Can you really change a bad LTC?

Specialties LTC Directors

Published

I worked in acute care and truly wanted to change to LTC, but for the last six months it has been crazy! I shed many tears shortly after taking my LTC job as I was not trained as promised and my corporate boss did not get along with the person training me at my LTC facility. The place was and still is chaotic with staff not caring about a darn thing! I was basically stuck in the middle of two people not wanting to train me - it was the "other one's job" so I ended up training myself. I've come to truly care about many of the residents so that has made me want to stay. My place is part.of a big LTC company. I had hoped to be able to move up the chain as I have my RN BSN MS, but to no avail. I think with all the garbage going on, and no one in Corporate truly knowing all the facts, I may appear to not be doing very well in my position when in fact it has more to do with the facility than my ability.

The last state survey was terrible; one of the worst in the state. No one seems to care and want change. There is a new DON. She is nearing retirement, just wanting to hang out until she does retire and has no interest in making change. Any problem she is confronted with is brushed off. The new administrator (probably about the 4th one in the past year) sits in his office all day talking to his girlfriend on the phone; never leaves the office to check things out, talk to staff or residents. There's tons of issues going on but if anyone speaks up they are viewed as a trouble maker.

I really feel like I want to speak with the VP about these issues, but know I will probably lose my job. I'm fed up with keeping my mouth shut. I want change and believe these residents deserve it. Does anyone have suggestions? I've only been in LTC for a short time; maybe this is more the norm than I expect, but I hope not! Thx.

You're right that I have been in LTC for only six months but I came from many years of acute experience. However, it doesn't take an experienced nurse to know good from bad nursing care; a new grad can see that. Even the janitor can see it! I stated many facts, one being that the state surveys have been terrible. The majority of my coworkers do not even know that I have my MS as I tell them very little about my education; it would serve them no purpose. Simply put, they are not willing to hear what other nurses have to say when it comes to improving the care we give our residents.

The goal I had in my post was gaining insight into how to handle such a poorly run facility. My biggest concern is the care our residents receive. I thank everyone who shared their experiences within their own organizations!

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There are bad facilities everywhere. Keep looking around til you find one better.

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Specializes in LTC, ER, ICU, Psych, Med-surg...etc....

One of my friends once said that the "fish starts stinking at the head"- meaning that if the top of the chain is crappy then the crappyness flows down. That is not to say that everyone is crappy because there are many who work hard and love their residents and try to do the right thing, but it seems that when there is a poor administration setting an example, then people who may have a tendency to do poor work or cut corners, do so because it is permitted. That makes it so hard on the ones who are there for the residents and who want to make a difference. It it sad to say, but usually the good people have to leave the stinking fish because they can't tolerate the smell any longer and try to find a place where the administration is supportive and cares about the residents and their staff....and the air is fresh....

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I've read this with interest and yes I do think it starts with the "fish head". I think our fish head is the corporate staff. We've had our share of great (and poor) DONs and ADMs that seem to get run out or the building. For the most part...all of the CNAs on a certain shift have stayed. That may be a good thing if they were great staff.

I really think that you can change a bad LTC if you have the support.

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""The last state survey was terrible; one of the worst in the state. No one seems to care and want change. There is a new DON. She is nearing retirement, just wanting to hang out until she does retire and has no interest in making change""

Given this information, in this LTC setting, I would say change is not likely to happen within this facility anytime soon. The survey being that terrible, they are just not committed to quality care.

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No, you can't change a bad LTC because it is deeply rooted to the Corporate culture and the people they hire from the top to the trenches, the Administrator and DON----they control the floor.

I had started working at this LTC and by the 5th week, I've been pushed out even though the DON knew that I am without experience and they lack the training structure or they simply don't want to train. When I did not work out on the floor, I was dribbled from place to place until I no longer have a schedule---apparently, that's how the DON push people out when they're done with them and simply do not respond to any follow-ups that the employee inquire about, until you get the message.

I am at that point right now, DON spinning the situation until no legitimate schedule to follow because the DON had scrambled the tasks for me to do to justify what they were paying me.

Whenever you speak your mind, they will retaliate. There are other jobs out there. They are a waste of people's time but not for the desperate esp. with this economic climate.

For those who can stand up to them and tell it like it is, hey, more power to us all!

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Specializes in Gerontology, Med surg, Home Health.

You sound bitter. Not all LTCs are bad.

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You can try but good luck! i work in a LTC facility that has had NO CHANGES to any rules/regs or procedures or anything in like 50 years. we dont have half of the equipment we need (if a pt needs fluilds, we have to send them to the Emergency Room at the hospital across the street) but what I do (i work nights, and haven't been there long but...) make sure I do everything right with what i am given. I know I wont change the policies but I can change the care my patients get while I am there. and hopefully (fingers crossed) the other nurses follow suit then its a cascade effect.....hopefully

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I used to work at one of the LTC facilities that was a part of a huge corporate. Let me tell you, the crap will always stay crap. In my 1st nursing home (it was a combination of subacute and nursing home) we had no equipment to even start an IV. My patient was in a respiratory distress and we didnt even have any nonrebreather. I decided to leave this place for a better one (thinking that it cant be any worse). I always said I can afford losing a job but I cant afford losing license. The other job however was a lot worse! In the first NH i had 16 patients (subacute) in the other place i had 38 patients (if i was lucky, it could go up to 42+). At night u have 60 patients. My DON told me that i can request to have the preceptor changed if we dont get along well together. My preceptor was nice but i wanted to see the routine of other people as well, therefore i went to DON and requested to have the preceptor change. Here the horror started. The DON wanted to write me up for "causing drama". She didnt give any explanation, nothing, just said that im causing drama and she will write me up.

Thank God i got accepted to one of the hospitals, I left that nursing home without blinking. Now I am on the oncology unit, it is busy but i love it.

Good luck to you! With your Masters degree you should apply for a management position not a staff nurse.

Nice to hear this Iam thinking about leavingmy current jobvery similar situation as you. How long did you work there?

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I am a DON at a long term care facility that I describe as "rough". There has been no leadership there for at least 6+ years. I was new there in Jan. a great organization. But whew!! What a task I have to try to reshape the culture. The employee handbook is my bible. I follow it to the T. However I have a brand new administrator, no LTC experience, and our relationship is like oil and water! He is not able to figure out that he is being manipulated by some of the trouble making staff. Stnas are smark aleks to the residents and he feels like I target people. I don't. But I DO address problems as they come up and I am NOT intimidated. I do not have adon support or unit managers. I have a SDC who stirs the pot with the stnas and 1 housekeeper they really keep the poop flying. These 2 are so much trouble you cannot even begin to imagine. It would be a much better place if they both went away. I want to do away with the SDC and get a adon who can and will support me in my mission. I am looking for another position d/t new administrator. However I am going to talk to my corporate support person before I give my notice, to see if they can offer any assistance.

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Specializes in LTC, Hospice, Case Management.
I am a DON at a long term care facility that I describe as "rough". There has been no leadership there for at least 6+ years. I was new there in Jan. a great organization. But whew!! What a task I have to try to reshape the culture. The employee handbook is my bible. I follow it to the T. However I have a brand new administrator, no LTC experience, and our relationship is like oil and water! He is not able to figure out that he is being manipulated by some of the trouble making staff. Stnas are smark aleks to the residents and he feels like I target people. I don't. But I DO address problems as they come up and I am NOT intimidated. I do not have adon support or unit managers. I have a SDC who stirs the pot with the stnas and 1 housekeeper they really keep the poop flying. These 2 are so much trouble you cannot even begin to imagine. It would be a much better place if they both went away. I want to do away with the SDC and get a adon who can and will support me in my mission. I am looking for another position d/t new administrator. However I am going to talk to my corporate support person before I give my notice, to see if they can offer any assistance.

Oh I can so relate to the new administrator with no LTC experience. Wears me out/stresses me out just thinking of it & trust me...I FEEL YOUR PAIN! Best of luck (to you and me both)

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Specializes in ICU, CM, Geriatrics, Management.
There are bad facilities everywhere. Keep looking around til you find one better.

Agree with this.

Realistically, it seems to me the initial poster would be taking on a mountain of a prob with little chance of succeeding.

Bad LTCs can be changed over time with the proper support: management, staff, financing, and an appropriate plan. If any of these necessities isn't there, "it ain't gonna happen."

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