Would love your input...

[Loribabble]

Hi All...

First let me say how much I admire and appreciate all you do to take of this special population! Thank you! I know the majority of nurses take great pride in the care they give and do a great job with the limited resources and support. Thank you!

My father is currently in a SNF for a 1 month stay for IV antiobiotics / wound care only (home infusion co-pay was $1600/month on his $1200/month SSI... don't even get me started on that one!). Otherwise, he lives independently, still drives, still putters in the garage doing odd construction projects etc.

I'm concerned about some of the things that have happened and would love your input as I have exhausted speaking with admin and his case manager.

1. His PICC line came out 8-10 inches in his sleep for an unknown amount of time - not happy but not upset as these things happen - problem was NOC RN tried to push it back in... no hand washing, no gloves, no swabbing. My dad threw a fit as he was concerned about infection so the RN didn't succeed. It ended up being pulled and new one placed.
   
2. An ARNP came in and took his dressing down, left it open and then left the building without telling anyone. This was confirmed with the staff.
   
3. His hemovac hadn't put out for days. The day before it was scheduled to be pulled, there was so much output that it was no longer compressed. He repeatedly asked staff to assess it and got no where. He ended up draining it himself with my instruction, estimated the amount and re-compressed it to keep track of any further drainage.
   
4. The staff do not do proper hand hygiene and when asked to do so, he gets push back.
   
5. His antibiotic is a 24 hour infusion and there have been several unexplained instances where he didn't get it for over 8 hrs. He repeatedly informs them but there's no follow through. I have inquired but have had no response.
   
6. Between being woken up at MN for vitals, 2 am for labs and 4 am for levothyroxine and the noise, it's difficult to sleep. We have both asked to have this changed and he was told by admin that he was being unreasonable. The DON was agreeable and supportive of giving him a chunk of time to sleep, was able to get his levo changed to 6 by the Dr and was put on the MAR but for some reason it keeps getting changed to administer at 4. We've inquired but haven't gotten any feedback.
   
7. Things are in disrepair - dining tables are all wobbly, PT stairs not sturdy. When he first moved in the heater above his bed wouldn't turn off, the toilet bowl wasn't securely bolted to the floor and his bed didn't lock. My dad requested that they be repaired and nothing was done (his roommate had been requesting for the last 3 months!). My dad is a journeyman carpenter so he has some experience in this area.
   

I tried and tried to call but kept getting put on hold >15 mins each time, was transferred as soon as they thought they knew what I wanted... only to be put on hold again. I was so frustrated that I ended up sending a fax with my concerns. This resulted in a phone call from Admin within the hour; but besides the glaring safety issues in his room, everything else has been lip service. I get no response to my questions from the case manager.

The State came in last week - but the resident panel was by 'invite' only. One of the friends

He's out in a week and we can ride that out but my heart breaks for those who don't have an advocate and/or unable to advocate for themselves. The stories he shares with me are painful.

My dad is a nice guy, very appreciative and doesn't speak up unless it's a safety issue and is respectful about it. He raves at how wonderful the day nursing staff is but the night crew and admin are another story.

Any thoughts from those that work in the trenches would be wonderful!

Thank you!

[ktwlpn, LPN]

I recommend demanding a meeting with the administrator, DON and the unit charge nurse and review this list of concerns.They need to know they have serious shortcomings with the education and experience of their staff and a lack of communication .Your dad co u 's have to go back there.You won't forgive yourself if you don't say your piece.These things need th one dealt with..

[Loribabble]

Thank you so much for your response ktwlpn... much appreciated. I will set something up and keep pushing.

[IsabelK]

If talking with administration doesn't work, you can report the issues to the state. The state will investigate and the facility will have to deal with it. It might be too late for your dad, but it might make a difference to someone else's.

[NutmeggeRN, BSN]

If talking with administration doesn't work, you can report the issues to the state. The state will investigate and the facility will have to deal with it. It might be too late for your dad, but it might make a difference to someone else's.

Yup! Every state has an ombudsman.

[blessedmomma247]

Def speak with the DON and ADMIN and if you feel like you got no where, report to the state. As a NOC nurse, I do not have labs in the middle of the night....and I do my best to limit vitals in the middle of the night; esp if they are stable. I do start my med pass at 4am, but a resident can prefer to take meds when they take their meds at home.

[TheCommuter, BSN, RN]

He raves at how wonderful the day nursing staff is but the night crew and admin are another story.

First and foremost, I am sorry about your father's substandard experiences. I hope he is on the road to recovery and wellness.

There might be a reason your father prefers the day nursing staff over the people at night: staffing. I had 68 residents as a night shift floor nurse in the SNF setting. I admit that the care I provided was sloppy at times. I admit that I sometimes forgot to complete certain nursing tasks. I simply didn't have the time because I was running from the start of the shift until the end.

I do not think talking with the administrator and DON would do much good. I suspect they already know how their facility is being run; hence, you're receiving lip service.

[mtjoanna]

I concur with the gal who commented on noc shift staffing issues. I don't do blood draws during my noc shift because we have no lab facilities at my place--it all has to be transported to the local hospital during the day. There is no noc shift "admin" as I am the only nurse in the building, often with only 2 CNAs , one of whom is locked in our special care unit (49 residents, several of whom require 3-4 staff for transfers). I have no backup at all--the DON has never come in when I've called for help and the doctors that I have available on-call are not reliable in emergencies either. We (the noc shift) faithfully report safety issues but rarely see a response. I do the best I can, but I know that there are time when I have dropped the ball because I have too many balls to juggle during my shift. If the place your Dad is in is similar to mine, the nurse and CNAs are likely simply too overwhelmed to be able to do better.