Integrity in nursing (LTC)

[bklynborn]

I am a RN have been for 10 years. I've worked both Acute and Long Term Care. I started as an CNA out of high school and worked my way through school.

Of all the things I have come across in Nursing, I feel most upset about having to do things I feel go against my personal integrity. It's amazing some of the things you are asked to do in preperation sor State Survey or during the survey itself.To me it seems that ongoing education and audits should be done on a routine basis rather than the week befor State is due. I have been obligated to falsify records as part of prep for State. I have seen incidents covered up. I could go on but I am sure you get my point.

I have worked for bad facitities where favortism is obvious. One nurse is written up for calling in and for another the DON will do everything including pulling a manager to the floor to work for her so she can leave mid- shift.

I have been forced to sit in meetings where discussions of personal events seems to be the main topic on the agenda rather than any work related topic. And forced to sit through the escapades of the gay DON the night before with the flavor of the week during the morning managers meeting.

What ever happened to the work ethic? Professionalism?

Sorry to go one but I tell you this can be tough stuff to deal with.

Do any of you deal with this? How do you cope?

Is any job, profession worth putting up with this?

[Jo Dirt]

I'm sorry for what you're going through. It doesn't sound like those people need to be there. It would be nice to see some of the higher ups just come in one day and sweep all that trash right out the door and start over with new management.

[nightmare, RN]

Moved to LTC for more input.

[BradleyRN]

It's amazing some of the things you are asked to do in preperation for State Survey

I always found it quite comical how the staffing seemed to significantly increase during the week of the state survey. If they can pull it off 1 week per year, then why not the other 51 as well?

From my perspective as an LPN in LTC, the state survey is bogus anyway. They will watch the nurse give meds to 4 patients. The nurse will wait 3 minutes between each puff of albuterol, atrovent, combivent, etc. The state will expect the nurse to remain with the patient for entire 10-15 minute aerosol treatments. Meanwhile, the nurse has 2 hours to complete the med pass. On many halls, breathing treatments alone could take up 2 hours.

As the state surveyors watch the nurses take 30 minutes to administer meds to 4 patients, their second grade math skills never seem to kick in with the realization that the med pass will not meet the state's time-frame guidelines on halls of over 30 patients and 1 nurse. Are they just pretending not to notice, or do they have to fail a basic math test to qualify for the job?:)

[TheCommuter, BSN, RN]

Unfortunately, some LTCFs are so hard-up and desperate for staff that management will bend over backward to retain certain employees. This often includes sloppy nurses who are in the workplace clique, as well as unethical employees who will fib in order to pass state surveys. These people are often viewed as valuable to the bad nursing home operations because they'll go along with the tide.

[CapeCodMermaid, RN]

Since we never know when the surveyors are going to show up for annual survey, it would be impossible to plan to have extra staff on the days they are in the building. I report everything to the DPH...if they don't want to keep my report or follow up on it, it's up to them. I've worked for many companies and only one time did one of the corporate people want me to change what I had written on my report to the DPH. What I had written was the unvarnished truth. I told them that as long as MY name was going on the report, it would be submitted with MY information on it.

We scoff at reputations some times but let me tell you, your reputation can sometimes save you. I've had many many surveyors in my building over the past year. They ask for certain information..and they say, "We know YOU'LL have it." Be honest with them and you build a certain amount of trust. Don't try to cover anything up or lie to them.

[TheCommuter, BSN, RN]

Here's another thought. . .

At my previous workplace, nurses who displayed some integrity were viewed as threats to the entire nursing home operation. The DON and management would do underhanded things to rid the facility of the better nurses, because they were more likely to report wrongdoings. Since there are quite a few LTCs in existence which suffer from bad management, the only people who manage to get along with the dishonest managers of these places tend to be unethical nurses and rough CNAs. Like attracts like. Being a decent nurse in a bad LTC can be a drain to the soul, like a vacuum that sucks the joy out of you.

[Jo Dirt]

Here's another thought. . .

At my previous workplace, nurses who displayed some integrity were viewed as threats to the entire nursing home operation. The DON and management would do underhanded things to rid the facility of the better nurses, because they were more likely to report wrongdoings. Since there are quite a few LTCs in existence which suffer from bad management, the only people who manage to get along with the dishonest managers of these places tend to be unethical nurses and rough CNAs. Like attracts like. Being a decent nurse in a bad LTC can be a drain to the soul, like a vacuum that sucks the joy out of you.

I don't know, at the LTC facility where I work, there are some dedicated nurses who have been there 10 yrs. or longer. The exception is the main NOC nurse, who scored a 1 out of 5 on her yearly evaluation(with 5 being the highest rating) because of calling in. She has been there longer than anyone. The only thing saving her is that she works the night shift, which virtually no one wants.

[Jo Dirt]

+

As the state surveyors watch the nurses take 30 minutes to administer meds to 4 patients, their second grade math skills never seem to kick in with the realization that the med pass will not meet the state's time-frame guidelines on halls of over 30 patients and 1 nurse. Are they just pretending not to notice, or do they have to fail a basic math test to qualify for the job?:)

I can't believe those inspectors can stand there with their clip boards and their glasses on the end of their noses thinking things are really done that way. How can they stand there with a straight face?

We haven't gotten to our survey yet, but apparently the nursing homes contact each other as they have their surveys. Apparently, at this one home there was a med. ordered 30 minutes before breakfast and the trays did not come out on time and it ended up being 40 minutes and the nurse got a big write up for it.

Who are these inspectors really working for?

[NurseExec]

Everything CapeCodMermaid said. I've also found that QIS has changed the whole survey landscape. This year was my second go-round with it, and I still can't decide if it's better or worse. There ARE facilities out there that value professionalism and integrity--I sincerely hope you find one.

[CoffeeRTC, BSN, RN]

Good and bad everywhere.

[JB2007, ASN, RN]

I always found it quite comical how the staffing seemed to significantly increase during the week of the state survey. If they can pull it off 1 week per year, then why not the other 51 as well?

From my perspective as an LPN in LTC, the state survey is bogus anyway. They will watch the nurse give meds to 4 patients. The nurse will wait 3 minutes between each puff of albuterol, atrovent, combivent, etc. The state will expect the nurse to remain with the patient for entire 10-15 minute aerosol treatments. Meanwhile, the nurse has 2 hours to complete the med pass. On many halls, breathing treatments alone could take up 2 hours.

As the state surveyors watch the nurses take 30 minutes to administer meds to 4 patients, their second grade math skills never seem to kick in with the realization that the med pass will not meet the state's time-frame guidelines on halls of over 30 patients and 1 nurse. Are they just pretending not to notice, or do they have to fail a basic math test to qualify for the job?:)

Thank you BradleyRN, I totally agree with your post!! This is what I have been trying to get across to my employer for the past year and a half. I am going to add this: There is a reason why we have a certain time frame to pass these meds and there is a certain way that we have to pass these meds. That reason is resident safety!

I ask all of you this when is the state going to do the math and realize that nurses in LTC are asked to do the impossible everyday? When is the government going to do something about it? When are they going to give these facilities the money and the mandates so that they have to hire enough staff to do the job within the time frame given, but also safely?