Re: Warning to New Grads

So... It's not Florida only
If everybody knows that this job is stressful per sé...If we are working short all the time...If the corporations are not paying enough......If we can be fired for any reason (Policy is observed or not depending also of your relationship with the "Bosses")...if we don't have administrative incentives since administrations change almost yearly and they usually prefer bringing somebody from outside known by them than promote the older employees...If the state during a survey follows a nurse and in order to have a good evaluation. it takes 20 min to give meds. through a GT to one patient, and another 20 min to take care of a patient with a trach., and 15 min to give Bp meds. and insulin to a third one (doing every thing "by the book"), and they already know that the nurse has an assignment of 30+ patients (so is impossible to finish med pass, if we follow state regulations, in 2 hours) but in their survey conclusions all that is not even mentioned...if we work 9-10 hours taking no break and the next day we are called to the office because we didn't leave on time...If we have to take care of Labs., Pharmx, invissible doctors, Doctor's telephone orders, family members, dining room, even the door; with little or no help ...If in the Nursing Homes & Rehab Centers, the acute level of care is higher every day...if the level of knowledge of the DONs is lower every day because in order to get out of the floor they accept less money that the fine prepared nurses......How in the world do we not have enough nurses in FL?? !!!
What do we have to do to be heard?

Re: Warning to New Grads

I am also a new grad, LPN in 2008. I am lucky in that I get to work in a
hospital. I did not want to go to SNF becuase of the same things I am hearing here. I think in the SNF's and the hospitals we have to many patients. Well, in the hospital some areas may be ok with 5 pt's but I get floated often to a surgical floor that has 20 beds , usually only 3 nurses and NO PCT most days.
On Monday I worked on that floor and I really, really wanted to quit!

Re: Warning to New Grads

Originally Posted by noc4senuf

I just want ot remind everyone that not "all" SNF's are terrible. I am the DON of a SNF, and staff at a much higher rate than what those of you have listed. I feel blessed to have wonderful LPN's and RN's working for our facility. I have hired new grads in the past and am very clear on the challenges that they will face once hired, most stay. I would never consider letting a new hire start working on their own without at least a month of full time orientation to the floor. If it is a new grad, it may take longer, each individual is different. Myself, the ADOn and the nurse managers are always available to assist when needed, and yes, i have come in during the night and weekends. I start my day at 5:30 AM and go until 4:00PM so I can see the staff on all shifts.

Please don't give up hope on LTC, the elderly need us.

Noc4senuf,
This sounds like a situation that I would love. Its overwhelming enough just starting a new job out of nursing school...anywhere for that matter. But to feel like you're just thrown into it, like I was, is another thing all together. In 3 shifts you're just getting your feet wet with the facility (finding the bathroom, learning how clock in, where is the back up stock kept, not to mention learning faces & names-of residents AND staff) I mentioned my experiences to RN friends of mine and they seemed shocked. One said, her unit required 4 months of full time orientation for new hires regardless of the shift they were hired for and more if they need it.

You obviously really care for your staff and their development and it shows.

Re: Warning to New Grads

Thanks for the advice - I'm so sorry you had to go through that! Wow, it makes you think twice before either working in a nursing home or putting someone you love in one.

Re: Warning to New Grads

hi everyone. would you believe that this is the picture of govt. hospitals here in the Philippines? nurses are no longer seen caring but documenting! more hours spent on transcribing mds orders than bedside care! nurses as they say in these places get jaded. there is no such thing as tx communication. patience is a very rare commodity. staff nurses are impatient. hot headed towards mds., patents, sos, expecially to student nurses. when i was a student and saw an ideal staff nurse,(by ideal i mean someone who cared and departed even for a short while from the charts/kardex) it was a miracle. but then again, can you blame them? when you have 80-100 pt in your ward and only 2 auxiliaries with you? and the 80 by they way is a light load already...but i salute them for choosing to serve our indigents. it is really not an easy task, that's why they say nursing is a vocation.

Re: Warning to New Grads

Good advice, but unfortunately I've found pretty much the same conditions in every SNF I've ever worked for. the only exception was one that didn't accept medicare...so the $ were spent on staff to care for the patients instead of additional staff to fill out all the feds paperwork & stay compliant with all their rules. (for a facility the size of the one you described, there's usually 2 or 3 licensed staff dealing with nothing but medicare stuff &are out of patient care completely)

Re: Warning to New Grads

BTW, I've never seen orientations longer than a week-2 max in skilled. Those long lovely new grad preceptorships & orientations are pretty much only in acute care...& not all of them any more.
It's not only frustrating, but can be dangerous.

Re: Warning to New Grads

Greetings,
I'm a 46 y/o male nursing student. Will graduate in Spring of 2011 from a community college in New York.

I've read through all the posts with great dismay. This is going to be my second career. My first career of 25 years will be laying me off at the end of the month. I thought nursing was a good choice but after reading all of the posts I'm not so sure. I'm also not sure what be job prospects will be upon completion.

The first thing that comes to mind is that all Ive heard have been horror stories except for one DON who sounds like she does the right thing for her staff and patients. Where are the other good stories? Is the system that broken? Why isn't the working popualtion in these facilities shouting out at the top of their lungs? What are the whistleblower protections, if any? Where are the unions in all of this? Aren't unions supposed to protect the worker from these very issues that are being described? When JCAHO comes through are they blind to the understaffing? Are they acting just like the Fed not seeing Madoff right under their noses? Why do you jepordize your license? Why do you jepordize the patient by not doing required V/S before passing meds. Work off the clock to finish your work *boggle* don't call me naive but that is wrong in so many ways. You are ENABLING the institution to get away with it.

If you are being abused and don't stand up to it you are allowing the abuser to do it to someone else.
Thats wrong!

Who is standing up for your rights as workers? Where is the nursing loby in Washigton? Who's calling JCAHO to tell them about the deplorable conditions? Does anyone from JCAHO subscribe to this website?

Im Spartacvs ! ! !

Re: Warning to New Grads

JCAHO (monitors hospitals) regulates very few nursing homes. Most are regulated by DHS. The staffing requirements are set by CMS and are decades old, some states do have some stricter requirements. What was ok for staffing back in the 70's and 80's is not adequate now, since acquity levels are higher. The reimbursement rates for medicaid and medicare are also dwindling and it is becoming a losing game. Facilities need to pay a decent rate for staff but, need to make some cuts somewhere along the way.

I believe all facilities need to be staffed according to the acquity levels of the residents. We have a union in place for our CNA's, housekeepers and dietray aides... it is a joke, the only thing they do is take their share of the worker's pay check.

Re: Warning to New Grads

Welcome to LTC world. Unfortunately, that’s how it is in the long term care field in general. A lot of politics involved. But there few skilled nursing facilities that are not so bad. I’m fortunate to be in one of them. I’ve been working here for <10 years, and I started as a staff nurse, and now I do Case Management—which is mainly office work. I miss bedside nursing too but I have more flexibility (as far as work-hours) in this position. Long term care is not just med pass and treatments…there are other aspects of long term care that you can get into. I never thought I will like long term care but I learned to like it. There’s more to it than you think. I wasn’t a new-grad when I started in LTC but I felt I was. It really was overwhelming. But sometimes when you learn the hard way, it sticks to your brain. You become a better nurse.

The hardest part in working in a long term care facility is getting to know the residents. It usually takes about 3-4 months to get to know them. Once you get past that, it’s not that bad. As a matter of fact, if you get assigned to a permanent section, you would know your resident meds by heart. During med pass, you look at the MAR for any changes, and pretty much the rest stays the same. They emphasize documentation in LTC’s because LTC facilities are one of the highly regulated industries here in the US. The only way you can save your “butt” is by documentation. It would be nice to have more nurses in the LTC setting, to lessen the load (of documentation), and more time at bedside. Acute changes/illnesses (in a resident) will throw you off your schedule, you just have to learn how to manage your time. Prioritize...

Unfortunately, because of heavy patient load (30:1 normally) this scare nurses away from LTCs. But if you want job security, LTC is the way to go. “For-Profit” facilities are usually understaffed (I had worked in one of them). Try looking into “Non-For-Profit” facilities. They may not pay as much as “For-Profit” but you won’t be overworked and understaffed. I work in a “Non-for-Profit” facility, and here’s the scenario: In our skilled floor, in 7-3 shift, 63-bed capacity, 7 CNAs (9:1 ratio), 3 nurses (the 3rd nurse is the “Sheltered Care” nurse doing treatments).

Good luck in you job search…