of these residents have family to advocate for them? I am amazed that this level of resident neglect is allowed to continue without anybody stepping up and complaining.

I am glad for your sake that you had a place to fall back on. Too bad about the longer commute, but it sounds like an infinitely better place to be.

snfnurse · Nov 30, 2015

I am still upset. Day after day I would add concerns to my supervisory report and no one addressed them. Twice I wrote about a patient who was taking meds for hypotension and hypertension at the same time. I never got any feedback on what I wrote. One resident had calcium Oxalate crystals in his urine and he never received an xray to check if he has stones though he screams in pain. He got Norco 5/325 which seemed to help him some but thats just a bandaid. One resident just died from a heal wound that wasnt debrided. It was a deep tissue injury that was closed and she became septic. It needed to be opened and drained. I was just mostly appalled that someone was allowed to cuss a supervisor. Maybe my discoveries were getting me on the bad list. I will say this after m my time at working in nursing...if you get the feeling you are in the wrong place...you are. Always protect your career and get out asap. It wont get better. Darn, I was so happy not to travel. I loved the staff on my shift. Of course I loved the residents. I am sad at how this profession treats each other.

CoffeeRTC, BSN, RN · Dec 1, 2015

Do you have a corporate complaince line? They should be third party and you don't need to leave your name to file a report.

katfish67lpn · Dec 4, 2015

Oh my, I just had to quit a new job (I was within my 90 days as a new employee) and I'm still reeling from it! Maybe you can help me process this.
For starters, I was not informed of all job requirements when interviewed. I didn't know I would be on call and work 70 hour work weeks. I got to the point that I was so exhausted I was taking prednisone so I could keep on going.
I was hired as a nursing supervisor and the place was short staffed every night. It was insane One CNA for 35 residents, one nurse per 50 residents. I am an experienced LTC nurse so I could keep up with my duties but the residents were so short-changed. It was sad. I saw sacral areas with eschar on them and skin assessment paperwork done that didn't even mention the pressure ulcer. Since there was no acknowledgement, there was no treatment either. That was nuts. I could go on and on but the last straw for me was when a first shift nurse and I were discussing CNA disagreements between the shifts and she started cussing at me and telling me to "do my job" as a supervisor and that I "wasn't a team player." I wrote her up for cussing at me (I'm a supervisor/RN and she is an LPN) and doing so in front of staff and residents. Administration did not present it to her. They didn't see an issue either with her being 45 minutes late on a Monday morning once after I had worked the weekend and just wanted to go home and die. Seriously? Lucky for me, I had stayed prn at my old job and they welcomed me back. My old job is a 5 star facility but I got tired of the traveling time. I will gladly go back and love my travel time and 36 hour a week schedule!!! I am still in shock over that place. I quit with no notice when no one cared about my concerns. I felt like my license was at risk every night. What would you have done?

I am an LPN with 26 years experience with the majority of my experience being as Charge Nurse in SNF's on both the LTC & Skilled units. I am not proud to say I just did the same thing...quit without notice during my probationary period because I also felt that my license was in jeopardy every shift I worked. I am from Washinton State and moved to the East Coast 2 years ago. I have never seen the short staffing like this before. The state I'm in has "minimum staffing levels" and I tried to point out it is called "minimum" for a reason! Like you, I saw 30+ patients with only 1-2 CNA's and 1 nurse. I spoke with the DON and told her that there is no way the CNAs can give good care at that ratio, they desperately want to but just can't and I tried to help as much as I could but obviously had my own responsibilities. She just said "we staff at the state minimum". Then we had wanders, one of which was an ambulatory older gentleman with behavioral issues and he has been aggressive with other residents before. No joke the DON & Owner/Administrator sent out a memo that that particular resident was " to be kept away from all other resident's". I pointed out we are short staff as is and if those were the parameters you were instructing us to stand by then we needed a 1:1 for him. I was told "use your float" to which I once again (very logically I thought) pointed out we needed the float for resident care! That got me no where and I told her I am not comfortable having responsibility for the floor with these types of residents (because that gentleman wasn't the only issue) without adequate staffing...nothing changed or was ever going to. I won't even get into the extremely unhelpful (to the point of sabotage and set up) nurses on staff there. Altogether a bad experience!

Cola89 · Dec 6, 2015

I woulda quit too. It's sad you were put in a position where that was basically your only option. Hopefully, you will report what you saw to STATE!!!

ttt4271 · Dec 7, 2015

Don't take this the wrong way-I do think the SNF you were at sounds like it has some real problems. But I don't understand why you were just putting concerns on a supervisory report and expecting others to take care of them? Why not contact the Dr. yourself if you have a resident concern? Also, with heel ulcers when the skin is intact it is common not to debride them; often they start as an intact blister and if you do betadine to dry it out it will eventually heal if circulation is sufficient. If circulation is not OK there is probably nothing you can do other than amputation to get to where the wound can heal. Infection is more likely to set into an opened wound than a closed heel blister.

gr8nrs · Dec 7, 2015

other