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Discussion

Guilty and relieved at the same time

So, I am finally leaving the SNF that I have been working at for the last 3 years. Over that time, I have seen a steady decay in the quality of care provided--mostly r/t reduced staffing, scarcity of supplies, loss of faith and trust in the DON and administrator and complete loss of respect for the doctors who are responsible for the health of our residents.

One of those doctors has been heard--in the facility within the hearing of his patients--telling a young PA student "...and remember that these patients are pretty much dying anyway, so we do as little as possible for them." I have a resident who's protime is at a critical level (+50) and it took the better of the 2 doctors over 24 hours to get back to us (following multiple phone calls, faxes, messages left with several of the doctor's staff) with the measly response of "hold coumadin for today. cut coumadin order in half and recheck in a week."

You may recall me mentioning an interaction with the DON who came to my house one morning (after a hellish noc shift) because she couldn't understand why I'd put a newly doubled lasix order on hold for a resident with a newly found critically low potassium level. Another example of waiting for almost a full day to hear back from those doctors about a critical lab level after multiple phone calls and faxes and messages from us to them.

The other noc nurse quit a couple of months ago (the two of us split the entire week of 12 hour shifts, each working 3 12s one week and 4 12s the next) and so we've had pool/travel nurses in for half the week and residents are not happy. The evening med pass is insane (every single travel nurse has commented on how they've "never seen anything like it"), and I've found myself resorting to unsafe practices to get it done in a reasonable time. My CNA staffing is minimal--sometimes there's only 1 CNA in the building and she is locked away on the special care unit, leaving me alone with the other 3 halls. Day and evening staffing has become skeletal also, meaning that we are triaging care rather than giving good care.

Bringing these concerns (along with multiple safety concerns and possible elder abuse by one of the CNAs) to the administrator and DON goes absolutely nowhere, except perhaps for hearing about how we are not actually short-staffed, "we (the DON and admin) are ALWAYS here to help (they sure are when state surveyors are around!) and stop spreading such negativity, just be positive!"

I've finally had enough and have been hired at the #1 ranked facility in the state (a not-for profit facility that I've heard really good things about from other nurses who work there). I'm excited to go but feel so guilty for leaving my residents in that hell hole! Every single one of my residents have replied with tears, expressed fears of "what will happen to us now" or "can anything I do make you stay? or "how can you leave us?" I've come close to backing out of the new job after several residents asked me to stay--but I don't think I can take more time there. I'm doing the right thing by leaving, right?

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    I'm doing the right thing by leaving, right?
    You don't need anyone's validation to leave the house of jokes that you've been working at for the past three years. Your reasons for doing so are more than valid.

    I wish you the best of luck with your journey. Change can be scary, but often worth it.

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    Wow...your post just described what I've been going through at work. After 13 years I am contemplating leaving. I love geriatrics and I love LTC, I just can't take the politics anymore. It's messing with my morale. Your post really hit home for me. Thanks for sharing and keep us posted on your new job!

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    That place sounds about as psychotic as the place I left a year ago. I stuck it out for 5 years, and felt like I was putting my license on the line every time I set foot in the building. If nobody else is going to have your back, and they can't get their collective %#^* together, then you need to protect your family, your license, and your sanity, and if leaving is what it takes, then it's time to go.

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    The best thing you can do for the residents stuck there is to drop a dime with the state ombudsman.

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    One of things I have always said is something my father has said to me. If you wake up one day and just dread going to work, or you at work and to the point you cannot do it anymore; then yes its time to go. If you are unhappy or feel that your career is at stake...then yes, you are doing the right thing. Good luck on your journey!

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    It is so sad that we treat our elderly in this way all due to the almighty dollar. I have the utmost respect for those that that can do this.

    I know that I could never do your job!

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    I think you are absolutely making the right decision and I agree about calling the State Ombudsman.

    Those working conditions sound horrid and yes those poor poor residents.

    It's shameful the poor response from the physicians. This is really frightening for those of us getting up there in age as well.

    What's it going to be like in another 10 years? State staffing minimums just don't cut it in the real world. Counting the DON/Management among the staff? LOL, that's a laugh.

    I haven't had a manager come work the floor with me when there's been a staff shortage in the last 20 years.

    Best of luck on your job!

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    Well, I've been in LTC now for the last 16 years. What I have seen is that facilities ebb and flow in quality. I have worked at 5 Star facilities and 1 Star facilities, helped get a de-certified facility back certified, and lots of other in between situations. I have seen staff that stays through thick and thin, not understanding how they can suffer the low tide times. I tend to ditch fairly quickly (once within 12 weeks) if the care is too scary. I never fear a new job when coming from a bad situation. Later when I check back I usually find that things have improved after a time. Long ago stopped worrying about residents receiving sub standard care, and like any good airline passenger, keep my own oxygen mask on before helping anyone else with theirs. The point of this ramble is that my own philosophy is not to support bad care by staying.

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    I get the guilt feeling, even though you've done nothing wrong. I stayed with a lousy facility with crappy conditions for residents and staff for the simple reasoning of, "well if I don't stay and help them (the residents) who will?"...that kind of mentality will wear you out quickly, and before you know it, you not only dread going to work everyday but your home life suffers along with it and your family doesn't recognize you as the once happy mother/wife/sister/daughter etc because that kind of stress eats at you as a human being. I left after almost 1 year in a similar hell hole. Best decision I could of made. It was hard leaving the residents there, but I had to get out. A tip to the state would never hurt either. Good luck with your new job

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    "A tip to the state would never hurt either." A few of you have mentioned calling the state--it is something I considered but ended up not doing as the State surveyors showed up, completely unannounced, my second to last day of work there. Someone (don't know if it was staff, resident, family or one of the pool nurses that have been filling in the noc shifts) called to report insufficient staffing. I don't know the end result, but I do know that they spoke with several of the fully alert and aware residents who gave rather scathing reports of the staffing and the administration. The surveyors noticed that the administrator and DON were really helping out on the floor and asked every resident and staff that they spoke with if this was common and the response received from everyone was "only when you guys show up."

    I do know that my own stress level has reduced so greatly that after turning in my notice--even with 2 weeks left to go--I noticed an immediate change in my mood and have been able to stop taking pepcid 1-2 times a day and haven't had a single tums since my last day. That't pretty good as I used to eat those like candy. I start my new job on Monday--they actually have a 2 week orientation period, which is great, and I'm looking forward to it. Having 24 residents rather than 49 sounds amazing!

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