I'm very tired after bad job experience

[oldLPN]

Hello nurses,

I wanted to get something off my chest. Since I will probably take a non-nursing home job for the future, I wanted to talk about why. I also wanted to warn new nurses about some facilities, and how easy it is to lose your license if you are not careful. I haven't lost mine, I actually have a clean record. But I had to quit my job to save it.

I have worked in the same facility for many years, after being an agency nurse with alot of experience - I decided to be "on staff" in a small nursing facility in Ohio. At first I worked "PRN", but when I felt more comfortable I asked for and received a full time position.

For over five years I worked HARD. I didn't mind the hard work, being an agency nurse was never easy. I grew attached to many of my residents and received many compliments from their families.

Recently, the nursing home hired several new grads and a few older LPNs were dismissed for various reasons, or had hours cut. A friend gave me warning, and I became hypervigilant. When the facility began remodeling to create a new post acute unit, I asked to change my hours to night shift to avoid the confusion and the construction dust. (My unit was the one being remodeled).

I was working night shift for over a month, when suddenly they cut the staff on long term care to staff the new unit. The reason was the post acute unit brought more profit to the company. They refused to hire another nurse (they had already fired one on night shift, an LPN with years of experience). I found myself - already not adjusting yet to the change in hours - suddenly overwhelmed with the work that had recently been handled by two nurses.

When I asked why, I was told the administrator wanted it that way and that was how it was, etc.

I did my best to adjust, but not well. I found myself running to pass medications, even beginning the am med pass way out of compliance with state regs just to keep my job. Every one of my residents received morning meds, just as if it were day shift. Day shift was actually OVER staffed often because the state surveyors were expected, but that will only last until it's over.

One night, a nurse never showed for work. The RN supervisor found herself working the other hall on our floor, doing the work of two LPNs when she wasn't used to work of one. She had a resident fall out of bed, and asked me to come in and help her with putting him back in. I did so, but I brought the BP cuff and neuro check paper work with me. She became uspet, and said that we "really didn't have to do that", although it was an unwitnessed fall. I was frightened of her, since she had been instrumental in the dismissal of my LPN coworker on nights. I told her to do what she felt was right, and helped her place him in bed. I told her that I would be doing the fall assessment and neuro checks on all my falls, and advised her to do the same. I actually started her assessment, taking his blood pressure and beginning the neuro assessments for her.

And then of course, a resident of mine fell out of bed because the CNA had left the wing to socialize at the desk.

So...I began doing a fall assessment and neuro checks on my own resident.

This angered the RN so much she harrassed me non stop the rest of the shift. I was going crazy trying to finish the workload and do my assessments, and had to tolerate her without losing my cool!

She came to me several times and told me that the other nurses NEVER did fall assessments, because it was "creating more work for themselves". I told her I would be doing mine each time, saying I only did what I felt was the right thing to do for my residents and my license. In the AM, since she herself had been overwhelmed by the patient load, she told me she didn't do her neuro checks. She did fill out the fall report at the last minute.

The next shift it was more of the same. The same CNA, another resident. I began completing my assessments and braced myself for the onslaught. It of course came, she became agitated. She told me that a resident on the floor who can get themselves up is not considered a fall assessment protocol. I advised her it wasn't true, and told her he could NOT get up by himself, and did not have a fall mat beside the bed to break the fall.

Needless to say, the rest of my shift was a nightmare. I felt like I would pass out and it was hard to breathe, but I did my work and then went home to write to the DON and give my two weeks notice. Of course, after I turned in my two weeks notice the staffing on our floor changed. Instead of hiring however, they had the young new nurse on the post acute unit take a long term care wing and work both because she "knew how to handle it". ???

My last shift, another LPN told me they usually "hide" things from that particular RN. I remembered one night when a new LPN found an open area on a resident and asked me to help with a pressure sore report. The RN took it from me, told me it wasn't a new area and threw it away. A week later the resident had a raging bed sore with tunneling and a treatment to be done. I was told that state surveyors look at pressure sores, so I assumed it was to make things look like we had enough staff and residents weren't getting them.

I simply want out of long term care.

I hope that most of you are having better experiences, but am aware that with budget cuts nursing homes will become unworkable. I am hoping that more advocates will promote home care as a more humane option than placing the elderly and sick in warehouses that will neglect them. I would possibly consider a non-profit job, but am looking for non nursing jobs and home care positions.

Thank you for letting me talk about this!

[Mom2boysRN]

Wow that's terrible. I also do ltc, rehab and dementia units. We are constantly doing fall reports even on those where they fall on a matt etc, a fall is a fall. If someone is on the floor it's automatically a fall, except one guy that has been witnessed laying on the floor to sleep... we filled out many fall reports on him before we figured out what he was doing.

I can't imagine having to work like that and being discouraged from doing what is best for my patients. LTC seems to always have very high pt/nurse ratios, but though it's insanely busy many/most nights after settling in it's managable.

Good luck finding a new job at a good facility! They are out there!

[maelstrom143]

Your job sounds untenable! I would run away from that situation ASAP. Good luck finding another job.

You are a patient advocate and looked out for the best care for your patients. The people you work with seem to have forgotten why they became nurses, if they ever knew.

A fall is a fall and must be documented appropriately. End of story. To do otherwise is neglecting your duty to your patient.

:hug:

[oldLPN]

Thank you for replying!

I know there are good facilities out there....I'm frightened I won't be in one!

I am an older LPN - I graduated wearing a dress and cap. I have worked night shifts with as many residents (about 49) in the past, but the acuity was much lower in those days.

I am 49, BTW.

[BellaRoseRN]

You know the right thing and it sounds like you were doing the right thing too! I work in an ACU at a hospital and I can tell you that we see our share of patients admitted from LTC with questionable falls, open sores that have gone gang busters and even reports that a patient was not fed for over a week! You absolutely did the right thing by leaving that job. It sounds like it was a toxic situation. Documentation of falls and proper assessments are so important especially when care is transferred. It is sad the state of care our elderly receive when there aren't enough diligent people watching out for them.

[oldLPN]

I feel alot of guilt for leaving, actually.

But if more nurses use the power of NO things will change.

I am happy to say I just received my orientation YES for a home care job.

[Double-Helix, BSN, RN]

It sounds like a good thing that you quit when you did. If you feel it's necessary, you can report this RN to the BON for failing to provide safe care. I'm sorry you had such a bad experience with this job but I hope you learned enough and got enough experience to land a great job next time.

I just have to add, please don't blame the CNA for the resident's fall. If you're out straight as the only nurse, I imagine the CNA is just as busy. I've worked as a CNA in LTC and there is NO WAY you can keep every resident from falling. They don't make a bunch of noise before they fall. She's entitled to take breaks too and she just as easily could have been in another room or in the bathroom when the resident fell.

[oldLPN]

You're right about the CNA. I shouldn't blame him, since he's working in a stressful situation himself.

BTW, I didn't write him up, and he DID help with the next fall.

I'm out of here to go buy a new scrub for my job :)

[jdchisolm68]

I work in the same type of facility. I have a bachelors, all the pre-reqs for the RN program and 20 years of training experience and took a CNA job to get experience while I got my RN...However, its hard to keep an eye on everyone when you have 18 patients and most of them are total cares...the residents get limited care and my license is constantly at risk.....nursing may different in other areas but my fast food medical care experience has turned me right to the Medical Lab Technologist program...less money but the for-profit treatment of the less fortunate turns my stomach

[caliotter3]

Sounds as if the facility made a mistake by not getting rid of that particular RN. She is dangerous and I am glad I don't have to work with her. I was told one time that I had to treat a "slide" out of bed as if it were a fall and do the initial check and paperwork. All the LOL did was slide out of bed and plant both feet on the floor, she didn't fall to the floor. I would never think that all I had to do was to ignore falls. You will feel a lot more comfortable in home care and hopefully you will be able to relax a bit after that bad experience. Best wishes.

[Debilpn23]

I feel alot of guilt for leaving, actually.

But if more nurses use the power of NO things will change.

I am happy to say I just received my orientation YES for a home care job.

I am so glad you have a new job, You are an awesome nurse who cares about her patients

[carolmaccas66, BSN, RN]

This is why I refuse to do LTC or NH work now. Old people are just shoved away in these places and nobody wants to bother with them - especially family.

You were doing the right thing, but the 'right thing' doesn't get you anywhere now. I've also worked with people who have hidden things from RNs cos the paperwork was too much, or they didn't want to get out late from their shift - yet again. The people I worked with last week told me that they quite often worked 2 hours past their shift to fin work and never got out on time.

And these places are so depressing. There isn't time to even talk to a resident - we were too busy doing meds.

I hate it so much, thank God I'm not going back.

I wish you luck in the future :)