I don't think I can handle this!

JeanineLPN1984 · Apr 3, 2008

I wanted to add that most facilities want to keep their nurses rather then try and find someone else.(costs them alot more to hire, then keep staff in place). You do need to speak up for yourself and change what can be. I will tell you in my experience 9 times out of 10, any problems that I have had that I took to the DON were resolved well and I was happy.

The only exception was a new DON who thought a .25 cent raise was good for long term employees with top reviews. After she handed out a few of these and the staff was in an uproar, she was fired in less than 2 months. The new DON came in and gave everyone a decent raise.

Good Luck

CoffeeRTC, BSN, RN · Apr 3, 2008

I am not a quitter, but unless the management would be willing to make changes, I would leave. There is no shame in leaving, sometimes the grass is greener..

Why does a nurse need to be in the dining room, can't dietary read the diet slips and pass them out? Why can't a CNA record consumptions? They should be able to read and document?? That is way to much wasted time for a day shift nurse. (Now I'm not saying that nurses shouldn't help out during tray pass or even feed)

As far as the rest......it is rather routine and just about the same every where. We try to not have that many meds for most of our residents and will work with the docs and pharm to get them reduced (google the Beers List)

Daily skin checks by a nurse? Why cant the CNAs be doing this when they are doing care? Why can't they be doing vitals?

Sounds like they need to utilize the CNAs more. I forget what you said the ratio is for the CNAs on days, but maybe if they hire one more, the nurse could be focus on more of her duties and in turn....the residents get the better care?

What are the other nurses saying/ doing?

Just remember....if you don't get something done....make sure you circle it. ( like a treatment)

SuesquatchRN, BSN, RN · Apr 3, 2008

They don't have enough nurses or aides. And they never will. LTC is notorious for never having enough people - and even the excellent ones could use more - but this place is unsafe and unfair, to staff and residents.

JCLVN67 · Apr 3, 2008

I understand what you mean about not wanting to feel like you are abandoning your patients, so maybe you ought to reprt any neglect or violations of rights to your department of aging and disability or whatever they call such enforcement agency in your state. you can file complaints anonymously, they'll surely investigate and the management will be forced to make changes or else be subject to fines and /or being closed down if the situation is that unacceptable.

eldragon · Apr 3, 2008

Thanks, everyone, for your helpful comments.

This morning I almost lost it first thing when a nurse who has been an LPN for 30 years, but 3 at this facility, and works a desk job, told me I couldn't "take anyones food trays from them."

The problem is that I have about 6 long-term residents eating in my dining room, aloing with 22 others from my hall. The long-term residents are by far the slowest eaters, and one woman in her 90's refuses to give me her tray everyday. She sits there and plays with butter, salt packets, etc., and everytime I ask her if I can take her tray, she says "No! I just started eating!" Well, of course, eventually I do take her tray and she glares at me but forgets soon enough.

So today this older nurse tells me I can't do that anymore. I went right to the RN, and the RN supervisor and told them I was already late starting my med pass each morning, and that I was overwhelmed as it is, and I wasn't going to let this resident run my med pass schedule. So the RN's decided to have me in the dining room until 15 minutes til the hour, then call one of them to come take over.

That will work, if they are really willing to be there.

Besides that, all the nurses are overworked right now. The treatment nurses are overwhelmed, so are the RN's. One Rn told me today she's "this close to quitting." Swing shift came on and when the RN in charge saw that we are getting yet another 3 admits tonight - she FREAKED out on the RN supervisor. The door was closed on the office door, and I made my way out of the place almost on time! Oh, I might get ragged on tomorrow for not charting today, but tonight I have sweet freedom.

Plus I got kudos today for catching an order for pneumonia shots and flu shots for a woman with an egg allergy. Granted, I had already drawn them up, but as soon as I saw her face, I recognized that she has "egg allergy" on her card in the dining room, and held the shots. So I got kudos for that.

I had time for a 20 minute lunch break today, too. But tomorrow we will be at max capacity. I think some of my morning meds will have to wait.

ktwlpn, LPN · Apr 3, 2008

Actually the "Lpn" who told you not to remove the residents tray was correct.The state would have field day with you.Instead consider some things to assist these slow residents with their meals.Can you get an OT consult for adaptive silverware and plates? After setting up the tray and offering the condiments always remove the scrap paper -it tends to befudddle the confused folks.Look at seating-maybe an area with less noise and distractions will help.IMHO the nurses I work with that have "desk jobs" are far more familiar with the ever changing regs-always take their advice. You are not going to be able to chane anything in this facility-it's all about the profit.

eldragon · Apr 3, 2008

Actually the "Lpn" who told you not to remove the residents tray was correct.The state would have field day with you.Instead consider some things to assist these slow residents with their meals.Can you get an OT consult for adaptive silverware and plates? After setting up the tray and offering the condiments always remove the scrap paper -it tends to befudddle the confused folks.Look at seating-maybe an area with less noise and distractions will help.IMHO the nurses I work with that have "desk jobs" are far more familiar with the ever changing regs-always take their advice. You are not going to be able to chane anything in this facility-it's all about the profit.

Thanks for the reply. I'm not sure why you had "LPN in quotes, as I am also an LPN.

The thing is, this woman is the first to get her tray, and has it for a full 45 minutes. She's eaten 90% of the food on her tray, and is allowed to drink her Boost drink,. but she doesn't want me to take her tray because she's playing with the butter, salt packages, etc. She takes a paper bag that bread comes in, and fills it with food from her tray. She's not hungry, and doesn't want to eat it. She's just playing. If I weren't on such an impossible schedule, she could sit there all day as far as I'm concerned, but she literally keeps me from having an early start on the med pass.

The LPN with the "desk job" gave a speech at my graduation, and I was seriously impressed that day, and told her so. But working with her is another story. She nit picks everything, and doesn't follow through on much. She's always picking on someone, and writing people up. She doesn't want to hear rational explanations as to why something didn't get done. She told me today I should stay 3 hours overtime if I have to, just to get it done. But the DON says no overtime. And when you just stood on your feet for 9 hours, without any kind of nourishment or break - and I'm taking NOT SITTING DOWN ONCE - it's kind of hard to give a crap about some of the stuff she nit picks about.

She loves to talk about how she's a patient advocate, and I believe she thinks she is, but not more than I am. I'm 44 years old, and had several interesting careers before deciding to go into nursing. I made that decision after volunteering at a nursing home for 2 years. So who is more of a patient advocate? Someone who spent 5 days a week and hundreds of dollars of month seeing that virtual strangers had things they needed, and a friend to talk to -

or someone who got paid to work with patients?

We both are, but I did it for free, or even at cost to me.

She'll even go as low as to say that, if a medication isn't in and there is no way to substitute or borrow it, you didn't give someone's medicine on purpose. Intentionally. Give me a break.

That's absurd. It's all about practicality and time limits.

JeanineLPN1984 · Apr 3, 2008

Dear eldragon,

Hopefully they will get you out of the dining room early and you can get going. Over the years I've worked with that "desk nurse", basically they like to run their mouths, but will do nothing to help you. Unless it's really important just find something to do elsewhere- they get the message after a while. Sometimes nurses can be really weird for one reason or another.

I started march 1st at this facility after moving here and it is hard starting a new job. I love all I work with in the beginning I felt like a chicken without a head. Then I had one I was orientating with send me on the goose chases and " Oh, by the way......". It's like a pecking order thing. Everything is fine, and they are getting used to me now.

Well have a great day- night.

squeakykitty · Apr 8, 2008

I feel bad for my patients.
Just last week she had a meeting during which she told us the owner was losing money, and how lucky we were to have so much staff, because the facility could certainly operate with less.

I would love to see the DON working like this. It's easy to see where her priorities are, and they're not with the residents.

CapeCodMermaid, RN · Apr 8, 2008

Right---when all else fails, blame the DON.

eldragon · Apr 8, 2008

I'm not exactly sure it's the DON in this case.

I think fault lies with every single employee, to some degree.

Just the past few days, I've found 2 medicine errors that could have killed the pts had they been continued.

And in both cases, common sense on the part of any medication nurse should have alerted them that something was wrong with the order. Instead, the orders were given - by nurse after nurse - shift after shift -and in one case - did result in injury to one patient.

I had already questioned this particular order, but was too busy to actually research in the pts chart and see when and if an error existed. Today I had ten minutes to investigate - and sure enough - an order for medicine that was supposed to be given q four hours prn - was written - q four hours, scheduled. It was a high dose pain medicine, and the daughter questioned why her mom was so doped up - LAST WEEK. Then, the woman fell out of bed and went to the hospital for several days, suffering injuries.

And finally, today, I found the error. I didn't have to be Sherlock Holmes, or an experienced nurse - just someone who knew that order couldn't be right.

And I had verbally questioned it to several of my superiors, and received downright dis-interested replies.

I find it quite grotesque and even negligent that employees who have worked there for years didn't question such an unusual order - when the pt herself was so out of it.

I can only imagine how many errors are being made everyday - in that place and others like it.

CapeCodMermaid, RN · Apr 9, 2008

We ALL need to take responsibility for ourselves. I think some people don't report medication errors for fear of being punished or belittled. Many times it is a systems' problem. I know we're all busy but what amazes me is when an error is found and instead of the nurse being sorry or shocked that she's made an error, she has an attitude of 'so what'.