ANOTHER new CMS guideline

catlady, BSN, RN · Jun 29, 2006

Yah, can you just see one of those alert residents whining to the state that they got left off the last Wally World outing and now they're depressed--F-tag coming!

I wish I could say hang in there but I can't. I'm going back to acute care myself, and I don't want to come back to LTC. You can never work hard enough or try to anticipate enough. You are always standing on the edge of that cliff. LTC isn't about taking care of the elderly any more. It's about paper compliance and an institutionalized need for perfection that no one, even perfectionist me, can ever achieve. You never start out at 100%, you always start out at zero and have to prove yourself every day. You did a good job yesterday, and that means nothing today because you're starting at zero again. I hope you find something that will deserve your talents.

southern_rn_brat · Jun 29, 2006

We got such a G tag on our survey this year:angryfire It started out a D tag from the survey group but once they got back in the office their supervisor made it a G tag:angryfire

Nascar nurse, ASN, RN · Jun 30, 2006

Yah, can you just see one of those alert residents whining to the state that they got left off the last Wally World outing and now they're depressed--F-tag coming!
I wish I could say hang in there but I can't. I'm going back to acute care myself, and I don't want to come back to LTC. You can never work hard enough or try to anticipate enough. You are always standing on the edge of that cliff. LTC isn't about taking care of the elderly any more. It's about paper compliance and an institutionalized need for perfection that no one, even perfectionist me, can ever achieve. You never start out at 100%, you always start out at zero and have to prove yourself every day. You did a good job yesterday, and that means nothing today because you're starting at zero again. I hope you find something that will deserve your talents.

:yeahthat: Amen! Makes you wonder where it will ever end! There is just no getting ahead in this game and I am pretty anal about it all too. Unfortunately I have 20 years LTC experience - but nothing else. Not sure who would want me now.

CapeCodMermaid, RN · Jun 30, 2006

;) Good SNF/LTC nurses are worth their weight in gold. Unfortunately, neither society nor our counter parts at the acute level value what we do. It is wonderful to be a great ICU nurse, but really, how many people are going to spend time as a patient in an ICU? Now, how many people are going to be old and need assistance? It won't be until we change those attitudes that SNF nurses work there because they can't get a job anyplace else that our situations will improve.

We offer significantly less pay than the acute care settings and wonder why we can't attract and keep dynamic, intelligent nurses.

My resignation went in yesterday and my administrator can't understand why. She thinks it's because I'm new to the facility .... jeezlies peezlies...she tells me she doesn't think about work at all when she goes home and always sleeps like a baby. I always think about work..all the work I didn't get done because I was chasing after the staff nurses and trying to get them to step up and do what they are supposed to do.

I've already put in applications at a few places, but if I don't get another job for a month, Cape Cod is not a bad place to be in the summer

cathy54 · Jul 1, 2006

This is why I am looking for something else. I like LTC, but I just cannot cope with the stupid regulations that don't really mean anything.

debRN0417 · Jul 1, 2006

But....have you been to facilities where people sat in their chairs all day in front of the TV and did nothing...for hours? Or have you had a Resident tell you that they love to go outside but don't get to any more bcause they don't provide that "activity"? Or that they are so bored because there is nothing to do that they feel like they may as well go ahead and die? There are places that provide for their residents to maintain a full and quality filled life....but then again....

CseMgr1, ASN, RN · Jul 1, 2006

What's with the federal government??? Here we go with another new CMS guideline...went into effect June 1. Tag 248...activities...yes ladies and gentlemen, your facility can now get cited at a G-actual harm level- for lack of activities because that could cause a decline in psychsocial well being. Hello...anyone ever see any actual harm because the resident missed BINGO.
I've been in LTC in Skilled Facilities my entire career and have seen many many changes...more regulations, less reimbursement, sicker patients with no increase in staff, and now we are going to be tagged starting at level 2 for activities?
I think this is it for me. Now I not only have to worry that I will be blamed as management for a mistake a staff nurse made, I have to worry that our activities aren't good enough.
I've spent the last week and a half feeling horrid every time I head for work. I've been at this place for less than 2 months and the DNS left to go on vacation. The administrator is not at all supportive. We have some of the worst nurses I've ever seen and the ED tells me they are nice to the patients so I have to cut them some slack. Nice? On the sub-acute unit they didn't recognize the classic symptoms of CHF...instead of IM lasix they kept giving the poor man nebulizers. The dementia unit is always noisy..half the nurses won't give a PRN unless one of the managers tells them they need to..of course you have to holler at that point to be heard over the screaming resident.
The salary is wonderful but...
Sorry for the long rant...I think I'll go play BINGO.

I know what you mean. I just stepped down from my position after less than three months as the Clinical Manager of a HHA, for many of the reasons in which you have just described, including the fact that a nurse who committed blatant Medicare fraud was given a pardon by the folks in the Ivory Tower because "he/she mad a careless mistake". Sorry, but the OIG does not look at fraudulent documentation as a "careless mistake". Just ask the former owners of a HHA I worked for back in the 90's who served time in federal prison for just that, including having to pay millions of dollars in fines and having their provider numbers and nursing license yanked. Instead of sending the message to the other nurses that they could be next, it gave them Carte Blanche to continue to to do as they damn well

please, which includes turning in their documentation whenever it is convenient for them, picking and choosing where and when they will see patients, and publicy accouncing that "they (myself included) can go

(the F word) themselves". The hostile work environment is the worst

I have ever seen in the 36-1/2 years I've been in this business, and I thank GOD for giving me the sense to get out of that office while the getting was good. I was making good money, too, but the liability wasn't worth it.

And as for CMS, they have to continue to justify their existence through their endless and sometimes mindless transmittals..regardless of whether they are intended to benefit the public or not. :lol_hitti

Daytonite, BSN, RN · Jul 4, 2006

I'd stand resolutely tall and defiant to the worst-case nurses just to show them what a good nurse looks like. Yes, it's tiring. When you become a charge nurse/supervisor/or manager you sign on to be a leader and role model. Can I just remind everyone that LTC is about helping patients with their ADLs? If you all remember back to your nursing school daze (I mis-spelled that on purpose), you were probably exposed to Gordon's 11 Functional Health Patterns or Maslow's Heirarchy of Needs. Diversional activities are part of Gordon's Activities/Exercise need and Maslow's Self Esteem need. Nursing isn't easy. I've worked in LTC too and seen some pretty bad stuff as well as some good. It takes dedication to stick with it when things are bad. There will be others who are watching and learning from good examples and silently practicing what they see the good nurses doing. Don't let CMS get you down. They base their edicts on statistical information and case mix figures they collect from all the LTC facilities that receive any kind of federal money from them. They really are trying to make a better world for some nursing homes where the residents are living in much worse conditions than where you work. This is primarily where this kind of regulation was originally intended to impact. It's partly up to nursing to translate the red tape into hands-on meaningful care. I would be inwardly cheering for CMS and hoping the powers to be of your facility finally get their act together and do what is right for their residents. Yes, I have that much arrogance and defiance. What I've learned over the years is not to broadcast it verbally to everyone where I work--lost a few good jobs that way.

QuigRN · Jul 5, 2006

;) Good SNF/LTC nurses are worth their weight in gold. Unfortunately, neither society nor our counter parts at the acute level value what we do. It is wonderful to be a great ICU nurse, but really, how many people are going to spend time as a patient in an ICU? Now, how many people are going to be old and need assistance? It won't be until we change those attitudes that SNF nurses work there because they can't get a job anyplace else that our situations will improve.
We offer significantly less pay than the acute care settings and wonder why we can't attract and keep dynamic, intelligent nurses.
My resignation went in yesterday and my administrator can't understand why. She thinks it's because I'm new to the facility .... jeezlies peezlies...she tells me she doesn't think about work at all when she goes home and always sleeps like a baby. I always think about work..all the work I didn't get done because I was chasing after the staff nurses and trying to get them to step up and do what they are supposed to do.
I've already put in applications at a few places, but if I don't get another job for a month, Cape Cod is not a bad place to be in the summer

I resigned my position as a Director of Nursing late last year because I felt like you. I had been the DON for 7 years in a small SNF and the stress was unrelenting. I was awake at night trying to figure out how to keep us in compliance and how to motivate nurses and CNA's along with activity director, food service and heaven help us, the housekeeping staff. The administrator was 85 and could care less, as a matter of fact, he was a hindrence because he thought we should operate circa 1970....you get the idea. I had my hands full and I wanted it to be run professionally and provide the highest level of care. My constant attempts and worries exacerbated health problems. And bam!! I was too sick to work. Please don't let this happen to you. Find a job where what you do truly makes a difference. Nursing has so many opportunities and not all of them are in LTC. I fought for good care in nursing homes for the last 20 years of my career. I don't regret resigning from LTC because now I am a director of a CNA training program and loving it. It makes me feel good to be sending out caring and competent caregivers to the community.

The Cape is a GREAT place in the summer!!

CapeCodMermaid, RN · Jul 5, 2006

Thank you QuigRN.

burn out · Jul 5, 2006

But....have you been to facilities where people sat in their chairs all day in front of the TV and did nothing...for hours? Or have you had a Resident tell you that they love to go outside but don't get to any more bcause they don't provide that "activity"? Or that they are so bored because there is nothing to do that they feel like they may as well go ahead and die? There are places that provide for their residents to maintain a full and quality filled life....but then again....

I agree 100% I would hate to be stuck in a chair wanting to go out but not allowed for one reason or another. But..on the other hand when I get old I am looking forward to just having to sit and watch tv instead of having to take someone out to walk. I hope by the time I reach the nursing home I have walked and ran all I am capable of and done all I want to do so that all that is left is sitting and watching tv.