Culture Change In LTC?

Simplepleasures · Jan 24, 2007

Wow, it is clear that most nurses work in facilities that struggle with staffing issues. I am just going to push the envelope a little by asking the question:
What have we as nurses done to be proactive in pushing staffing mandates in LTC?
Have we called the state to notify them of unsafe staffing issues?
Have written letters to our local councelman or woman?
Have we went public [wrote letters or emails to the news stations] with our concerns?
I am just asking the question because many of us will in the future [50-70 years] be in a situation where we may be faced with long term care as our living place and I truly want the culture change initiative to be apart of my life. Will it be?

I reported to state, not staffing, but something as serious and pervasive in LTC, PROMPTLY got fired, now involved in lawsuit. Thank goodness for the WI Healthcare Whistleblower Retaliation Act and my excellent lawyers who have not taken a penny from me. Also I am very disapointed in the lackluster investigation by the state into this matter. How can things improve if the agencies we depend on to enforce the healthcare laws are not doing it? Yet the DOJ seems to be going after individual nurses when something goes wrong. The facilities still seem to be getting their hands slapped by puny cursory fines, very few criminal investigations.

I wrote the DOJ. I wrote a newspaper and a national columnist at his blog site, have been in contact with many nursing home reform groups across the country, have contacted several legal nursing home abuse lawyers blogs, letting them know that the poor care that are bringing forth these lawsuits are caused by corporate greed, causing critically short staffing and that nurses work their tails off trying to give decent care in abysmal circumstances.Have talked to many people about this sick system we have and the general concensus is that because the LTC industry is worth mutibillions of dollars a year and continues to have such a strong lobby in this Administration, things are not going to improve until a strong congress gets into power and has the clout to change the laws. There are some initiatives in government already , but it will not happen overnight. Too bad , its been way too long already.

Simplepleasures · Jan 24, 2007

I tried. I got fired.

This is what usually happens when individual nurses try to make a difference and go against the accepted culture of their facility. :banghead:

RN 4 Life · Jan 24, 2007

My applause goes out to Seusquatch & ingelein. You are an advocate for your residents and you are an Idol for all those nurses whom want to go public but lack the ability to do so for various reasons. I know in the future ingelein your case will be referenced as more and more individuals are affected by the staffing issues due to Corporate greed. I can relate to this imbalance and I too am currently leaving a facility for this same reason. I am very verbal and out spoken for what I know is right. I call Corporate myself and voice concerns. Unfortunately, after 2 years nothing has changed. Thank you both for your couragious efforts...there are many residents and nursing staff that appreciate what you have done and are doing!

Simplepleasures · Jan 25, 2007

My applause goes out to Seusquatch & ingelein. You are an advocate for your residents and you are an Idol for all those nurses whom want to go public but lack the ability to do so for various reasons. I know in the future ingelein your case will be referenced as more and more individuals are affected by the staffing issues due to Corporate greed. I can relate to this imbalance and I too am currently leaving a facility for this same reason. I am very verbal and out spoken for what I know is right. I call Corporate myself and voice concerns. Unfortunately, after 2 years nothing has changed. Thank you both for your couragious efforts...there are many residents and nursing staff that appreciate what you have done and are doing!

Thankyou,RN4Life.At the facility I was fired from, we had what was called a "Corporate Compliance Policy".Supposed to be anonymous and non punitive, turned out to be just the opposite. Nurses who used it to complain of this illegal policy that I was fired for reporting, were retaliated against by threats of discipline, actually fired- myself and my night shift supervisor OR scared into silence "IF you want to keep your job", type threats .The DON actually told myself and my supervisor, "we know it was you who reported this to corporate, they tell us everything", it isnt going to help anyone here to run to Corporate, they are the ones who put these policies in place".SO TRUE, Corporate is only just that, the Corporate headquarters of a unscrupulous, unsavory bunch of businessmen interested only in continuing the status quo ,until they are forced to change LEGALLY.

DO NOT TRUST CORPORATE OR HUMAN RESOURCES, they are after all paid to watch out for the Corporation's interests, not ours. They have very tough bulldogs for laywers and they pay a pretty penny to defend themselves, I know this first hand. My lawyer got so mad at the down and dirty tactics at my hearing by the facilities lawyer that she yelled at him to "WIPE THAT SMIRK OFF YOUR FACE!!

Oh I wish that you nurses out there could have seen the depths to which these corporations sink to. Its DISGUSTING that they whine and moan about cost issues, yet continue to rake in the BIG bucks, and dont bat an eyelash,when spending THOUSANDS for their legal fees.

When this lawsuit is over, if I dont get a gag order, I will spill my guts, in detail about what actually transpired, if the administrative board on this forum allows me to.Well I will continue to fight and hope my case can set a precedent that will affect LTC staff and patients for the better.

Jo Dirt · Jan 25, 2007

It's a nice fantasy, but reality is that it is not likely that such an unstructured enviornment would be feasable for these people at this point in their lives.

Of course, they are adults, but the truth is that as people age, they become more like children in a sense. Many suffer memory loss, incontinence, inability to perform many ADL...and if you gave many of these people a choice of when to sleep they would never get out of bed (though I may feel the same way if I live long enough).

Try as we may to reconstruct a "homey" environment for these people it is not realistic. A nursing home is an institution. And unless they want to run off more employees with the extra burden that "meals when we want" and "get up when we want" and "take a bath when we want, even though we require considerable help with all these activities" will cause they had better just try to find a way to make the best of what they have.

Sounds like a way to invite more stress and chaos to an already stressful situation.

twojays · Jan 25, 2007

We are in the process of culture change. Conceptually a delightful aesthetic and marketing idea but most facilities now are mixed use. I work on a subacute rehab unit and we are being dragged into this model before the issues of a weak unit infastructure have been addressed. There is an empowering of the patient/resident/consumer/guest (where are we on this food chain of monikers). An empowering of families and an empowering of the marketing people but interestingly nursing feels somewhat trivialized in all this.

How would you like to be a subacute rehab nurse and have to answer the phone "Petunia NEIGBORHOOD, how may I help you?" How would you like to be told that you can't wear colored uniforms but must wear a name tag that screams "Petunia Neighborhood" under your hardearned BSN CCRN.

We get it. We get the marketing angle. We get the rolling message board with quotes from Maya Angelou and misidentified quotes that were said by Aristotle long before Bruce Springsteen. But what we don't get is why we have only two working thermometers for 40 people and no ice available for ice packs on a ortho unit. No gloves in rooms, no hand sanitizer wall mounted.

Our consultants who came to introduce this concept were not nurses but we played along with the team building and game playing and listened as they tried to tell us that we should move that lousy Vitamin C at 9 a to 5 p to help lighten that am med pass. Or better yet, it was offered, see if you can get it d'c'd (How about 12 patients instead of 18 then they can be on Vitamin C RTC). Let everyone get up whenever. Trust me we do anyway by way of acuity of patient combined with staffing which adds up to a protracted first round of the day.

You can paint and paper and hang lousy art all you want. You can hide everything but rehab units are not birthing rooms. If we don't make changes unit specific and thoughtful to their identities and functions we are going to be made fools and will not be successful in our transition to culture change.

RN 4 Life · Jan 27, 2007

Thank You two jays...keep me posted with the progress of culture change in your facility. I will be helping to initiate culture change in the facility I am going to, while most seem to think it is a structureless system of allowing the residents to do what ever they want. I view it as more flexibility in allowing us [the nursing staff] to do things for the residents we care for. Obviously some residents lack the ability to choose and in this case we do as we have always done, which is choose for them. I am really excited by this challenge, I am going to use all the feedback from this thread to help understand the nurses and nurses aides frustrations.

twojays · Jan 27, 2007

I think RN4Life might have gotten me mixed up with another poster! I don't believe that my deepest concerns were about the organic nature of the day that the culture change will foster. I think I was writing about my concerns about the inefficiency of the infrastructure (accessibility to supplies, staff tasks etc) as it exists now and the need to tidy up how we function before we create an environment that walks like a duck and talks like a duck but isn't a duck. I work in a sub acute rehab. My concern was that our issues on our unit were not being addressed separate from those of LTC. I wish that our facility had set up a web site from the start that was accessible to staff so we could be continually updated and informed. Email could have been sent to the culture change admin who could post a weekly update that answered our questions or posed others for input. Thank you so much for taking the time to write me.

RN 4 Life · Jan 28, 2007

No, twojays my comments were intended for you...while you may not be 100% in agreement with the initiation of culture change in your facility [and trust me I do understand your concerns] I appreciate your feedback! Why because I understand and can relate to your frustrations! My guess is the biggest difference between me and you is I am 100% agreement with the philosophy of culture change. I am also in 100% agreement with you views. So as a result being in a position to advocate for both the employee and the resident I plan to do just that! Culture change can not be implemented with out having the basic needs of the unit met i.e. staffing, supplies, etc... thanks.

BmtTXLVN · Jan 29, 2007

Nice concept but most of my res. would starve and smell awful because they just hate baths and forget to eat

RN 4 Life · Jan 30, 2007

Are you serious...Your being sarcastic? Right? I am know you wouldn't let your residents suffer because a policy allows you more flexibility to care for your residents? I know you would use your skill as a nurse and your critical thinking skills to guide the actions of those who lack the judgment to guide themselves. This concept will only work with nurses whom have insight and critical thinking to judge who is appropriate to make choices and who is not.

BmtTXLVN · Jan 30, 2007

yes that was a sarcastic remark i would do everything within my powers to make sure my res. had the highest quality of life possible.