My almost venture into LTC! Verrrrrrrry long!

[Brownms46]

My Per Deim positions is nearing an end, as it doesn't offer enough hours. So I have been looking for a good reg PT position.

So I see this ad for a PT position in what is state to be one of the "facility of the year". So I check it out, and go for an interview. The money is good $25/hr until 2pm and then another $1/hr. But I'm not quite sure this is the place for me. So the NM and I agree on my shadowing a nurse, who is doing this Med/Tx position in a 20 bed TCU "supposedly"

Well the morning comes finally after the facility had to cancel d/t the nurse calling in sick, and so I rescheluded the date. Well I go in, and everyone seems very nice, but just a little too glad to see me! I notice somethings that bother me, but I just toss if off.

Then I meet this wonderful nurse who I'm to shadow! She looks professional, and was very knowledgeable. She states she LOVES working at this facility, and it is her PT position. The other place she works is a dump, and she admits it, but has been there since graduated 10yrs ago. So to her this place is a gem.

But as we go along, I soon discover, this is NOT the place for me! I'm not there 2 hrs, before I'm almost running ummm walking out the door! That is after this very sweet nurse finally let go of my arm:chuckle!!! She was pleading for me to stay, and telling the NM to offer me more money! But I'm sorry it's not all about the money!

I found out, that my duties not only were to be on this 20 bed unit, but that I would be responsible for treatments on another wing, that made the DFW phone book look small!! Not only that most of the orders were in cursor, and not even printed!!

One of the treatments was to wash under this lady's breast, dry it, and place a dry cloth there???? Another problem were skin assessments of pts. when most are already up by the time they were to take place. Second I watched her be called by a CNA to give a PRN to a pt on this hall, while the nurse was on break. Yet there was an RN who was sitting at the desk who could've given it, and who was doing nothing but yada...yada...about nothing!

Then we went to get supplies to do another tx. You got it, not there, but guess what was not there??? NO NASAL cannulas..NONE!!! Then we went into a room where a total care, very large man, was lying in urine, with a draw sheet waaaay up his back!! The CNA who answered the call bell, stated" just do the treatment, and will get him up, as "his" aide was on break!!! This man needed to be cleaned NOW!!!

How do you go on break and leave someone like that?? And the fact that his member was outside of his brief looked to me, like someone was in too big of a hurry, since the man had no use of his hands!

Now here is one more reason why I ran ...umm walk out the door. This large book of treatments was to be done in only two hours! After seeing the frequent amount of interruptions this nurse had during the hour that I was there, and seeing that that she had only been able to get to 3 or 4 pts during that time, I asked her what happens with the treatments that don't get done?? She said...they don't get done,and she doesn't sign them off, and "they" know about it!

Yes there were some unneccessary stuff, but I asked her if it frustrated her to not be able to do what needed to be done. She said it did, but that this place was a lot better than the other place she worked. And I will say, that I'm glad that she is there, at least PT. I'm glad these pts. have someone at least. But I couldn't be one of them!

Considering the money, would anyone else have taken this position??? I would have been working three days a week Mon -Thurs 10a to 6p

[laughingfairy]

Its the fact that so often I here..."they work in LTC because they can't keep up at the hospital...its where incompetent nurses or old nurses go instead of retiring."

I don't know. It is sad....

But I love long term care...for my elderly residents with all of their life experiances, for my young residents that will never have those life experiances, for my co-workers who bust their tails to provide a safe, pleasent home to our residents.

And we do see more of everything in LTC than even five years ago.

We get post-op knees less than 24 hours old (we are also a rehab)

Workers comp cases.

Wound Vacs, IV abt, Central lines, blood draws, TPN, ETOH dementia in young residents, violant head injuries and psychotics, MRSA, VRE, isolation, trachs, drug overdoses in young people barely out of their teens.

But we do care and we do make a difference.

Right now we have a resident who came from a local hospital with a decub I could put both of my hands in (He was an OD who had been there literally months), TF, nonverbal, withdrawing from painful stimuli only and we were told he was basically never coming back.

And now he is talking

Last week he wanted to know what his meds were...called me a name...scared a night shift nurse to death (she didn't know he had started to talk)...seeing these residents as people not just problems and dx is what makes it worth while...

that's why I left med surg and came back to LTC...I was tired of "Drive- through" nursing.

[pickledpepperRN]

Originally posted by laughingfairy

Its the fact that so often I here..."they work in LTC because they can't keep up at the hospital...its where incompetent nurses or old nurses go instead of retiring."

I don't know. It is sad....

But I love long term care...for my elderly residents with all of their life experiances, for my young residents that will never have those life experiances, for my co-workers who bust their tails to provide a safe, pleasent home to our residents.

And we do see more of everything in LTC than even five years ago.

We get post-op knees less than 24 hours old (we are also a rehab)

Workers comp cases.

Wound Vacs, IV abt, Central lines, blood draws, TPN, ETOH dementia in young residents, violant head injuries and psychotics, MRSA, VRE, isolation, trachs, drug overdoses in young people barely out of their teens.

But we do care and we do make a difference.

Right now we have a resident who came from a local hospital with a decub I could put both of my hands in (He was an OD who had been there literally months), TF, nonverbal, withdrawing from painful stimuli only and we were told he was basically never coming back.

And now he is talking

Last week he wanted to know what his meds were...called me a name...scared a night shift nurse to death (she didn't know he had started to talk)...seeing these residents as people not just problems and dx is what makes it worth while...

that's why I left med surg and came back to LTC...I was tired of "Drive- through" nursing.

The patients are med surg or even step down patients.

The long term facilities do not staff for such care.

MANY if not most LTC nursing staff has the competence to care for these patients. If not they can learn. STAFFING be HPPD does NOT allow safe, effective, therapeutic nursing care with the staffing levels provided.

I admit there are exceptions.

[laughingfairy]

That's the part that makes me sad... I could do so much more if there were more of us...With mandatory staffing ratios in LTC in my state LTC nurses get paid better than hospital nurses...but there still aren't enough of us. Either in general or specifically in any facility.

Ratio's are 1:15 days and it goes down hill from there. The nurses also don't have to be "direct care providers". All of the unit managers, supervisors, tx nurses, med nurses, etc count.

And yes, these would be med-surg patients a few years ago...but our local hospitals can't keep beds open due to nursing shortages. Entire units are closed. Acuity is going up there too.

At least in long term care I don't feel like I have to throw these folks out the door. If and when they some are able to go home, I can feel like complete care was deivered right down to family and patient education.

[mattsmom81]

Originally posted by Brownms46

Thanks mattsmom, but a job at Wally World is almost starting to look good...:chuckle!

One of my former coworkers is now at Disneyworld...she took a summer vacation there, got offered a job and stayed permanent!! She LOVES it!!! Can't even remember why she tried nursing, and her bad memories made her forget most of it....

Some days the Walmart greeter job looks good to me...I look forward to retiring to that.... some day.. :roll

[mattsmom81]

Originally posted by laughingfairy

Its the fact that so often I here..."they work in LTC because they can't keep up at the hospital...its where incompetent nurses or old nurses go instead of retiring."

I don't know. It is sad....

B]

Its part of the negative nursing culture we practice in to badmouth what we DON'T do...like "ICU nurses only work there cuz they can't handle more than 2 patients, Medsurg nurses stay there cuz they're not smart enuf to move up," 'ER nurses can only deal with people a short time " "OR people can only deal with unconscious folks"....etc etc.

Don't pay attention to ignorant comments like this. I don't.

We make our contribution and accept our liability where we wish. No more no less...and we all make our unique contributions. :)

[laughingfairy]

Actually the bad mouthing I usually hear is from physcians and families. That is the sad part. Other nurses are starting to see what we do. More have been drawn to LTC due to increased wages and then run for the hills, i.e. the first post in this thread. So I see a growing respect of LTC nurses

But I knew nurses played the bad mouth game.

That I expected. My mother was a nurse and she forewarned me that is something really weird about nursing in general. I didn't expect it from the other fronts

[ohioln, RN]

I hope we nurses get better working conditions. We just want to take care of our patients and do good for them.

[nurse62]

I have always worked in LTC facilities. When I was nursing school, I new I would stay in geriactrics....for it was always my goal to be a nurse for the elderly. I have interviewed at several hospitals, and I would of took at least a $5.00 an hour cut in pay if I would of accepted. I only work three days a week and bring home a very good pay check. There are many things that need "fixed".......in LTC. Staffing being the number one issue. If LTC had the nurse per patient ratio that a hospital has, LTC wouldn't have the problems they have now.

[MiaLyse, APRN]

>

Even this is bad. We have one LTC facility, in my city, that assigns each aid 20 patients. It is unsafe and insane!

Kelly

[mattsmom81]

when a bad outcome has occurred. In LTC as well as acute care. Even though the nurse was doing the best she could in the bad situation (where management sets staffing ratios), our nurse practice act still holds us accountable.

I don't think things will change unless we organize and change the way we deal with these institutions. And form our own lobby groups to make laws to govern healthcare institutions and their poor working conditions/staffing ratios.

I know too many nurses who lose their licenses 'just doing the best they can'...and they do, until the facility scapegoats them.

We have to be careful out there.