Closing the Chapter on SNFs

After two years of working in SNFs, I saw the nurse I was becoming and knew it was time to move on. I got a new job at a great hospital and am not looking back, except to write about my experience of course! Nurses Announcements Archive Article

Closing the Chapter on SNFs

If you are the one reader [this may even be an overestimate] that read my super eloquent tirade on working in surgical rehab facilities (i.e., skilled nursing facilities or SNFs), you may know that I loathe them and would not wish that fate on anyone I know. This goes for both being a worker and being a patient in the nightmare-as-a-place-of-healing.

Recently my job has had a lot of staff turnover [read: people quit all the time], which is not really a surprise. And now that I care for 14-15 people a night with half of the normal staff, I want to light my hair on fire and run screaming from the building. Indulge me when I say I am working as fast + efficiently as I possibly can while trying very hard to not make any errors, and I still leave feeling like an absolute failure of a human. I probably feel like that because on any given night 1-2 patients or their family members will in various combinations of words tell me that I am doing a crappy job and am a crappy human. Yes, a thick skin is important. Yes many of the patients are in various states of delirium/dementia and I shouldn't take it too personally. But they don't even have to tell me, I know I am becoming a crappy nurse and hate it.

I spend my days rushing around as quickly as possible with a grimace-almost-a-snarl. I'm not able to actually engage with patients and their families with any more than a curt pleasantry and a clipped answer to any question BECAUSE I CAN HEAR BETTY SCREAMING DOWN THE HALL or because a nursing aid is the room saying Joe just fell again and is bleeding from the head.

I realize now that the way most nurses get stuff done is by not doing it! Awesome. Of course the big stuff gets done - most of the medication pass, IVs, blood sugar checks and insulin administration, etc. But I've had patients tell me their [supposed-to-be] daily dressing changes haven't been done in days and I pull off the dressing and it smells like a sewer and looks like one too. Or they say they haven't been showered for 6 days. And they are incontinent. Or that they never got their breathing treatment that they need for you know, not gasping for air like a 75 year old with COPD.

Also, can I just recount this error that happened recently? Errors do happen, but this was a I-feel-ill-that-this-could-even-happen type of error. A patient admitted one evening and the admitting nurse used another person's medical record to transcribe that [wrong] patient's medications onto a paper MAR for the new patient.

Let me first enlighten you on the MAR. Since many of these SNFs are not a bastion of cutting edge technology, we use paper charts and a paper Medication Administration Record (MAR). You probably know this, but a MAR is the long list of physician orders that you use throughout your shift to know what medications or therapies a patient needs. It's almost unbelievable that paper MARs still exist since they depend on being able to read what the nurse with crappy handwriting wrote and because of the little known fact that COMPUTERS ARE A THING. And electronic MARs are widespread and reduce medication errors.

So anyways, the new patient received the WRONG MEDICATIONS FOR THREE WEEKS. Wow. I can't even wrap my head around that. She was receiving multiple strong blood pressure medications and the doctors couldn't figure out why her blood pressure was so low and kept trying to titrate her dose. The error was finally noticed when she discharged home and her regular doctor read her chart [including her medications] from our facility and called with a big ole WOW!.

Regardless of that incident, I feel like I've already outstayed my welcome. If I were to continue for another 20 years like a good lil employee that I know I'm not, I would probably need a partial lobotomy so that I could become OK with giving [what I believe for myself to be] sub-par nursing care. Yes, I've met good nurses. But in my experience a lot of nursing cares cannot be completed because of chronic poor staffing, of course at the detriment of the patients. I'll politely decline any continuing involvement in that.

So now I've jumped around to enough jobs to know many of the things I dislike and cannot tolerate. And after waiting around in the purgatory of unknowing, kicking rocks and hoping an answer would magically bloom in my mind, I thought to apply to this one hospital that is known to be really great, with a rehab unit. And it had one opening that had been on the website for a few weeks. And after one particularly bad string of shifts I threw my vulnerability [and caution] to the wind and just applied, thinking it was probably already closed and I'd get an automated "duh, it's closed" response. But I got an interview! And then a second one! And then I shadowed for half of a shift. And it was so amazing. Everyone seemed genuinely happy to be at work. It was a strange thing to witness. I almost wanted to touch their faces and ensure that they were people and not just robots. And everyone was helpful and supportive of each other. And the nurse I was with had time to actually listen to each of her patients for more than 1 minute. And it wasn't absolute chaos. It was almost unbelievable that a place like this existed all along.

It's kind of like dating crappy people over and over and you start to think it's just you (note: it partially is). But then one day you meet a person and they're just as weird and silly as you but they are also loving and supportive and it feels like you've found home. I know I'm fast forwarding a lot here, but that's what it feels like.

In summary, hooray for a new job where I can be more of the nurse I want to be! To all of you lovely nurses that are in a crappy job where you feel like a shadow of the nurse you wanted to be going into nursing school: GET OUT. One way or another, get out and apply to new jobs, they exist. And it can be better, if you let it.

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rehab_nurse

About rehab_nurse, LPN, RN

I have been a nurse for a few months shy of 3 years. I love a lot about nursing, but I haven't been happy in SNFs so off I go into the hospital world! Of personal note, I love to being outside - hiking, rock climbing, and canyoneering.

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Specializes in Critical care.

Best wishes to you!!

Specializes in LTC, Rehab.

I'm going to. Soon.

Specializes in school nurse.

I gag at the very name "Skilled Nursing Facility" when these places staff so poorly that people hardly get any actual quality nursing care...

I have been feeling the same way. I work in a SNF that is suppose to be post acute care and rehab. We are frequently understaffed. The most important thing with the facility that I work at is making money. Our unit is a money maker and so they strive is to keep us full as possible. Sometimes these people do not need skilled nursing, but because their insurance will pay for it they are placed with us. These folks are generally time suckers. There are days when it is impossible to give all of them top notch nursing. I do what I can but there are days. We are often staffed by agency nurses or floats from other parts of the facility. They do just the minimum amount and chart that things have been done, Frequently I have to go back and do things that should have been done a previous shift, but was not. This stresses my shift. I try hard not to leave things for the next shift (I know they won't do them). Our facility stresses patient centered care and I try to do the best for my patients, but there are days.

It is time for me to move on.

I completely agree with you. I had the exact same experience. Although I have had no luck getting hired in a hospital I did find a WAAAYYYY better SNF to work at.

Specializes in PCCN.
I'm going to. Soon.

I hope to be also, someday...

Curious, which SNFs are actually good? Any names that anyone is proud of working for, that would be "models" for good care at all? What about the frou-frou nursing homes where people pay a lot of money, is it worth the care/staff ratio that's being allotted? I do care about how the population is aging and wonder if working in an SNF is in the cards, by going into nursing it almost seems like at some point I'll encounter care of the elderly even though my focus now is hopefully to be in underserved populations.

Hearing your account, it's terrifying what goes on in some of these SNFs--and this is where people are entrusting their aging parents and paying money for that care. There seem to be the nurses that don't care at all who are on their phones all the time and just doing the bare minimum (for whom nursing is just a means to a salary) and the nurses who are passionate and really want to be good nurses, who end up bearing the brunt of the work and burning out. It's so bad, because that could mean good nurses who care are being driven out and patients are left with no one else to advocate for them.

Specializes in CNOR.

Your experience sounds too familiar. I have been a RN since 1993 and started my career in med/surg. It is really sad that you are still working in that environment. Unless you are a martyr try something new. I transferred to surgery after working myself to death for 2 yrs on med/surg. I received OJT and a lot of encouragement and developed a rewarding career. I had to study and use a lot of common sense but it was a great career move for me. There will always be nurses who do the bare minimum or say they did treatments and didn't. But it's not just in nursing. Liars and lazy people are in every profession. As far as blaming the agency nurses and floats may not be far. Where they given the most difficult patients? Were they given a good orientation on the unit. I've worked as PRN staff (thinking I would keep my floor skills up). I always got the assignment of the most difficult patients and the largest number of patients too. If a new admit came in usually got that too. So your agency and float my not get it as good as you think. They too maybe burned out.

I have been feeling the same way. I work in a SNF that is suppose to be post acute care and rehab. We are frequently understaffed. The most important thing with the facility that I work at is making money. Our unit is a money maker and so they strive is to keep us full as possible. Sometimes these people do not need skilled nursing, but because their insurance will pay for it they are placed with us. These folks are generally time suckers. There are days when it is impossible to give all of them top notch nursing. I do what I can but there are days. We are often staffed by agency nurses or floats from other parts of the facility. They do just the minimum amount and chart that things have been done, Frequently I have to go back and do things that should have been done a previous shift, but was not. This stresses my shift. I try hard not to leave things for the next shift (I know they won't do them). Our facility stresses patient centered care and I try to do the best for my patients, but there are days.

It is time for me to move on.[/quote

You are working in a unit that is not good for your license, mental health, and the health of your patients. It is definitely time to move on.

I totally agree with your post. Working ltc - paper charting you can't read, more patients than you can possibly give good care to let alone spend a minute with them to talk so they have some basic human interaction. Then being told you don't have "good time management" because you don't cut some corners like others did. I got out and told my husband I will not work ltc again even if that means I won't be a nurse again. Got a job working peds home health with 1 patient and it has been so much better. I feel like I get to be more like the nurse I would like to be.

If the nurse to patient ratio were better, there wouldn't be a problem with SNF. WORD!