Frustrated and need to vent

Specialties Geriatric

Published

I work in a LTC facility which is very heavy. I work on a floor with 52 residents, all which need a lot of care, and quite a few are dying (not stable). Just for background there is one other long term floor with 52 residents and an acute rehab floor with 47 residents. Rehab floor has more nurses and is a breeze. Day shift is rough but there is usually 3 nurses on each floor plus the DON and a supervisior. On Evenings the long term floors have 1.5 nurses. One nurse gets split between both long term floors for treatments and the other nurse does meds (same for days on weekends only). Then the rehab floor has 2 nurses and there is 1 supervisior. On nights long term has 1 nurse on each floor, rehab has 2 nurses and we have 1 supervisior. If schedule is tight, the supervisior does the floor (on rehab).

The day nurses often want to give the evening nurses what ever they do not finish which is causing a lot of friction. Of course one particular evening nurse always says why isn't this done... blah blah. Well the next day I have to listen to the bickering (I work nights).

Usually I say, you know its really hard on evenings... Well, recently there is a Rt who was not able to be hemodialysised (she has an emboli in the AV graft). She is do not hospitalize. So, we are caring for her. She had a STAT BMP done and potassium was 6.4. Day nurse received order for Kayexalate, but did not put in the computer nor did she give it. I know its hard on weekends blah blah, they have less staff. However, that is a med that should be given STAT, we have in the E box, so no excuses! This nurse is very good and I respect her, but come on!! I am so sick of BS! All morning the two nurses are going back and forth, why is evenings complaining... Oh she worked Saturday on days so now she knows how it is haha. No, maybe they should work eves and see how it is!! No one, and I mean no nurse gets out on time! That evening nurse often stays an hr past her time. No one gets paid for leaving late, but most people finish their job and then gripe about not getting paid.

Regardless, of how much work each shift has, work should not be passed along to the next shift especially important orders!

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Specializes in LTC, Nursing Management, WCC.

Where I work, passing of work is an unfortunate byproduct of cutting labor and overtime. But not the STAT stuff. That should be done STAT. So, the morning shift should be faxing their INR results right away, so they get orders sooner. I used to work with this AM nurse who would wait until 1:30 to fax her stuff out... ALL OF IT and I would come in on PMs and guess how much crap would be getting faxed to us at 5 PM. GRRRR... But passing things to the next shift (again, non urgent), is the nature of the beast and it should be mentioned in report.

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Specializes in LTC, Nursing Management, WCC.

What gets me is when something comes to the unit at let's say 11:00 (non urgent, no med orders, etc), it gets passed to PM (little irritated), PMs passes it to NOCs, (getting pretty ticked) and then NOCs passes it to AMs. Are you kidding me!! I have been telling the nurses they need to time manage better. All this passing is dangerous and the order might get lost plus there is NO reason it should be "floating" around for 24 hours. As a nurse manager, that gets my goat.

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Specializes in PCU.

Wow. Some things will be passed to the next shift as sometimes we cannot get everything done on days. However, Kayexelate for high K+ levels is considered a STAT order and must be administered STAT, not whenever the nurse feels like it. You may respect the nurse who passed this to the next shift, but she was not looking out for her patient. Kayexelate is better given earlier than later, as the diarrhea it causes increases the risk for falls, especially as the evening progresses and nobody wants to be getting on the pot all night long. That is just not right. This particular incident would be considered an incident report at my facility. No excuses.

Some things can be handed off to the next shift, but when it becomes a chronic malady, something needs to change for the safety of your patients.

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yep, agree about the stat order not being done...

poor, poor nsg judgment.

we nurses need to know how to prioritize, vs what can be passed on.

seriously...no excuses for that.

leslie

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Then there are the orders for stool for guiac that go on for months, as if the Rt never has a BM :rolleyes: .

For some reason they think only nights can get a urine specimen.

I don't mind when some things get passed along but it seems to be getting out of hand at the facility I work at. Pt/inrs are often passed along here too and that is not cool.

Plus, that nurse should have never made the next nurse put the order in the computer. She received the order so she has to follow it through. There is no "I don't have time for this" and leaving.

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Specializes in ED/ICU/TELEMETRY/LTC.

I understand your need to rant. However it's not going to go very far getting your problem solved. If stat meds aren't given in a timely manner (I bet there is policy), it 's a med error.

You have two choices if you want to stop this.

1. Tell the nurse who didn't give it to give it before going home

2. Write up a med error.

I bet it won't happen again.

As for the ever and ongoing stool for guiac not getting done. As the manager I fixed that in my facility. You have one week. After that, you have an index finger and a glove.

Things handled straight forwardly and simply will not always win friends but they ususally get the job done. COB

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Specializes in Med/Surg/Tele/SNF-LTC/Supervisory.

There will always be things passed on from shift to shift. No amount of squawking seems to get things to change where I have been. However! That Kayex order should have taken priority!

I agree.. nights always being assigned to get urine! Especially from a resident that uses the toilet.. grrrrr.!!

What gets me, especially recently.. a day nurse saw CLEARLY that I was staying late to finish things up, has the GALL to ask me, "are you going to be here for a while"? With the intention fo asking me to do something for her...NERVY huh!? Some people just don't get it, or just don't CARE!

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Yes think you just got dumped on. Happens so often. Not everyone has the same work ethic and it is not a supportive team member. Am finding many are just so self focused and the good ole team gets forgotten. Better luck next time. Hang in there!!

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i'm a student and last month during a clinical i ran into a similar situation.

the clinical day was almost over and it was time to do blood sugars. our instructor had gone to get the glucometer (there was only one for the unit) the nursing assistant had it and said that she would do the blood sugars.

when my instructor told charge nurse she SNEERED at my instructor and made it clear that that was not acceptable.

so we went and got the meter and began to get the blood sugars. everyone of them was >200 and when compared to the pt's usually numbers way above normal. we told our instructor and the charge nurse that we were concerned that the meter was malfunctioning and didn't think the numbers were correct. the charge nurse didn't seem to care and made it clear that she and the nurses wanted nothing to do with those blood sugars and if they needed to be treated we were suppose to do it. so were gave the pt insulin as per sliding scale charted it and then left the unit. none of us felt good about it but felt like as student we had no choice.

the semester before i had clinicals on the floor above. the nurses there were very supportive and took the time to show us all the interesting thing that were going on with the patients on the floor: wound care: picc line dressing changes; tpn ect. who knew that there could be such a difference just one floor down.

that day the pt assigned to me was the pt of one of the "meanies" at the nurses station. the whole time i was there she never checked on the pt. i was with the pt. almost continously for 6hrs. the nurse was so gruff and nasty i dreaded talking to her. she treated me like i was a PIA when i asked for the PT's mar so i could administer the scheduled meds and if she could print out the pt's new lab results.

when i went to see my pt at preclinical she was coughing and said she was having trouble breathing. she had a permanent trach because 20 years before she had damage to her trachea r/t trauma from domestic violence. she was normally never on O2 but they had a collar on the trach and the O2 was at > 15L. (the highest level on the gauge was 15 and the little ball was above that) there was no humidification and it was obvious that the O2 was too high and drying and causing secretions to be thick. twice i asked the nursing to come suction the pt (i didn't think i was allowd to do it because my instructor wasn't present). i asked if it was possible for her have the O2 humidified and was told she didn't need it. the secretions that were suction out were dark red. i asked if that was normal (i had never had a pt that required suctioning) and was told the suctioning sometimes caused the bleeding the nurse seemed unconcerned. i couldn't find any orders in her chart for O2 let alone 15L. i was very worried about the pt when i left and told to hit her call button as soon as she has any problems breathing. in the morning she was on 2L of humidified O2. surprise surprise. she said she was feeling much better.

i never could understand why they continued to give her O2 when their were no orders for it. also i was the only person (perhaps beside her doctor) who asked her why she had the trach in the first place.

luckily this was first time this happened. that unit just seemed like a miserable place to work filled with miserable nurses.

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Specializes in PCU.
Then there are the orders for stool for [guaiac] that go on for months, as if the Rt never has a BM :rolleyes: .

For some reason they think only nights can get a urine specimen.

I don't mind when some things get passed along but it seems to be getting out of hand at the facility I work at. Pt/inrs are often passed along here too and that is not cool.

Plus, that nurse should have never made the next nurse put the order in the computer. She received the order so she has to follow it through. There is no "I don't have time for this" and leaving.

There should be a protocol in place regarding "STAT, ASAP, Now, Routine" orders and a time limit within which it is acceptable to carry them out. We have a 30 min window w/STAT orders (it may take an hour, depending on pharmacy). Any antibiotic order must be administered within 4h of the original order or it is considered a med error. Routine orders usually must be carried out within the shift the order was placed (i.e. things the nurse can do herself vs procedures that must be done by ancillary, i.e. echo, stress test, etc). 2h seems to be the median time for carrying out routine orders.

If several shifts go by without a urine collection, that needs to be addressed. Either the patient urinated and therefore no excuse for missing at least one of the urine collections or the patient is having issues (i.e. retaining urine, anuric!), in which case the nurse is responsible for finding out why the patient isn't peeing and getting appropriate orders. In our LTC, we used to have to call for straight cath orders if we could not collect a urine in a timely manner.

If no BM within 2 days (charted and/or stated for A&O x3), ALL of my patients get a suppository and/or prune juice w/butter on the 3rd day. Ideally, I want my patients to have a BM BEFORE the next shift comes online. And voila! There is your stool sample. Besides, routine bowel habits/movements decrease the risk of further problems developing:)

With that being said, if you are in LTC I feel for you. The nurse to patient ratio facilitates sloppy carrying out of orders due to too many patients, needs, requirements that must be met by the nurse on duty. It would be lovely if there were a max ratio set to ensure safety, for both the patients and the nurses at these facilities. When I worked LTC, my area had a 1:28 ratio. However, as the only RN on the floor, I was also assigned to "supervise" or assist the LPNs working the other areas (thank God for experienced, caring LPNs that made "supervising" inconsequential:D) and sometimes when we were down a nurse, I was also in charge of the lock-down Alzheimer/dementia unit, so I would run from one area to the other, praying that I would not make any mistakes, have any falls, etc :uhoh3: One of my CNAs was a God-send to me and a blessing to our patients. All shift long we would pass each other on the fly from one end to the other (I think she and I were the only ones who ran back and forth...lol...made the older, more experienced nurses laugh, but we got the job done in a timely manner at least:up:). My heart goes out to all the LTC nurses out there. It is one heck of a job.

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Specializes in PCU.
i'm a student and last month during a clinical i ran into a similar situation.

the clinical day was almost over and it was time to do blood sugars. our instructor had gone to get the glucometer (there was only one for the unit) the nursing assistant had it and said that she would do the blood sugars.

when my instructor told charge nurse she SNEERED at my instructor and made it clear that that was not acceptable.

[...].

The floor w/the "meanie" nurses sounds like a very toxic and dangerous work environment. Avoid it like the plague:eek:

It is good that you got to witness both sides of the coin as far as the two different nursing units. It will give you a better feel for what you are looking for as you progress in your career.

As to the sneering and oversights by the core staff on that floor, shame on them. Regardless of whether or not the patient has a student nurse, the patient is still "my" patient if I am the nurse assigned to him/her and I must round on the patient just like I will round on everyone else. You are a student. Things might be missed. Meds might be inappropriate/missed/whatever! Besides, if there are questions, we need to be available to answer those questions or at least direct you to the appropriate sources if we ourselves cannot answer them (i.e. pharmacy, lab, etc.). We have had patients whose meds would have been very late had I not been keeping an eye out double-checking the MAR (preceptor was running behind). Conditions change. I am responsible for calling a rapid response and giving report when they arrive if my patient goes downhill. What if the patient is receiving Methotrexate! Will the nursing student be aware that she must wear gloves handling this med? And gloves w/nitro paste, as it is absorbed through the skin?

If there is a question as to the accuracy of the glucometer, it would have been easy enough for the nurse to run a systems check (i.e. run controls and see results) to ensure proper numbers.

You guys will be on the floor with us eventually. It behooves us to give you information and assistance so when you finally are on the floor as one of us you will be an asset and not a detriment to the care of our patients:mad:

Good luck in your studies:up:

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