Am I Babysitting or Supervising?

[BSN_after_40]

Working in rural areas has its challenges, especially when working in a long term care facility in the middle of nowhere.

I was a new RN grad and full of enthusiasm, even though I was in my late thirties. As I scanned the local job listings and word of mouth jobs, I came across an ad for a Unit Manager in a small nursing home 30 miles away from my home. I thought well, it couldn't hurt to apply even though my only experience was 14 years as an LPN at that point.

I made the call and was surprised to find out it that the DON was a person I had worked with years ago, she hired me on the spot! I hadn't even taken my board exam yet. Talk about pressure!

Well, I started out fine and oriented with a great BSN who taught me a lot. It was a busy little place with a memory care unit that was always full with a waiting list a lot of the time. The facility was known for taking the "tough" patients that other facilities would not take. Somehow, they did well and the staff worked well in that area. The general area was a different story.

One of my jobs was to make out assignments for the aides, 2 to a group. Sounds pretty straight forward right? At least I thought so. I was not told of the "rules" when I made out schedules for a week. It turned out that 2 aides only worked one wing together because separately, they were the meanest pair of women you could meet! They did good patient care though. So when I tried to put them on separate wings, you would have thought that the world ended. The tough part was they didn't just bring this to my attention; they screamed and hollered like children! I calmly adjusted the schedule and told them to relax, the world was not over. Lots of grumbling went on about that for a day or two.

Next, I found out that the PM schedule was not "expectable" either by the aides' standards because I had put a female aide and a male aide together that had slept together before and now they can't work together because he will ignore her all shift. What? I have to know who slept with whom before making out the schedule. Are you serious? This type of bologna went on and on because it was allowed. But it gets worse.

Some of the PM shifts I was working in my office and noticed that several of the teenage aides took many breaks, sometimes to the point where they were outside more than working with the patients. It turns out that there were a lot of "herbal" breaks going on. I couldn't believe it; even one of the LPN's on the med carts would join them from time to time. I was blown away.

I complained, I confronted, and I wrote people up, nothing changed. The administrator would get close to the young caregivers and they would talk her into letting them get away with it. The DON was completely disconnected and couldn't confront anyone. I was so frustrated!

The last straw came when one of our patients that was completely unable to move or speak was found on the floor with a large gash in his head. Luckily, I was on that evening and heard his feeding pump beeping. I found him on the floor beside his bed; tubing pulled to the limit, drenched in sweat, probably moments away from a heart attack, in a large pool of blood. I found out that they had just done rounds and it was obvious he had been repositioned so poorly that he fell out of bed. Thank God that feeding pump went off or he would have been found dead.

I reprimanded these aides after I gathered all the information, wrote them up and gave them a 1 day suspension; I wanted to impose a more severe suspension but the administration said no. The capper was when the union rep chewed me out for "embarrassing" them in front of the other staff, and I had no proof of their negligence. I am usually a pretty calm person, but I "freaked" out on this person, reminding her of the potential liability of the facility to give good competent care to all residents and how I was tired of the behaviors that were tolerated there. Are you kidding me? 1 day off for almost causing a man to lose his life because they were too busy rushing to go on break or take the time to make sure he was safe? Good lord! I resigned.

I know that the facility has improved greatly since then, and state has watched them very carefully. I feel I learned a lot in my nursing career from that experience, and will never allow myself to get in a position such as that again. It is no wonder that there is a nursing shortage; I had an ulcer from working there not to mention anxiety like I have never felt before. I even started smoking after quitting for 16 years. Talk about getting thrown into the fire!

[Fyllis LPN]

Having been an LPN working in LTC facilities for 19 years, I have seen exactly what you described here and, so much more! Patient neglect, physical, verbal, and emotional abuse, and even wrongful deaths. Nurse Aids who are there for the money, and nurses who just gave up caring, or never did to begin with. And that doesn't cover the 'higher-ups' who push papers behind closed doors and claim they never see anything. Out of sight - Out of mind. And doctors who have complained to Administration because their dinners were interupted by some annoying nurse who couldn't handle her job.

I have worked severely short staffed, with Aids who weren't state tested or certified, 'supervisors' who didn't have a clue, DON's that were afraid to support their nurses for fear of retribution for discrimination of insubordinates, and lack of supplies because the bureaucrats in the state capital (who have never stepped foot in a nursing home or worked in the medical field) have the power to dictate how many bandages it will take to treat a wound.

I have been fired for being honest with patients and family, wrongly diciplined for crying in front of family when a patient passed away (I was told I was weak and should consider choosing a different career!), and written up for advocating my patients rights.

We have become glorified secretaries. We are bombarded with politics! Everything documented in triplicate to protect the facilities and Administrators. We aren't allowed to be nurses anymore - to spend time sitting with our patients and listening to their complaints, or just to share time with them as companions. We are too busy protecting our backs and licences against the inappropriate and unethical actions of poorly or untrained/taught Nurse Aids. We wait endlessly for unconcerned doctors to return our calls. We are over-stressed attempting to give adequate care for 30 to 50 patients in an 8 or 12 hour shift. We are worked hard and paid far less than we are worth!

Average pay for an LPN in my state falls between $16 and $24 an hour, depending on the field you choose. We hold the very lives of our patients in our hands, and what do we get? A plastic coffee cup during Nurses Week, emblazoned with the facilities logo for advertisement.

Actors, entertainers, and those in sports get paid millions a year! When are we going to take a stand for ourselves, our patients, and our careers?

And they wonder why there is a shortage of nurses? It's not because of the baby-boomers overloading the hospitals and nursing homes. It's because we are tired of being treated without the recognition and respect we deserve for the jobs we perform.

Why am I still a nurse? Because I give a damn! Because, if I can be there to save one life, hold one dying person's hand, to intervene on a patients behalf when no one else will, my job is worth it!

Fyllis - Ohio