Burnt out and need advice

[GeminiNurse29]

Please move to the appropriate forum if necessary.

So I'm a long time lurker and 2nd time poster. I graduated in the spring and took a job at the end of July working in a memory card unit. Truth is, I mostly took it due to the schedule: M-F 9-5 with no weekends or holidays. I have a toddler and my husband works nights so I was lucky to get a family friendly schedule that fit my needs.

I have about 34 residents and typically 4 resident assistants/CNAs during the day. An LPN does come in the afternoons too but she floats to different units. The former RN left in May...and now I'm seeing why.

Right around that time, they accepted a resident from a skilled nursing facility. He is a chronic faller, he's had over 30 falls since he arrived. Family was against any medications at first but finally agreed to seroquel. He's also on hospice. He was very combative and verbally aggressive when he first came, but has mellowed out a lot. He still attempts to crawl out of his low bed or occasionally try to get up and walk. His family is also not the easiest to deal with. State came and cited us, among other reasons, for his falls. Then recently, state checked out the hospice agency working with him and (probably) dinged them too. The day they came he was uncooperative and somewhat agitated. Just last week, his hospice nurse got his Md to prescribe a behavioral medication for 3X/day on top of the already scheduled seroquel. This new med is also available as a PRN for him, and was used only 3X the whole month. Her view was "to be proactive." Now he's had 3-4 falls from being too sleepy and falling out of his chair. I'm trying to get the MD to discontinue the med, and waiting an update.

Which brings me to my point. What should I do? This guy needs SNF not CBRF. I don't know why we are still hanging on to him, probably $$$. I'm so burnt out. I'm supposed to do care plans for each resident every 6 months and I'm still trying to catch up due to the stuff left from the previous nurse. I spend more time on the phone or doing paperwork than with my residents. Instead of hiring extra nurses, the company spends $ to hire consultants to talk about time management and leadership. And state is supposed to return this month. The company is also trying to redefine what a fall is, such as not counting when he crawls out of bed bc that's a "behavioral" issue. I got in trouble for notifying the MD when he had some of those episodes.

I haven't been at this job long and I'm so burnt out already. I could use any advice or tips. Thanks for reading.

[anewsns]

Just make sure you're charting everything you're doing to prevent falls. A good note on every shift on your problems and interventions with this individual. It is definitely worth the extra 5-10 minutes to get that note out. And don't leave anything to the imagination. And look for a new job in the meantime.

[HouTx, BSN, MSN, EdD]

I completely agree about the need for SNF in this case. Take a look at your organization's admission criteria - they should contain specifics. If so, I'll bet that this patient's current situation is not in alignment with those criteria. If so, are there any resources available to help you make your case? Do you have access to a Case Manager who can work with the family to help them make a decision to move to a more appropriate level of care? What about risk management? It's probably only a matter of time before the patient is seriously injured in a fall.