Advice needed, please

[actioncat]

I have been working on a SNF. There are things about it that I like-- it seems to lack the shift report hostility that is widespread in hospital nursing. I like the aides with whom I work as well as most of the nurses. I really do like the patients and getting to know them. I like getting to know the families too. I like the therapy staff.

Now for the negatives. The other day I returned from my shift four hours after my clock out time. I stayed to try to get some stuff done that had been passed on (I'm sure because the other nurses did not have time, and at some point you cannot say "nursing is a 24 hour job"-- things need to get done.)

The staffing is done strictly by census-- not acuity. I had a peritoneal dialysis patient who gets 6 exchanges a day-- 2 on my 8 hour shift. She also has several dressing changes that can take a while to do as she is kind of picky. She wants one of the dressing changes done twice on my shift-- even though it is TID. I told her that this was not possible, but the administrator told her something else.

I had another patient going out for an invasive procedure. Her last INR was 1.9. Nobody had mentioned this or followed up with it. I just went to check it and then called the hospital to find out the acceptable INR. It was 1.5, so about two hours before she was to go out I had to order a stat INR and follow up with the lab to make sure they got there in time.

I checked one of my new patient's BP before giving her meds. I turned out to be 210/100. The attending physician was there so his nurse checked it and got the same. Clonidine was ordered. I went to check her BP again when I gave her the clonidine and found out she had thrown up. Same BP. Had to get a hold of the doc for phenergan IM and see if we should do her other BP meds again. He wanted to. Later, same woman had a pain in her calf and positive Homan's so I had to order a venous doppler for her (the pt was TKA).

Let's see, I had a midline abdominal wet to dry dressing to do on another patient and a wound vac on another patient. The wound vac was in an awkward place. I also had several other patients going out for appointments. Of course, I had to chart and pass meds for 15 patients and run to answer the phone when I was paged. There is no unit clerk and managers, even if they are sitting right by the phone and you are paged several times over, will not take a call.

All the charting is by paper. There is no pyxis machine and we have a very finicky fax machine that you can never be certain if it sent something through. The work space is incredibly cramped and ther is no room for the nurses to get their charting done during the day.

The DON has been with the company from the beginning of her career, I'm pretty certain. What she really cares about is paperwork, meaning paerwork that is important in state surveys. I definitely would not look to her for answers to nursing questions.

The place is very hierarchical and the nursing staff (aides included) don't seem to be valued too highly. They have hired a new grad RN without even any experience as a tech as a 3-11 nurse on my unit. He got 4 days of orientation! He is doing the best he can, but it has to be hard.

If they really respected nurses wouldn't they invest more in them?

Instead, they rely more on window dressing. This consists of the various managers making rounds and listening to complaints. They never ask us "what can we do to make this better?" It is just more like "make this better-- no excuses."

The medical records tech who has the exalted title of "medical records manager" and is really quite insufferable will go into a room and ask about call lights being answered. She then says "I'll be your guardian angel while you're here." All this while I'm standing right outside the room preparing meds!

The learning opportunities here are nonexistent-- by that I mean any sort of well designed in service program. Like I said, it does not seem like they care about investing in nurses.

Anyway, I guess my question is is this par for the course? Might things be better in a not-for profit facility? There are things I really do like about my job.

Thanks in advance.

[noc4senuf]

It sounds like you are on a TCU (transitional care unit). Which in other terms is a rehab unit. I have one which is 28 beds with two nurses, a HUC and a hands on nurse manager, along with 3 CNA's. I have not heard of doing any kind of dialysis in-house as we send them out for that. We do run IV's, have wound vacs, dressing changes, etc. I'm sorry you are in that position. I certainly wouldn't want to be the DON there or any other nurse, it sounds like all their licenses would be on the line.

Our orienatation is two days i nthe classroom and as many shifts on the floor to complete a multi page checklist and be safe working on your own (each nurse is individualized as to how long that takes).

My advice? RUN!

[SakredStrega]

I would probably find another position elsewhere, too.

Sorry to hear that.