LTC / SNF /Nursing Home Nightmares: Pls Help!

[nursemanon]

It is my first time to work in the US, and since I am a re entry RN who couldn't get into a hospital ("you have to have 1 yr acute care experience before we could accept you" or "try working in a nursing home first so you could get used to patient care again") decided to try working in a SNF despite the many horror stories that I have heard from friends. It has always been my principle to get a first hand experience before I draw conclusions.

I initially applied for a NS position, then discovered that I have to cover 54 beds, average of 8 daily chartings, 4 weekly chartings, and mandatory charting for those with changes in condition (i.e., unlimited, but at the time there were 10 who have UTIs, pneumonia, falls..) I turned down the shift and wanted to resign, but was later on convinced to continue when one of my bosses told me that I could just be an AM or PM med nurse and later on do the AM or PM shift (max 26 patients, and depending which side, you will have a med nurse for four hours)..

I decided to focus on the positives, and tried to ignore the fact that nurses DON'T have time to check (or re-check/re-validate) the accuracy of the MAR. WE (my batchmate and other medication nurses) talked and concluded that the average time we consume in giving meds is 2.5hrs for every turn (for 8am meds, we finish at 1030am, sometimes 1015am). They say management knows about this, but the updating of the MAR has been delegated to Medical Records personnel because it is too expensive to hire more nurses.

The biggest thing that bothers me is that a co-worker discovered that we have been giving Metformin to a certain resident 2 months beyond the date it was discontinued.

I only worked 3 times on that side, and I was an orientee, but still I was a part of the error. And honestly, I think about this a lot now that my DON wants me to be oriented on the more acute side of the NH.

I am funding my nephew's nursing education, but other than that, my finances are ok because my hubby works.

I want to resign, should I? But I'm worried as to how this will reflect on my future job interviews, should I tell my interviewee these issues? Honestly right now, I am thinking of going back to the Phils and just be a clinical instructor. It seems there's no real nursing shortage here.

Do you have any other issues with nursing home staffing / patient safety? Pls do tell.

[Ms.RN]

i work in nursing home and i find mistakes all the time from nurses not doing right when they are doing renewals for the next month. i work in only one unit so its easy for me to catch mistakes since i know what medications my residents are taking. you need to track down where the mistake is made from, is it that a nurse who carried out an order to d/c glucophage forgot to transcribe it in the mar? or did a nurse made a mistake when she was doing to renwals? whoever made that mistake should be held accountable because a nurse giving medication from mar has no way of knowing that it is a mistake.

i think a good way to catch an error is by placing a copy of new order inside patient's mar, so that next shift nurse can check the order and make sure it is transcribed right. i think wherever you go you are going to see that nurses make mistakes.

[OldMareLPN]

I had similiar concerns when I first start at my ALF and was about to run for the front door, until I discussed it with my daughter.

No matter what any LTC is not going to be staffed, correctly, or give you enough time to do your work.

In the beginning I carried every issue on my shoulders and complained and complained. I finally came to the conclusion my bosses knew what I was complaining about and did not want to hear about it because they couldn't do anything about it themselves!.

So I let the whole thing go, and don't worry about anything except my patiensts, my documentation, my performance, and my license.

If they complain about the paper work, I smile and suggest they get a secretary because for me, my patients come first. I don't answer the phone during medpass, and the line in my sand is patient care.

While they pay me, I have no loyalty as an employee, for they see me only as a overhead cost. Work is just a door I go into to practice my profession.

Things are running better since I have stopped complaining. I read everything note and command, smile and go about my nursing duties.

Remember, god gave you two ears, one for the noise to go in and one for the noise to go out. Don't get in the way of the output :wink2:.

If you like being a nurse with the patients in that environment, be a nurse. If your gut says no, follow your gut.

Be happy, this is not a practice run.

[bubblymom373]

At the facility where I work the unit clerk does the MD orders. They are then double checked by a night shift nurse, to ensure that the new orders are recorded in the right places and old meds pulled. The new orders are then passed along when giving report to the next shift and are written on our report sheets. Does your facility have a system to double check new orders that come in? Or maybe a way of passing on the info to the next shift?

[Lexxie, LPN]

Do you know who is making the transcription errors? We have a nurse who often makes transcription errors and are aware to double check what she writes on the MAR. Our nightshift nurse is supposed to check all of the orders on change over nights, but with 60 residents, it's not always easy to get to every record.

[fairy65]

I have a problem last night at SNF also. I was working there as a PM supervisor and last night I admit new patient that brought with herself the IV Anitibiotic and one bottle of dakin's solution for dressing change I took the ATB from her and put it in frig and got busy to verify some of her order since she was in pain and no pain medication. I was 3 hours on calling to get the order since it was after hours. after every thing was done I left the facility, and the charge nurse for that patient took her solution away from her and the heparin that i did not notice when i took away the ATB and left in the treatment cart. ( she did not notice of the heparin also, since it was among some papers.

Today again in my shift they called me that patient want to leave the facility. I talked to her she complained that i did not recieve my treatment. no dressing chang and also they took away my white bags that have treatment solution and heparin and I don't remeber who took it away from me the person who took it wripped my name off of the bottle. I look at after it and could not find it. I called the Am supervisor that was on call for any issue. she came to help me and convince the resident to stay until tomorrow at least we can get the order for her. mean while we search for white bag that she mentioned the solution and heparin was inside. I called the charge nurse for last night and could not get hold of her. patient mentioned that the nurse to gave me ATB took my heparin and solution and wripped my name off the solution bottle. Finally AM supervisor conviced her to stay but she told us let we talk in private and decide (with her daughter and her son who were there). when we left them for decision we found the bag of heparin and but we noticed that a cop came to facility and went to her room. and they copmlained to 911 that we steal the meds and unfortunately the resident name was wriped off and also the solution was used. eventhogh she didn't received the dressing change.

she made an case against us that we used her meds for others and the cop asked question from every body to find out who took the meds. we have the camera but not in the patient room it is in the halway. hope we can see who had the white bag in her hands when left the room

and i talked to charge nurse later. she told me she took them but she did not wripped the patient name off of the bottle..

the officer gave us one card for case number, "suspicious circomstances" and left the facility.

Our DON also is in vacation this week.

I am so scared for my license. is there any advice