Appalled at LTC standards of nursing care

[nightengalegoddess]

Hi. I have never worked in an LTC before. Just hospital acute care. Orienting, I noticed there is not assessment going on, there is not proper documentation going on, nor infection control. There are not even readily used anti-microbial wipes nor proper sized gloves in the rooms. Patients have MRSA and there are not infection control measures being enacted. The system is completely askew, and the charts are completely disorganized. There is not system for lab retrieval, and I wonder what the clerk is actually doing? When the physicians come, it seems like the LPNs don't know what to discuss with them re: SBAR. How can you discourse about the patient if you have not even physically assessed! I am an RN. Is this the difference? Are LPNs educated to such a less degree about the thouroughness? Or is this place uncommon. Much prefer the nitpicking hospital environment. Please tell me what the heck is going on here?

[nightengalegoddess]

I would try and complete orientation in hopes something may reveal itself to me to be of worth in pursuing. And not downing LPNs at all...just stating facts of this situation. Know that there are also scary RNs....good and bad with all types

[Chin up]

I would try and complete orientation in hopes something may reveal itself to me to be of worth in pursuing. And not downing LPNs at all...just stating facts of this situation. Know that there are also scary RNs....good and bad with all types

Don't feel bad about writing what you experienced. You had valid questions. We LPN's can get defensive because of all the abuse unleashed on us. But those of us who know who we are and care about what we do, will answer someone who ask honest questions, without defense. What you wrote is appalling, no question. But the leadership of that facility should be addressing it. Like I said earlier, I would not put up with that mess for my residents sake and also, it is my job to weed out the bad through consistent education. Every facility has a state survey and these issues will be addressed. Just do what you do, and I bet some will begin to follow. Most nurses want to do a good job, and if taught and given a chance, will rise to the occasion. In some settings the bar is low, they think they are doing well. Right now in this country, is a dumbing down, never before seen. This applies to all professions. But when those of us who know, do, others will follow. Thanks again and good luck. I hope you stick it out. Peace!

[taalyn_1, CNA]

Good thread, very interesting. I work in LTC and the LPN's are the backbone of our facility. There are only a few RN's that work there. Some RN's have this notion that LTC is beneath them. But I think it is just as someone else said, LTC is a different animal. The LPN's I work with are excellent nurses, they do everything an RN does and even more sometimes. I think it boils down to the facility you are at right now. Not all LTC facilities are ran that way, but it does happen. I think more RNs need to give LTC a chance. It is so rewarding to work with these often times forgotten people (forgotten by their families, the doctors etc). Maybe this particular facility needs a good RN like you to be an example. Get in there and get your hands dirty and turn things around. I am sure the little residents would appreciate a caring compassionate person there advocating for them if it is truly as bad as you say. Sometimes the patient load is just too high to get things done the way it should be done, but as an RN you have the experience/training to lead the nursing team of LPNs in the right direction. Good Luck, and I hope you stick it out because it sounds like the residents there need someone to take charge for them.

[Old.Timer]

When I worked LTC, even when calling a doc about a fall, their first question was always code status, which often even affected their treatment. For instance, if the resident fell and neuro assessment wasn't right, MD would ask for code status and if a full code, send to ER, if DNR, keep on monitoring. I learned to always contact the family first and find out what they wanted even before calling the MD. Of course, you have to use your head, feel free to call an ambulance and then get an order to send to ER, just make sure it is really called for. A not uncommon call for me, "Good evening Doctor, thanks for calling back. So and so fell off his bed and hit a garbage can with his ribs and was in respiratory distress with tracheal deviation, he is now in ER, facility policy states we must have an MD order to send to ER? May we please have an order?"(yes this happened)

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Uh oh, don't you know that it is the physicians job to return your call? If you thank them,they'll get an entitled feeling, act nasty and start yelling................( heavy sarcasm related to another thread.:) :))

[LPNweezy]

i have no idea what SNF you went too but mine is NOT like that at all! all the rooms have gloves, our charting is organized, we keep antiviral sani-wipes in the med cart, and i happen to be very cautious of MRSA. I practice frequent hand-washing all day long. I know that when a physician comes, i know what they want to know. But i can't say that it is as organized as acute care. Just because an RN went to school one year more than i did does not mean i happen to be vastly less educated.

[JacknSweetpea]

Nightengale....sounds like that facility has a lot of problems, but have a care as to how you talk about LPNs. I personally don't give a rat's patoot about what other LPNs or RNs think about me, but have a care. Oh, and I'm in an LPN to RN program at my local community college, and we utilize the same textbook for basic nursing skills....infection control, calling MDs, etc.. for both programs.

[kool-aide, RN]

OP: I'm a CNA in a hospital and I have many of the same values that you do and I can definitely see where you're coming from. I know you may want to head for the hills, and if you do, I don't blame you, but I think it would be great if you stayed at this LTCF and tried your best to turn things around. I think as an RN you will probably be more able to make changes in this facility. Talk to management and clinical education and discuss methods for improving assessment, infection control, SBAR, and care standards, policies, and practices. If it was me, this is what I would strive to do. I think you were called there to be an advocate for these residents. Best of luck and let us know what you decide! :)

[MouseMichelle]

What you were orientating in IS NOT THE NORM. I work in LTC and we have HIGH standards, so please don't put down LTC because of one bad facility, please. We are good nurses who care for and love our patients and we do a very good job at it.

[Finallydidit]

Hosp vs LTC totally diff. In LTC there has to be team effort, there are far too many residents on a unit to otherwise give proper care. As an LPN, I could never do my job without my CNAs nor could my RN supervisor do her job without her LPNs. We count on each other, and we help each other, we question and advise each other. But most important we TRUST and RESPECT each other. It has so little to do with the initials that follow our names and so much to do with the attitude that is in our hearts.

As an RN at a new facility, you should calaborate with your team, they know the facility, the residents, the family members, the Drs etc. learn from them no matter what their title, and allow them to learn from you. Together develop trust and make a plan, then you as the RN lead by example. The other units may continue be in chaos, but you may soon find that your unit runs like a fine tuned engine.

Good luck to you

[kool-aide, RN]

Hosp vs LTC totally diff. In LTC there has to be team effort, there are far too many residents on a unit to otherwise give proper care. As an LPN, I could never do my job without my CNAs nor could my RN supervisor do her job without her LPNs. We count on each other, and we help each other, we question and advise each other. But most important we TRUST and RESPECT each other. It has so little to do with the initials that follow our names and so much to do with the attitude that is in our hearts.

As an RN at a new facility, you should calaborate with your team, they know the facility, the residents, the family members, the Drs etc. learn from them no matter what their title, and allow them to learn from you. Together develop trust and make a plan, then you as the RN lead by example. The other units may continue be in chaos, but you may soon find that your unit runs like a fine tuned engine.

Good luck to you

AWESOME advice.

[CapeCodMermaid, RN]

WOW....you never came to one of my buildings!

As far as the nit pick of the hospital--the last 3 times I was a patient in one, none of the staff washed their hands coming into the room. I wouldn't let them touch me until they had. My nurse, who came in ONLY to hang an IV, never did any kind of assessment on me. I was there for 10 days so there was more than one nurse. I was given the wrong IV, and almost given a medication I shouldn't have taken because the nurse, an RN with a BSN, didn't know what the medication did. By the way, the nurses had no more than 6 patients each, didn't do their own vitals, didn't offer to assist with hygiene. They did, however, stand outside my room discussing which one amongst them should be able to try to start my IV again.

I'll make a deal with the original poster: don't lump all skilled facilities into the same bad category and I won't say all hospital nurses are dumb, lazy, and clueless.

PS. The housekeeper certainly took cleanliness to heart. I dropped a magazine on the floor and she tried to throw it away because there were 'germs' on the floor. Bless her heart.

[*Posh*]

I cannot weigh in on the LTC question since I have always worked acute care. What I can say, however, is that I am an LVN (in my state) and no, one year less education does not a bad nurse make. thankyouverymuch