Mature LPN's Treated Unfairly

[FrustratedLPN]

Just wanting to know if anyone else has experienced any of these issues.

As an LPN of 16 yrs., and almost 60 years old, I find myself on the "outside, looking in" quite frequently. Needless to say, I'm the oldest floor nurse at the LTC facility where I work, and very near the oldest employee at the facility.

I can laugh and joke with the best of them, but I also believe patient care is priority. On 3-11 shift there are 3 nurses for 100 patients (at capacity). All of us are LPN's. HR at this particular facility hired approximately 8-10 newly licensed LPN's. I remember being new, but this is an entirely different attitude displayed. These new graduates with less than a year's experience, parade up and down, the first ones to see everything as life or death, and the ones that aren't experienced enough to recognize certain signs and symptoms. One nurse in particular has AADD, and freely admits it. She is hyper continually and takes Phentermine (which does not slow her down).

Four nurses that I know are taking phentermine while on the job, the DON, ADON are aware. There are instances where CNA's have fed patients the wrong diet, where incident reports were changed by the DON (along with explanations she forwarded to the State). When any concern is brought to the attention of Nursing Supervision, nothing happens. Instead of welcoming suggestions that relate to safety of the residents, you're viewed as a "troublemaker". I have expressed my feelings to the administrator, and although he sympathized with my frustration, he's accepted another job at another facility.

As I told him, some people get so comfortable with their jobs because they've had them so long that anyone they perceive as a "threat" to their way of conducting business is given the "squeeze". The social services director is married to the Physical Therapist. CNA's allowed to get away with non professional conduct, violating Hipaa regulations, a tx nurse that doesn't do treatments, but sits outside and smokes. The list goes on and on. It begins with HR and follows to the DON, ADON, and nurse managers. There is never enough staffing, residents do without their showers, some CNA's don't wash the residents when giving pericare, some residents don't get evening snacks offered them, some don't even have ice passed.

When healthcare became "for profit", and department managers are given bonuses for coming in under budget, it ceased to be HEALTHCARE. When patients are "skilled" for balance or something else ridiculous, when they can't even sit up. Then again, we all know "skilled" residents mean more revenue, don't we?

Residents admitted for "skilled" care that have mental disorders ranging from schizophrenia to bi-polar, 2 cna's responsible for 30 residents, not to mention that "nursing hours" are what counts with the State. No one bothers to tell families these "nursing hours" also include the 10 or more nurses in management that never touch or see residents. When is anyone in the government going to wake up and take note of what is REALLY going on in nursing homes?

CNA's discharged for patient neglect and/or abuse never reported to the State registry, but go on to other facilities to repeat the same behaviors.

Sorry for the rant, but there are so many things that could be corrected if only someone cared enough to hold people accountable for actions.

[TheCommuter, BSN, RN]

I am going to be rather blunt, and my reply might offend some people. At my workplace, caring nurses are viewed as a threat to the nursing home operation. The DON and management will do underhanded things to rid the facility of good nurses, because they are more likely to report wrongdoings. Since many LTCs suffer from bad management, the only people who can get along with bad managers tend to be uncaring nurses and rough CNAs. Like attracts like. Being a good nurse in a bad LTC is a drain to the soul, like a vacuum that sucks the joy out of you. I'd hate to sound pessimistic, but it is immensely difficult to bring about change in a vacuum.

Nursing homes tend to get the short end of the stick because of societal attitudes regarding the elderly. Elderly people in America are marginalized and often deemed no longer useful to society, so they are shoved to the background by lawmakers, administrators, and some family members.

Any nurse who works in LTC knows very well that a significant number of their elderly patients never receive any visits from family or friends. The ones who actually get visits typically receive them on a very infrequent basis. Only about 25 percent of my elderly patients are visited regularly by their loved ones. So, yes, many family members are using nursing homes to shove their elderly, unwanted relatives to the wayside. And, how can lawmakers, administrators, and the state care if countless family members no longer care? I call it the circle of uncaring...

And I understand your frustrations!

[FrustratedLPN]

Thank you so very much, and you said it beautifully!!!

[psalm, RN]

God bless the caring nurse and na! Do your part to make the resident's lives healthier and happier. You can only do your part, and report when necessary. Is there a hotline in your state where you can report anonymously? Or just request an unscheduled visit from someone who can make citations? There are many of us who feel the same way you do and have done what we can, for the pts. and residents.

[yessie11604]

I feel so hurt for everything that is being done in that facility I worked for a nursing home for about 2 years and it was a decent place for the elderly... what I strongly suggest is calling your ombudsmen and tell him everything you are witnessing do you even have one in your state? ... but pls try your best to help those pts Im sorry you are in that situation and i hope it doesn't bring you to a breaking point you are a good nurse I can tell you that... pls keep us updated

[pagandeva2000, LPN]

Sometimes, it is easier said than done to be the hero unless you have another job immediately waiting in the wings for yourself. These same horrible nurses have the ability to ruin your career even though you try your hardest to dot your 'I's and cross your 'T's.

My advice is while you are there to do the best that you can, but try and discover a way to disappear from that place. Document things on a pad, rewrite them at home and keep in a safe place. Once you leave, you will have specific times, dates and names to report. People usually know who the culprit is when they are told on or if not, they choose to focus on a person that does not advocate for themselves.

Sorry to say it; nursing is a cold world.

[havedirtwillplant]

Sometimes, it is easier said than done to be the hero unless you have another job immediately waiting in the wings for yourself. These same horrible nurses have the ability to ruin your career even though you try your hardest to dot your 'I's and cross your 'T's.

Sadly, I have to agree 150%. I'm going through the exact same thing right now...... I've been an LPN for 21 years, ALL of it in LTC. UNfortunately, I haven't yet learned to keep my mouth shut when I see something that needs to be addressed for the benefit of a patient, and it has cost me more than one job.

Iin some of these places you simply cannot be they kind of nurse that you want to be, that you *should* be, if you want to keep your job. I've learned, a bit too late, the best thing to do is CONFORM, keep your head down, your mouth shut, do your own job and don't say anything about anyone else's blatant lack of responsibility for their residents. Do the best you can for them, and have a good cry on the way home at least 3 times a week.

I know, I just *lost* my job for this very reason, after only being there for about a month! How can you get fired after only a month?? Be a responsible, caring nurse and report things the correct way; follow the chain of command; and keep the resident's best interest top of your priority list. And this isn't the first time this has happened, it's actually about the 3rd time in the last few years, and I keep thinking "this place will be different; they actually care about their residents, and they want to follow the rules, etc...."...... NOT!!!

I was fine until I documented a med error, then all hell broke loose. I worked at an inner-city LTC facility where the DON, ADON, Unit Manager, Staffing Coordinator, etc. are all good friends.....and have all been there at least 3 years..... And not that this should matter but I think it might have: I was the only Caucasian nurse there, (including all Administration) with the exception of an RN who works 3 eves a week. This is out of 12-15 nurses on all 3 shifts.

I was cool til I wrote up a med error: I had actually found it right before I left at 3:30, and turned it over to the unit manager, just to see what she would do about it... I had already had a feeling that things were being swept under the rug, and they were all covering each other's butts, but was curious to see how she would handle this.

It was an order for a Medrol dose pack, (ordered to be titrated, obviously) and an order for Ibuprofen, and an order to REASSESS in 1 week by the doc. Order had been written 3 days prior, noted off by 3-11 nurse, but not faxed to pharmacy for med, and not on MAR. So, I didn't find it until another order was written on same chart, and I happened to see the order above it, and knew I had not been giving this person any Medrol..... so I turned it over to UM.

I come back the next morning, the order for Medrol and Ibuprofen is now on the MAR, and has been faxed to Pharmacy. That's it. No paperwork, no report, nothing. Now, my dilemma: I know the doc is coming in 3 days, on MY shift, and is going to want to know how effective the meds have been..... how can I assess someone and give what I perceive to be a false report, since the doc is assuming this person has been receiving medrol and ibuprofen for the past week and will in reality only have been getting it for a couple of days??? I conferred with the other day shift nurse on the unit, (she's new too, and I've worked with her in the past) and we both agreed it should be reported. So, I wrote it up, called the doc, called the family, documented everything, etc. crossed all my T's and dotted all my I's, put the copy in the DON's box, and let it go at that.

The very NEXT day, I get called in the DON's office and written up, because I *supposedly* had not been doing my 9 a.m. G-tube flushes....

2 days after that, I get called in for not giving an ATB at 9:00 am as scheduled..... even though the person REFUSED her meds, (not uncommon for her; refusals had been documented twice the previous week) it was documented on the back of the MAR, also in the NN, AND the doc had already been called for an order to extend the length of the ATB order for one day to account for the refused dose!

I didn't write the med error up to get anyone in trouble; I did it because it was the right thing to do, considering the follow-up that was to be done, and the fact that it was a medrol dose pack, not a docusate!!!

And that's just a couple of things; there are a few more instances of basically the same thing..... I didn't do this, I forgot to do that; I should have reported this to a different person, etc. etc. Then after I left work on Tuesday, I get a call from the staff dev., saying the DON wanted to see me in her office at 10:00 am the next morning; do NOT go to my work station..... I knew the axe was falling, so I just politely told her I didn't feel the facility was the right place for me, so I was hereby rendering my verbal resignation.......

So now, I'm looking for a fresh start, planning on moving to TN in a few months, and keeping in mind my own advice: This time, keep my head down, my mouth shut, do my own job and stay blind to whatever else is going on........ and wishing I could make a decent living being a WalMart door greeter.

[FrustratedLPN]

Havedirtwilltravel.... You're right on target with what you say. It's unbelieveable that the "powers that be" will SAY they want to make a difference... they SAY "tell us what needs improving"... they SAY, "you are the charge nurse, write those CNA's up". I to, have said many times to myself.... "just keep your head down and mouth shut".

In reality, what management is doing is telling you what they're required to tell you... what they WANT is for you to say nothing. They want to pretend everything is fine, if anything is brought to their attention, they THEY have to do something about it.

It's so very true that usually upper management, HR, DON, and ADON, are a very tight little group that do not want anyone to "rock the boat", "contribute ideas", "suggest improvements", or heaven forbid, find errors, things not done, suspected staff drug use. I've seen it in every LTC facility I've worked. Maybe there is no physical abuse of patients in the sense of beatings or slappings... but the system is being abused by those very people trusted to do the legal and caring thing.

Instead they "milk" Medicare and Medicaid by operating in the "gray" areas. It's a "no win" situation for us, we're charged with being advocates for our patients/residents, but when we try, we lose our jobs (of course, it's NEVER because we asked for additional help, or reported falsification of records to our supervisors.) The system is designed for us to fail. Management knows full well that we are short staffed, have paperwork, medpasses, emergencies, phone calls, all this to complete on an 8 hour shift. Overtime has to be "authorized" or a write up is given. Nevermind that 30 minute lunch break that is automatically deducted from our pay (the one we never get to take).

These same people will talk about having "prayer" together each morning. I was always one that believed "walk the walk" is preferable to "talk the talk".

Reporting to our state agencies does no good... I've tried that recourse. I've reported to the ombudsman, cited names, dates. She came and did an inspection then notified me that "there was nothing to substantiate the allegations". State and local lawmakers don't want anything to do with it, since the CEO of the corporation is a major contributor to the Republican party.

The proverbial "between a rock and a hard place" comes to mind, and yet people question why there is a "nursing shortage"? We put ourselves on the line everyday for the residents we love. We risk lawsuits, personal injury, loss of jobs, stress induced illness, all for that core belief.... I want to comfort the ill and infirmed. If I can ease one heart the aching... or soothe one fevered brow, then I shall not live in vain.

[pagandeva2000, LPN]

FrustratedLPN; if I can press the thank you button 100 times over, I would have done so reading your post!!!

[MrsBradyMom]

You all are scaring me. I want nothing more than to work with the elderly when I graduate in December. My rotations in LTC have felt like "home". After reading some of these posts, I don't know now. The elderly need advocates....what's the point of working in LTC if management won't let me do that? Perhaps I should remove my rose colored glasses. Now I'm depressed.

[psalm, RN]

You all are scaring me. I want nothing more than to work with the elderly when I graduate in December. My rotations in LTC have felt like "home". After reading some of these posts, I don't know now. The elderly need advocates....what's the point of working in LTC if management won't let me do that? Perhaps I should remove my rose colored glasses. Now I'm depressed.

Don't be depressed! If that is your calling go to LTC while working towards your RN...ask when you interview at LTCs what their long-range goals are for staffing, as in will they be placing LPNs in any/all phases of the shifts and managements. Get it in writing, lol.

And congrats on being a grad this December!

[Fiona59]

I wanted to spend my time in Geriatrics. My rose coloured glasses lasted nearly three years. I worked understaffed, was verbally abused by family members who dropped by maybe once a month (we charted family visits), was scratched, punched, kicked, and slapped by seniors, and worked every damn shift I was asked. My overtime days were changed to save the facility money by paying me straight time for the extra weekend shifts.

I thank God that I left because my husband's employer transferred him.

The place was running before me and has continued on since I left. Nurses are expendable and replaceable.