I recently started a new position in LTC, after 3 years of working in a hospital setting (critical care float pool)... I was burntout from working nights, wanted a change, closer to home, etc.... so I took a .8 day position on a 64 bed skilled unit in a privately owned nursing home...... okay so now I am responsible for 32 people and not only am I the nurse... I am also the TMA, secretary, housekeeper, babysitter (where are all 6 aides anyways?!), waitress, kitchen supervisor, etc... I am supposed to find time to do everyones job as well as my own, take a lunch break, and leave 8 hours later. I have to deal with NP's who don't give a two cents about the residents, incompetent nursing staff... (no, you don't SHOVE a spoonful of food into someones tightly closed mouth.... it means they don't want it... NO you don't pull people backwards in their wheelchairs... NO you don't leave someone sitting in their own crap for an hour while you take a break)
I took a 10 dollar an hour pay cut so I could join the world of the living and enjoy my kids while they are young and that part is great... but how am I supposed to do it all AND provide the quality of care to my residents???? When I come in at 6:00 am to discover that 1. a resident has been rectally bleeding for almost 24 hours and has a Bp of 68/32, lethargic, etc... and no arrangements for either hospice or hospitalization has been started ... and 2. the chest x-ray that I ordered two days before for a resident (ethel) was done, found that resident had right sided pneumonia, and placed in ANOTHER residents (bonnie) chart and the WRONG resident (Bonnie) is started on ABX, while the one with pneumonia gets nothing for 2 days.... and I am left to clear it all up with the docs, family, etc:bugeyes:... even though at the top of the Xray report it clearly states Ethel's name....... UGH!!! frustrating... I feel like this LTC has an abnormally concentrated amount of unprofessional people there........ like housekeepers who empty garbage cans in bathrooms while residents are using them, or secretary's who think I can perform 15 tasks at the same time, recreational aides doling out medical advice, etc...... How do I manage to give the care I want to give to 32 people while performing all of these other tasks????????????
Just do the best you possibly know how to do. With nursing you learn some as you go. It is busy, it is difficult, it is demanding....and no most of us 'good' nurses don't just pass pills; that came from hospital nurses. I wish sometimes they would walk in our shoes. And the ones who can't handle it...go back to the hospital. The elderly need care by nurses who care.
You are going to have things that you don't get done as planned, that is reality. I keep a steno notebook and write all the things (prioritizing) that need done, and cross them out as I accomplish. The next day, I start my list with the previous day. Things do get done, it just takes time.
The doctor should not be calling your supervisors if you call too much, that is crap! But do try to be respectful and 'bunch' your faxes or calls to as many residents as you can.
If things go downhill at work....your DNS or Charge nurse needs to step up to the plate and help. Mine do....even my Administrator/RN helps on the floor. That is what team work is about. If you don't get help and the backing you need.........find another facility.
It really upsets me that some nurses still feel all we do is pass pills! If you care, you will end up making a difference.
I am a Charge Nurse(not sitting at desk) on day shift, but still work the floor/giving meds(daily), make the MD calls, labs, arranging appts, check on and make the weekly list for weights and baths(like an audit) weekly, write orders, deal with the pharmacy, deal with the idiots who don't want to be there, or don't work, deal with nurses who leave everything for dayshift, oh I could go on and on....but at the end of the day, I know I did my best that day, and so did most of my CNA'S. I also always reward them or give them a bonus they so deserve. Yes, we have our issues, and here's my motto: The Serenity Prayer! Change what you can, don't worry about what you can't change, and the wisdom to know the difference.
Specializes in Ortho/neuro, LTC, med-surg, stroke.
only been lpn for 18mths now and i can sympathize with u. ltc for 7 half months and now cant stand to go to work. i know what u mean. it gets tiring doing other people's job when u are bustin ur hump to do yours. my peeve is this: when u have an 8-4 nurse who takes hour long lunches ( supp to be 30 min), and several smoke breaks in late afternoon, leaving at 5/530 and leaves u with her 5-530-6p meds to do and doesnt ever count narc with me. havnt been to work in several days ( days off) and there is always some u have to ck rectally and lax etc...... no dates of open/exp on insulins and i have to be the one to do them all....... my licensed is threatend b/c of their laziness ( insulin etc.) am looking for another job now...feel guilty b/c cna's guilt me " everytime we get a nurse that cares and we can laugh with...she has to leave" or by residents " thank you for caring" after resident asks for laxitive/pain tab...... what more can we do?
Specializes in ICU, CCU,Wound Care,LTC, Hospice, MDS.
All I can say is "shop around" If you are in an area with several LTC's. Not all LTC's are like this. The last one I worked in, the Administrator and secretaries took the CNA course so that they could help out when staffing was short. Needless to say, I stayed there 10 years and only left when I had to relocate D/T aging parents. By the way, I Am one of those baby boomers you are talking about:rolleyes:!
If you stay, you're probably headed for major burnout. You seem as though you're a good nurse. This is far too much for one person. Sounds like a very unsafe facility: for you and the residents.
I agree completely- it sounds like you really care:yeah: and deserve to be in a setting where that is appreciated. Many of us have left bad facilities after realizing that one person CANT fix all their problems. Believe it or not no good will come by staying - try to find a better place that will still allow you the quality time (and energy) to raise your family:heartbeat.
. I'd rather work a busy med/surg floor where I at least have the backing of another RN or two if things go to pot. It can't possibly be less stressful where you are than it was on nights.
Suanna, I appreciate what your saying but there is a huge difference btwn LTC and Med-surg. When I come to work- I know my patients better than my own self cause they are with us LONG TERM- that means I remember that eye infection is recurring and what needs to be done without experimenting, I know when a visitor comes- who they are and how to help them- before being asked. I know how each patient likes their coffee, wants to be bathed, favorite color, what their last CBC results were and why we do an EKG each month on them , the best place to insert the needle to insert the IV, etc. etc. etc. Sure I could go back to hospital nursing, but I prefer the long term relationships I have in LTC- at this point I lack the interest and energy to build new relationships every day. Thank God there are so many facets to our profession and we each choose to fill them according to talents. Altogether we make a formidable team.
Simply put, worry about YOUR job first. I wouldn't play secertary and housekeeper and nurse aide. I would tell my nurse aides that I expect them to be on the floor where I can find them when I need them and if they keep "disappearing" I would hunt them down.
My expericence has been that if ppl know that you will do their crap for them, they will take full advantage of it. I am also a firm believer that if you don't want to do your job, you need to find another one. I have never been shy to tell my aides what I expected of them, nor to tell housekeeping that I was too busy with a resident concern to clean up a mess...
I do MY job in caring for my residents...I expect my support staff to do the same.
I know how you feel. I started a threa re: the good, bad and the ugly and my last comments were how I just quit one day. I too couldn't do it all and of course they (mgmt) expect you to and complain when you don't. I won't ramble on since I have in two threads already, but the fact of the matter is you can only do what you can and if you know in your heart that your residents are not getting what they deserve and you have fought for better care and gotten nowhere than you fought the fight and lost. I fought, and I lost and then I quit. When is America going to allow the geriatric (middle class, Medicare, Medicaid, not private pay) to get the care they so deservingly need? I've asked mgmt. at my prior place of employment, would you let your family member live here? They always say we're doing our best to improve things. But my question is "How did things get so bad in the first place?" Well enough for now, but I feel for you. One thing is that I absolutely refuse to stop being a patient advocate and fighting for better quality care wherever I may end up. Noone is going to make me end up going to work just for a paycheck and stop caring, if it ever gets to that point, I'm done with nursing. Machinist can be non- caring, robotic and have no empathy or compassion, but nursing has no place for that.
You have to put your foot down if you are going to survive. Don't be afraid to say not right now I'm too busy, don't be afraid to ignore non-nurses who think they know your job, don't be afraid to ignore a ringing telephone (let them hunt you down). Make a copy of the CNA assignment for the day and keep it with you so that you don't have to deal with the "that's not my resident" B.S. If you are allowed to use the intercom system page disappearing CNAs if it takes more than two minutes to find them. If the supervisor asks why you are always paging so and so tell them it's because they are always NOT where they are supposed to be.
Do your best and bless the rest. Most nurses don't want to work in LTC for perfectly legitimate reasons but the way I see it is that these people NEED care and someone has to provide it so I refuse to beat myself up because greedy administrators can't be bothered to staff properly or provide adequate resources and supplies.
Simply put, worry about YOUR job first. I wouldn't play secertary and housekeeper and nurse aide. I would tell my nurse aides that I expect them to be on the floor where I can find them when I need them and if they keep "disappearing" I would hunt them down.
My expericence has been that if ppl know that you will do their crap for them, they will take full advantage of it. I am also a firm believer that if you don't want to do your job, you need to find another one. I have never been shy to tell my aides what I expected of them, nor to tell housekeeping that I was too busy with a resident concern to clean up a mess...
I do MY job in caring for my residents...I expect my support staff to do the same.
hope you can find a better snf--my prayers are for you and the reisdents there.:heartbeat
i spent a very long year in a privately owned snf..went from day supervisor to don in 5 months, which should have been a big:redlight: .
finally left to save my sanity and marriage. was told at the next job [and have heard many times since]that it was good i didn't stay in long term care, because the opinion in other nursing fields is that ltc is where the burn-outs who don't give a fig congregate.
i know this is an unfair exageration, but there is sadly an element of truth. i would literaly rather be dead than in a snf, as a nurse or a patient! something has got to change..
i am fortunate to work in a wonderful ltc facility with great staff. don't get me wrong, we have our problems, but overall, i'm happy to be there. i think someone hit the nail on the head when they stated that things might get better as we age. already i can see demanding family members having an impact. they're not always reasonable, but the more of them there are, the more attention they'll get. i truly believe that ltc facilities want to provide great care, but aren't reimbursed well enough to compete with acute care facilities for quality staff. cna's must be state licensed to work in ltc, but not in a hospital. also, the hospital pays a bit more, and take the cream of the crop....since acute care is reimbursed at a higher rate (rightly so, overall) they can afford to pay more. plus, they don't have to pay an rn/lpn to do what a cna can do. if our ltc facility is reimbursed at the ma default rate, it receives $139/day. that sounds like a lot, but when you add up all the staff it takes to care for our residents, we don't break even. therefore medicare rehab residents are encouraged (because the government pays more for them, up to $400+/day), but they're more acutely ill and require more skilled nursing time. plus, all those admissions and discharges require mountains of paperwork. sorry, i started to ramble...i took a thought and ran with it!
... and 2. the chest x-ray that I ordered two days before for a resident (ethel) was done, found that resident had right sided pneumonia, and placed in ANOTHER residents (bonnie) chart and the WRONG resident (Bonnie) is started on ABX, while the one with pneumonia gets nothing for 2 days.... and I am left to clear it all up with the docs, family, etc:bugeyes:... even though at the top of the Xray report it clearly states Ethel's name....... UGH!!! frustrating... I feel like this LTC has an abnormally concentrated amount of unprofessional people there........ like housekeepers who empty garbage cans in bathrooms while residents are using them, or secretary's who think I can perform 15 tasks at the same time, recreational aides doling out medical advice, etc...... 
How do I manage to give the care I want to give to 32 people while performing all of these other tasks???????????? 
try to find a better place that will still allow you the quality time (and energy) to raise your family:heartbeat.
Furwillfly
61 Posts
For: Jvilleredhead22
Just do the best you possibly know how to do. With nursing you learn some as you go. It is busy, it is difficult, it is demanding....and no most of us 'good' nurses don't just pass pills; that came from hospital nurses. I wish sometimes they would walk in our shoes. And the ones who can't handle it...go back to the hospital. The elderly need care by nurses who care.
You are going to have things that you don't get done as planned, that is reality. I keep a steno notebook and write all the things (prioritizing) that need done, and cross them out as I accomplish. The next day, I start my list with the previous day. Things do get done, it just takes time.
The doctor should not be calling your supervisors if you call too much, that is crap! But do try to be respectful and 'bunch' your faxes or calls to as many residents as you can.
If things go downhill at work....your DNS or Charge nurse needs to step up to the plate and help. Mine do....even my Administrator/RN helps on the floor. That is what team work is about. If you don't get help and the backing you need.........find another facility.
It really upsets me that some nurses still feel all we do is pass pills! If you care, you will end up making a difference.
I am a Charge Nurse(not sitting at desk) on day shift, but still work the floor/giving meds(daily), make the MD calls, labs, arranging appts, check on and make the weekly list for weights and baths(like an audit) weekly, write orders, deal with the pharmacy, deal with the idiots who don't want to be there, or don't work, deal with nurses who leave everything for dayshift, oh I could go on and on....but at the end of the day, I know I did my best that day, and so did most of my CNA'S. I also always reward them or give them a bonus they so deserve. Yes, we have our issues, and here's my motto: The Serenity Prayer! Change what you can, don't worry about what you can't change, and the wisdom to know the difference.
Ok...I've probably babbled enough. Sorry. :typing