Who Must "Take the Fall?"

Specialties Geriatric

Published

You are reading page 4 of Who Must "Take the Fall?"

banditrn

1,249 Posts

Capecod - another thing, about being mad at our 'friends and co-workers' - well, yes, those of us that DO come in on time, and don't call in sick often do get mad at people like that - but we didn't hire them, and we can't fire them.

There are nurses and CNA's who routinely come in late and call in sick - the DON mentioned this at the meeting - she mentioned one CNA who had been late everyday for 3 months. Well, what I want to know is, why is she still there?

There is also a day nurse who routinely calls in sick the Monday after her week-end off. She has worked there for YEARS. So NOW the DON wants nite shift to put a note on her door if this particular nurse calls in. What, she can't check when she comes in to see that she's absent? She wants us to get involved in something that should have been taken care of long ago.

There are nurses and CNA's who routinely come in late and call in sick - the DON mentioned this at the meeting - she mentioned one CNA who had been late everyday for 3 months. Well, what I want to know is, why is she still there?

Where I was, there were no replacements. And everyone in the facility was pretty much related to one another, so the meds nurse who was 5 - 10 minutes late every morning was also the ADON's DIL.

It's hard to get nurses and aides when the pay is less than comparable facilities and the work is backbreakingly hard.

The management, though, usually doesn't get to set pay rates, although I believe they could certainly advocate for us better.

Simplepleasures

1,355 Posts

Where I was, there were no replacements. And everyone in the facility was pretty much related to one another, so the meds nurse who was 5 - 10 minutes late every morning was also the ADON's DIL.

It's hard to get nurses and aides when the pay is less than comparable facilities and the work is backbreakingly hard.

The management, though, usually doesn't get to set pay rates, although I believe they could certainly advocate for us better.

Even though I may seem to be anti management, Really I am not. The truth of the matter is I am anti LTC multibillion dollar a year industry that has created this nightmare. The mangement and even administrator may actually try to advocate for their staff and generally for a better workplace, BUT they dont usually last too long in that role, because it would COST too much MONEY.As CapeCod said, there are no staffing quotas mandated by state in LTC. So the corporate greed continues and the MESS in LTC continues.

CapeCodMermaid, RN

6,090 Posts

Specializes in Gerontology, Med surg, Home Health.

Yikes...this is scary Ingelein...I actually agree with you;) Things won't change in long term care until consumers make them change. When the people whose taxes pay the bills see what is going on, they will demand change....maybe not until THEY are in the SNF...but I think the day will come when things get better because the patients demand it. I will not be sticking around LTC long enough to see the change.

I am a better than average nurse...graduated at the top of my class. I know the regulations, know how to take care of really sick people and not so sick people who just want someone,anyone,to sit and talk to them for a few minutes. I've saved lives and greatly improved the lives of the residents in the facilities at which I've worked. But, when the surveyors come in, I get a sinking feeling in the pit of my stomach. It matters not how well we've done things. They, who couldn't do what they expect us to do, base their survey on standards which are practically impossible to follow given the constraints of time, money, and man(woman)power.

Unfortunately, the best most caring nurses will be forced to leave the LTC business and the residents will be left with uncaring administrators who work for the paycheck and not for the residents.

Sorry to carry on but after a week of short staffing and 13-14 hour days, I am fried.

Simplepleasures

1,355 Posts

Yikes...this is scary Ingelein...I actually agree with you;) Things won't change in long term care until consumers make them change. When the people whose taxes pay the bills see what is going on, they will demand change....maybe not until THEY are in the SNF...but I think the day will come when things get better because the patients demand it. I will not be sticking around LTC long enough to see the change.

I am a better than average nurse...graduated at the top of my class. I know the regulations, know how to take care of really sick people and not so sick people who just want someone,anyone,to sit and talk to them for a few minutes. I've saved lives and greatly improved the lives of the residents in the facilities at which I've worked. But, when the surveyors come in, I get a sinking feeling in the pit of my stomach. It matters not how well we've done things. They, who couldn't do what they expect us to do, base their survey on standards which are practically impossible to follow given the constraints of time, money, and man(woman)power.

Unfortunately, the best most caring nurses will be forced to leave the LTC business and the residents will be left with uncaring administrators who work for the paycheck and not for the residents.

Sorry to carry on but after a week of short staffing and 13-14 hour days, I am fried.

Cape Cod, I NEVER once thought that you were not a QUALITY person.I too have a deep distrust of the state surveyors, they have their own agenda and it is a mystery to me.Sometimes they pounce when it isnt important and sometimes they totally neglect to address something very wrong.I know I have harped about this book many times, but it really is worth reading, its by Mary Richards Rollins RN BSN titled "Patients, Pain and Politics".Its a true account of a WI state surveyor and the underhanded stuff she saw( much of it by the state itself) she talks about several DONs that are caught between a rock and a hard place.If I have come down on you too hard, I do apologise, I am so passionate about LTC reform I sometimes forget that management really is in a tough spot.

RobCPhT

83 Posts

I once read that the nursing home industry is regulated second only to nuclear energy. The common issue is that nurses can't possibly do their job by the books when they are understaffed. I also read that in 10 years the economy won't be able to afford nursing homes. This may be for the better, because when it comes down to the almightly dollar nursing home officials could care less about how many patiens you have or how many call lights are blinking. When is enough enough?

banditrn

1,249 Posts

Yikes...this is scary Ingelein...I actually agree with you;) Things won't change in long term care until consumers make them change. When the people whose taxes pay the bills see what is going on, they will demand change....maybe not until THEY are in the SNF...but I think the day will come when things get better because the patients demand it. I will not be sticking around LTC long enough to see the change.

I am a better than average nurse...graduated at the top of my class. I know the regulations, know how to take care of really sick people and not so sick people who just want someone,anyone,to sit and talk to them for a few minutes. I've saved lives and greatly improved the lives of the residents in the facilities at which I've worked. But, when the surveyors come in, I get a sinking feeling in the pit of my stomach. It matters not how well we've done things. They, who couldn't do what they expect us to do, base their survey on standards which are practically impossible to follow given the constraints of time, money, and man(woman)power.

Unfortunately, the best most caring nurses will be forced to leave the LTC business and the residents will be left with uncaring administrators who work for the paycheck and not for the residents.

Sorry to carry on but after a week of short staffing and 13-14 hour days, I am fried.

:D :D Yes, capecod, that is scary. And I understand what you're saying about the surveyors - I used to feel the same way about JCAHO at the hospital! Of all the potential for GOOD they could do - they would come in and get hung up on really stupid things that usually caused us to perform some MORE paperwork.

I mean, is it really that awful that nurses kept their own coffee cups in the unit kitchen?:uhoh3: It seems like they would get totally out of shape about things like that. I used to think they were a bunch of people trying to justify their jobs!!:madface:

I'm getting a sick feeling when I go to work anymore, knowing that the biggest amount of my time will be taken up with paperwork instead of peoplework. And heaven forbid, if I don't have every I, dotted, and T, crossed!

Long Term Care Columnist / Guide

VivaLasViejas, ASN, RN

22 Articles; 9,987 Posts

Specializes in LTC, assisted living, med-surg, psych.

I'm hearing an incredible amount of frustration here, on both sides of the desk.

What I'm NOT hearing is a sense that all of us---managers, nurses, aides, and ancillary staff---are in this together, and that gives me cause for concern. How can we fight the forces of evil (in this case, bureaucracy, greed, insurance companies, and the government) on behalf of the people we care for, if we're too busy fighting each other?

For what it's worth, it's not always the floor nurse who gets kicked to the curb after a sentinel event or a bad survey. A few years ago, I myself was fired from a resident-care manager position in one of the state's worst LTCs after only five months on the job. After a disastrous survey in which I was pressured to answer for things that happened two years before I ever went to work there to residents I never met or even heard of, the corporation that owned the facility decided it needed a sacrificial lamb as part of the plan of correction. And since the Medicare and young-adult units I oversaw both received several F- and G-tags apiece, I was it.

Now, it would have been easy to blame it all on the nurses and aides who "allowed" residents to develop fecal impactions and pressure ulcers while they "sat and did paperwork". The fact is, much of the fault lies with the patchwork mess that America calls a health care system, which puts profits before patients and keeps LTC facilities understaffed, undersupplied, and underpaid. I don't think very many nurses or aides go into elder care thinking, "Let's see, how little work can I possibly get away with? How many hours can I let little 75-pound Nora lie in one position so she'll develop a pressure ulcer? How many residents can I NOT feed so I can do all my charting and get out on time?"

It's the system that demands more and more paperwork, takes nurses away from the bedside, and directs the flow of money away from resident care. We cannot hope to change it if LTC management and staff are constantly at each other's throats. There is no "us vs. them". There is only us..........and the sooner we learn to ignore labels and remember what brought us into LTC in the first place (hopefully, it's an abiding love for the elderly and not the almighty $$), the more effective we can be in changing the system to make it work for the people it was intended to serve.

Call me Pollyanna, but that's how I feel. All of this infighting just weakens us and allows the bloated, dysfunctional bureaucracy that is at the heart of all that's wrong with health care in general---and LTC in particular---to keep growing. Let's stop viewing each other as adversaries, and work together in keeping the 'care' in long-term care.

banditrn

1,249 Posts

mjlrn - Girl - you are right, and your post was great!! But how do you propose we solve it?:o

heamoRN

6 Posts

once told this by a person who was taught this during orientation at forensic psychiatric unit.

we as nurses CARE!

COVER your

ASS and

RETAIN

EMPLOYMENT!!!!!!

BoomerRN

63 Posts

I have worked in LTC for 30 yrs. off and on and the same problems described above existed then as today. It seems to me that the public has been part of the problem. They can't/won't take care of grandma/grandpa and expect miracles from the facility. Also, part of the cause of the mountains of paperwork is the beaucracy which responds to complaints and just adds another piece of paper for the nurse to complete. I've always said that when the surveyors come to a facility, they get some charts go sit in a room with coffee, snacks & socialize. There could be patients rotting in bed and all they are concerned with is that every item on a checklist is checked. It seems that priorities are all mixed up in our society. I used to work my backside off helping the aides complete their work & a don or administrator would chew me out and wonder why I wasn't doing the paperwork instead. I did work for one (God bless them) nursing home that cared for the patients and staff and gave the nurses great support and lots of help. There was a union there. The nurses weren't in it but we received raises and other benefits whenever the cna, housekeepers, etc. did. We had a wonderful facility and I would still be there today but moved out of state. I love the elderly and they are not getting the best care and we that care for them are also getting treated badly. Just had to vent some tonight.

gitterbug

540 Posts

What is happening with you now? Hope you moved on to better things.

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