Maybe some of you can help me and some of my colleagues (RN) where I work.
I have been working a number of years in an LTC facility and things have generally run along well with other colleagues. We have had a very supportive team.
Recently two younger but experienced nurses were hired to work on my floor opposite me. I am not sure of their backgrounds, but both have worked fairly extensively in acute care prior to this, but I believe they both have come into their new positions with some LTC experience.
As the weeks and months go by I and a few of the other nurses have become alarmed at the aggressive nature that these nurses appear to display in the way they seem to manage the problems on the floor. There are always a bunch of residents on antibiotics at any one time, a reddened area under a breast or groin will have a request flying to the doctor for an antibiotic, a urine result that is contaminated will do the same, or any cloudy appearance. Lab results are scrutinised and faxed to doctors (who get the results anyway) with remarks and suggestions on what treatment options should be thought of, asking them to initiate certain treatments that we others feel are not necessary and not in the interests of our elderly residents, and are concerned that this approach can undermine our good relationships with our doctors.They do procedures which we others feel,are uncalled for, but get "its the only way to do it." kind of thing. I am not the only nurse that feels this way. I mean, this place where we work are these residents' home, its not a hospital. And its not that we do not want to work and learn new things, and support our colleagues. We generally have had a very supportive team. The problem is that when we have approached these two nurses with some of these issues they become quite aggressive and emphatic. Our nursing manager is very nice and helpful when we need her, but we are getting the idea that we think she doesn't quite know how to handle this, or maybe is unaware of how it is affecting things. We haven't had this as a problem before. The acuity is increasing, the workload is becoming unmanageable and I think its time for us older ones to nip this in the bud. How do you think we should tackle this and still keep the supportive culture in our facility intact??
Ummm, I'm a nursing home nurse. Damn good one too! Look at where you are posting....this is a Long Term care nurses forum.
Actually, I do not need to "look" at where I'm posting, I'm well aware that this is the LTC forum. I work in LTC too, so I wasn't making derogatory remarks about the nurses who do, just making reference to the negative things I've heard LTC nurses called, such as "nursing home nurse" with the underlying meaning being nurses that don't really do any "real" nursing. Of course, I know that the largest majority of us do "real" nursing. Just for clarification, I don't ever want to be guilty of just doing a med pass, and ignoring the rest of the resident's needs.
Specializes in Gerontology, Med surg, Home Health.
I guess I see this from some of the resident's view too. I am an ER Case Manager who regularly admits patients to NH from the ER. THese patients may have IV needs, new onset diabetes, poor social situation, wound care needs, not to mention more monitoring than has previously been provided in NH. So, I feel that as the acuity in the NH increases, so too must the nursing education. I don't want this to turn into a LTC versus hospital thread, but I do see that over the years, the line is blurring between NH and hospital. Many of our patients are short-term NH patients due to the need for rehab, IV drug needs, ventilator weaning.
AMEN to that. LTC isn't just long term anymore. We have a sub-acute unit that is some days as acute as a med surg. floor. I wish I had "acute" minded nurses come work for me. I am not in favor of antibiotics for every little thing....we must use our assessment skills....(but then again, I am not in favor of "better living through chemicals"...). I don't need nurses with the mentality that the patients are old so what's the point. Treat what needs to be treated as long as it brings comfort to the patient and in accordance with what they want. I need nurses with good assessment skills and good clinical/critical thinking skills. I don't need a bunch of people who just want to hand out meds and not bother the docs because they might get mad.
Specializes in Clinical Research, Outpt Women's Health.
I think jumping on any little red mark on the skin is a great thing to do in acute care and long term settings. Those frail elderly need aggressive care when it comes to skin. Skin breakdown happens so fast and is so difficult to treat once it has progressed. I think that kind of prevention is nurses doing an awesome job.
i do not believe that jumping to systemic antibiotic care for minor skin flareups is the proper way to do...usually a rash will respond to skin care...if you have a decub you need to determine the cause and the tx..
as for op...they cannot rewire their brains from their previous experience over night..but too often they believe the that they are right and that you are incompetent and how did poor patients survive without them
and people who use the term 'nursing home nurse' in a derogatory manner are wrong the the ratio of good nurses to bad nurses is the same in any kind of facility
This is wonderful! I am taking in all the posts one by one, each one of you have helped me to gain some perspective here. Thank you! I won't be going in there to "nip this in the bud." no no. What I have done is gone to my nursing manager and laid it out on the table. It all opened up over a situation in which a resident had developed some redness under her breasts. I called the doc for a Rx cream which was to be applied am and hs. When I came back from days off, the resident had just started on one dose of po antibiotic which the other nurse had requested an order for , for "inflamed" reddened area. When I checked, the Rx cream had not been applied at the hs doses and the breasts were no redder than when I first noticed them - I had another nurse double check my assessment and we both agreed that we should hold the 2nd dose of antibiotic,(She's had C Diff before), faxed the doctor to let him know and asked for his advise. I went off that shift for two days, came back, and the other nurse had faxed the doc, said there were missed doses, got her back on the antibiotic, wrote me up on an incident report. I felt I had done the right thing, the other nurse made me out to be incompetent. But! Good news, out of all this, we will have an inservice with the infection control nurse, my nursing manager was very supportive, and I don't need to have a confrontation with the other nurse - (I am not a confrontative type person). I'd like to be able to work with her. She is an attentive nurse - she just tends to jump on things really really quick - like the "auto pilot" mode which we all tend to do sometimes. I agree, in geriatrics, we are not "nursing home nurses" - we have to use all our skills and critical thinking skills and need to act when it is time to act. But there is a fine balance to achieve. I didn't realise so many others out there struggle with that too. Thank you for helping me deal with this.
As a nurse who works in a hospital and sees many patients from LTC's, I think the situation you describe should be looked upon as a benefit to the residents to prevent a hospital stay. Yes, your facility may be their home, but they are looking for the best care as well. Be well.
Maybe some of you can help me and some of my colleagues (RN) where I work.
I have been working a number of years in an LTC facility and things have generally run along well with other colleagues. We have had a very supportive team.
Recently two younger but experienced nurses were hired to work on my floor opposite me. I am not sure of their backgrounds, but both have worked fairly extensively in acute care prior to this, but I believe they both have come into their new positions with some LTC experience.
As the weeks and months go by I and a few of the other nurses have become alarmed at the aggressive nature that these nurses appear to display in the way they seem to manage the problems on the floor. There are always a bunch of residents on antibiotics at any one time, a reddened area under a breast or groin will have a request flying to the doctor for an antibiotic, a urine result that is contaminated will do the same, or any cloudy appearance. Lab results are scrutinised and faxed to doctors (who get the results anyway) with remarks and suggestions on what treatment options should be thought of, asking them to initiate certain treatments that we others feel are not necessary and not in the interests of our elderly residents, and are concerned that this approach can undermine our good relationships with our doctors.They do procedures which we others feel,are uncalled for, but get "its the only way to do it." kind of thing. I am not the only nurse that feels this way. I mean, this place where we work are these residents' home, its not a hospital. And its not that we do not want to work and learn new things, and support our colleagues. We generally have had a very supportive team. The problem is that when we have approached these two nurses with some of these issues they become quite aggressive and emphatic. Our nursing manager is very nice and helpful when we need her, but we are getting the idea that we think she doesn't quite know how to handle this, or maybe is unaware of how it is affecting things. We haven't had this as a problem before. The acuity is increasing, the workload is becoming unmanageable and I think its time for us older ones to nip this in the bud. How do you think we should tackle this and still keep the supportive culture in our facility intact??
Excellent posts from so many professionals on this topic. A thought to add here: If the entire provider community, all settings, understood hospice a little better, and referred to it in a truly timely manner, then all other patients should be medically and from a nursing perspective treated per protocols. There are many many hospice eligible patients in the LTC setting that have not been identified as such, and aggressive curative care continues.
I agree with you. I have almost 20 yers experience and could see me calling the docs/ CYA and protecting/advocating for the residents. More complicated than I originally thought.
This is wonderful! I am taking in all the posts one by one, each one of you have helped me to gain some perspective here. Thank you! I won't be going in there to "nip this in the bud." no no. What I have done is gone to my nursing manager and laid it out on the table. It all opened up over a situation in which a resident had developed some redness under her breasts. I called the doc for a Rx cream which was to be applied am and hs. When I came back from days off, the resident had just started on one dose of po antibiotic which the other nurse had requested an order for , for "inflamed" reddened area. When I checked, the Rx cream had not been applied at the hs doses and the breasts were no redder than when I first noticed them - I had another nurse double check my assessment and we both agreed that we should hold the 2nd dose of antibiotic,(She's had C Diff before), faxed the doctor to let him know and asked for his advise. I went off that shift for two days, came back, and the other nurse had faxed the doc, said there were missed doses, got her back on the antibiotic, wrote me up on an incident report. I felt I had done the right thing, the other nurse made me out to be incompetent. But! Good news, out of all this, we will have an inservice with the infection control nurse, my nursing manager was very supportive, and I don't need to have a confrontation with the other nurse - (I am not a confrontative type person). I'd like to be able to work with her. She is an attentive nurse - she just tends to jump on things really really quick - like the "auto pilot" mode which we all tend to do sometimes. I agree, in geriatrics, we are not "nursing home nurses" - we have to use all our skills and critical thinking skills and need to act when it is time to act. But there is a fine balance to achieve. I didn't realise so many others out there struggle with that too. Thank you for helping me deal with this.
All of this probably could have been avoided if the resident received proper skin care with am and pm care. Breast, groin and abd fold redness and excoriation is very popular in my facility during the warm months.
Wow, didn't realize that something like this was such a two sided thing. I guess I would fall under the more acute style, although I have never done acute nursing. By state regs, we have to call "every little thing" into the Drs. We would always report an abnormal U/A (but then also report res. is asymptomatic). We were sited a few years ago for not doing this. Tried to explain to surveyors that Dr. automatically get lab reports as well. The responded "prove to me that the Dr. has seen this". I also don't know why you would not want to get some kind of skin treatment for any red area, although prevention is always priority. As far as the part with quicker hospice referrals; often we do see the need and have several care conferences with family before they are ready to accept the residents condition. We've got one gentleman now who would desperately benefit from hospice, but his sweet little wife just won't give up (she really is a doll to - no joke). We get her convinced, hospice evals and she backs out when time to sign their paperwork. Has done this 3 times so far.
But anyways, to all the "nursing home nurses", I feel we have all earned our spot in heaven. It takes a very special person to do this job every day.
Absolutely, I agree. The resident continued with the complete course of oral Clindamycin which I felt was totally unecessary. The reddened area was still reddened and I asked the doctor to change the Rx cream to a completely anti-fungal one. It cleared up within a few days of this. We since have had an inservice on infection control and discussion surrounding antibiotic use and management of urinary tract infections which was a real eye opener to many of the nurses there. Unfortunately, the two nurses I speak of were not in attendance, but now there are other nurses in the facility who are on board and hopefully the message will get out. I like the idea identifying the hospice patients. When I get back to the unit I will certainly suggest that to the management. Thank you!
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LPN01112005
110 Posts
Actually, I do not need to "look" at where I'm posting, I'm well aware that this is the LTC forum. I work in LTC too,
so I wasn't making derogatory remarks about the nurses who do, just making reference to the negative things I've heard LTC nurses called, such as "nursing home nurse" with the underlying meaning being nurses that don't really do any "real" nursing. Of course, I know that the largest majority of us do "real" nursing. Just for clarification, I don't ever want to be guilty of just doing a med pass, and ignoring the rest of the resident's needs.