At my wits end...

[DierkyBrewster]

I am so tired of how nit picky LTC can be. It's really taking a toll on me. I'm sure I'm just reading into it too much, but I SWEAR my facility is trying to push me over the edge and either fire me or make me mad enough to quit. They attempted to write me up for 4 different things today. Of those 4 things, only one of them I admitted was understandable. We work 12 hour 6-6 shifts, and a R came back from the hospital around 5:30am and I asked the oncoming nurse if she wouldn't mind initial dosing the R's N.O. Antibiotic along with their other 6am meds. She agreed, but apparently also decided to tell the admins that I did not I.D. the med even though the R came back technically on my shift. It's dumb, but whatever, I take responsibility for it.

However, the other write up I had to sign was RIDICULOUS. I was passing 8pm meds, and a R was hard to arouse and mumbling and had rapid eye movement in their sleep. I got the R to wake up, and she was startled and said she was having s terrible dream where she couldn't wake up. I sat with her awhile and talked to her and she cheered back up. It was all fine, but I went ahead and charted what had happened anyways. Well I guess it fell back on my because the facility went through the charting and wrote me up for not notifying the R's family about this "incident". The R had a bad dream! I mean, it's crazy! They expect us to chart/notify/jump hoops every time a R blinks funny! I think I need to begin looking into a different field. Although being only an LPN that can be difficult. (Sigh) Sorry, just looking for some ranting space!

[OldGrayNurse]

OP, I feel your pain. I've been in LTC for almost 30 years and I see more and more regulations with less and less staff and money to handle them all. Yes, to any who ask, you are required to notify the doc, the family, the town crier, for Pete's sake, about the most trivial things it's not even the least bit funny. You are told to make a more "home-like" environment by the same people who insist you call a doc because a resident ran into their bedframe their own selves and got a bruise. What sense does it make to call the doc because Granny got a bruise at the SNF if it doesn't make sense you'd call him if Granny got a bruise at home????? This is what we are dealing with in geriatric services of the 21st century folks. Paradox and irony rule the day.

[NickiLaughs, ADN, BSN, RN]

I think your nurses note is what got you in trouble. Next time focus more on the end result and not the pt was not arousable. Your work sucks

[mtjoanna]

You get written up for not calling over a bad dream while I get cussed at (f-bomb) because I called the doc over a resident with a distended, taut abdomen and absolutely no bowel sounds because that call produced too much paperwork for my DON... yeah. Gotta love SNF.

Oh, I've an idea--let's combine the 2 DONs and get one reasonable person!

[flashpoint]

LOL...I was once written up for buttering a patient's toast wrong. I didn't spread the butter clear to the edge of the bread. She felt that I was "juvenilizing" by leaving a dry edge. She cried that I didn't think she could eat without having sticky and greasy fingers. I had to go in and demonstrate for the DON that I could spread butter to the edge of the toast. I had to repeat the process six months later to show that I still knew how to butter toast.

It is sometimes hard to know what to document in LTC. If you hadn't documented about the nightmare and the resident talked about it hte next day, you might have been in trouble for not documenting. Hang in there!

[odaat]

LOL...I was once written up for buttering a patient's toast wrong. I didn't spread the butter clear to the edge of the bread. She felt that I was "juvenilizing" by leaving a dry edge. She cried that I didn't think she could eat without having sticky and greasy fingers. I had to go in and demonstrate for the DON that I could spread butter to the edge of the toast. I had to repeat the process six months later to show that I still knew how to butter toast.

It is sometimes hard to know what to document in LTC. If you hadn't documented about the nightmare and the resident talked about it hte next day, you might have been in trouble for not documenting. Hang in there!

Oh just no, I think I would've had to find a new job over that one. And then to add insult to injury they brought it all back up 6 months later?? incredible ugh

[LPNtoRNin2016OH, LPN]

SNF can be so miserable that way..it's just mind boggling the things management comes up with. I was an STNA in one LTC before I got my LPN and there was a policy put in place that we were only allowed to sit down - on breaks lol. I am not lying. There were meeting areas in the hall I worked on so once all my residents were safely tucked in, I would sit down to chart (paper then) and I was told I had to do it standing.

I left LTC after 6 months in my first job as an LPN. Our DON essentially told us we were no longer to send residents out on emergencies - I am not lying. Because they were loosing money when the residents were admitted. I had a patient came in who was in withdrawal from opiates (we took all kinds at this SNF), seizing, and had scary vitals. I called 911, the patient was young (40's), full code, and nonresponsive, I know I made the right call and he lived. I got in trouble for not calling the doctor prior to sending him out (nevermind that he crashed in the ambulance on the way to the hospital and we were completely ill equipped to handle full codes). That was around 5-6 years ago.

I recently returned to another SNF PRN while in my bridge program. The only reason it's not a complete hole is that the DON is my age, 28, and completely understands what we are going through because she was an STNA and LPN once. If we mistakes (that do no harm patients) she educates us but doesn't have us sign anything or write us up unless its a completely chronic error. She makes all the difference. That said, the families of the residents are off the chain like never before. I have 25 patients, 10 in a separate area that are skilled, and the 10 skilled patients and their posse are so demanding that I literally only see my LTC folks long enough to give them their 20 meds. They want one on one nursing service but do not want to pay for it. I literally had to tell a patients wife that I could not sit in the room and watch her husband (who was a bit talkative but otherwise resting peacefully) sleep because I had 24 other people who needed me. She looked confused and repeated the question..it's just crazy.

They do sound as if they are trying to get you out. Any clue as to why? I also wouldn't chart something that small. Now, with all the lawsuits that seem to be happening, I chart on skilled patients, any change of conditions, anything out of the ordinary but other than that I do not chart anything on LTC patients besides vitals and BS if needed. I make sure all of my charting has a solution as well, even if it's just "Second shift to monitor for changes".

SNF needs a huge overhaul. It's unrealistic, caters to the resident's family instead of the resident themselves, and is generally a toxic/hateful/backstabbing enviroments. I count myself very lucky that I found a rare SNF with nurses who work together and an actual practical DON and administrator.