My ! How this thread and topic has caused such a wonderful expanse of thoughts since its arrival !!!
The area that I seem to be missing is the lower middle class. Being a 'single' mother when my children were younger I went into nursing. But only worked part time. That was enough to cover our home, property, bills and a bit more. Certainly nothing extravagant. I cannot believe that there aren't other women or men in a similar position. Those that worked hard both for income and home and family. So, having been an RN since 1984, and absolutely loving it ! - I find myself in a place that is nearly intolerable. I have worked since 1966. Yes, nursing was a 'mid-life' change. Enougth hx. Yes, I did set up as best I could. My preference was to have one of my sons and his family live on the land with me. So when I became more ill or unable there would be someone close.
Now, because I am Social Security age, but not yet Medicare age, there are no jobs for us well seasoned nurses. And the Soc Sec does not cover my bills - much less health insurance ! I guess that should tell all younger people to screw family and home so that you can always and just focus on yourself and your everlasting wellbeing. If that is how you take it, then so be it.
I am glad for those that have planned and done well for themselves. I am glad for those that can't and, yet, receive health care. As a nurse and a human, I wish money could be taken out of all health care concerns. Obviously it can't. So, we are left with those 'in-betweens' - like me. Those that have worked for 40+ years. Those that may or may not receive Social Securiy. But cannot afford health care insurance. This is the working lower middle class. That is where we live and survive.
Other nations' view our country as unbelievable and uncivilized in the way we care for our peoples in their time of need. Our country calls it socialist, or worse. We are not outstanding, as a nation, in our healthcare. We have some great hospitals, nurses and doctors, but - overall - our general and ongoing health care is crap. I do blame the corporations for sending our healthcare system into a profit motivated cesspool.
Yes, I do think we should have 'socialized medicine' for basic and needed care. If one can't afford plastic surgery or bariatric surgery, then so be it. Too bad.
Politically speaking ~ 'Obama Care' is the best we have yet that can provide what might be marginally accepted to such a greedy and self-centered group of people as we have produced.
If you are a nurse of any moral and ethical value, could you refuse care to a person in need ?
This is an area of nursing that is so dear to me. After years in acute and critical care I had to modify my activity for health and physical reasons. Begrudgingly I began nursing in an ALF. I have to admit, I wasn't very good at the first one. I guess I really didn't understand the scope of what was needed from me. But the years and experience educated me well to this area. I guess I had been so accustomed to working with other licensed professionals, I didn't know what to expect from 'caregivers' and 'med aides'.
Anyway, initially [and continually] I found that there was little direction or training for ALF nurses. I guess they expect that if you have acute care nursing skills - you should be able to manage an ALF. What bothered me so much was that my layman staff was given so little training - - and even less respect for the jobs they do. Luckily, I love to teach nearly as much as I love hands on nursing. Over the years I developed a med aide training manual and all sorts of other training, education, delegations, forms, etc. Anytime one of my staff came up with an inquiry about a particular diagnosis that I already hadn't addressed I would make up more educational sheets ~ not required reading but available for their interest. Even though the corporation[s] I worked for gave little time to training med aids I felt it was of ultimate importance. Beyond the practicle, I wanted to feel assured that this new med aide was empathetic and held themselves as 'patient advocate'. So had the primary good nurse qualities.
ALF is a whole different arena of nursing. It is not well paid or much respected. But it is essential and will only be needing more qualified nurses as my 'baby boomer' generation continues to age and become needy.
Now that I am retired (unwillingly !) I can say things that I couldn't before. My gripe is the focus of these corporations is strictly profitability. Sure I want ends to meet and everyone to have their profit. But healthcare is a service - a hands on caring for individuals. If the profit out-ranks the care, then it will eventually either become cruel or fold.
Maybe someone here can direct me in a way that I can provide some of the educational resources I have put together for other nurses and/or facilities. Sure, I would like to make some money at it, but the important thing is to be a resource.
Always a day late ! Or, in this case a month...... As sad as it is, I am glad to see that other competent nurses are in my position. At least I know it is not just me !
I started nursing school in my mid 30's (change of vocation) and got my RN in 1984. Worked at our small rural hospital for nearly 20 years before I had to stop for medical reasons. After 4 years of illness I realized I no longer was capable of acute and critical care in a hospital. So I sought work in assisted living. It was a good choice, even though I was largely unprepared for that type of job in the beginning. But I found that - eventually - that it was perfect for me ! Hours were generally part time, I no longer had to do all the heavy lifting and running, I love to teach and nurture both staff and residents, I am very good with creating teaching materials, protocols and forms, plus it is a position of respectability and 'say' within the facility.
What could go wrong?
. . . . Age . . . I lost my job a year and a half ago - not because I wasn't doing well or not getting my job done - but because corp wanted a younger nurse who could work more hours. State survey came through a week later and facility was deficiency free. That was MY doing ! I am so disgusted with corporations that place their profitability above the service that they say they are committed to.
So now I am on Social Security ~ yes, old enough ! But that is only just about half of what I need to live and pay bills. (I have worked since 1966) I would really love to provide training and educational materials for other assisted living facility nurses so they wouldn't have to start from next to nothing. It is a needed aspect of our health care management that costs far less than hospitals or nursing homes.
So what do you do when you are older, but still capable (within limitations), have vast experience and education, want to give, share and use the abilities you have, and retain your nursing license a bit longer ? I love nursing. I just hate the way it is being used these days.
So much for me.
A note to the younger generations ~ The profession of nursing is almost sacred. It may not get much acknowledgement or reward, but it is your knowledge, your caring, your intervention, your insight, your teaching, your commitment to care ~ your touch ~ that changes and saves lives. Know that for yourselves when no one else acknowledges that. You are not there to be a slave to the computer, but to serve those in need.
I have not read through the entire thread either, but hope this isn't too redundant.
We all learned in nursing school that not only different cultures, but also, different generations express discomfort>pain in their own way. I really think that understanding needs to be kept in mind when we attempt to interpret our patient's needs.
The last number of years I worked with geriatrics, many with some dementia (and certainly much of my time in acute and critical care was also with the elderly). Most places seemed to work with the 'faces' for our elderly because the number system didn't seem to work so well. The one presentation that seemed to work the best - most of the time - was a picture of a thermometer. For some reason that had greater meaning for the elderly. They could point or verbalize. Plus it gives a scale so the patient can move up or down after pain med. I have never understood why this isn't used more often for the elderly. Of course, it wouldn't make much sense for young people who know only digital.
I so much relate and am empathetic to your concerns. I, along with -I'm sure - many others who have similar concerns share with you right now. We loved being a nurse. We loved the hands on care, education and support we could give.
Though I left acute and critical care due to medical concerns in 2000, I did finally get back to an aspect of nursing in 2004 - - assisted living. Finally after 2.5 years in dementia care, in October 2010, I was replaced by a younger nurse who would and could work more hours. (She quit after 3 weeks) I know I managed my job and facility well in my 25 hours a week because 2 weeks after they replaced me, State Survey gave my facility a deficiency free survey. Even the regional manager emailed me stating that he knew this was because I was 'a h___ of a good nurse'.
So what good does that do ? Not a thing, it seems. Who is going to hire you in your later years, with limited, yet functional ability after you have been 'offed' in assisted living ? Nobody !!!! You have already hit the bottom of the nursing pool. You are already working for the least wage per hour and without benefits. You are doing this because you love nursing, are good at it and have a lot to give of your expertise and profession. You are doing this because you have assessed for yourself that you do not have the physical and/or mental capability to work long hours under great physical, mental and emotional stress. It is not self serving or greedy - it is because it fits the tolerance of your well being and care for others.
So what now???? I hope you find better than I have. Home Health/Hospice was mentioned. You bet!, we would be a great addition. Only regretful denials from here (and I was the first nurse hired to them back in the early '80's). Volunteer - - well isn't that sweet. Between my limited reserve of energy and managing my finances to stay alive . . . . well, I must 'volunteer' for me and my family to keep things afloat. (Though, I must admit the person and nurse in me wants to volunteer for many things.) I am glad that your Social Security income 'barely' manages your subsistence. For me, it is about half of what is needed to maintain my home [of 30+ years) and other monthly bills.
So what do you do? It is so hard to say. You have a gift and a love and experience that gives you such great worth. I wish for you that it does not turn to depression and hopelessness as it seems to have done for me.
You do have options. As long as you are secure to maintain your current livelihood - do what you love and enjoy, the best you can, for as long as you can. You can be a woman, stronger than me, to advance the true concept of nursing in a way that only you can.
Bless you for the courage to start this line of forum. It already shows that you are wise and with discretion.
As usual, I am a bit late to respond - which probably isn't a concern. What is nursing's greatest setback? Well, many of you seem too avant guard for me. I may be old, but I am not particularly 'old fashioned'. So here is my gist of things.
I became an RN in the mid '80's while in my 30's. I do live in a rather rural area so things may have a different perspective from other areas. So I will give you my view of our nursing [and health care provision].
Corporations !!!!! and health Insurance !!!!
In my northwest we were largely small, wonderful hospitals dedicated to serving our communities. The entire staff was a family of sorts with our entire focus to those in need of our care. In came the large corporation with all of its remodeling and division to take over not only our hospital, but every hospital and clinic for half the state. Not all their ideas were wrong, but so many were not focused to patient care. With corporations, presentation and profit seem to equate with a good success and the focus of their intent. I have to disagree ! As a nurse, my prime intent is as patient advocate - not 'yes-man/woman' - to the corporate people who seem to know nothing about real patient care and advocacy. It has been several years since I have worked in a hospital, but see the same thing in extended care and assisted living. Once a corporation umbrella takes over functioning facilities the whole focus turns from patient or resident care to profitability for the owner and share holders.
Insurance - I will not even go there. I just know that many, if not most, of our MD's stopped delivering babies as their liability insurance elevated to unreasonable costs. I can only imagine what things are like now. My own doctor was 'black-balled' out of her excellent practice by a corporation years ago.
So, to nursing. . . . . Nurses are held to oblige whatever the facility or corporation designs - regardless of their better judgment or advocacy. They have no say while feeling the hard edge of the boot when they cannot ethically comply or voice differently. Good nurses - REAL NURSES - face this setback every day, I suspect. Do you keep your job ? Or do you set your foot to what is needed for your patients ?
Good wishes to any and all that may continue to feel the call of this profession at its essence.
This is so against my grain, but I will say it anyway. I think private/corporate marketing to health care is the greatest set back to nurses being able to provide excellent nursing care. A 'patient advocate' nurse knows what she needs to do to provide the best care for her patients. And that should not be restricted to corp guidelines or insurance costs.
First of all ~ let me say that I am soooo sorry that you {or anyone} have had that experience. That would sure be a way to turn you off nursing in a hurry ! Now, I am an older nurse and have been nursing a few decades. What's the first thing you learn ? Your first responsibility is as Patient Advocate !
Everything you witnessed was deplorable. Your actions were just as they needed to be. I commend you for standing your ground. I guess the only thing I would say to have done [maybe] differently - - when you got no support or change - turn the facility in to state, but keep your position and keep trying until they fire you. That way you get unemployment and you have not abandoned your patients. (I'm sure you gave a proper resignation, so this last part may not be as crucial, but it might be construed that way otherwise.)
Now I am in a rural long term dementia care facility and the only licensed person. Any mishap or failure could tarnish my license. I teach, train and counsel a lot ! In many ways its like babysitting or being 'mama'. But I do not tolerate staff that do not care and refuse to learn - do not look after our residents in the way they should. Thankfully, I have largely a good bunch of ladies and gents. Sometimes it takes time to separate the 'wheat from the chaff' and develop a competent and caring staff. It is impossible if you don't have the format or support from administration.
I hope you have found more worthy use and place for yourself in nursing.
Hey worldtraveler - - so am I ! (born in Panama, kindergarten in Japan and high school in France) Long time ago because I'm 61 now. Ugh.... Still travel when I can [a month in Peru a couple years ago]
Anyway, back to the subject........ You did not hijack me ! You stated, much as I feel.
When my small rural local hospital was just that - we were a family. And we were one of the top 100 hospitals of our designation in the country ! We worked together. Worked well and compassionately. Eventually all was taken over by a large hospital concern. Yes, it had its good sides, but predominantly it did not seem individual and patient oriented. Designers and PR people came in with a few, very decent ideas, but totally neglected our community hospital purpose. Nor did they take any input from the professional 'working staff' in remodeling to facilitate patient care. At least half of our patient care areas were taken over by administrative offices. The additions and therapies to out-patients is good. But the loss of general public respect and confidence has been awful.
And that is just my wee part of this world !
Since I have been out of the hospital I have been largely with corporations. Maybe I am too naive, but it - even more - seems to be only profit ridden. The corporate focus seems largely toward profit and keeping up to state regs. So, in my case, the paperwork keeps expanding and the individual nursing time keeps diminishing. Always wanting and being - in essence - a bedside nurse ~ this is frustrating. Thankfully - somehow - I have been able to push through a few 'real resident' care concerns. And, thankfully, I love teaching. I have a super staff ! Do I know it all ~ NEVER !
So, if I am reading you right, we are in absolute accord !
The old nursing commitment is as Patient Advocate. It is too important to gloss over. It is our job.
Not to worry ~~~ Good nurses will always be needed. It just may not be where or how you had in your plans. I know everyone comes through and out of school with 'their plan' and preference. If you can get it right away - go for it. I have worked in nursing for nearly 30 years (and I live in a rural community). Spent nearly 20 years at the local hospital, but got old and 'not so well'. Now I am 'health care coordinator' for a dementia care facility. Pay is crappy as compared to hospital and paperwork is overwhelming, but my knowledge and insights are crucial to caring for these people. (And believe me ! There is always a waiting list of residents !)
That is one of the things I have always loved about nursing ~ You can always take those skills and license to a vast arena of job types that either require or prefer an RN. Assisted living is growing by leaps and bounds - and requires an RN to manage uncertified staff (training, direction, etc) Nursing homes and Rehab facilities need nurses. Even independent living often wants nursing oversight. As do foster care homes and businesses. Some insurance companies want nurses to provide evaluations. As healthcare becomes more 'socialized' (yea! because I feel very much as someone noted above that greedy corporations are ruining our healthcare delivery systems), it is likely that that more clinics will be opened to provide less expensive health management than we have had in years past. Naturopaths, chiropractors and such often want an RN on their team. Of course, there is working in a doctor's office, too. I'm sure the list could go on.
So ~ if you really want to nurse. Then, so be it, and your wish is fulfilled ! But if you're just looking at the place, position or wages . . . . . well, job availability might be less than you hoped.
Good wishes and good luck.
Thank you so much for your concern and direct response. Like the old movie said "Let it be said. Let it be done !" All those concerns have passed. Yes, one was sent to another facility - the most volatile. Another has passed away. Another that got swept up in the confrontations moved to a foster care home and returned to his sweet, gentle self. And the last has had no incidents or altercations ~ now quiet and cooperative.
Though challenges remain every day, I am so thankful that that particular time and combination of residents has been resolved.
Believe me - if it ever happens again I will be more forceful to gain resolution.
Surely you jest ! ~ A psychiatrist at hand ! No, I know you are not. But surely must be accustomed to a different environment. As mentioned before, our first resource is the county psyche specialist. She covers 2 counties and is hard pressed for time. It is a slow process, taking weeks and months to alter this and up that or . . . . whatever. Of course I can always contact the PCP (which I do because I have to request a psyche eval). Unfortunately, many PCPs do not know their way around senior dementia/psyche meds. One of the greatest assets is the pharmacist who comes every quarter and advises needs or modifications to us or MD directly. As many of my residents are no longer articulate, short term memory is virtually nil, and none based in the reality that is evident to others - a typical 'sit down and talk' eval is almost laughable. We do have a wonderful facility about 100 miles away that is well equipped and able to {MD specialists, RN specialists, etc} take the truly problematic temporarily and endeavor to create the best solution for that individual. All ducks must be in a row. All sanctions in place. And, of course, there must be room in the inn.
Sorry, cannot contact prior predecessor. We are under new ownership and management for not quite a year. Prior ran the facility to bankruptcy and sorely did not pass state survey. At least we passed survey well a couple months ago and, most often, stay - begrudenly - within budget.
I do not want this to sound like a gripe session. I can gripe and complain to myself all I want. This needs to be solution oriented to respect the residents we care for, provide the best care we can, while safeguarding other residents and staff. I appreciate the 2 staff members to provide our more difficult situations or residents. And this is done. We do have to be realistic, though. There is never more than 1 med aide and 2 resident aides on any shift. Of course admin, office manager, activity director and myself can hands on input time, care and intervention but that amounts to 1/3 of a 24 hr day, 5 days a week. And, as you well know, each of us have our own special obligations to accomplish. A day is never done that is finished !
I couldn't agree more with staff meetings that are solution oriented and truly care education full. I think we could make great strides for the majority of our residents's care and well being while developing greater understanding and workability between the shifts and departments. It would allow us to problem solve as a working group. Though we do have our staff meetings they are pretty much by rote - often too boring for even myself to keep attention. I value the input and interaction of my 'hands on' staff. They are the 'meat and potatoes' of our work. Hey ! I guess that will be a New Year's resolution ! To Initiate a truly meaningful forum for our staff, at staff meetings. The required 'by rote' requirements can be handled differently and serve the same purpose.
I thank you so much for your thoughtful response and, certainly, the 'heads up'.
Ya know ~ at this point ~ I am thinking that a thread - or sticky? - needs to be initiated for all the assisted living (including dementia care) facilities. We seem to be such an off-shoot of primary, acute, or, even LTC, that little is addressed or understood. And yet - especially if you are a 'baby boomer' like me - could be near around the corner - and certainly an eventuality for an ever enlarging population.
Thanks to all that wrote with your responses. I appologize for being so tardy with my return. Just dealing with holidays, work and illness has kept me away.
I couldn't agree more about staffing. I feel we are terribly understaffed for the needs and behaviors of our residents, but there will be no changing that ! . . . And we are a dementia facility. In Oregon dementia facilities are under the 'assisted living' regs. Senior psyche/dementia specialty units can be counted on one hand - taking time and much hoop jumping to get someone in IF there is available temporary space.
I am interested in 'sam1998' response about having a separate area for the 'trouble making gentlemen'. It has been my impression that the interaction and interface between my gents just exacerbates their behaviors. I think all would behave much better if they were alone and not in an interactive community. I would like to think differently than that !
At least, since intial post, the county psyche specialist is finally understanding (after 2-3 months!) that our concerns for one of the men needs to be addressed sooner, rather than later. Whooppee !!!!
OK ~ I had been in acute and critical care for 20 years. But since 2004 I have been in assisted living. Currently I am in a 'memory care' facility. All residents have significant dementia along with their other medical concerns. You may probably know that staffing is scant and without certificate or license. The RN is the only licensed person there and in a facility of my size (30 residents) - part time (20 hours/wk).
My biggest concern at present are a half dozen {mostly male} that get into physical altercations. :angryfire I can care plan all I want and direct staff to attempt to intervene and re-direct early on before intrusive or obnoxious behavior escalates to physical altercation, but these people have no 'sensor' anymore to inappropriate social behavior. And many things are just 'knee jerk' reaction. One was a military MP followed by a carreer as a police officer - plus a boxer while in the military. He is 'set to go' to defend and protect and can deliver a swift double punch to the face when he perceives another affronted or to defend himself. Another can turn on a dime from pleasant and joking to yelling, name calling, throwing and pushing. Another intrudes on others so badly in all aspects throughout the day that he invokes the rath of others. He is resistant to any care and when attempts are made to re-direct or care for he becomes combative. I have worried greatly for the safety of my staff. Although his punches do not deliver much pack, his grip could be lethal (especially after trying to loose him from the juglars of one of the aids!). They all live in their own reality and we go with that and try to calm. One gentleman speaks to no one or nothing in particular, but his comments can incite reaction from others. If there is a verbal or physical reaction by another this little 'Italian hot rod' can spark fire rapidly. If one or two get started it can incite a 'revolution' !
Oh, I could just go on...... But I really need to know what to do to reduce these physical altercations. Recently I am getting one or two a day and I need to be able to care plan a reasonable solution. I really need to try to avert any injury to residents or staff ! Yes ~ being a small facility and long term, we know our residents well and intimately. We do try to keep those that offend each other separated, but remember - most are independently mobile. We try to listen and be aware of inciting verbage or behaviors to intervene before it escalates to physical confrontation.
I am at a loss and I don't want anyone hurt.
Gosh~ I'm going to jump right in here! Not that I have any great wisdom to contribute...... I work in assisted living and falls are one of the greatest concerns. I always wonder how to deal with a resident that you just know is going to fall. As you indicate goal setting for "no falls" is just unrealistic. With a frequent faller I have enlisted the help of the doctor to evaluate the medications along with a specialist in such things. That was, eventually helpful. I also had PT and OT evals and follow through. I and we educate and encourage to call for assistance constantly. I even had the staff making checks every time they entered the apartment - requiring at least 2/hour. I knew we were doing everything we could possibly do to safeguard this lady, but it still looks bad and feels bad when she falls. Her falls are less now with all our interventions, but she is still a lady with dementia, on narcotic pain meds and psychoactive meds, with poor motor skills and balance and.....impulsive. We finally did a 'risk agreement' so that we could not be held accountable if she did not comply with seeking assistance.
I have been working toward a 'fall prevention program' for a good while, though it keeps sliding below other priorities, so is unfinished. Any good ideas would be appreciated.
While I'm here. . . . . Can anyone tell me how to post a new thread? I can't seem to find the info and am new to this forum. Thanks!
So good to see such a discussion. I am new to this forum, so this is my first post. However, I have been an RN in acute and critical care for 20 years and insulin and heparin always required 2 signature checks [not 2 people at administration]. Believe me ~ the best and most cautious nurse can make errors!! It should not demean your license - or be taken that way.
I find myself in a different situation, now, as Health Care Coordinator on an assisted living facility. Oregon - I've heard - is on the 'avant guard' in this area. I am the only licensed person in the facility and it is my license if I don't train and delegate adequately. I have just finished a full delegation process for injecting insulin for my med aide staff. There is no way possible to have two RN signatures. And not required in such a facility. But this forum helped me recognize that I will have to substantiate and sign for each syringe I draw up for later administration by med aide. Thanks for the 'lights on'.
My ! How this thread and topic has caused such a wonderful expanse of thoughts since its arrival !!!
The area that I seem to be missing is the lower middle class. Being a 'single' mother when my children were younger I went into nursing. But only worked part time. That was enough to cover our home, property, bills and a bit more. Certainly nothing extravagant. I cannot believe that there aren't other women or men in a similar position. Those that worked hard both for income and home and family. So, having been an RN since 1984, and absolutely loving it ! - I find myself in a place that is nearly intolerable. I have worked since 1966. Yes, nursing was a 'mid-life' change. Enougth hx. Yes, I did set up as best I could. My preference was to have one of my sons and his family live on the land with me. So when I became more ill or unable there would be someone close.
Now, because I am Social Security age, but not yet Medicare age, there are no jobs for us well seasoned nurses. And the Soc Sec does not cover my bills - much less health insurance ! I guess that should tell all younger people to screw family and home so that you can always and just focus on yourself and your everlasting wellbeing. If that is how you take it, then so be it.
I am glad for those that have planned and done well for themselves. I am glad for those that can't and, yet, receive health care. As a nurse and a human, I wish money could be taken out of all health care concerns. Obviously it can't. So, we are left with those 'in-betweens' - like me. Those that have worked for 40+ years. Those that may or may not receive Social Securiy. But cannot afford health care insurance. This is the working lower middle class. That is where we live and survive.
Other nations' view our country as unbelievable and uncivilized in the way we care for our peoples in their time of need. Our country calls it socialist, or worse. We are not outstanding, as a nation, in our healthcare. We have some great hospitals, nurses and doctors, but - overall - our general and ongoing health care is crap. I do blame the corporations for sending our healthcare system into a profit motivated cesspool.
Yes, I do think we should have 'socialized medicine' for basic and needed care. If one can't afford plastic surgery or bariatric surgery, then so be it. Too bad.
Politically speaking ~ 'Obama Care' is the best we have yet that can provide what might be marginally accepted to such a greedy and self-centered group of people as we have produced.
If you are a nurse of any moral and ethical value, could you refuse care to a person in need ?
This is an area of nursing that is so dear to me. After years in acute and critical care I had to modify my activity for health and physical reasons. Begrudgingly I began nursing in an ALF. I have to admit, I wasn't very good at the first one. I guess I really didn't understand the scope of what was needed from me. But the years and experience educated me well to this area. I guess I had been so accustomed to working with other licensed professionals, I didn't know what to expect from 'caregivers' and 'med aides'.
Anyway, initially [and continually] I found that there was little direction or training for ALF nurses. I guess they expect that if you have acute care nursing skills - you should be able to manage an ALF. What bothered me so much was that my layman staff was given so little training - - and even less respect for the jobs they do. Luckily, I love to teach nearly as much as I love hands on nursing. Over the years I developed a med aide training manual and all sorts of other training, education, delegations, forms, etc. Anytime one of my staff came up with an inquiry about a particular diagnosis that I already hadn't addressed I would make up more educational sheets ~ not required reading but available for their interest. Even though the corporation[s] I worked for gave little time to training med aids I felt it was of ultimate importance. Beyond the practicle, I wanted to feel assured that this new med aide was empathetic and held themselves as 'patient advocate'. So had the primary good nurse qualities.
ALF is a whole different arena of nursing. It is not well paid or much respected. But it is essential and will only be needing more qualified nurses as my 'baby boomer' generation continues to age and become needy.
Now that I am retired (unwillingly !) I can say things that I couldn't before. My gripe is the focus of these corporations is strictly profitability. Sure I want ends to meet and everyone to have their profit. But healthcare is a service - a hands on caring for individuals. If the profit out-ranks the care, then it will eventually either become cruel or fold.
Maybe someone here can direct me in a way that I can provide some of the educational resources I have put together for other nurses and/or facilities. Sure, I would like to make some money at it, but the important thing is to be a resource.
Always a day late ! Or, in this case a month...... As sad as it is, I am glad to see that other competent nurses are in my position. At least I know it is not just me !
I started nursing school in my mid 30's (change of vocation) and got my RN in 1984. Worked at our small rural hospital for nearly 20 years before I had to stop for medical reasons. After 4 years of illness I realized I no longer was capable of acute and critical care in a hospital. So I sought work in assisted living. It was a good choice, even though I was largely unprepared for that type of job in the beginning. But I found that - eventually - that it was perfect for me ! Hours were generally part time, I no longer had to do all the heavy lifting and running, I love to teach and nurture both staff and residents, I am very good with creating teaching materials, protocols and forms, plus it is a position of respectability and 'say' within the facility.
What could go wrong?
. . . . Age . . . I lost my job a year and a half ago - not because I wasn't doing well or not getting my job done - but because corp wanted a younger nurse who could work more hours. State survey came through a week later and facility was deficiency free. That was MY doing ! I am so disgusted with corporations that place their profitability above the service that they say they are committed to.
So now I am on Social Security ~ yes, old enough ! But that is only just about half of what I need to live and pay bills. (I have worked since 1966) I would really love to provide training and educational materials for other assisted living facility nurses so they wouldn't have to start from next to nothing. It is a needed aspect of our health care management that costs far less than hospitals or nursing homes.
So what do you do when you are older, but still capable (within limitations), have vast experience and education, want to give, share and use the abilities you have, and retain your nursing license a bit longer ? I love nursing. I just hate the way it is being used these days.
So much for me.
A note to the younger generations ~ The profession of nursing is almost sacred. It may not get much acknowledgement or reward, but it is your knowledge, your caring, your intervention, your insight, your teaching, your commitment to care ~ your touch ~ that changes and saves lives. Know that for yourselves when no one else acknowledges that. You are not there to be a slave to the computer, but to serve those in need.
I have not read through the entire thread either, but hope this isn't too redundant.
We all learned in nursing school that not only different cultures, but also, different generations express discomfort>pain in their own way. I really think that understanding needs to be kept in mind when we attempt to interpret our patient's needs.
The last number of years I worked with geriatrics, many with some dementia (and certainly much of my time in acute and critical care was also with the elderly). Most places seemed to work with the 'faces' for our elderly because the number system didn't seem to work so well. The one presentation that seemed to work the best - most of the time - was a picture of a thermometer. For some reason that had greater meaning for the elderly. They could point or verbalize. Plus it gives a scale so the patient can move up or down after pain med. I have never understood why this isn't used more often for the elderly. Of course, it wouldn't make much sense for young people who know only digital.
I so much relate and am empathetic to your concerns. I, along with -I'm sure - many others who have similar concerns share with you right now. We loved being a nurse. We loved the hands on care, education and support we could give.
Though I left acute and critical care due to medical concerns in 2000, I did finally get back to an aspect of nursing in 2004 - - assisted living. Finally after 2.5 years in dementia care, in October 2010, I was replaced by a younger nurse who would and could work more hours. (She quit after 3 weeks) I know I managed my job and facility well in my 25 hours a week because 2 weeks after they replaced me, State Survey gave my facility a deficiency free survey. Even the regional manager emailed me stating that he knew this was because I was 'a h___ of a good nurse'.
So what good does that do ? Not a thing, it seems. Who is going to hire you in your later years, with limited, yet functional ability after you have been 'offed' in assisted living ? Nobody !!!! You have already hit the bottom of the nursing pool. You are already working for the least wage per hour and without benefits. You are doing this because you love nursing, are good at it and have a lot to give of your expertise and profession. You are doing this because you have assessed for yourself that you do not have the physical and/or mental capability to work long hours under great physical, mental and emotional stress. It is not self serving or greedy - it is because it fits the tolerance of your well being and care for others.
So what now???? I hope you find better than I have. Home Health/Hospice was mentioned. You bet!, we would be a great addition. Only regretful denials from here (and I was the first nurse hired to them back in the early '80's). Volunteer - - well isn't that sweet. Between my limited reserve of energy and managing my finances to stay alive . . . . well, I must 'volunteer' for me and my family to keep things afloat. (Though, I must admit the person and nurse in me wants to volunteer for many things.) I am glad that your Social Security income 'barely' manages your subsistence. For me, it is about half of what is needed to maintain my home [of 30+ years) and other monthly bills.
So what do you do? It is so hard to say. You have a gift and a love and experience that gives you such great worth. I wish for you that it does not turn to depression and hopelessness as it seems to have done for me.
You do have options. As long as you are secure to maintain your current livelihood - do what you love and enjoy, the best you can, for as long as you can. You can be a woman, stronger than me, to advance the true concept of nursing in a way that only you can.
Bless you for the courage to start this line of forum. It already shows that you are wise and with discretion.
As usual, I am a bit late to respond - which probably isn't a concern.
What is nursing's greatest setback? Well, many of you seem too avant guard for me. I may be old, but I am not particularly 'old fashioned'. So here is my gist of things.
I became an RN in the mid '80's while in my 30's. I do live in a rather rural area so things may have a different perspective from other areas. So I will give you my view of our nursing [and health care provision].
Corporations !!!!! and health Insurance !!!!
In my northwest we were largely small, wonderful hospitals dedicated to serving our communities. The entire staff was a family of sorts with our entire focus to those in need of our care. In came the large corporation with all of its remodeling and division to take over not only our hospital, but every hospital and clinic for half the state. Not all their ideas were wrong, but so many were not focused to patient care. With corporations, presentation and profit seem to equate with a good success and the focus of their intent. I have to disagree ! As a nurse, my prime intent is as patient advocate - not 'yes-man/woman' - to the corporate people who seem to know nothing about real patient care and advocacy. It has been several years since I have worked in a hospital, but see the same thing in extended care and assisted living. Once a corporation umbrella takes over functioning facilities the whole focus turns from patient or resident care to profitability for the owner and share holders.
Insurance - I will not even go there. I just know that many, if not most, of our MD's stopped delivering babies as their liability insurance elevated to unreasonable costs. I can only imagine what things are like now. My own doctor was 'black-balled' out of her excellent practice by a corporation years ago.
So, to nursing. . . . . Nurses are held to oblige whatever the facility or corporation designs - regardless of their better judgment or advocacy. They have no say while feeling the hard edge of the boot when they cannot ethically comply or voice differently. Good nurses - REAL NURSES - face this setback every day, I suspect. Do you keep your job ? Or do you set your foot to what is needed for your patients ?
Good wishes to any and all that may continue to feel the call of this profession at its essence.
This is so against my grain, but I will say it anyway. I think private/corporate marketing to health care is the greatest set back to nurses being able to provide excellent nursing care. A 'patient advocate' nurse knows what she needs to do to provide the best care for her patients. And that should not be restricted to corp guidelines or insurance costs.
First of all ~ let me say that I am soooo sorry that you {or anyone} have had that experience. That would sure be a way to turn you off nursing in a hurry ! Now, I am an older nurse and have been nursing a few decades. What's the first thing you learn ? Your first responsibility is as Patient Advocate !
Everything you witnessed was deplorable. Your actions were just as they needed to be. I commend you for standing your ground. I guess the only thing I would say to have done [maybe] differently - - when you got no support or change - turn the facility in to state, but keep your position and keep trying until they fire you. That way you get unemployment and you have not abandoned your patients. (I'm sure you gave a proper resignation, so this last part may not be as crucial, but it might be construed that way otherwise.)
Now I am in a rural long term dementia care facility and the only licensed person. Any mishap or failure could tarnish my license. I teach, train and counsel a lot ! In many ways its like babysitting or being 'mama'. But I do not tolerate staff that do not care and refuse to learn - do not look after our residents in the way they should. Thankfully, I have largely a good bunch of ladies and gents. Sometimes it takes time to separate the 'wheat from the chaff' and develop a competent and caring staff. It is impossible if you don't have the format or support from administration.
I hope you have found more worthy use and place for yourself in nursing.
Hey worldtraveler - - so am I ! (born in Panama, kindergarten in Japan and high school in France) Long time ago because I'm 61 now. Ugh.... Still travel when I can [a month in Peru a couple years ago]
Anyway, back to the subject........ You did not hijack me ! You stated, much as I feel.
When my small rural local hospital was just that - we were a family. And we were one of the top 100 hospitals of our designation in the country ! We worked together. Worked well and compassionately. Eventually all was taken over by a large hospital concern. Yes, it had its good sides, but predominantly it did not seem individual and patient oriented. Designers and PR people came in with a few, very decent ideas, but totally neglected our community hospital purpose. Nor did they take any input from the professional 'working staff' in remodeling to facilitate patient care. At least half of our patient care areas were taken over by administrative offices. The additions and therapies to out-patients is good. But the loss of general public respect and confidence has been awful.
And that is just my wee part of this world !
Since I have been out of the hospital I have been largely with corporations. Maybe I am too naive, but it - even more - seems to be only profit ridden. The corporate focus seems largely toward profit and keeping up to state regs. So, in my case, the paperwork keeps expanding and the individual nursing time keeps diminishing. Always wanting and being - in essence - a bedside nurse ~ this is frustrating. Thankfully - somehow - I have been able to push through a few 'real resident' care concerns. And, thankfully, I love teaching. I have a super staff ! Do I know it all ~ NEVER !
So, if I am reading you right, we are in absolute accord !
The old nursing commitment is as Patient Advocate. It is too important to gloss over. It is our job.
Cannot thank you enough for your input.
Not to worry ~~~ Good nurses will always be needed. It just may not be where or how you had in your plans. I know everyone comes through and out of school with 'their plan' and preference. If you can get it right away - go for it. I have worked in nursing for nearly 30 years (and I live in a rural community). Spent nearly 20 years at the local hospital, but got old and 'not so well'. Now I am 'health care coordinator' for a dementia care facility. Pay is crappy as compared to hospital and paperwork is overwhelming, but my knowledge and insights are crucial to caring for these people. (And believe me ! There is always a waiting list of residents !)
That is one of the things I have always loved about nursing ~ You can always take those skills and license to a vast arena of job types that either require or prefer an RN. Assisted living is growing by leaps and bounds - and requires an RN to manage uncertified staff (training, direction, etc) Nursing homes and Rehab facilities need nurses. Even independent living often wants nursing oversight. As do foster care homes and businesses. Some insurance companies want nurses to provide evaluations. As healthcare becomes more 'socialized' (yea! because I feel very much as someone noted above that greedy corporations are ruining our healthcare delivery systems), it is likely that that more clinics will be opened to provide less expensive health management than we have had in years past. Naturopaths, chiropractors and such often want an RN on their team. Of course, there is working in a doctor's office, too. I'm sure the list could go on.
So ~ if you really want to nurse. Then, so be it, and your wish is fulfilled ! But if you're just looking at the place, position or wages . . . . . well, job availability might be less than you hoped.
Good wishes and good luck.
Thank you so much for your concern and direct response. Like the old movie said "Let it be said. Let it be done !" All those concerns have passed. Yes, one was sent to another facility - the most volatile. Another has passed away. Another that got swept up in the confrontations moved to a foster care home and returned to his sweet, gentle self. And the last has had no incidents or altercations ~ now quiet and cooperative.
Though challenges remain every day, I am so thankful that that particular time and combination of residents has been resolved.
Believe me - if it ever happens again I will be more forceful to gain resolution.
Surely you jest ! ~ A psychiatrist at hand ! No, I know you are not. But surely must be accustomed to a different environment. As mentioned before, our first resource is the county psyche specialist. She covers 2 counties and is hard pressed for time. It is a slow process, taking weeks and months to alter this and up that or . . . . whatever. Of course I can always contact the PCP (which I do because I have to request a psyche eval). Unfortunately, many PCPs do not know their way around senior dementia/psyche meds. One of the greatest assets is the pharmacist who comes every quarter and advises needs or modifications to us or MD directly. As many of my residents are no longer articulate, short term memory is virtually nil, and none based in the reality that is evident to others - a typical 'sit down and talk' eval is almost laughable. We do have a wonderful facility about 100 miles away that is well equipped and able to {MD specialists, RN specialists, etc} take the truly problematic temporarily and endeavor to create the best solution for that individual. All ducks must be in a row. All sanctions in place. And, of course, there must be room in the inn.
Sorry, cannot contact prior predecessor. We are under new ownership and management for not quite a year. Prior ran the facility to bankruptcy and sorely did not pass state survey. At least we passed survey well a couple months ago and, most often, stay - begrudenly - within budget.
I do not want this to sound like a gripe session. I can gripe and complain to myself all I want. This needs to be solution oriented to respect the residents we care for, provide the best care we can, while safeguarding other residents and staff. I appreciate the 2 staff members to provide our more difficult situations or residents. And this is done. We do have to be realistic, though. There is never more than 1 med aide and 2 resident aides on any shift. Of course admin, office manager, activity director and myself can hands on input time, care and intervention but that amounts to 1/3 of a 24 hr day, 5 days a week. And, as you well know, each of us have our own special obligations to accomplish. A day is never done that is finished !
I couldn't agree more with staff meetings that are solution oriented and truly care education full. I think we could make great strides for the majority of our residents's care and well being while developing greater understanding and workability between the shifts and departments. It would allow us to problem solve as a working group. Though we do have our staff meetings they are pretty much by rote - often too boring for even myself to keep attention. I value the input and interaction of my 'hands on' staff. They are the 'meat and potatoes' of our work.
Hey ! I guess that will be a New Year's resolution ! To Initiate a truly meaningful forum for our staff, at staff meetings. The required 'by rote' requirements can be handled differently and serve the same purpose.
I thank you so much for your thoughtful response and, certainly, the 'heads up'.
Ya know ~ at this point ~ I am thinking that a thread - or sticky? - needs to be initiated for all the assisted living (including dementia care) facilities. We seem to be such an off-shoot of primary, acute, or, even LTC, that little is addressed or understood. And yet - especially if you are a 'baby boomer' like me - could be near around the corner - and certainly an eventuality for an ever enlarging population.
Thanks to all that wrote with your responses. I appologize for being so tardy with my return. Just dealing with holidays, work and illness has kept me away.
I couldn't agree more about staffing. I feel we are terribly understaffed for the needs and behaviors of our residents, but there will be no changing that ! . . . And we are a dementia facility. In Oregon dementia facilities are under the 'assisted living' regs. Senior psyche/dementia specialty units can be counted on one hand - taking time and much hoop jumping to get someone in IF there is available temporary space.
I am interested in 'sam1998' response about having a separate area for the 'trouble making gentlemen'. It has been my impression that the interaction and interface between my gents just exacerbates their behaviors. I think all would behave much better if they were alone and not in an interactive community. I would like to think differently than that !
At least, since intial post, the county psyche specialist is finally understanding (after 2-3 months!) that our concerns for one of the men needs to be addressed sooner, rather than later. Whooppee !!!!
Again ~ thanks ! And any input welcome.
OK ~ I had been in acute and critical care for 20 years. But since 2004 I have been in assisted living. Currently I am in a 'memory care' facility. All residents have significant dementia along with their other medical concerns. You may probably know that staffing is scant and without certificate or license. The RN is the only licensed person there and in a facility of my size (30 residents) - part time (20 hours/wk).
I can care plan all I want and direct staff to attempt to intervene and re-direct early on before intrusive or obnoxious behavior escalates to physical altercation, but these people have no 'sensor' anymore to inappropriate social behavior. And many things are just 'knee jerk' reaction. One was a military MP followed by a carreer as a police officer - plus a boxer while in the military. He is 'set to go' to defend and protect and can deliver a swift double punch to the face when he perceives another affronted or to defend himself. Another can turn on a dime from pleasant and joking to yelling, name calling, throwing and pushing. Another intrudes on others so badly in all aspects throughout the day that he invokes the rath of others. He is resistant to any care and when attempts are made to re-direct or care for he becomes combative. I have worried greatly for the safety of my staff. Although his punches do not deliver much pack, his grip could be lethal (especially after trying to loose him from the juglars of one of the aids!). They all live in their own reality and we go with that and try to calm. One gentleman speaks to no one or nothing in particular, but his comments can incite reaction from others. If there is a verbal or physical reaction by another this little 'Italian hot rod' can spark fire rapidly. If one or two get started it can incite a 'revolution' !
My biggest concern at present are a half dozen {mostly male} that get into physical altercations. :angryfire
Oh, I could just go on...... But I really need to know what to do to reduce these physical altercations. Recently I am getting one or two a day and I need to be able to care plan a reasonable solution. I really need to try to avert any injury to residents or staff ! Yes ~ being a small facility and long term, we know our residents well and intimately. We do try to keep those that offend each other separated, but remember - most are independently mobile. We try to listen and be aware of inciting verbage or behaviors to intervene before it escalates to physical confrontation.
I am at a loss and I don't want anyone hurt.
Any ideas ? PLEASE !!!!!
Gosh~ I'm going to jump right in here! Not that I have any great wisdom to contribute...... I work in assisted living and falls are one of the greatest concerns. I always wonder how to deal with a resident that you just know is going to fall. As you indicate goal setting for "no falls" is just unrealistic. With a frequent faller I have enlisted the help of the doctor to evaluate the medications along with a specialist in such things. That was, eventually helpful. I also had PT and OT evals and follow through. I and we educate and encourage to call for assistance constantly. I even had the staff making checks every time they entered the apartment - requiring at least 2/hour. I knew we were doing everything we could possibly do to safeguard this lady, but it still looks bad and feels bad when she falls. Her falls are less now with all our interventions, but she is still a lady with dementia, on narcotic pain meds and psychoactive meds, with poor motor skills and balance and.....impulsive. We finally did a 'risk agreement' so that we could not be held accountable if she did not comply with seeking assistance.
I have been working toward a 'fall prevention program' for a good while, though it keeps sliding below other priorities, so is unfinished. Any good ideas would be appreciated.
While I'm here. . . . . Can anyone tell me how to post a new thread? I can't seem to find the info and am new to this forum. Thanks!
So good to see such a discussion. I am new to this forum, so this is my first post. However, I have been an RN in acute and critical care for 20 years and insulin and heparin always required 2 signature checks [not 2 people at administration]. Believe me ~ the best and most cautious nurse can make errors!! It should not demean your license - or be taken that way.
I find myself in a different situation, now, as Health Care Coordinator on an assisted living facility. Oregon - I've heard - is on the 'avant guard' in this area. I am the only licensed person in the facility and it is my license if I don't train and delegate adequately. I have just finished a full delegation process for injecting insulin for my med aide staff. There is no way possible to have two RN signatures. And not required in such a facility. But this forum helped me recognize that I will have to substantiate and sign for each syringe I draw up for later administration by med aide. Thanks for the 'lights on'.