Alright, so I need to vent (I seem to need to do this a lot, maybe I shouldn't work every day). EMS brings me a 93 year old man from a nursing home who fell from his chair and hit his head. Non-urgent, head lac, no biggie. Until, of course, I get him undressed.
This poor old guy was totally AAO and coherent. He had been moved to the nursing home because his wife couldn't take care of him alone any longer and they have no family. He's just old and fragile. I get his pants off just to assess his skin to see how well he's being taken care of and... he has cellulitis all up his right leg and he's red in his groin and backside. The doc is with me when I do this. He semi freaks out because there was no mention of the leg in his NH papers and the pt himself didn't really know he had cellulitis.
The patient starts to tell us how he's neglected at the NH. He is put in his room early he says, around 7 or 8, alone and without being checked on. He says he can't get anyone to help him get up to go to the bathroom or bring a urinal and is consistently wetting himself and laying in it until morning because no one checks in on him.
I call the NH and they tell me he's being treated for a wart on the bottom of his foot and they soak it in warm water. And he's not on any medications. Despite his being on medications per his paperwork. So at this point, I'm ******. I call his wife who was the POA and was very knowledgable when I spoke with her. She explained to me how he had been complaining to her about the care at the NH. When I asked her about the cellulitis, she said every day when she came to see him, they had socks and shoes on him so she never saw his leg. So, I hotlined the NH for neglect.
Throughout his entire stay in the ED, he just went on and on about how grateful he was for us just being there for him, taking care of him, paying attention to him. Even when I was bandaging his head, he went on about how gentle I was and that I never need to become like the people at the NH. I teared up when I had to go tell him we were sending him back to the NH. He just had the saddest look I've ever seen when I said that. All he wanted, he said, was to go back home, where he could be with his wife and not have people neglect him every day.
I just do NOT understand how anyone, whether it's a nurse, an aide, or a clerk could even witness neglect and let it go. When do people lose their ability to care about another human being? They might be old, but they are still humans with very real emotions and not all of them have dementia. The only thing this poor little old man wanted in the world was to be cared about. He wasn't needy or mean or anything less than kind. It's a tragic thing how far some people deviate from the line of caring.
thelema13- I feel for that poor patient and I appreciate you caring for her!
Consider this as well though- in the LTC setting a lot of the patients will say "OH, I haven't slept in days, I haven't had a shower in months, no one cleans me, no one feeds me, I haven't had a BM in 8 days) when I can go back to the chart and see when these activities last occurred and the person is confused and agitated.
Also, I have multiple residents who refuse care at certain times and have tried to hit me for providing foley care, irrigations, dressing changes, etc. First time they swing at me it is a refusal, I am sorry, I have had too many black eyes and too much broken skin to spend an hour fighting someone when I could spend that hour giving care to another patient who is not trying to abuse me.
I am in no way justifying this patient's issues or saying that she wasn't neglected, nor condoning neglect, even for the abusive patient, however, you don't know the whole story. I just do the best I can for my patients but I will not be bludgeoned by them for trying to do care. I pass it on and alert the doctor, and usually they do nothing either. Sad but true but I got 50+ other patients who need me as well and if I let one knock me out on the floor, who will be there for them? Just food for thought. Hope this patient gets well though.
I don't get how we as nurses can not see "the big picture" of what is going on in our own industry.
I don't get how we can not see that 1 nurse for 20, 30, 50 debilitated, fragile patients is morally and ethically wrong. This is totally inappropriate staffing and yet this goes on in all nursg facilites across this counrty. I don't get why we nurses feel the need to point a finger at 1 nurse for this number of these kinds of patient is spread so thin; thin is not even the word- how's transparent. Why, we as nurses are not outraged at the abusive situation that is occuring for both the nurse AND the patient.
That LTC, like it or not, IS that patient's home! It's not the adminstrators home, it's not the CEO's home- it's the patient's home. That patient via their next of kin, has had to sign over every piece of property they have ever worked for to that lousey place and hense to that company CEO to pay for their stay. And that is just one patient, every patient in that building has done the same. The patient's wife, son, daughter,niece etc has lost that patient's assets just, in the hopes,so mom or dad will be watched and cared for because for what ever reason, can not care for themselves. And that administrator or CEO deems it appropriate to staff a LTC unit with 1 licensed nurse and 2-3 CNA's? This defies all logic to me. That nurse cannot be in 50 places at one time, just like an ED nurse can't, an ICU nurse can't, a med/surg nurse can't, I don't care how young and physically fit one is. It is humanly impossible.
It IS time we nurses started telling these patient's families the way it it. We call ourselves patient advocates, who are we advocting for when we allow staffing like this to continue in this day and age when administrators and CEO's are raking in million dollar paychecks and going unchallenged.? Why are we are condeming 1 nurse for trying to "do the best they can" Should it be reported to the proper authorities- Yes, by all means. Maybe the state regulatory depts can do something and get this nurse more help; aka, more nursing staff. Seems to me the nurse is as much a victim in these places as the patients are.!!!
Not one of us would stay in a hotel for $3,000-$5,000 a month to be fed slop- veges so over cooked from yesterday or meat cooked and recooked for days, mashed potatoes made from water instead of milk and then sleep in a urine soaked bed because there are only 2-3 CNA's and 1 RN on shift at night. The CNA's have to go from one patient to the next- changing, toileting, keeping from falling, The RN has meds- mostly crushed, charting- this along can keep one person busy for days in a LTC facility, tube feeds. I worked LTC on/off through an agency for 1 year- It's a tremendous amount of work for one nurse. I was still doing my 10 AM med pass at 2:30 that was for 30 patient's who couldn't tell me their name let alone mine. That administrator or CEO is not spending every dime of intake revenue on the room and board for the patient's. Any good thrify housewife could see through that BS. One who does the grocery shopping and house hold budget. Maybe that's why the administrators and CEO's are so not intune with the nursing mentality- because they nver set foot in a grocery store so they assume the nurses don't and won't know the difference that they are keeping a good chunk of change for themselves and robbing the patients- the "RESIDENTS"
Mr CEO or Mr/Ms administrator's mom or dad would never be on the recipient end of this - They have the money to pay "round the clock private duty nurse's out of pocket in their own homes or in law suite, decorated to the 9's.
Alright, so I need to vent (I seem to need to do this a lot, maybe I shouldn't work every day). EMS brings me a 93 year old man from a nursing home who fell from his chair and hit his head. Non-urgent, head lac, no biggie. Until, of course, I get him undressed.
This poor old guy was totally AAO and coherent. He had been moved to the nursing home because his wife couldn't take care of him alone any longer and they have no family. He's just old and fragile. I get his pants off just to assess his skin to see how well he's being taken care of and... he has cellulitis all up his right leg and he's red in his groin and backside. The doc is with me when I do this. He semi freaks out because there was no mention of the leg in his NH papers and the pt himself didn't really know he had cellulitis.
The patient starts to tell us how he's neglected at the NH. He is put in his room early he says, around 7 or 8, alone and without being checked on. He says he can't get anyone to help him get up to go to the bathroom or bring a urinal and is consistently wetting himself and laying in it until morning because no one checks in on him.
I call the NH and they tell me he's being treated for a wart on the bottom of his foot and they soak it in warm water. And he's not on any medications. Despite his being on medications per his paperwork. So at this point, I'm ******. I call his wife who was the POA and was very knowledgable when I spoke with her. She explained to me how he had been complaining to her about the care at the NH. When I asked her about the cellulitis, she said every day when she came to see him, they had socks and shoes on him so she never saw his leg. So, I hotlined the NH for neglect.
Throughout his entire stay in the ED, he just went on and on about how grateful he was for us just being there for him, taking care of him, paying attention to him. Even when I was bandaging his head, he went on about how gentle I was and that I never need to become like the people at the NH. I teared up when I had to go tell him we were sending him back to the NH. He just had the saddest look I've ever seen when I said that. All he wanted, he said, was to go back home, where he could be with his wife and not have people neglect him every day.
I just do NOT understand how anyone, whether it's a nurse, an aide, or a clerk could even witness neglect and let it go. When do people lose their ability to care about another human being? They might be old, but they are still humans with very real emotions and not all of them have dementia. The only thing this poor little old man wanted in the world was to be cared about. He wasn't needy or mean or anything less than kind. It's a tragic thing how far some people deviate from the line of caring.
Neglect happens at all levels. Having been in LTC for 24 (!When did that happen!!) years and having had responsibility for from 7 to 110 (not a typo- as night floor supervisor) patients for a shift during career I have learned there is NO SUBSTITUTE for laying eyes on a patient. You go to each room, even if only for less than 1 minute, at the start and the end of your shiftand you make round of your room during the shift (yes you have the time). You introduce yourself, you don't talk, you look and your LISTEN. You make sure you know, and the NACs know you know, where they are at all times. You focus like a laser. Nurses spend too much time vacillating and second-guessing. We're all smarter than we think. You learn to chart to the point and really fast (learn from your MDs who know how to do rounds). Kudos to you for holding people accountable. There is no panacea. Last word- a relative of mine is in a nursing home. Our family have a camera mounted with view of the room doorway (Yes, the administration and staff know it's there and it never allows visualization of private, personal care.). All family, even out of state, can check in any time. In my opinion, this wife should buy a camera and wire her husband up with a microphone. OldChargeNurse
Specializes in LTC, CPR instructor, First aid instructor..
Neglect happens at all levels. Having been in LTC for 24 (!When did that happen!!) years and having had responsibility for from 7 to 110 (not a typo- as night floor supervisor) patients for a shift during career I have learned there is NO SUBSTITUTE for laying eyes on a patient. You go to each room, even if only for less than 1 minute, at the start and the end of your shiftand you make round of your room during the shift (yes you have the time). You introduce yourself, you don't talk, you look and your LISTEN. You make sure you know, and the NACs know you know, where they are at all times. You focus like a laser. Nurses spend too much time vacillating and second-guessing. We're all smarter than we think. You learn to chart to the point and really fast (learn from your MDs who know how to do rounds). Kudos to you for holding people accountable. There is no panacea. Last word- a relative of mine is in a nursing home. Our family have a camera mounted with view of the room doorway (Yes, the administration and staff know it's there and it never allows visualization of private, personal care.). All family, even out of state, can check in any time. In my opinion, this wife should buy a camera and wire her husband up with a microphone. OldChargeNurse
Honestly in my state of Washington. I turned in a LTC I once worked out for bad care and the state called them and announced they were coming and what the issues were and of course when they got there the state DSHS didn't see a problem because the facility had to time to fix it. They (DSHS and DOH) here dont want to deal with problems and they don't. Most of the patients there were Medicaid and I do believe it is rampant fraud and the government needs to stop it and go in these horrid places and see how it is. If staff does complain like myself up the chain of command you are eliminated.
Though I have seen residents come back from hospitals however in just the shape you describe as well.
I would have turned the nursing home in. I had a patient who came from a skilled nursing facility and his skin was the worst I had ever seen. We have to document, take photos, and put in chart. Well, it upset me so much that I took extra pictures of the wounds (probably not legal) and mailed them to the county health dept.
Specializes in Med-Surg, Oncology, Neurology, Rehab.
:kiss God bless you for your Kindness!!! How sad that we neglect our elderly! Thank God that this man was able to experience your kindness and compassion!!
This may be a little long but please bare with me. I have worked LTC for 25+ years as both a NA and a Nurse. I'm not condoning any of the neglect you mention, nor attacking you in anyway. I'm just trying to give a small insight into LTC operations. We all are aware of the Patients B.O.R's. I beleive that is the same in NH's as well as hosp. I'm sure there are others out there who beleive that its a very fine line between protecting their right to ref cares and preventing them from harming themselfs with those refsuals.
One thing you need to know is that LTC operates under a whole diff set of rules then a hosp. In the hosp you are allowed to restrain pateints, either physically or chemically, if they are presenting a harm to themselfs or others. I can not do that until I first try to distract/redirect them with: BRP's, food, massages, changing their environment, playing calming music, having someone do 1 on 1 with them, chart all this and its success/failure. Then check to see if the behavior is caused by either pain or a UTI, cart this info. Then I need to notify social services and administration and ask them for sugestions and permission for a restraint. Chart all of this. If I get a green light then I have to notify the Dr and then the POA/Gaurdian, chart all this. I'm not gonna get into trying to get the Dr to call the pharm in the middle of the night (shutter).
I don't know what staffing guidelines are in a hosp but ours are as follows:
1) [7-3] 8 patients to 1 nursing staff.
2) [3-11] 12 patients to 1 nursing staff.
3) [11-7] 15 patients to 1 nursing staff.
That does not differentiate between nurse or cena, which I beleive they should. It should be so many pt's to 1 direct care staff. In NH's nurses usually do not do direct care. Thats a whole other thread (LOL). Now where I work we never work short, per admin! We have 159 residents and the least amt of cens we can work with is 14 with 5 nurses, thats an 8.4 ratio. Excellent staffing right? Well here is the problem. Those 159 res are split into 5 diff units in a 3 floor building. So if we are to be down 1 cena on my floor, which we rotate between units, that means I have 37 res to 2 cenas and 1 nurse. Now I can do cena work to help them out but they can not do nurse work to help me out and I have all 37 res's I'm responsable for, meds, charting and tx's. Now if my cens took their 15 res's like the guidelines say then who is responsable for the other 7 res's? I can't do that plus my work because nothing would get done. Its unlogical to pull a few cenas from other units. 1 they can't hear call lights from my unit an others have to watch their res while on my unit. So even though the numbers show we have excellent staffing, we are actually short staffed. Which we are no longer allowed to use that phrase. Looks and sounds frustrating doesn't it? It's more so when your in the middle of it. Hmmmm, I feel like I am so off the subject of the original post, but there ya go.
Nothing is black and white, there are almost always other factors in play here. And lets face it, we are dealing with humans who do not feel well to begin with, who can be really fickle, and not on their best behavior, either angry or depressed about being sick. Angry that they are in a NH and trying to make their family feel quilty and take them home. The one thing I love about my job is that fact that I know my residents. I know their moods, their habits, and all their idiosyncrasies. I take care of my residents 8 hrs/day, 40hrs/wk for wks or months and even years. Unfortunatly hosp nurses don't get that oppertunity. So siad your gentelman is AAO and a sweet nice old man, but is that his normal dispostion? I could tell you stories after stories where res who are indep have with held info from us on their health.
Now after all that, here is my big ol 180 degree turn!!! I'm glad you notified the authorities of your concerns. Yeah it's a pain in our backsides when state comes in for investigations, but it shows your morals and your heart and your concerns for your patients. And to be that makes for 1 hell of a nurse, and your patients are lucky to have an advocte such as yourself in their cornor.
Once again I appoligize for the length but I hope this gives some insight or education into the 2 diff styles of nursing.
Specializes in Critical Care, Emergency Medicine, Flight.
Alright, so I need to vent (I seem to need to do this a lot, maybe I shouldn't work every day). EMS brings me a 93 year old man from a nursing home who fell from his chair and hit his head. Non-urgent, head lac, no biggie. Until, of course, I get him undressed.
This poor old guy was totally AAO and coherent. He had been moved to the nursing home because his wife couldn't take care of him alone any longer and they have no family. He's just old and fragile. I get his pants off just to assess his skin to see how well he's being taken care of and... he has cellulitis all up his right leg and he's red in his groin and backside. The doc is with me when I do this. He semi freaks out because there was no mention of the leg in his NH papers and the pt himself didn't really know he had cellulitis.
The patient starts to tell us how he's neglected at the NH. He is put in his room early he says, around 7 or 8, alone and without being checked on. He says he can't get anyone to help him get up to go to the bathroom or bring a urinal and is consistently wetting himself and laying in it until morning because no one checks in on him.
I call the NH and they tell me he's being treated for a wart on the bottom of his foot and they soak it in warm water. And he's not on any medications. Despite his being on medications per his paperwork. So at this point, I'm ******. I call his wife who was the POA and was very knowledgable when I spoke with her. She explained to me how he had been complaining to her about the care at the NH. When I asked her about the cellulitis, she said every day when she came to see him, they had socks and shoes on him so she never saw his leg. So, I hotlined the NH for neglect.
Throughout his entire stay in the ED, he just went on and on about how grateful he was for us just being there for him, taking care of him, paying attention to him. Even when I was bandaging his head, he went on about how gentle I was and that I never need to become like the people at the NH. I teared up when I had to go tell him we were sending him back to the NH. He just had the saddest look I've ever seen when I said that. All he wanted, he said, was to go back home, where he could be with his wife and not have people neglect him every day.
I just do NOT understand how anyone, whether it's a nurse, an aide, or a clerk could even witness neglect and let it go. When do people lose their ability to care about another human being? They might be old, but they are still humans with very real emotions and not all of them have dementia. The only thing this poor little old man wanted in the world was to be cared about. He wasn't needy or mean or anything less than kind. It's a tragic thing how far some people deviate from the line of caring.
its things like this that ******** me off so bad, ive picked up/dropped off patients to NH's & the complete lack of giving a $h!t, is just unbelievable, i have also seen a couple patients in ICU w/ Stage IV decubitis on the sacrum/coccyx...from NH. You dont just develop that over night. It makes me so ANGRY you have no idea. Granted i am basing my judgements soley on the patients IVe personally had, however, they should not look/present the way they are. its really really sad and you are right they are people and deserve to be treated as such, not as a burden.
very sad indeed.
I am glad that you were able to make a different in his life for the better :)
Just know it goes both ways. I also sometimes get ticked off when a LTC patient we've been tending and kept with intact skin, no behavior problems, continent etc. for years goes out to the hospital and comes back with a stage 3-4 (or multiple, I've seen people with the heals and coccyx broken down after a couple weeks in the hospital), a foley, clearly hasn't been bathed while gone, fingernails long caked with stuff, hair matted and having been restrained chemically and physically the whole time they were there.
I know pts often flip out at the hospital, they are sick, they have mental status changes, the hospital is also short staffed and dealing with more acuity etc. so I don't immediately assign blame to one nurse and assume all the patients are neglected at the hospital.
I tried working for a NF for about 6 months on the 3-11 shift. I really couldn't believe what a @#$%hole that place was. The understaffing was unbelieveable. There was no DON, and the ADON was just fired by the corporate idiots for virtually no reason. She was the only person who had a clue. As a RN charge nurse (normally a LVN position) my duties were as follows: For 25 - 30 patients, I alone assessed all patients, administered all medications, charted, and if there were admissions, I completed that as well. The admission paperwork was a stack of papers about 3/4 inch thick (which required overtime to complete in the event there was an admit). We also managed the evening meal, delivered trays to rooms, etc. There was only 1 aide on my wing to provide personal care. On another wing, there were patients with Stage III decubs which were not being treated adequately...no WCON or MD oversight. Add to this the cut-throat culture of LTC. Downright scary to work there.
imintrouble, BSN, RN
2,406 Posts
I have an enormous amt of respect for those nurses who work in LTC.
But then, I have an enormous amt of respect for nurses in general.