Help! The worst training ever!

banditrn · Dec 27, 2006

The correct way is always going to be what the facility policy and procedure manual says. That manual is the final word. Whenever anything goes wrong, whether it be something involving a lawsuit, accreditation or a facility licensing violation, the facility's policy and procedure manuals are one of the first places that everybody goes looking. The reason is because these things are in black and white, set in stone. There are certain procedures and policies that you'll want to become familiar with. Get xerox copies of them and put them on a clipboard you keep with you. One might be on the facility fire policy. You might also have a policy on notification of physicians. You are going to find policies on all kinds of things you probably never thought of. So, it's always a good idea to periodically go through these books just to refresh yourself as to what is in them. I've always felt that everyone should go through another refresher orientation after 6 months on the job because there is so much you just don't "pick up" in the first days of working. When I worked in the acute hospital I had xerox copies of the policies on hypoglycemic and heparin protocols, and arrhythmia protocols when I worked on a stepdown unit. When I worked in nursing homes I also kept a list of all the patients who were DNRs on my clipboard.
If you find that someone is telling you to do something that is different from what the policy and procedure book says then go to the DON and ask him/her to clarify it for you. If the DON is also going against the written policy, then I would ask why the written policy hasn't been changed and won't the facility get in trouble with the state surveyors.
When it comes to nursing you will never go wrong with the basic things. When you chart, chart facts. I used to ask the MDS nurse to help tell me what was important to be charted, particularly on the Medicare patients. The MDS nurse depends on the nurses charting to complete the MDS reports that have to be sent to Medicare every 90 days. Once I got oriented and comfortable with a place I found out who to call at the pharmacy to find out how to get things changed on the monthly printouts of the MARs and TARs. What you will find is that some people, but not all, will know the answers to some of your questions, and other times you'll have to go searching for your own answers. But, keep in mind that there are right and wrong ways to do things. Someone will know the answers to your questions. Sometimes it will just be a matter of who. And, when the state surveyors come in for their onsite inspection, these nurses who are such bad examples are going to suddenly have a great transformation, I promise! And, they will be revealed for the hypocrites and lazy marys they really are.
If you are ever in question about the way something is being done, either post a question on a thread here on allnurses, or do a search of the forums for that subject. One thing you will find is that the nurses on allnurses are never without something to say on a subject! Let me also say, that as crappy a beginning as I had when I started in LTC (and my beginning was really crappy) I was determined not to become negative and lazy myself. I've busted my rear end over the years to bring quality to my nursing when ever I've worked in a LTC and I'm proud of that. There are some of us who do want to see things done correctly. I am very much aware of what kind of lowlife nurses still work in nursing homes. You can't let them beat you down. You have know that you are better because you stand for quality. You'll like yourself better at the end of every day. I promise.

Daytonite - I understand what you're saying, but what should be isn't always what IS! At the last facility when they started accepting trached patients, I wanted a policy and procedure - went thru their books and there was none. One finally showed up after the third patient.

Now at this facility, they've accepted two, and NO ONE knew how to take care of them - I was absolutely appalled when I came in the first nite to take care of this new fella to learn that none of the girls there had ever taken care of a patient like that!! I had to do a quick inservice for the girls - but I wanted to know why the facility hadn't done that?! No one could tell me where the policy and procedure manual was!!

When I finally got ahold of the DON, who is fairly new, she had no idea that the nurses there hadn't ever suctioned or taken care of that type of patient. I asked her about the P&P manual and she told me that she'd been trying to work on it - so I volunteered to type anything she needed on my own time.

Another thing I found out before I talked to her, was that some of them wouldn't admit that they didn't know what they were doing, so they thought they'd just come to me on the QT - well, that doesn't impress me - if I don't know something, I admit it. The DON NEEDED to know what kind of situation had been created by accepting residents without knowing if the nurses had the skills to care for them.

But who would I have reported these situations too?

Simplepleasures · Dec 27, 2006

When I finally got ahold of the DON, who is fairly new, she had no idea that the nurses there hadn't ever suctioned or taken care of that type of patient. I asked her about the P&P manual and she told me that she'd been trying to work on it - so I volunteered to type anything she needed on my own time.
Another thing I found out before I talked to her, was that some of them wouldn't admit that they didn't know what they were doing, so they thought they'd just come to me on the QT - well, that doesn't impress me - if I don't know something, I admit it. The DON NEEDED to know what kind of situation had been created by accepting residents without knowing if the nurses had the skills to care for them.
But who would I have reported these situations too?

Banditrn, chances are that if you had reported this to the state you would be fired in retaliation, the same way I was. This type of retaliatory discipline and firing is MODUS OPERENDI in LTC.

2real · Dec 28, 2006

LTC facilities are in need of people just like you. And, a new grad has an opportunity to learn many things, and gain invaluable experience. Compromising your integrity and good nursing judgement is a CHOICE. You do not seem to be someone who will allow that to happen. Bravo for youto demand better for our ltc facilities. When more nurses like you are committed and willing to care for the elderly in ltc facilities...and do it RIGHT. Then there is POWER in numbers! The facility has the POWER to relieve the BAD nurses from employment, and REPLACE them with competent , caring nurses like yourself. The days of keeping incompetent staff out of desperation will be over. And, LTC will gain the respect it deserves. Our elders will get the care they DESERVE. And more nurses will WANT to work in LTC!

I think you should give it some time before you cut and run. Many nurses start in LTC as new grads, and NEVER leave ...because they LOVE it! Those are the nurses I want taking care of my FAMILY when and if they need it!

As timepasses, schedule a mtg with your DON. discuss your concerns. Especially if negligent care continues. She has the power to address the situation. HER license is at stake when this kind of care is overlooked. She/ or he, may not be aware of the practices, and be very interested in investigating it.

Not all LTC facilities practice poor , substandard care. Some do- and always will.

LTC's generally do not have anywhere the budget to operate as the hospitals you trained in. So it seems so archaeic, and to some degree- it is. Thank insurance, medicare and medicaid reimbursement for that~! But do not discount ALL ltc's because of a bad experience in ONE!

Thanks for letting me vent!

FYI...I started in LTC as a new grad- got lots of experience that helped me be a better nurse many times over. On the advice of other nurses I left my ltc job, so as not to"lose my skills". I worked 20 years in many areas of nursing. My next job from ltc was to ICU! Why , because I had experience... and a mgr willing to train a dedicated , competent nurse. Then ortho/neuro, then office nurse. Then 15 yrs of Emergency Dept. Now- I've returned to my roots. I HAVE SKILLS. And am nowDON of a LTC facility. And have made it my business and am DETERMINED to elevate the care in ltc's and will not tolerate substandard care in my facility! ....because THEY deserve it! OUR elders- and we'll be one someday too! So we better not drop the ball!

Simplepleasures · Dec 28, 2006

LTC facilities are in need of people just like you. And, a new grad has an opportunity to learn many things, and gain invaluable experience. Compromising your integrity and good nursing judgement is a CHOICE. You do not seem to be someone who will allow that to happen. Bravo for youto demand better for our ltc facilities. When more nurses like you are committed and willing to care for the elderly in ltc facilities...and do it RIGHT. Then there is POWER in numbers! The facility has the POWER to relieve the BAD nurses from employment, and REPLACE them with competent , caring nurses like yourself. The days of keeping incompetent staff out of desperation will be over. And, LTC will gain the respect it deserves. Our elders will get the care they DESERVE. And more nurses will WANT to work in LTC!
I think you should give it some time before you cut and run. Many nurses start in LTC as new grads, and NEVER leave ...because they LOVE it! Those are the nurses I want taking care of my FAMILY when and if they need it!
As timepasses, schedule a mtg with your DON. discuss your concerns. Especially if negligent care continues. She has the power to address the situation. HER license is at stake when this kind of care is overlooked. She/ or he, may not be aware of the practices, and be very interested in investigating it.
Not all LTC facilities practice poor , substandard care. Some do- and always will.
LTC's generally do not have anywhere the budget to operate as the hospitals you trained in. So it seems so archaeic, and to some degree- it is. Thank insurance, medicare and medicaid reimbursement for that~! But do not discount ALL ltc's because of a bad experience in ONE!
Thanks for letting me vent!
FYI...I started in LTC as a new grad- got lots of experience that helped me be a better nurse many times over. On the advice of other nurses I left my ltc job, so as not to"lose my skills". I worked 20 years in many areas of nursing. My next job from ltc was to ICU! Why , because I had experience... and a mgr willing to train a dedicated , competent nurse. Then ortho/neuro, then office nurse. Then 15 yrs of Emergency Dept. Now- I've returned to my roots. I HAVE SKILLS. And am nowDON of a LTC facility. And have made it my business and am DETERMINED to elevate the care in ltc's and will not tolerate substandard care in my facility! ....because THEY deserve it! OUR elders- and we'll be one someday too! So we better not drop the ball!

I mean this very sincerely, I wish you well in your endevour to improve care in LTCs.You will need all the srength and determination you appear to have.You seem like an ethical caring person, I hope the LTC multi billion dollar industry doesnt eat you up alive, because what you propose to do is desperatly needed. Bravo to you!

mandykal, ADN, RN · Dec 28, 2006

I just started my first job as a new grad in LTC. And yes, I'm truely afraid of what's going to happen once I'm on the floor alone. Orientation consisted of 3 days of watching "How to not slip and fall on the job" and the administrator telling us that she needed to leave early to go pick up her kids. I was excited to hear that I would be allowed to have 5 days of training on the floor instead of the usual 4 (because I'm a new grad), but I soon learned that training is basically a nurse showing me all of her bad habits. I'm just the type of person that wants to do everything the right way regardless of what everyone else is doing. But it seemed like there were no good models to learn from. NO one wears gloves (regardless of what they are doing). No one ever answers call lights unless either it's been going off for 20 minutes or the DON walks past. The nurse training me just casually stood around and conversated with coworkers while giving out 6am meds at 1pm. None of the CNAs scheduled to work showed up for work, and from what I was told this happens all the time. I'm new to this and I just want to see SOME examples of how things should be done, not just told that "If State were here then you should do this..." It was horrible and I was told that this was a GOOD day. :angryfire What should I do? How can I be successful in this type of environment? My choice was not to work in LTC, but I have no experience in any other areas.

Oh, this is definitely drama!!!.. This kinda reminds me of my old job.. I see lots of nurses would get out and leave because it's not worth the risk....but when I took the job (my former job) I stuck around and my suggestion is for you to do the same. You say there's "no good models to learn from," well you don't need 'em. Take what you already know from school and clinical and use that. The only thing you need to focus while under orientation is observe the daily routine. Find your support with where to find info such as policies and procedures. But before you could ever do that lets go back to what you mentioned. You're allowed to have 5 days of training on the floor, does that mean, 5 days on the floor of each unit or just plain 5 days and then your on your own? Because if it's just plain 5 days then yes I would agree to other nurses and get out. OR I would also question the staff development nurse and DON, "how are they suppose to hire these nurses and expect them to represent the company, knowing they don't know much with the short amount of orientation?" Ask that question and you might just see how supportive your management is. SUPPORT GOES A LONG WAY IN LTC AND THAT IS WHAT YOU NEED. When I was a first grad, It was on a month of orientation. A year later at my new job (different employer), it doesn't matter how long you've been a nurse, you have a month of orientation. And that long orientation shows how much the company wants to invest on you as their new nurse.

Going back to this brutal environment. I'll tell you, I've learned alot. This wasn't just brutal it was filthy dirty. But I kept on with the good habits and reinforced it with the CNA's. It will be difficult to make the right judgements in the beginning, but what new job isn't? Use resources you got esp with time management. Don't put off task until later because something unexpected might just pop-up. During your orientation, question, question, question. Question any potential complex issuses, falls, skin tears, codes, nurse's role during emergencies, and most important, paperwork...where the hell is it?...

I remember, I once had a census of 25 and 17 residents' had a pressure ulcer. That told me alot about the level of care. Then I started cracking the whip on incontinent care, repositioning, increasing fluid intake and nourishments...Sure enough it was known that I wasn't there for just a sorry a55 pay check (I say that b/c my pay rate was the same working as a nurse's aide).

It was the only job around that area hiring at the time. There was so much problems I got accustomed to writing A&I's. Everytime I had a problem, I've always carried the nursing process in everything I did.....Remember, when you fill out an A&I at your work place, management has to follow up. You know what's is ethical, and now you're a nurse go-on and advocate. Don't be afraid to get your hands dirty! It's things like this that pisses me off when people lose so much of their money, I've known people who had to give up their house and life savings just to pay for long-term care, and I'll be dammned if they are going to receive lousy care while I'm on the clock.....

I had a rough time but above all, I've learn a heck of alot. When you start off at this new job, don't take all the negativity to your heart, find your coping mechanism, have that positive attitude. The job can be done and done right... good luck.

mandykal, ADN, RN · Dec 28, 2006

You are fortunate to have received a few days of training. I was a new grad 10 months ago and received only 8 hours of orientation before being cut loose to work on my own at a shabby nursing home.
I have worked at several nursing homes and, honestly, very few nurses do things by the book due to limited time. Who has the time to pass medications to 40 patients within the legally allotted time, perform all the treatments by the book, and answer call lights within a timely manner? If I pass morning meds by the book, I will start my 0800 med pass at 0700 and not be done until 1000. Sorry, but a 3-hour window to pass meds is illegal in my state.

8 hours of orientation, whoa! did you feel competent as a new nurse at the time?

I really don't know how these agency nurses function sometimes they never been to a certain facility, and they are expected to function their role 100%...

TheCommuter, BSN, RN · Dec 28, 2006

8 hours of orientation, whoa! did you feel competent as a new nurse at the time?

No. There was a whole lot that I was not acquainted with, especially the paperwork aspects of the job.

I really don't know how these agency nurses function sometimes they never been to a certain facility, and they are expected to function their role 100%...

That's the very reason why they are paid the big bucks. They are expected to jump right in there, learn quickly, and go with the flow. It takes a special, patient, assertive nurse to be able to work agency.

wefdm21 · Dec 28, 2006

Oh, this is definitely drama!!!.. This kinda reminds me of my old job.. I see lots of nurses would get out and leave because it's not worth the risk....but when I took the job (my former job) I stuck around and my suggestion is for you to do the same. You say there's "no good models to learn from," well you don't need 'em. Take what you already know from school and clinical and use that. The only thing you need to focus while under orientation is observe the daily routine. Find your support with where to find info such as policies and procedures. But before you could ever do that lets go back to what you mentioned. You're allowed to have 5 days of training on the floor, does that mean, 5 days on the floor of each unit or just plain 5 days and then your on your own? Because if it's just plain 5 days then yes I would agree to other nurses and get out. OR I would also question the staff development nurse and DON, "how are they suppose to hire these nurses and expect them to represent the company, knowing they don't know much with the short amount of orientation?" Ask that question and you might just see how supportive your management is. SUPPORT GOES A LONG WAY IN LTC AND THAT IS WHAT YOU NEED. When I was a first grad, It was on a month of orientation. A year later at my new job (different employer), it doesn't matter how long you've been a nurse, you have a month of orientation. And that long orientation shows how much the company wants to invest on you as their new nurse.
Going back to this brutal environment. I'll tell you, I've learned alot. This wasn't just brutal it was filthy dirty. But I kept on with the good habits and reinforced it with the CNA's. It will be difficult to make the right judgements in the beginning, but what new job isn't? Use resources you got esp with time management. Don't put off task until later because something unexpected might just pop-up. During your orientation, question, question, question. Question any potential complex issuses, falls, skin tears, codes, nurse's role during emergencies, and most important, paperwork...where the hell is it?...
I remember, I once had a census of 25 and 17 residents' had a pressure ulcer. That told me alot about the level of care. Then I started cracking the whip on incontinent care, repositioning, increasing fluid intake and nourishments...Sure enough it was known that I wasn't there for just a sorry a55 pay check (I say that b/c my pay rate was the same working as a nurse's aide).
It was the only job around that area hiring at the time. There was so much problems I got accustomed to writing A&I's. Everytime I had a problem, I've always carried the nursing process in everything I did.....Remember, when you fill out an A&I at your work place, management has to follow up. You know what's is ethical, and now you're a nurse go-on and advocate. Don't be afraid to get your hands dirty! It's things like this that pisses me off when people lose so much of their money, I've known people who had to give up their house and life savings just to pay for long-term care, and I'll be dammned if they are going to receive lousy care while I'm on the clock.....
I had a rough time but above all, I've learn a heck of alot. When you start off at this new job, don't take all the negativity to your heart, find your coping mechanism, have that positive attitude. The job can be done and done right... good luck.

Thank you so much everybody for your advice. I'm not the type to get out and run. My pride just wont let me quit. Just like you mentioned, I know what is ethical and I've been taught what to do in school. Now that I'm going through this I see what all the hard work and strict observance in nursing school is all about. If I can go back and recall all of the organization and time management skills that we learned there I think I just may be able to manage this. I've just come to the conclusion that I can't use them (the other nurses) as examples. Like you said, I am observing the basic routine. I don't think that they are all BAD nurses. I just think that they just don't want to take the time anymore, the time that is needed for the residents or the time needed to explain to me how things need to be done. I'm on day 4 of training tonight so I'm just going to keep keeping on. :nurse: