Charge nurse not for me

[Pumpkinpie314]

Hey Nurses, I really need some advice. I was a hospice aide for about 5 years with a company I loved. I graduated as an LPN in in 2018 and worked per diem as a staff nurse in a rehab/long term care facility. I missed hospice and the one on one interactions, time with families, the slower pace. A friend offered me a position with a new hospice agency in the area and I jumped at the opportunity. I loved my job until COVID hit. My new role was to get gowned up in trash PPE and do intake with the RN via phone. We lost half our census in a weekend. I saw deaths that shouldn't have happened the way they happened. Facilities administrators' despised me because hospice was allowed to travel building to building and I was not welcomed. ( I understand why 100%)

Anyway I needed a break from hospice and so I a job as a charge nurse in a nearby, small rehab/long term care facility. I am floated between 3 floors. Yesterday I was short-staffed cnas, the ones I do have are full of eye rolls and sarcastic remarks, and never got the weights I asked for. I had an orient to train. The computer was down for 2 hours of morning med pass. All the patients are yelling for their "LATE PRN". Three admissions and a room change nobody told me about today. Today the DON asked why the admission wasn't completed on my shift. I'm so over it.

Where should I go from here? Being a charge nurse is definitely not for me. Is Assisted Living an easier pace? A better environment? I don't want to go to work everyday hating my job. Thanks in advance

[TheMoonisMyLantern, ADN, LPN, RN]

Your mileage may vary with ALF's. I've never worked one, but have had numerous friends who have. Some are ran well, and the acuity is generally less than that of a LTC/SNF. However, ALF's generally aren't as tightly regulated as LTC is so you may have "caregivers" who are hired off the street, given minimum training, terrible pay, and expected to do the work of a CNA. As the licensed nurse you may be supervising Medications aides are CNA's with extra training to pass meds. Some ALF's are ran and staffed well, but unfortunately many are just trying to make a buck like every other company in healthcare.

Have you thought about home health instead of hospice? You could also consider corrections, I've known a lot of nurses that have enjoyed corrections. Also dialysis, psych facilities. In my area LPN's are still utilized in hospitals, is that an option in your area?

[Pumpkinpie314]

9 hours ago, TheMoonisMyLantern said:

Have you thought about home health instead of hospice? You could also consider corrections, I've known a lot of nurses that have enjoyed corrections. Also dialysis, psych facilities. In my area LPN's are still utilized in hospitals, is that an option in your area?

Thank you for your response. I hear you on the ALFs, I thought it would be like that. I know the grass isn't greener. I hadn't considered home health. I will definitely look into these avenues! 

[Davey Do]

On 1/14/2021 at 5:50 PM, Pumpkinpie314 said:

Yesterday I was short-staffed cnas, the ones I do have are full of eye rolls and sarcastic remarks, and never got the weights I asked for. I had an orient to train. The computer was down for 2 hours of morning med pass. All the patients are yelling for their "LATE PRN". Three admissions and a room change nobody told me about today. Today the DON asked why the admission wasn't completed on my shift. I'm so over it.

I copied this portion of your post because it gave me pause to reflect. Your description was like one which was a usual shift at Wrongway Regional Medical Center, and I am "so over it", being retired for 10 months now.

Thank you for this trip down Memory Lane, Pumpkinpie. I sense you are a good nurse. Continue seeking and you will find.

The very best to you.

 

[TiPPs]

This was a trip down memory lane for me as well. Where to begin? Kudos to anyone who is willing to do that type of work, but it certainly is not for everyone. I worked in similar situations and then decided I needed to advance my degree to get out. However, these days I believe there are more options for RNs.

I have never worked in an ALF, but I imagine for an RN, if you found the right facility, it would be a good fit. Although, I have heard from patients and families of what they think of the "wrong" ones.

Have you heard of Guidewell? Not certain that they are located everywhere. But, it is an outpatient clinic that employs RNs. It is for walk-in patients that are not sick enough to go to an ER. I have had friends work there and seemed to like it. If you like doing procedures, this might be for you. 

Wish you the best!

https://www.thepatientpractitioner.com/

[JBMmom, MSN, NP]

Oh, I remember the day I quit my SNF supervisor job. (Pardon me as I digress). The NOC supervisor was given charge of the dementia unit with 37 patients. That morning my CNA had to float for about 45 minutes to the floor with 60 residents and one aide because he was a male and several female residents had "no male aide" orders. Not long after she left, I awoke my first patient for her life saving synthroid about 5:15am. When I went into the next room she proceeded down the hall and peed on the blind gentleman sleeping soundly in his bed- at least until he was warm and wet and being squished by a relatively large former principal who thought she was in the school bathroom. While escorting her back down the hall, sans pants, she began to defecate in small piles. The roommate of the gentleman who had been peed on then traveled out of his room, through the small piles of feces, to let me know that he was awake and would like something to eat "NOW".  I was able to redirect him to a chair in the hall with the promise of some graham crackers. I threw towels in the hall to cover the piles. escorted my pantless companion back to her room and found a new pair of pants and recommended she could go back to sleep until breakfast. I ran past the gentleman in the chair to find him another pair of socks from his room, and another damp towel. I cleaned his feet off and took him to the dining room, he was happy enough to sit with a pack of graham crackers. I was able to clean up and change the gentleman who was peed on, fortunately he was still mostly asleep, and he appeared to drift back off. I looked into the hall and no one else was about, so I awoke the second patient, from dead sleep, for her vital pre-breakfast omeprazole and she proceeded to punch me, her weak 90-year-old blows heartbreakingly glancing off my arm as she accused me of trying to kill her. I looked up and in the doorway I see patient number one, pantless again, advancing towards the bed of the roommate of the woman punching me, and figured I had about 10 seconds to avert another wet awakening. The next 10 or 15 minutes passed as I tried to shuffle patients about and direct others that were awakening, in various stages of dress, to any available chairs. 

One of the RN administrators popped her head in the unit and said "how's it going?". I said "I'm leaving my resignation when I leave, I'm alone with 37 residents because we had three nurses and three aides all night for 127 beds, which I'm pretty sure doesn't even meet the DPH requirements, and this place has been nuts. And no one is getting a 6 am medication today." She said "okay", and disappeared behind the locked door. I looked at the faces of confusion sitting around me and I have never felt sadder for people in my life- the staff and the residents, that had to navigate barely tolerable conditions at times in the name of "profits". I did quit, I wrote a letter to corporate outlining my observations and perhaps naming some names, so I'm now persona non grata on facility grounds.

Anyway, LTC can be a challenge. But some can also be great places to work! Word of mouth in your area will probably get you the best options. Home health, corrections and outpatient psych are popular in my area. I hope you find something that fits your needs- thanks for that trip down memory lane, too.