Hi I am a new graduate nurse and I just got my first job in a long term care facilty. We have rehab, alzheimers and a psych unit. I am so happy to have a job and to get 3 weeks of orientation but a few things have me confused. I am hoping to get some imput from more experienced LTC nurses.
1.) Med Pass - we were always taught to check med, dose, patient id, etc 3x. The patients in our facilty do not have id bracelets on. In the mar some of the patients have pictures but not all of them and they don't always look the same as the picture. The alzheimers and psych patients can't always tell you who they are or sometimes tell you they are someone else! They lay in each others beds and I have found some with clothes with other peoples names in them. I have resorted to asking the cna's " is this so and so". The cna's are very busy and I think get a little annoyed with my constant questions about who is who. Even though I am orienting, I do med pass by myself. It seems to take me about 3 days to get the 28 or so residents memorized but I still get very nervous giving medications w/o positive id. Is this common?
2.) Treatments. The nurses mostly just sign off on the treatment book. When I was in school I did all treatments myself at clinicals...if I signed it, I did it. (but I had less patients and no paperwork). Nurses at work say the cna's put zinc and barrier creams on when they change the residents but I have yet to see any white coated butts! The nurses just do the bandaging and dressing change treatments. Is this normal?
3.) In the locked down psych unit patient wander around alot. Men go into women's rooms uninvited. It is common for residents to walk off with other residents items. I have heard family complaing about this. I even had one resident say she had been raped. The regular staff said there is no way this happened and that this particular resident shouts out all kinds of things and that it is a part of her dementia. However, given that the male patients enter the females rooms, I can see that this could have happend...a activities employee reported it to social services. The social service director(who looks like she is 12) investigated it and some of the nursing and cna staff got angry an complained about interfearance
4.) Medpass. I work 7-3, first med pass is 9am, residents are pulled for activities and therapy in the morning. Many of my patients are gone from 9 - 11:30. We are not allowed to interupt therapy or activities for meds. We are suppossed to give meds within a 30 minute window of the time they are ordered for? Excuse me but *****
I asked the ADON what to do about this, she said well we are not suppossed to interupt therapy or activities but sometimes when I worked the floor I would sneak the meds to them in my pocket...I don't want to sneak anything, I want to do the right thing...wish I knew what it is. Currently I start my med pass as close after shift report as possible and get the patients first who I think might leave.
5.) Paperwork. What a cumbersome task. We do not have computer records and the paperwork is totally interfearing with getting the job done. We have 2 people (cna + nurse) recording vitals in three different places...does that make sense? We have 3 ring binder after 3 ring binders full of cumbersome paperwork, that must have your full attention while you are suppossed to be caring for the patients? (don't the patient's need your full attention?) Sometimes I think it would be better to come in 1/2 hour before your shift starts and stay 1/2 hour later to do this while some other nurse is caring for the patients, but this is not allowed.
Please let me know...is this just the way it is. Do I just need to learn "real world nursing" as I hear so much about. Can I use the "real world nursing" argument when I am before the board because I messed up (I don't think so) Are there facilities who are better about patient care than this, should I be looking for another job?
Somebody with some experience please help me out!!!
Specializes in Acute Care Hosp, Nursing Home, Clinics.
Sorry my friend that place sounds more like a wherehouse than a LTC. I don't know what State you're in but in Calif that place would either be heavley fined or closed. What do the Care Plans say? What is the Plan of Action for people going into other peoples rooms? That is a violation of Privacy. Who is responsible for updating photos and why hasn't it been done? Why are they not wearing ID Bands? What does the Care Plan say about ID bans? According to Title 22 Regs (Calif) You cannot give meds or tx to residents while they are engaged in an activity it's considered "invasion of privacy". Nurses who sign off on tx and don't actually do them are commiting a crime. It's called NEGLECT.
There is a lot going on here that needs to be fixed not try to find a way to make it work. As a new grad you will find some things that are not as taught in school. What they teach you in school if the ideal situation. What happens on the floor usually ends up somewhat modified to meet the needs of the patient or facility. What you have going is outright neglect. I am reluctant to tell you to find another job because someone needs to report these problems to the correct Authority. But there is too much CYA going on there and if it were me I wouldn't risk it. The patients in this facility deserve better and if this facility is so poorly managed it needs to get attention from the Sate Licensing Agency. If you work in Calif you are mandated to report neglect under penality of the law. I actually think it is now a federal law and comes under the "Patient's Rights Act" Good Luck and God Help the patients.
Specializes in Acute Care Hosp, Nursing Home, Clinics.
Hi. I just wanted to ask how you got hired in LTC as a new grad? I got my license 6 months ago and I still don't have a job. - Im in SF area. Need some advice please....
thanks : )
Probably because you live in Calif. Many LTC's are hiring only R.N.'s because they are taking on IV Therapy to increase their revenue. There are other things you can do. Women's Clinics and MedStops hire LVN's. More Doc's are hiring LVN's. They don't pay that well but it's good experience. California is hiring LVN's for their Correctional Facilities. Community Colleges are hiring experienced LVN's to teach their C.N.A. Classes (some) Keep looking and Good Luck.
To Redroses13, I must admit - it is hard to find a job as a new grad. I actually drove around all day with resume's in my car and just walked into places. I would ask the receptionist if they were taking applications. Some places told me to fill applications out online, but I think the personal visit helped to put a face with the name. I filled out a lot of applications. I searched state job sites and all of the company websites for job openings day after day until someone hired me. It took a little over a month to find a part time job. If I don't get enough hours I am going to go back around and sign up for prn jobs near my home. Good luck, persistence and determination pay off in the end!
PS- I don't know if by SF you mean San Francisco or South Fla.
I hate to be a Debbie Downer but I see a lot of people saying it will get better but I been doing this for 10 years now worked all over NJ in all the LTC places its the same! I have two girlfriends one in NY and one in NC and my mom in VA all who are LPN's who share the same story. I'm sorry I'm a great nurse I always try to do my job the way it should be but it's just impossible!!! I feel working in LTC is a trap it's a set up there is NO WAY anyone can do it the way it should be done, I been saying this for years and I also have asked my coworkers who claim that it doesnt bother them and oh I can get it done to show me how!! It's been 10 years and I still waiting!!
Timetoshine, your state must have the most perfect of nursing homes:yeah:
In a dementia/alzheimer's unit I would love to know how you regulate people going in other people's rooms?? That's WHY they are in that unit of the facility.
Try calling your board of nursing to report a nurse for signing out treatments before they are given, see how hard they laugh because they have much more serious allegations to attend to unfortunately.
Most states don't require name bands in long term care. It's their home, they don't feel they should have to be banded 24/7 for the rest of their lives. I agree, even though it can make it difficult when you are new. You'll learn the names in good time and then it will be so much easier. I actually think learning who is who is the hardest part. When you ask "who is Mary", don't accept the answer "the lady with the white curly hair and glasses"!! haha :)
I have worked in long term care for over 10 years and unfortunately my experience sounds just like the OP's experience. Short staff, uncaring staff (not all, but there are always enough to make you want to hurl), paperwork up the ying yang (I have to do everything by hand also), nurses who have given the treatments and meds long enough that they rarely even check the MARS/TARS like they should (and even myself guilty of it at times when it's chaotic). Honestly, people don't give LTC nurses the credit they deserve. We don't get 6 to 10 patients, we get more like 15-40 (I get 40 to myself!). We assist the aides because we care about the residents and know they have no control over the unfair staff to resident ratio. We stay late because we want to make sure all the i's are dotted and the t's are crossed. We deal with much! But if you love the elderly you will get through it, and you'll come to love the people you care for more than hate the rest of the doings.. and you'll know that you are making a difference because you CARE.. we need more people that care :heartbeat
Specializes in Acute Care Hosp, Nursing Home, Clinics.
Timetoshine, your state must have the most perfect of nursing homes:yeah:
In a dementia/alzheimer's unit I would love to know how you regulate people going in other people's rooms?? That's WHY they are in that unit of the facility.
Try calling your board of nursing to report a nurse for signing out treatments before they are given, see how hard they laugh because they have much more serious allegations to attend to unfortunately.
Most states don't require name bands in long term care. It's their home, they don't feel they should have to be banded 24/7 for the rest of their lives. I agree, even though it can make it difficult when you are new. You'll learn the names in good time and then it will be so much easier. I actually think learning who is who is the hardest part. When you ask "who is Mary", don't accept the answer "the lady with the white curly hair and glasses"!! haha :)
I have worked in long term care for over 10 years and unfortunately my experience sounds just like the OP's experience. Short staff, uncaring staff (not all, but there are always enough to make you want to hurl), paperwork up the ying yang (I have to do everything by hand also), nurses who have given the treatments and meds long enough that they rarely even check the MARS/TARS like they should (and even myself guilty of it at times when it's chaotic). Honestly, people don't give LTC nurses the credit they deserve. We don't get 6 to 10 patients, we get more like 15-40 (I get 40 to myself!). We assist the aides because we care about the residents and know they have no control over the unfair staff to resident ratio. We stay late because we want to make sure all the i's are dotted and the t's are crossed. We deal with much! But if you love the elderly you will get through it, and you'll come to love the people you care for more than hate the rest of the doings.. and you'll know that you are making a difference because you CARE.. we need more people that care :heartbeat
I wish I could give you a hug. Everything you are doing is the right thing to do. But everything you, and the others, who find themselves in the same situation do, only contributes to the problems if you just try "to go along to get along. Facilities like yours are Warehouses were people just go to die and there are too many of them in this Country. It is going to take someone who is not afraid to take the people running this Facility to the State Board of Licensing and demand they investigate. All of these facilities receive the majority of their revenue from State and Federal Funds. If the response from the State is not satisfactory then it needs to be taken toThe Dept of Health and Human Services.
I don't know what State you live in but I can assure you the Feds don't fool around with situations like you describe and I know you and the others are telling the truth because I have been there and know exactly what you are talking about. Nursing Home Administrators complain they are underfunded and they are for the most part but that does not excuse the neglect and improper treatment of the frail and elderly they serve, and it is not always the case.
I was fortunate in the last years of my Nursing Career I worked for a non-profit and a D.O.N. and Admin. who encouraged and supported me in "Raising The Bar of Expectations" It was not a "perfect" Nursing Home but it was managed by people who were also Patient Advocates and open to new ideas.
I want to thank you for helping the C.N.A's when there is a crunch and I want to thank you for this post At the very least you know you are not alone but aside from that you have identified what is wrong with Nursing in a Nursing Home. Can it be fixed? Only when people like you decide to "Raise the Bar of Expectations" and refuse to accept the conditions all of you are trying to deal with now. :redbeathe
Well I guess I am not alone. I am currently working in a long term care facility on the locked down unit. I have twenty men with bran injueries, that are on this unit b/c they are dangerous to themselves or others ( mostley others). I have been spit on, slapped, and yes walked around with a black eye. But the worst is when the doctor yells at me over the phone. I feel as though when I talk to him about labs, or a patients complaints, I am not giving the correct information... or slow taking his order. I too am truely thinking of working at McDonalds, at least there if someone gets burned I won't get hit while applying Ice, and whats the worst, I burn a few fries.
Yes that sounds about right. I have been working at a LTC for a little over 2 yrs and yes my first day andsome days it still is sorta like that. 1. Learn to prioritize. 2. Delegate less critical tasks. 3. Hang in there!
Just an update for everyone. I resigned from my SNF job and took a job at an ALF. Wish I could say this was a happy ending but sometimes I feel like I should have stayed with the old job. I got to do more at the SNF. I was learning more at the SNF and they were less concerned with the bottom line. The ALF job is easier but I am afraid that I will loose skills if I stay here long. The surroundings are more pleasant, which is nice but the DON is so cheap with the budget that we constantly run out of gloves and have no 11p-7a nurse! In hindsight I believe it was a mistake to quit the SNF job and just wanted to let others know.
Thanks for the update Krisintheweb. I'm just beginning school this month. Your experience is something I will have to keep in mind when I begin working.
Good Luck in school. Nursing school is hard but try to remember to enjoy it! Although I have made some mistakes starting out, I am very glad that I became a nurse. Working as a nurse is very rewarding if you like taking care of people and I always say that my nursing education was the best investment I ever made:idea:. At least I am able to pick and choose jobs in this economy!
timetoshine
74 Posts
Sorry my friend that place sounds more like a wherehouse than a LTC. I don't know what State you're in but in Calif that place would either be heavley fined or closed. What do the Care Plans say? What is the Plan of Action for people going into other peoples rooms? That is a violation of Privacy. Who is responsible for updating photos and why hasn't it been done? Why are they not wearing ID Bands? What does the Care Plan say about ID bans? According to Title 22 Regs (Calif) You cannot give meds or tx to residents while they are engaged in an activity it's considered "invasion of privacy". Nurses who sign off on tx and don't actually do them are commiting a crime. It's called NEGLECT.
There is a lot going on here that needs to be fixed not try to find a way to make it work. As a new grad you will find some things that are not as taught in school. What they teach you in school if the ideal situation. What happens on the floor usually ends up somewhat modified to meet the needs of the patient or facility. What you have going is outright neglect. I am reluctant to tell you to find another job because someone needs to report these problems to the correct Authority. But there is too much CYA going on there and if it were me I wouldn't risk it. The patients in this facility deserve better and if this facility is so poorly managed it needs to get attention from the Sate Licensing Agency. If you work in Calif you are mandated to report neglect under penality of the law. I actually think it is now a federal law and comes under the "Patient's Rights Act" Good Luck and God Help the patients.