Culture Change In LTC?

Specialties Geriatric

Published

I personally think it is wonderful plan, but understand the fear and concerns direct care staff face while implementing these changes? Is anyone implementing this in there facility?If so what are some of the changes you have made? & How is it working so far? Any tips?:rotfl:

I am very fortunate to work in a facility that when they say the resident comes first, they really mean it. I've never worked anywhere like this place.

We are slowly implementing changes, it does take money and my company is spending it!

Residents come first, employees second and believe it or not, the budget comes in about third place!

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Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.

Culture Change sounds just great, AFTER all the more important, basic issues have been addressed; low staffing and morale, high staff workloads and turn-over (both decrease the quality of care), lack of needed supplies, etc.

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Specializes in Assisted Living nursing, LTC/SNF nursing.
Ive been on duty when the administrator or DON is showing around a family of a potential patient. The sales pitch is amazing, "our alzheimer unit is state of the art", "we have family style dining", the staff are here to meet every need your loved one has. BUT never have the family been told the real story, that despite the wonderful new furniture or the great new "concept" in living, it is NOT their home, it is a nursing home full of strangers,taking care of their loved ones to the best of their ability, despite CRITICAL short staffing and overwork, PLUS underappreciation.The LTC of the future cannot ever improve the lives of the patients in them until there are ENOUGH staff to be able to take care of them PROPERLY , the way the family is led to believe.

Oh so very true! This norm is only getting worse and with gas prices, low cost of living pay wages, so very difficult to get 1/2 shifts covered which really should be a full time positions, heaven forbid one extra person working and if you can't find a replacement of a call-in, a full time person can not have overtime, period, so you work short Even those so called "not for prophet" NH's have an agenda to make money to "build and expand for the community needs" which is for the upper class with the money available. Say they won't turn anyone away but they are selective since they usually only offer private rooms which medicaid folk's can't afford. The all inclusive not for profit retirement, religion based complexes are sooooooooo expensive but you wouldn't know it by the wage or the staffing. It's so frustrating and sad but I will admit, the families are usually involved with the residents and they advocate often if they see neglect. Some problems are petty/minor, but some are well founded. In all cases, we are reprimended but nothing changes with staffing. I think staffing correctly, above and beyond the state's bare minimum should be mandated for all NH's and wish I knew how to advocate that legislatively in my state.

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Oh please ! "Mention it to the surveyor"....You should be working WITH management not whispering to the surveyors behind their back. Don't you realize that ANY care issues reflect on YOU.

You dont owe anything to the nursing home, you owe it to the patients and your self respect to tell the ugly truth, hopefully the "state" will do the right thing and correct the situation. Management is NOT there to work with you, dont be fooled. If they are the rare breed who does have some ethics, they dont last too long and are soon gotton rid of. THAT is the ugly truth also.

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I currently work in a culture change facility in Ohio & I love it!!

I see that the residents are more in charge of their own lives, it's just as if they were still living at home. There are rules/guidelines of course that have to be followed. And I have asked many of my residents if they like it & most of them definately do!! There are no set times for alot of things & if you work as a team in your households (as we call them) it will run smoothly. Meds are no different than any set times as before, I pass them as rising, lunch & dinner, for specific meds as 9's or every four hours or every 12 hours then thats different you have to follow those orders. But I find it easy this way, there are no med carts on the floors, we do have a nurses station & thats where we give meds out, or bring to their rooms!! I've been working there for a year & I find it beneficial for the residents themselves, they call the shots with in good reasonings of course. And the ones that can't well thats what we are here for!! I know some people don't like change but in my opinion this is a change for the better. If you have any questions more about culture change ask me I will try to answer at least what I know from my facility...Oh one more thing anyone know of culture change in Houston or Dallas, please let me know..

Thanks Jovi

:tinkbll:

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You dont owe anything to the nursing home, you owe it to the patients and your self respect to tell the ugly truth, hopefully the "state" will do the right thing and correct the situation.Management is NOT there to work with you, dont be fooled.If they are the rare breed who does have some ethics, they dont last too long and are soon gotton rid of. THAT is the ugly truth also.

Actually, I think you DO owe something to the nursing home, they're the people that give you money for your services, and allow you to live with a roof over your head and eat, pay bills, put your kids thru school, and not be on the street.

I agree that some management is just looking out for the bottom line, and may not be AS concerned with pt advocacy as they should be, but I don't by any means feel that they all are like this.

I work at a facility that's advocating culture change, and it's a slow process, but believe me when I tell you, our DON is all about pt advocacy, and also defends her nurses as long as they're in the right.

There are alot of other agencies that you can go to to blow the whistle other than directly to the state during a survey. That's kinda' like cutting off your nose to spite your face.

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Actually, I think you DO owe something to the nursing home, they're the people that give you money for your services, and allow you to live with a roof over your head and eat, pay bills, put your kids thru school, and not be on the street.

I agree that some management is just looking out for the bottom line, and may not be AS concerned with pt advocacy as they should be, but I don't by any means feel that they all are like this.

I work at a facility that's advocating culture change, and it's a slow process, but believe me when I tell you, our DON is all about pt advocacy, and also defends her nurses as long as they're in the right.

There are alot of other agencies that you can go to to blow the whistle other than directly to the state during a survey. That's kinda' like cutting off your nose to spite your face.

That is my sentiment and unfortunately it is REAL. I am well aware that there are agencies who take complaints and reports from nurses, the surveyors belong to one of these agencies,it is called the BQA in my state. Why would an employee NOT want to tell then something if the opportunity arose? We are there to ensure the patient given care, we are not there to hide and lie to protect the interests of the facility, when they are engaging in illegal/ unethical behavior.

I stated that there were some management people with scruples, did I not? I am a nurse who has been around the block so to speak , in LTC and I don't mindlessly buy the management's spiel of put your loyalties to the facility first, my first loyalty as a nurse is to my patient. LTC will never improve as long as nurses have MISPLACED loyalties, or loyalties born out of fear of retaliation.

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Specializes in subacute/ltc.
Actually, I think you DO owe something to the nursing home, they're the people that give you money for your services, and allow you to live with a roof over your head and eat, pay bills, put your kids thru school, and not be on the street.

Lets see the majority of my residents are on medicare or

medicaid.....yes they have paid into "the system". However it is my current tax dollars that allow for their continuing care....so not only am I paying for my residents....but by default am paying my own salary....

sorry to be OT

as to the original topic....I would love to see that be our care modality..

Tres

heaven forfend, when I am in ltc some poor aide trying to wake this night owl at 8am with a breakfast tray....tray will go flying and I will be labeled and prolly medicated for other's protection...(said in a not so facetious manner)

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That is my sentiment and unfortunately it is REAL. I am well aware that there are agencies who take complaints and reports from nurses, the surveyors belong to one of these agencies,it is called the BQA in my state. Why would an employee NOT want to tell then something if the opportunity arose? We are there to ensure the patient given care, we are not there to hide and lie to protect the interests of the facility, when they are engaging in illegal/ unethical behavior.

If a facility is engaged in illegal activity, it surely needs to be reported to state, but most facilities are NOT engaging in illegal or unethical activity, other than the short-staffing that is prevalent in our profession. The facilities that are engaged in anything illegal are caught by regulatory agencies and closed down, as they should be. I'd be willing to bet that if you polled most nurses on this forum, most would say that their facility works above board. To make a blanket statement is a disservice to the profession, as it makes it seem as the nurses are part of the problem, because they have no choice but to go running to the state surveyors because there are no facilities that are good out there, and we're forced to work in lousy facilities that are working illegally and unethically. That makes us as nurses part of the problem.

I stated that there were some management people with scruples, did I not? I am a nurse who has been around the block so to speak , in LTC and I don't mindlessly buy the management's spiel of put your loyalties to the facility first, my first loyalty as a nurse is to my patient. LTC will never improve as long as nurses have MISPLACED loyalties, or loyalties born out of fear of retaliation.

You did state that there were some management people with scruples, but in the same sentence, you stated that they're soon run off out of the business. I also didn't state that the employee was incorrect to report, just that there are other avenues that carry less of a punch financially to the facility that signs our paychecks.

I've been around the block a few times myself, having been in this field one way or another since I was 16 working as an orderly for the summers in a state hospital. I'm well aware there are instances where management turns a blind eye to anything but profits, but believe me, in my experience that's not the norm you are trying to portray.

I'm truly sorry for your bad experiences. My loyalties are also to my pt's, as are my DON's, and my administrators. Staff that doesn't feel this way doesn't last long at my place. My loyalty lies in the fact that my facility lets me do my job, advocate for my pts, and pays me well to boot.

Have a great day, and may you someday find a facility as pleasant as mine to work at.

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Lets see the majority of my residents are on medicare or

medicaid.....yes they have paid into "the system". However it is my current tax dollars that allow for their continuing care....so not only am I paying for my residents....but by default am paying my own salary....

You have a point. but if it wasn't for the facility being open and getting paid for it's residents by your tax dollars, they wouldn't have the money to pay you, creating those tax dollars that you're paying to take care of those residents, now would they?

As for culture change, which is what I originally wanted to post on, our place is going thru this now, and it seems a success, except for the fact that overhead paging is no longer allowed. MD's have to wait longer on the phone, but that seems the only drawback so far. Then again, we're VERY early in the change, so it'll be interesting to see where it goes.

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i'd be willing to bet that if you polled most nurses on this forum, most would say that their facility works above board. i encourage you to do so.

to make a blanket statement is a disservice to the profession, as it makes it seem as the nurses are part of the problem, because they have no choice but to go running to the state surveyors because there are no facilities that are good out there, and we're forced to work in lousy facilities that are working illegally and unethically. that makes us as nurses part of the problem.nurses are not part of the problem, nurses whose loyalties are to the employer, instead of to the patient are part of the problem.i do not fault nurses for being afraid of retaliation for reporting, it is a very real thing.

you did state that there were some management people with scruples, but in the same sentence, you stated that they're soon run off out of the business.i stand by my statement.

i also didn't state that the employee was incorrect to report, just that there are other avenues that carry less of a punch financially to the facility that signs our paychecks.you must do whatever you feel is correct for your own situation, but there are nurses out there, who do not feel the employer has their or the patients best interests at heart.

i've been around the block a few times myself, having been in this field one way or another since i was 16 working as an orderly for the summers in a state hospital. i'm well aware there are instances where management turns a blind eye to anything but profits, but believe me, in my experience that's not the norm you are trying to portray.

i'm truly sorry for your bad experiences. there are very good facilities out there, and you're giving them a bad name by association with the absolutes you're using in your posting. you are entitled to your opinion and i to mine, i have my fellow nurses and patients in my best interests.

my loyalties are also to my pt's, as are my don's, and my administrators. staff that doesn't feel this way doesn't last long at my place. my loyalty lies in the fact that my facility lets me do my job, advocate for my pts, and pays me well to boot. again, you are fortunate, but to state that most ltcs are as you describe, is simply inaccurate.

have a good evening.
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We'll just have to agree to disagree. Again, my sincere wishes for you to have a great day, and be happy in what you do, whatever that may be.

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