Disrespect of LTC nurses by acute care (even though BMs neglected in hospitals)

SuesquatchRN, BSN, RN · Jan 1, 2008

:)

I'm not trying to do LTC vs. med/surg. My experience is primarily LTC, and my experiences in nursing, period, have not been good. But that's another thread.

I was told to return to LTC, where I wouldn't have to think. That's a pretty damning testament to what that particular nurse thought of LTC nurses.

I had a horrible time on med/surg, not least because the preceptors completely discounted my year's experience as a nurse because it wasn't acute care. They became irate at my conviction that I had a clue. It wasn't a good situation. I was told that I knew nothing. In those words. By more than one person. Because I said I was comfortable with PO meds. And that statement meant I was cocky.

Anyway.

Having now done a short stint in acute care I understand better why everyone comes back with a bed sore. The units are filled with old people who are often total care and the staffing - and Kardexes - don't reflect that. Basically, they were half nursing home residents who were too weak to feed themselves and an acute care unit doesn't have staffing adequate to sit with someone like that for 30 minutes and then turn Q2h.

I dunno. I just find being a nurse the most disheartening, demoralizing thing I've ever done, and it's from other nurses. Here's a sweeping generaliation - if I worked with the folks from this board I'd love it. But I didn't.

Happy new year.

NurseCherlove · Jan 1, 2008

:)
I'm not trying to do LTC vs. med/surg. My experience is primarily LTC, and my experiences in nursing, period, have not been good. But that's another thread.
I was told to return to LTC, where I wouldn't have to think. That's a pretty damning testament to what that particular nurse thought of LTC nurses.
I had a horrible time on med/surg, not least because the preceptors completely discounted my year's experience as a nurse because it wasn't acute care. They became irate at my conviction that I had a clue. It wasn't a good situation. I was told that I knew nothing. In those words. By more than one person. Because I said I was comfortable with PO meds. And that statement meant I was cocky.
Anyway.
Having now done a short stint in acute care I understand better why everyone comes back with a bed sore. The units are filled with old people who are often total care and the staffing - and Kardexes - don't reflect that. Basically, they were half nursing home residents who were too weak to feed themselves and an acute care unit doesn't have staffing adequate to sit with someone like that for 30 minutes and then turn Q2h.
I dunno. I just find being a nurse the most disheartening, demoralizing thing I've ever done, and it's from other nurses. Here's a sweeping generaliation - if I worked with the folks from this board I'd love it. But I didn't.
Happy new year.

HAPPY NEW YEAR TO YOU!

I hear ya...it's a rough world, the nursing world. When I first started back to acute care nursing and I would tell people that I had just worked psych for the last year, I felt like I would get that look that said, "Oh, so basically you know nothing about real nursing then." Of course, then I'd have to school 'em a little. Just kidding. Well, not really.

But yeah, nurses as a group, can be so darned judgemental. Even within a unit, amongst individuals.

Prime example....At my recent m/s job, while just about all of my coworkers liked me, I also know that a few would talk about me as a poor time manager. Well this from one who was literally ALWAYS done with all of her AM assessments first, ALWAYS got breakfast, and somehow ALWAYS managed to be the one hanging out the most at the nursing station or even moreso, the breakroom.

Well, yeah, I mostly never did leave on time, and very rarely ever sat at the nursing station, etc. HOWEVER, some of the things I would hear....

For instance, I actually had one patient who had been there for a few days and he actuallly told me that I was the first nurse who had "done that", palpated his radial pulses. This guy ended up with a vascular consult for possible radial DVT.

And I also had this one tech who had been there for 10+ years tell me how she loved how I always checked out the patients 'real good' and that she'd seen nurses who didn't even really touch their patients!!!

The point I'm getting to is: would I rather have accolades for being an "efficient time manager/nurse" or one of the best darn nurses (in terms of patient care) on the unit?? I guess it's obvious which one I picked. But at the same time, the whole "poor time management" label thing bothered the crap outta me.

Fortunately, there was another nurse there, very detail-oriented like me and very seasoned, and we would sit together (staying late and charting of course while everyone else had gone home) and we would talk about the lame nursing practice of those very staff members who were "oh so efficient".

For some reason, in my mind, it is ok to kinda judge them because they were more than likely making a conscious choice to be nurses who provide minimal care.

Sorry so long and tangential...

oldiebutgoodie, RN · Jan 1, 2008

HAPPY NEW YEAR TO YOU!
Well, yeah, I mostly never did leave on time, and very rarely ever sat at the nursing station, etc. HOWEVER, some of the things I would hear....
For instance, I actually had one patient who had been there for a few days and he actuallly told me that I was the first nurse who had "done that", palpated his radial pulses. This guy ended up with a vascular consult for possible radial DVT.
And I also had this one tech who had been there for 10+ years tell me how she loved how I always checked out the patients 'real good' and that she'd seen nurses who didn't even really touch their patients!!!
The point I'm getting to is: would I rather have accolades for being an "efficient time manager/nurse" or one of the best darn nurses (in terms of patient care) on the unit?? I guess it's obvious which one I picked. But at the same time, the whole "poor time management" label thing bothered the crap outta me.
Fortunately, there was another nurse there, very detail-oriented like me and very seasoned, and we would sit together (staying late and charting of course while everyone else had gone home) and we would talk about the lame nursing practice of those very staff members who were "oh so efficient".
For some reason, in my mind, it is ok to kinda judge them because they were more than likely making a conscious choice to be nurses who provide minimal care.
Sorry so long and tangential...

I think that "time management" is preached to nurses too much as:

1. Justification for giving nurses too many patients ("You just need to work on your time management")

2. An excuse for skipping certain things.

I agree that nurses will complete their tasks faster as they go along (naturally), and figure out short cuts, but it shouldn't be forced, because then basics are skipped (like assessments). I recall orienting in a new M/S unit and the precepting nurse gave me a funny look as I listened to chest, back, abdomen, checked skin, etc. She didn't say anything, but I have a feeling that my assessment was much more complete than the norm.

On my last M/S floor, there was a very detail-oriented nurse who the patients loved, but she was always staying late, doing charting, etc. She was the nurse that patients sent letters to the manager about praising her compassion. Of course, the manager is up her butt all the time because she is "slow". Very sad.

Oldiebutgoodie

NurseCherlove · Jan 1, 2008

i think that "time management" is preached to nurses too much as:
1. justification for giving nurses too many patients ("you just need to work on your time management")
2. an excuse for skipping certain things. except, you better not skip that customer service. don't you know it is more important to get that cup o' coffee to patients rather than listening to their chest, etc.
and don't forget...
3. they basically do not want to have to pay you that ot!!! like 30 minutes is gonna really be that substantial.
i agree that nurses will complete their tasks faster as they go along (naturally), and figure out short cuts, but it shouldn't be forced, because then basics are skipped (like assessments). i recall orienting in a new m/s unit and the precepting nurse gave me a funny look as i listened to chest, back, abdomen, checked skin, etc. she didn't say anything, but i have a feeling that my assessment was much more complete than the norm.
on my last m/s floor, there was a very detail-oriented nurse who the patients loved, but she was always staying late, doing charting, etc. she was the nurse that patients sent letters to the manager about praising her compassion. of course, the manager is up her butt all the time because she is "slow". very sad.
not trying to "toot my own horn" here, but this was me exactly. and the "time efficient nurses" would even snicker a little about how fast i walked to try and compensate. well, i can't help how i am, kinda type a and all. i know it's "impossible" to "do it all", but indeed, i would still try. do you know i actually had the manager tell me to just do the minimum? arrrgh. well, let's not go there....
oldiebutgoodie

happy new year to everybody at allnurses!!!!

squeakykitty · Jan 2, 2008

.........................
I mentioned to the other nurse that I was going to get his bowels going. I said to her that I thought we sometimes didn't pay enough attention to bowels. She kind of laughed it off, saying in essense that we had more important things to do, like making sure they are still breathing. I said that in LTC they really are on top of keeping the bowels going. I told her that I thought it would be nice to make sure the patient had a BM before sending him to the nursing home. She made some snotty remark about the inferiority of nursing home nurses, so I dropped the subject.
................

Heres something to tell her:

If the patient stays constipated long enough, they will stop breathing.

squeakykitty · Jan 2, 2008

One shift in SNF that had a BM log I had to stop and think.
I knew I had flushed a BM but it was mine!

:lol2:Let me see............

Medium, brown, well-formed-----Hey wait a minute! That's my BM!

:roll:roll:roll

FireStarterRN, BSN, RN · Jan 2, 2008

come to think of it, BMs do look like logs... :clown:

oldiebutgoodie, RN · Jan 3, 2008

come to think of it, BMs do look like logs...

Well, while we're on the subject, I DO hope you are aware of the Bristol Stool Scale, which gives you a nifty way to classify your or your patient's stools:

http://www.crappersquarterly.com/features/bristolstoolscale.htm

I actually listened to a speaker sponsored by Convatec Flexiseal who discussed the details of this.

Who says nursing ain't fun!

Oldiebutgoodie

PS So, would you say yours was a Type 3 or a Type 4? (please refer to illustration).

FireStarterRN, BSN, RN · Jan 3, 2008

Well, while we're on the subject, I DO hope you are aware of the Bristol Stool Scale, which gives you a nifty way to classify your or your patient's stools:
http://www.crappersquarterly.com/features/bristolstoolscale.htm
I actually listened to a speaker sponsored by Convatec Flexiseal who discussed the details of this.
Who says nursing ain't fun!
Oldiebutgoodie
PS So, would you say yours was a Type 3 or a Type 4? (please refer to illustration).

:lol2: is that a for real scale??? :lol2: LOL! :rotfl:

Regarding my own excretory matter, I refuse to reveal. :imbar:

Simba&NalasMom, LPN · Jan 3, 2008

And that's how we always got them back from the hospital. Not that badly, but always with a new decub, usually sacral.

One of my nursing school instructors who worked a lot of LTC was fond of saying "It's amazing how many stage IV's develop in the ambulance from the hospital back to the nursing home!" :lol2:

Having worked my first two years in LTC and FINALLY realizing that it was NEVER EVER gonna be a fit for me, I have nothing but respect for those who can stick it out in that specialty; I have no idea how those amazing nurses and aides do it. :balloons:

MAISY, RN-ER, BSN, RN · Jan 3, 2008

Hats off to all of you in LTC, definately not my bag. There is definately a place in heaven for "good" LTC nurses.

I can't say how patients end their time in hospital, but I can say that when they arrive part of our initial ER assessment is when our patient had their last bm and whether it was normal or not. If I have a

'hold' patient, I'll document BM's.....but I know most ER nurses will not. Foley outputs unless ordered aren't documented, as for bodysores of any type...I will seek them out for non-movers, and diapered individuals to have a baseline....even break out my measuring tape (floor nurses die when I actually have measurements of wounds and edema, marked with surgimarker too!) For all others, most skin issues are addressed at permanent room time.

Unfortunately, I have seen my share of flayed memberes, patients with nasty decubiti, nasty foleys, dressings, and many other signs of neglect exhibited by some LTC facilities. They are always the same ones. The ones who don't have staffing, the ones who always are sending the altered patients, the ones always sending those pneumonia and septic patients a day later than they should sent, the ones ems and als want no part of.

I think we should all work together, there just isn't enough continuity of care between facilities, charting, and patient parameters. IMHO continuity of care and ownership of patient conditions is the answer to better patient care between facilities.

Maisy

joyflnoyz, LPN · Jan 3, 2008

I have nothing but respect for those who can stick it out in that specialty; I have no idea how those amazing nurses and aides do it. :balloons:

We get hugs.:heartbeat

..and thank you