How do you determine what is a good facility BEFORE you work for them?

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So, at the risk of divulging too much personal information on the internet, I will keep this post a little broad. I am struggling with working with a facility that continually puts the CNAs, residents and LPNs/RNs in unsafe situations. There is bad or non-existant communication, unrealistic RN-patient ratios, no care plans written (due to crazy ratios), medication errors blamed on CNA's, when there was no communication about medication reminders to begin with, and poor treatment of all employees. If anyone complains about anything, they are dismissed as "having a bad attitude". I have very little notice of when I work (less that 24 hrs usually, sometimes less that 1 hr), which has negatively affected my family and social life. In short, I have never been treated so poorly by any employer. This is my 2nd CNA job (quit 1st for relocation), and I have my share of other work experience.

After perusing the boards, it seems like poor treatment is a common occurance in the nursing profession. I felt like I asked the right questions about pt ratios during my interview, but they were not completely honest in this regard. How do you go about "digging up the dirt" about a facility before you work for them? I would much rather avoid a bad situation, than work for a facility and quit.

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First know that you will never get the whole truth during an interview or from HR, even if they don't outright lie to you. That doesn't mean that you shouldn't ask all of the appropriate questions, but take them with a grain of salt and understand that they will paint as rosy a picture as they can.

The best piece of advice I can offer is to job shadow for a few hours on the exact unit/floor and shift that you are being hired for prior to accepting any job offer. This will give you an opportunity to see how the work flows, if staff work together, how problems are handled, how they treat each other and you, and gives you an opportunity to ask any questions that you may not have wanted to ask during an interview. After that, listen to your gut. If you have any reservations at all, don't take the job.

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Specializes in Hospice, LTC, Rehab, Home Health.

Most of the administrative types work until 4 or 5 pm. Show up at about 5:15 and "look around" for someone to ask for an application. Really of course you are looking to see how many staff are on duty at dinner time. Since this is the busiest time of the afternoon shift you will get a fairly good idea of the staffing in the facility. You will probably get a chance to look around the place for a few minutes before someone notices you and asks if they can help you. If no one ever takes notice of you then you will have all the information you need.

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Specializes in LTC, Memory loss, PDN.

At the end of an interview, or when you're asked if you have any questions, ask the person interviewing you, "What are some of the things you really like about working here?" You wouldn't believe how many I've seen stumble and fumble, but I've also gotten some really great answers and info that didn't come up during the interview.

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Specializes in Med-Surg, Home Health, LTC.

I recently considered be a "mystery shopper!"

I think I just heard some gov agency do this and I though what a great idea for nurses....

maybe could even be its own job. haha!

I have not figured out the logistics of doing this, but the idea is intriguing.

However...my personal experience, many LTC is dysfunctional by its nature.

There is little oversight or laws protecting and business is driven by profit.

I have found the bigger city facilities are the worst offenders, rural small towns so much

better- more like family!! (neither of these an absolute)

This has just been my experience as a travel/agency nurse:-)

When I see stresses: not happy staff, not friendly to each other, nose to the ground,

this can be an indicator of work environment.

Places that are always hiring- a big red flag!

Best to you!

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There is little oversight or laws protecting and business is driven by profit.

:lol2: "Nursing homes" are one of the most heavily regulated industries in the nation having to satisfy both state and federal regulations.

To the original poster: Two good places to check are

(1) The Feds have info on every facility in the country that receives Medicare/Medicaid funds. Go to http://www.medicare.gov/NHCompare/Include/DataSection/Questions/SearchCriteriaNEW.asp?version=default&browser=IE%7C8%7CWindows+7&language=English&defaultstatus=0&pagelist=Home&CookiesEnabledStatus=True and search for facilities in the area you want to work.

(2) You can also go to the website for the agency that licenses facilities in your State (tho the Fed link above will have the State Survey results. If you don't know the name of your state agency you can google 'who licenses nursing homes in . If that doesn't net you a link to the actual agency it should at least get you the name of the entity to google from there.

When it comes to staffing ratios the Feds don't mandate absolute numbers for nursing assistants (tho many States do). The Medicare link (above) does provide information on a facility's staffing but it's quality indicators are based on state and federal averages. Information on how it's determined can be found here http://www.medicare.gov/NHCompare/static/tabhelp.asp?language=English&activeTab=3&subTab=0&version=default

The most recent information I can find on ratios seems to be (at least in part) based limited studies from 10-ish years ago that identified the minimum hours per day needed by different disciplines to reduce the likelihood of quality problems (and it isn't much, 20-30 minutes per 8 hour shift is all). This link is to the 'report to Congress' from 2001 http://www.cga.ct.gov/pri/archives/2000sifinalappendix_D.pdf that outlines the minimums.

Keep in mind that the information gleaned from the above isn't the be all, end all.

*Perfect* surveys are not uncommon but a few tags for things that are unlikely to result in patient harm are not especially worrisome.

A facility that did poorly in their last survey may have had made major changes in admin along with correcting any deficiencies. A facility with a history of good surveys that suddenly tanks may have had a change in ownership, it doesn't mean the facility has gone bad, there is often a brief period of intense turnover when a facility changes hands (that is not necessarily the fault of the new owners, some people just react poorly to changes in policy and leadership).

You can glean a lot of information on a facility from the State and Fed websites but you need to balance that with what you see for yourself (I rarely if ever rely on what I'm told at the interview).

How does the building look?

Is it clean, well lit, maintained? Is the flooring stained or torn? How does it smell? A facility doesn't have to be brand shiny new or have perfect landscape to be good, what matters is how well they keep up with what they have.

How do the patients look?

Are they clean and tidy? Do they seem depressed, distressed or agitated? Are they parked in the halls & dining rooms or are they being engaged by staff, are they doing anything besides sitting there?

How does the building sound?

Are patients yelling, moaning or calling out? If they are, is staff engaging, redirecting, responding? Are phones, buzzers and alarms going off? Is staff responding? Are staff calling back and forth to each other up and down the halls?

How does the staff look?

Do they look stressed or hurried? Is their appearance neat and tidy? Believe it or not you can get some good cues about a facility's attitude toward their staff from that. People who are stressed out and overworked don't have the energy to put a lot of effort into their appearance. People who can't afford to maintain their work clothes aren't being paid decently.

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Specializes in Obstetrics.

In past interviews I've gently asked some pointed questions, like another poster mentioned. If you have specific ones, great, but if not, just ask what the interviewer likes and dislikes about their employer/work environment. If you can build a friendly, open rapport with the person interviewing you, you can often get them to relax enough to be real with you about the situation. On a side note, you are CORRECT in saying that there is simply a culture of "bad treatment" in our profession, and you'll probably never find that perfect employer (if anyone reading this works for the perfect employer, PLEASE message me!). In the end, trust your gut.....the gut always knows!

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Specializes in Critical Care.

When a family member needed to go to a NH for rehab I checked the govt website and one thing I noticed most facilities either had very high turnover of nurses or very high turnover of aids. I always wondered why one or the other and not both?

If you are trying to find a good place to work it might help to work for a temp agency first, you get higher pay and then you can check out places yourself and see the real truth. Then if you like a place you can apply there or stay at the agency if you want.

I don't know about health insurance with the agency if it would be available or if you would qualify for govt insurance for low income families. You would have to check into that.

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Once, on a weekend, I was approached by a potential job applicant (I was on the nurse cart doing my rounds) and she introduced herself and asked if I liked working there. She then asked what I struggled with the most at my job. I fumbled and struggled to be positive, but it was obvious how miserable I was. I dont think she ever bothered applying.

Maybe try that? Catch them off guard and try to get an honest reaction.

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Specializes in COS-C, Risk Management.

When I was considering relocating, I did the "mystery shopper" thing. I went to several different hospitals on the weekend and just found the tele floor. Once there, I was very upfront, told them that I was an experienced tele nurse and considering relocating, asked them what it was like to work there. Then also asked them about the dirt on other hospitals. Without admin types around to force feed the soylent green, it was pretty easy to figure out where I wanted to work (or not). I can imagine that it would work the same way for a SNF or rehab.

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Specializes in Med Surg - Renal.
How do you go about "digging up the dirt" about a facility before you work for them? I would much rather avoid a bad situation, than work for a facility and quit.

If it is a nursing home and almost all of its revenue comes from public funds....

It's gonna be bad.

But...that's where I worked my first job and I'm glad I did.

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Specializes in Behavorial Health Case Management.

Hey, check the newspapers in the area of the potential employer and try to go back about 5 years. If anything major happened it might be that (i.e. continuation of a major audit, fire, or nurses strike). Also, anyone that you meet that is an RN, LPN, or CNA ask them how they like there work, the facility they work for, and what places they've heard good things about. While your at it share your plans and don't restrict yourself to employment in nursing homes. It may sound strange but I had a chance encounter at Barnes and Noble with a complete stranger. She was nice, willing to talk and suggested places for me to apply and stay away from. When I did further research I found out the hospital she warned me against had had a nurses strike only a few years ago and the facility still had done very little to improve treatment of nurses, assistants and other support staff. Employees in the offices were miserable. So remember, speak up and talk to people.

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