Yikes! Another bad observation at an LTC facility - page 7

YIKES!!!!! That's about the only word I can express about this one. Got off a weekend night shift (through my agency) at a nursing home I have never been to previously. I prefer to stick to... Read More

  1. by   Enabled
    Originally posted by realmean1
    I work at a LTC fac as a supervisor and also cover 12hr shifts in an LPN slot: meds, tx, etc. I sympathize with those who work in h#llholes. I certainly agree that the steps Eddy took were excellent. I guess I am a troublemaker at my fac., when I see something wrong, I usually bit#h about it, until something is done. My current targets are unnec. drugs and figersticks. Have yet for an RN to justify sticking someone's finger every day for months with no change in routine insulin or oral meds. Routine tylenol every 6hrs for yrs. Megace for yrs, even when the pt is eating well. My all time fav. Ventolin treatments, 3 bronch dilators, nasalnex, give Tussex for cough. These are all v.o. by the nurses. The MD has no clue what all His pts are taking. 6am med pass takes as long as 9am. Can someone tell me why a geri pt needs lo-dose synthroid at 6 am????? with no hx of thyroid problems??????
    realmean1 thank you also for your advocacy as much as you can. As someone mentioned these unnecessary treatments,etc will continue to go on. What is the physician saying about any of these things or does he/she know or even care. That person is recieving a stipend if not charging the individual patients. Maybe getting a geriatric nurse practitioner in the facility may be a start who will have a physician or the current physician contract with them. My girlfriend and I were joking the other day about when we get to 65 we have already rented a hotel room, with a microwave and small fridge, room and maid service. That would still be far cheaper than going to a LTC when necessary. We could even hire someone to help us with ADLs. I have always treated my patients as if they were my family members or if it were me in that bed as some day it could be. I think HIPPA is going to make reporting more difficult as patient's confidentiality could become an issue.
    With the nursing shortage why are facilities not hiring on flexible scheduling such as using a mom with young children. When significant other is home she could work just a day or two and when gets home takes the children to school and goes home to bed. We need to do this also in hospitals by offering shortened shifts for parents with small children.
  2. by   Enabled
    Originally posted by Betty Smith
    Stat minimums for staffing in LTC have not been updated in 15 years. what do you expect? Our LTC facility stays above the minimum and still does not have enough staff and of course, company won't pay for more. They recently decreased a few of the "extra" employee positions. Nurses should demand Nursing Boards update the stafing ratios for nurses and CNAs. Of course this would close some facilities but what is the alternative? Dead or injured pts.
    Not too long ago the regulations changed for LTC facilities as ratios were established. There has to be one PCT to every 10 patients and no less. They also have to be insured with a certain type and amount. However, as you probably already know most of the LTC are not meeting this requirement. It is truly frightening and I don't want to even think about were it could go in the next decade or so
  3. by   CougRN
    I just have to say that it's great that you were there to bring this all into the light. It is wonderful that you took such pride in your work to care for those people as best you could. You are a wonderful nurse for taking charge of the situation and helping those that you could. The profession needs people like you.
  4. by   ilovetheelderly
    Oh, its unbelievable what you saw and experienced. Bless you a thousand fold, you must've wanted to just cry. I'm so grateful for the dedication it took for you to just start your duties that shift, you just don't know how proud and honored I am to just know that for such a time as this, you witnessed this place they so much have their nerve to call a "home" for those who can't even advocate or vouch for themselves. How can this so called DON even live with herself.!!!!???? How sad and pathetic and cold heart she must have to allow this place to continue, someone special like you, had to come and take a stand for such a pathetic nursing facility who take tax dollars and private dollars to throw down the drain in the name of 'CARING FOR THE ELDERLY". It just makes me cry for who else is out there without no one to speak up for them and help these human beings who need help the most. Oh, my heart just cries and cries. Help us to care and give with love and dedication as you did and continue to do. Thank you and may someone help us to stand and advocate for those who can't help themselves. A fellow lpn in an upstate nursing home who also continually gives until I can't give anymore.!!!!
  5. by   DNS
    In reply to "YIKES" another observation in LTC:

    I do realize that there are many nursing homes in the nation where residents receive poor care & it IS almost always due to poor staffing, for many different reasons. And for this reason, the state does have to survey & follow up on complaints. But let me tell you, I've had many residents return from the hospital in worse shape then when we sent them. So, remember that poor care is a result of incompetence, not the environment. It can happen anywhere.

    After having been a DNS for 9 years, in facilities that are absolutely wonderful, it saddens me, no I am horrified, to think that a nurse would ever have to deal with what you did, much less what that poor resident(s) went through. I agree, that this facility should be turned in to the state, & the administrator should be hung out to dry, for not providing ample staff to care for the residents. This is definitely fraud, abuse & neglect.

    However, please understand that not all nursing homes are like this. I work for a nationally known chain, where residents come first. And I'd have it no other way.

    I have never, in 16 yrs. of nursing seen anything like this. And I have never, in 9 yrs. of being a DNS, ever had a resident in this condition. I realize that I am lucky to have always had wonderful nurses & CNA's & although I have had many situations that were scary, we have managed to do what was in the best interest of the resident & family members. No it wasnt' easy, & I have had to stay on my toes to keep up with all the changes & in turn communicate those changes. And skilled nursing homes, like mine, have much more going on than the traditional nursing home, but we take little credit for it. We are the mini-hospitals of yesterday.

    And please understand that it's this kind of information about LTC nursing that gives all of us a bad name. There are many geriatric nurses out there who do care, & who are proud of their accomplishments. We all deserve a hand for dealing with day to day crisis. We are never bored. And although it is highly stressful, we are nurses first.

    In the nursing home environment, you are not only the nurse, you are often the only family some residents have. You are also a mother-figure for many of your staff, who, perhaps, the best part of their day, is coming to work. I've raised many CNA's, & some have become responsible career-CNA's who love their residents.

    Too often, we've been treated like outcasts, who couldn't succeed in the 'hospital' world, but in reality, we do more than hospital nurses on a day to day basis. Especially in skilled care homes. We don't have lab & x-ray staff 'downstairs' to identify conditions, but we're expected to know what's going on at all times. It's our specialized assessment skills that help us prevent complications, & it's those assessment skills & interventions that allow residents to rehabilitate & go home.

    We have many success stories, whether someone is discharged to home or not. Helping a resident maintain a quality of life for several years in an institutional environment is not easy. We have to be creative. We have to work as a team, & we generally have to do it for less pay than other nurses. But we do it because we love nursing & we love long term care nursing. We know our residents well & we care for their every need day after day. Helping someone die with dignity in itself can be a success story, if you realize the dynamics of families in crisis. And when your staff have cared for a resident for 5 years, losing them is like losing their own grandparents. You also have to be the on-site counselor when staff are grieving.

    We don't have ward clerks to help answer the phones & we don't have security guards to make sure the building is safe, we don't have doctors making rounds on a daily basis, or pharmacists on staff to review our orders, & most of our staff are non-professionals, but we manage to provide a life of dignity for those we are responsible for.

    So please, nursing students & new nurses out there, please don't think that what Eddy went through is a typical day in a nursing home. We have stress, but we have fun. We love what we do & we welcome anyone with integrity to join the world of geriatric nursing. Because that is what it takes.

    Thanks for the opportunity to remind others that geriatric nursing is the best of both worlds.
  6. by   MamaBear1958
    Thanks for your post DNS! I too am a DNS. I work in Minnesota. I'm less than a year as DNS, but have worked in management for several years.

    I was planning to post much what you said myself, and I'm glad you did it for me. There ARE good people working in LTC. And, there ARE good nursing homes out there.

    What Eddy experienced was horrid, and I hope they get their just rewards so to speak.

    The LTC industry needs good people, nurses and nursing assistants. The residents need them too!
  7. by   fiestynurse
    Check out this previous post regarding LTC and Whistleblowing:

    http://allnurses.com/forums/showthre...leblower+Nurse
  8. by   cadeusus2004
    You got it. Write 'em up. You don't have options here. As the man said, "Hoist them up the flag pole and watch them slowly twist in the wind."
    Hope you charted the living daylights out of the man's decub and your interventions. The facility can't touch the documentation 'cause its a federal felony to obliterate clinical documentation.
    Please call your malpractice insurance company and notify them. That way they won't be sandbagged when the s--t hits the fan and the facility wants to blame you. the insurance company likes to keep the premiums and doesn't like to give any money out.
    Cross this hell hole off your list and tell your friends to do the same.
  9. by   stevierae
    I read through every single post and I am speechless--all I can say is "Oh, my." Yes, I have seen maggots in wounds--when I was a Vietnam Era Corpsman, or when people scratched under their leg casts with a wire hanger and caused an open, festering wound--again, not since the Vietnam Era.

    Eddy, you are a hero. Was the nursing home chain Beverly Enterprises? I am not afraid to put the name in print--they have been the subject of lawsuits since the '70s. I am glad you were there to advocate for that elderly gentleman with the
    "itch" --there are far too many cases of wrongful deaths in nursing homes today. You were that man's guardian angel. If Medicare is involved, hopefully they will be fined and shut down. Keep us informed.

    I live in Oregon, where we have the Assisted Suicide Law; actually meant for terminal patients who choose to take their own lives and end suffering. The opponents of this law should read about what these poor nursing home residents Eddy describes are experiencing on a daily basis, with so few to advocate for them--truly a fate worse than death...thank God Eddy spoke up....
  10. by   cadeusus2004
    This one will hit you.
    In some places they actually make dressings with maggots inside the decubs. The maggots eat the dead tissue and seem to cleanse the wound. Lots of articles on it in the Index Medicus. Of course, these are special maggots for wound care only and come in little bottles. A semipermeable dressing is put on them. I encountered this working in Canada.
    But, open wounds with maggots? Oh, man!
  11. by   eddy
    At the moment I am somewhat "gagged" in what I am allowed to say about this situation specifically. I WILL say that things are looking "very good", and I really do thank each and every one of you for the support and kind words.

    The important thing for all of us to keep in mind here though is that I am no hero, I only did what I felt was "the right thing to do". I would hope that anyone in my shoes would have done the same.

    As many people have said throughout this conversation, don't let this discourage you from considering a nursing home as your place of employment. Things will only improve for our elderly if more good nurses get into the field, and it can be an incredibly rewarding career. I firmly believe there is no better place to truly make a difference than in long term care. However, should you see things that you would not wish to have happen to you or a loved one it's time to pipe up and do something about it. Don't be a martyr and simply chug along and kill yourself in the process. In the end, you are only helping the greedy owners of these places, and you'll be of no good to anyone, including yourself, if you can't function due to burn out, fatigue or injury. Rather take action and follow through with it. Go through the proper channels and cover your butt, as revenge is just around the corner if you present any angle for it. But, for everyone's sake TAKE ACTION!

    Again, thank you everyone. I will update you if and when I am allowed to do so.
  12. by   sallyrnrrt
    Sorry you had such a horrible experience. I've been an Geriatric RN for nine years--just left it for Rehabilitation nursing, but NOT for experiences like that. Just needed a change. Let me say I'm sure places that like exist, but they are not the norm. Most people working in and managing long term care facilities are caring; a situation like you described would never happen where I worked or anywhere I am familiar with. There is no excuse for that--not lack of staff or time or money. Unfortunately, all the public hears about is stories like yours. They don't hear about the overwhelming majority of people and places that are working hard with not enough resources or staff, held to impossible standards by the Powers That Be. The elderly in this country deserve far more than they are receiving. It's a darn shame.
  13. by   sallyrnrrt
    Sorry you had such a horrible experience. I've been an Geriatric RN for nine years--just left it for Rehabilitation nursing, but NOT for experiences like that. Just needed a change. Let me say I'm sure places that like exist, but they are not the norm. Most people working in and managing long term care facilities are caring; a situation like you described would never happen where I worked or anywhere I am familiar with. There is no excuse for that--not lack of staff or time or money. Unfortunately, all the public hears about is stories like yours. They don't hear about the overwhelming majority of people and places that are working hard with not enough resources or staff, held to impossible standards by the Powers That Be. The elderly in this country deserve far more than they are receiving. It's a darn shame.

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