hey everybody, I've worked as a nurse for four years in a long-term care facility/rehabilitation center. I can honestly say that being an LPN in my setting is probably the worst job anybody could ever have. I make more money than I would anywhere else, but it's definitely not worth it. I know what you're thinking. Nursing varies so much. Why don't I just change fields? But, I'm married with children. I can't take a ginormous pay cut because I'm not happy at work.
Any nurse knows that I'm beating a dead horse when I bring up staffing, but it has to be said. How the hell can 2 nurses and 3 nursing assistants take care of 60 people? This ratio is rationalized by saying that in a rehab setting the acuity level is lower than that of the hospital. ********! The acuity level is whatever the patient's status is when the hospital bleeds the payor source dry and needs another bed. I've got 35 patients to be responsible for, and they are no less acute than they were when on the unit. State legislation mandates a minimum ratio for staff to patients. This doesn't help because when checking for compliance, the facility is including all the office nurses (directors of nursing, assistant directors of nursing, assessment coordinators, staff development, etc). Corporate and other contracts involved dictate a labyrinth of rules involved when staffing for the shift. Which might I add is a duty that falls right in the lap of the staff nurses. surprised? Corporate says you may have a maximum of X amount of staff. (God forbid that there be a second to...I don't know talk to a patient. this would constitute down time) The state then says you must have a minimum of X amount of staff. They try to make it sound like there is some room to play with it, but in all reality. X=X. Corporate dictates that we can not staff anymore than the minimum. the maximum is the minimum.
That brings me to my next point. Nursing as an institution is so top heavy. Take my unit for example. Two nurses do the work. Meanwhile, 8 nurses supervise. Yea, I said 8. And they are not alone. Then you have the administration and their quest for quality control. Then there's the therapists and other various non-nursing staff and their never ending concern for what the nurses are doing. Wouldn't the patients be better served with 2 supervisors and 8 hands-on nurses. Can anybody say MICROMANAGEMENT? To the "jump off a bridge" degree. It doesn't stop there. That was only the in-house supervision. It doesn't stop there; not even close. It goes on to include OSHA, corporate, the state board, the ombudsman, social services, etc, etc, etc. Everybody wants to know what 2 ******* nurses are doing.
Don't get me started on the absurdity of pain control scrutiny. when I have to wake you up to give you your pain medication because you rated it a wopping 10 on a scale of 0-10. sleeping at a 10? get real. and annoying family members." NO! your 100 year old mom is not better than she was 90 minutes ago. She is still brain dead. can I get off the phone now?" "she's been here for years and I've never met you, and you wanna come in and scrutinize the staff." "TAKE THEM HOME WITH YOU if you can do so much better" They can try to argue that they're paying out the ass for good care. What they don't know is that I can open the chart and see that the payor source is medicare and medicaid every time. So whose paying what? In fact, I am paying out the ass for the care that I provide. Don't get me started on the google'ologist. You know what I'm talking about. The person who just got done reading about every side effect and possible cause....on some dot com web site. Do they know that I can go on wikipedia and say that vitamin C causes coronary artery disease right now and a million people idiots would quit drinking juice by tomorrow? I'm all for patient advocacy, but nurses are not the bad guys. and I'm all for patient empowerment through education, but **** it let me do my job.
Nursing shortage? what nursing shortage? Did you know that the current number of available nursing positions in America pales in comparison to the number of licensed nurses that are not working as such. These people came to nursing with good intentions, couldn't stand it anymore, and left nursing just like that. It would be naive to think that they made that decision without much thought. Think of all the time, energy, and money spent on education to work as a nurse. Then think of what it would take to make people turn their backs on it. It's not an illusion. I'm not just one burned out nurse who didn't like his job. You've just heard the voice of thousands.
