Am I just too idealistic?

BarbPick · Dec 4, 2003

Listening to your rant, I suggest you try a real estate course, as a new Grad, you do not have the slightest clue what goes on in a nursing home 24/7 365. How could everyone be so wrong in a govenrment regulated institution?

Perhaps flower arraignments.

SnowymtnRN · Dec 4, 2003

Well not sure what the previous poster's point was, but i've done the LTC route and i know exactly what you are talking about. All you can do is worry about what you are doing and giving the best possible care to your residents as possible. I know it sounds off, but try not to worry about what other nurses are doing UNLESS a patient is in harm's way. if you spend your time worrying and monitoring everyone else, then you won't get YOUR job done and your patients will suffer.

Make sure you give your meds. Be as gentle and compassionate with your residents as you can. Don't let the CNA's push you around. If they K NOW who's boss, they may test you a few times with their BS but in the longrun you'll come out ahead and be respected more.

As for nurses who give PRN meds to residents whose families don't want themt o have it, HONESTLY until you are put in this situation, try not to judge. The reason i say that is lots of time in my past, family would request no PRN meds, but residents for various reasons would NEED them. So unless the resident could absolutely NOT make any type of request for themselves, then i would go with what the resident, NOT the family wanted. Its not your job to please the family first, you please the resident first. KWIM? I do know where you are coming from tho. Its so hard.

LTC is hard nursing cuz its all about routine, schedules, and daily living. Its not the kind of nursing that you always think you'll be doing, but it is important. Just try to go to work and remember why YOU are there, and do your best. You'll be much happier if you do!

And to the other poster, have you ever BEEN in a LTC setting for any legnth of time? If you haven't, then i seriousely doubt that you have a clue as to what she's talking about. And if you have, are you saying that these things going on are ok??? Just confused why you weren't more supportive.

JaHazle · Dec 4, 2003

Thank you snowy for your advice. It is very much appreciated and I will take it to heart. BTW Barb...so you're saying just chuck it all in and give up. Hey hun, thanks for the encouragement. I bet you have a wonderful bedside manner. :)

CCU NRS · Dec 4, 2003

I am not sure about BarbPick either she is usually pretty supportive and encouraging, If I may Iwill say that I think she may have meant that if you are just starting you need to give it some time to get better aquainted to reality as nursing school and reality are usually very very very different. She may have also been less than encouraging but I think that was also probably due to your seemingly Judgemental tone. Just my opinion about Barbpick's post

Unfortunately LTC is one of the hardest and most demanding and least fulfilling jobs in nursing for the very reasons you mention. There are those that have been at it a long time and know which Pts will or won't cooperate with certain things and some Pts that if not given their PRN Ativan are going to drive every employee in the Home crazy and the family does not stay to see the whole picture but only knows that for their personal reasons they don't want Mom medicated. If you truly believe there is a problem along these lines you do have options. 1. Call the doctor yourself and ask if the medication is still needed and make the family's wishes known and get an order to D/C the med. 2. Go to your supervisor and explain the situation and ask where s/he really stands on this issue and to explain if there is a reason that this med is being used that you perhaps don't now about. 3. Attempt to promote change from within and make it a better place for nurses and residents.

JaHazle · Dec 4, 2003

Thank you for your words CCU...and yes, maybe I did sound judgemental....maybe I am...who knows. The circumstance where the woman was given a PRN med...was this...she was close to death...little did we know, it was to be within days. She was saying she had no pain, and that she wanted to remain alert. The family way only backing up her wishes. The nursing supervisor took it upon herself to give morphine. Which as we all know decreases resp. function. I understand her reasons, however, I don't agree. The woman made a coherant decision, and the family did so as well. I just believe it should have been left at that. When I asked why she gave it anyway, I was told because it would help ease her into death. It was def. not my intention to be judgemental, only to state that I have an opinion. As far as chosing who gets meds. This came from a nurse who says when she is on her med pass and running late...alert and oriented only is her philosophy.

CCU NRS · Dec 4, 2003

LTC is not for everyone and especially not for the conscientious. I am trying to put down anyone that works LTC see earlier post I think is one of the hardest jobs in the market.

Perhaps you would be better off looking for something in an Ortho unit this is where I personally got my first year of experience when I got my LVN (Texas) Then When I moved back to OK it was LPN which after that first year I began working CCU, Telemetry, Med-surg.

I would only suggest that if you are not happy you should look for something different. God will put you where he wants you. If you feel he has alredy done that then do what it is you feel you need to do to make the changes you feel are needed where you are.

No not a Bible thumper or card carrying fanatic, just certain that there are "Greater things in Heaven and earth than are dreamt of in my feeble mind" that is not exact but it is from Hamlet

Also another litle saying I picked up back in my Oil field days when I finsihed or left a job " I was lookin when I found this one" meaning Job

BarbPick · Dec 4, 2003

The comments were made so maybe you would re think.

First of all, it concerned me that you said you wanted to put in your hours before you can become an RN. The most precious patients under our care are the ones who really can't speak for themselves. Many family members put all their faith in the nurses at LTC facilities.

My only living relative, My cousin Susan works LTC, she does what she can to make sure her 8 hours there that she retains the trust of her patients. ( I usually say something sarcastic about Susan, that will be another day)

You are a Nurse. This is when you are to learn to be a nurse, after you finish nursing school the education begins. Sone who was more patient than I was when I first read the post, went into great detail explaining so much to you. I was just stuck on what appeared to be your killing time to be an RN.

She focused on something very important as well that got to me, criticizing the other nurses and the worst thing, wanting to tell the families to take their loved one out.

My God, placement is so hard to find in many places. What is better the nursing home, or no one at home with the patients at all?

My Dad died in a Nursing Home Hospice wing. My mother could not handle my Dad with Brain CA when he had a stroke. The LTC facility did. I brought the staff something every day, bagels, candy, cookies from Costco.

My Mom always told me do not criticize anyone till you walk in their shoes for a year.

angelbear · Dec 4, 2003

I worked LTC geriatrics for 2.5yrs before I left which broke my heart. I am here to tell you that what the original posters says is for the most part true. I do not think she is being judgemental nor do I think she is just putting in time without caring about the job. I think she is disillusioned just as I was. Staffing is deplorable and too many times the ones willing to stay and put their license at risk dont care a whole lot about the job they do. Notice that I did not say all just that too many dont care about their jobs. The care in LTC is not deplorable because staff wants it that way the problem is that staffing sucks and their is far too much for far too few to do. It is a money making business and it isnt the staff getting rich. Yes I am judgemental about LTC in geriatrics and that is because I Loved it so much and I miss it terribley but I couldnt change it and I wasnt willing to lose my license. Just my 2cents.

crankyasanoldma · Dec 4, 2003

BP seems to be an expert in alot of areas!

Anyway, LTC is probably one of the hardest areas of nursing due to poor staffing, tight budgets, and low pay. Keep your chin up and try to make a difference.

AndiMac · Dec 6, 2003

I too am a new grad, I took a different route and started working in an Assisted Living Alzheimer's Unit. It is an extremely small unit, only 11 residents. You start to learn the family as well as the residents. And that's where the problems start. Being dementia, they don't know what is best for them, therefore here comes the POA. The POA doesn't always know what is best. They may request no PRN, no this or d/c that, but, that is your job as a nurse, to know what is best.

I constantly see med changes because the family requests it, but they don't see the changes in res. we do ... they don't know the knowledge we do ...

So do your best, and cover your butt ... :)