Don't You Just Want To Scream?

Specialties LTC Directors

Published

I've had it with nurses not doing what they are supposed to do! There was an order to 'encourage fluids every shift and monitor intake on Caretracker" For 3 days the nurses signed off the order, but not one of them documented or even looked at Caretracker. If I didn't think the DPH would have a hissy fit, I'd write in the MAR "Stand in the middle of the hall way naked and whistle the Star Spangled Banner". I'm sure they'd sign that off, too. What is the matter with these people? The nurse practitioner is 'surprised' we can do IVs??? Jeezlies Peezlies I want to smack 'em all upside the head and yell " WAKE UP.....YOU"RE A NURSE....DIDN'T YOU LEARN ANYTHING IN SCHOOL????"

Thank you for letting me vent.

Specializes in LTC, Agency, HHC.
So what do you do or say to these nurses who make these blatant (and dangerous) errors? How do we put the fear back into their practice? Do you make one into a scapegoat? Do you report them?

NO, NO, NO!!! You do none of that. You bring them in BEHIND CLOSED DOORS and review P&P manual. Spell it out. Give them one chance and then disciplinary action if necessary. Management loves to make scapegoats out of almost every floor nurse. I have seen it all too often. On that note, let me say I am scared whitless of my DON. She is rude, MEAN, loud, scolding staff in front of other staff AND residents, "I know it all" attitude and I am a puny LPN. If she had her way our whole facility would be RN's. She isn't being an effective leader, the kind I know NOT to be. None of my management are effective leaders, IMO. I sit in my BSN classes and say "They do that wrong, they do that wrong, ....." I see so many things done wrong at teh facility I work in. And it all boils down to money. The big bonus.

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Specializes in LTC, Agency, HHC.
I've become very embittered to these sort of things.

If they aren't going to do their job and do it safely replace them with someone who will. There are a lot of good nurses out there begging to work.

Ummm, not always. Having the mentality that there are nurses begging to work will get you in trouble, especially if they aren't there and you fire the ones you think are "bad." You have to take a look at the whole picture, not just the few mistakes that are made. Most LTC's are stressful, too many patients, too much paperwork, too high of acuity, too many patients that shouldn't even BE in LTC and management refuses to provide assistance to help make things better.

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Specializes in LTC.

I don't feel I have any lack of use of my critical thinking skills when I send a Resident to the hospital at 4am for sats in low 80's, irregular heartbeat, and diminished lower lobe lung sounds. I may not get to fix them, but sending them out before they get real bad or die is enough for me.

My only complaint about nurses in LTC are the ones just sitting around to get a paycheck. They don't do what they are supposed to do, help other nurses or CNA's, and they definitely don't do anything extra to make work more pleasant (stocking carts, cleaning, auditing lab sheets, calibrating accucheck meters-- in down time on nights) Some of them even brag about their ability to do "nothing"... I take a certain amount of pride in my work and it shows. I just wish I could come to work without all the undone things from the lazy ones making my night harder. I know sometimes things get crazy and some nights are bad, but its always the same people doing nothing.

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I totally agree with Polly, there are so many rules and regulation that it becomes counter productive. We are so consumed with legalities and repetative documentation that we loose time with pts. It especially bugs me when I have a question regarding pt. care people ask me "are they medi-care".......I am not treating the pts. insurance policy or payer, I AM TREATING THE PT!

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Specializes in Med-Surg, LTC.

I'd really like a discussion about how to make nurses think. I took over as don in a facility where it seems no one knows anything. I've educated, I've put processes in place to streamline their work, I've yelled. I have some good staff, but there are some who just don't seem to want to take responsibility for their care.

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Specializes in LTC, Agency, HHC.
I'd really like a discussion about how to make nurses think. I took over as don in a facility where it seems no one knows anything. I've educated, I've put processes in place to streamline their work, I've yelled. I have some good staff, but there are some who just don't seem to want to take responsibility for their care.

I think it depends on your approach. If you come in yelling, expect crappy work. If your staff feels like they can't come to you, give suggestions on how to improve care, and are ignored, expect crappy work. Maybe its been the way of the facility for so long to do the thinking FOR the nurses, and they feel they aren't ALLOWED to think......my facility does this. We can't even have collaborative practice orders for simple things because someone has screwed it up too many times.

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Specializes in Med-Surg, LTC.

Lvn2bsoon - I totally agree with you in theory. The thing is, though, that it doesn't seem to make a difference when I praise, give constructive advice, etc. That's where I get frustrated. I'm not talking about minimal errors here. I'm talking missing 2doses of phenobarbital because we didn't have a script for a pt admitted with seizures. It's patient's lives here, and staff have the same license I do. I'm frustrated, it's been a bad month.

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Specializes in LTC, Agency, HHC.
Lvn2bsoon - I totally agree with you in theory. The thing is, though, that it doesn't seem to make a difference when I praise, give constructive advice, etc. That's where I get frustrated. I'm not talking about minimal errors here. I'm talking missing 2doses of phenobarbital because we didn't have a script for a pt admitted with seizures. It's patient's lives here, and staff have the same license I do. I'm frustrated, it's been a bad month.

What's the protocol for a script? Does your facility have a number straight to the pharmacist for a VO so he can make sure the meds are sent without a script if it is a weekend? Did the pt come in from the hospital, and, if so, why didn't the ER send a script? Or was the med just not reordered in time? I'd go through pharmacy on that one.....

I know its frustrating, but have you asked staff for input? What about corporate? Surely there is a nurse consultant who can come in and evaluate things. Did you just take over DON from being a floor nurse in the facility, or did you come from another facility? Does the staff know you well?

I can only give you advice from my experience with working at an awful facility that has me thinking all LTC and all DON's are the same. I spent too much time being taken advantage of and walked on, and passed up for promotions....so if I come off as harsh, I don't mean to, but that may be how your staff sees you....but maybe something I mention (or someone else on here) may be something you haven't thought of....

Have you had your state survey yet? If not, that may be adding to the stress and oversight.

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