Is it the same everywhere?

[actioncat]

Well, I thought I would like my job more than I do. It seemed to be ideal when I started, but the bloom is off the rose. And I wonder if it is the same everywhere.

First, I want to say I love my patients and I love getting to know the families.

But...I come from a hospital background and I'm used to getting a little more respect-- that is the nurses on the floor are encouraged to have more input in patient care.

Instead, it seems to be more like "don't question. We know what is best."

For example, I had a patient that I kept trying to find out whether they would be getting home health care upon discharge. I finally was able to speak to the social worker and all she said is "it's taken care of." I asked her to elaborate and I got an annoyed "she does not qualify for it." And that was it. A few days later, doing the discharge papers I saw that she was getting home health care. There had been a change in plans, but nobody told me. Not important, I guess.

OK, here is another example. We have scheduled inservices on payday. I thought they would be true inservices. The one I went to was entitled "needs of the geriatric resident" or something like that. I thought this might be useful. Instead, it seemed to me like a session berating the poor CNAs about how they treat the residents. I was stunned. There did not seem to be any acknowledgement of the difficulty of their job. Or the fact that aides can get burned out because, yes residents who are not in their right mind may be abusive to them. They often bear the brunt of this. And, what I see is aides remaining patient in the face of this and all their other demands.

The social worker who went on and on about how this was a subject that she was passionate about has never really demonstrated to me that she is through her actions. She seems to be more concerned about her outfit that she is going to wear that day.

There really does not seem to be many opportunities to expand my knowledge of rehab nursing via the facility.

My unit manager is the singularly most unpleasant manager that I have ever had the displeasure of working with. Multiple times I have tried to raise concerns with her and she just blows me off. She has shown no compassion for the patients on my unit. Here is an example of something she said. She comes stomping to the nurses station and says " why is X reclining in her (motorized wheel) chair? I've told the aides that she can't do this. " at this point I thought "Oh she does care about the residents" but then she blows it by saying "it'll be my butt when she gets a pressure sore." Right at the nurses station-- in front of everyone! I've seen her make faces when a patient had a bowel movement in their bed. I've heard her talk rather sharply to residents. I know that I wasn't imagining that because they later said something to me about it. All these things make me lose respect for my manger. I cannot respect her simply because she is my manager. When I spoke to my DON about my issues with he I did just limit it to her behavior with me. I still don't want to be "telling on someone" until I have spoken with her. Problem is, I'm afraid to speak to her about these concerns.

Another example-- she is big on making sure we group calls to the doctor with her doing the talking. Fine, that makes sense to me. But sometimes it is not possible. The other day I had a patient that needed pain medicine. The poor guy looked miserable and he was in PT. I knew he had no breakthrough ordered, but I checked anyway. his scheduled medication was not due for 4 hours. My manager was in a meeting. I called the other units to see if they had any concerns for the doctor. Actually, I called them twice and they did not answer back. So, I called the doctor. Later, my manager asked me if I checked to see if he had breakthrough medication ordered! Then the kicker was that she said "Well, I'm not really sure if he is having pain." Huh? How exactly does she know this? At any rate, I came back after three days off, noticed some changes (that I'm not sure why the other nurses did not pick up on)

and now he is in the hospital with some serious problems.

Is it all like this?

[bethin]

I'm not a nurse, but that place sounds dreadful! I don't think I could work in those conditions. Your managers last statement really frost my crack. You assessed the situation and determined that he needed pain medication for breakthrough pain.

I've only worked in one LTCF as a CNA and I didn't like it. But it was NOTHING like what you described. Taking care of the elderly is not my niche.

[actioncat]

I find I enjoy working with the elderly, although all my patients are not elderly. I'm surprised, because I really did not enjoy my clinical rotation in geriatrics, but I now realize that had more to do with not knowing much and the stress that created. Now that I feel much more clinically competent from my time working in the hospital, I have a different take on things.

[Simplepleasures]

:igtsyt:Sad to say, but Im not surprised. Maybe one day LTC will be a great place to work, one can only keep hoping.:plsebeg:

[lil' girl, LPN]

Well I would have asked her how she knew if the patient was in pain or not. Just flat out ask her. SHE knows that we are not supposed to judge "pain". If a patient says they have pain then we are required to do something about it. If someone doesn't speak up this behavior will just continue. Sometimes all it takes is someone questioning the offender and they will back off. As long as you are following protocol and doing your job correctly she can't throw it back on you. Good Luck!

[sharlynn]

They are definitely not all like this! I've worked in several LTC's in two states and none were as bad as what you describe. I would be looking around for another job if possible.

[TheCommuter, BSN, RN]

Actioncat: It seems that you work in nursing home rehab. Rehab units in nursing homes are, in my honest opinion, little hellholes on earth. The patients tend to be higher-acuity than the typical geriatric patient, the management seems to be most concerned with sucking every last dollar out of these residents' medicare coverage, and the nursing staff gets placed at the bottom of the interdisciplinary totem pole.

You cannot bring about sweeping changes in a vacuum, so get out.

[Rexie68]

actioncat: it seems that you work in nursing home rehab. rehab units in nursing homes are, in my honest opinion, little hellholes on earth. the patients tend to be higher-acuity than the typical geriatric patient, the management seems to be most concerned with sucking every last dollar out of these residents' medicare coverage, and the nursing staff gets placed at the bottom of the interdisciplinary totem pole.

you cannot bring about sweeping changes in a vacuum, so get out.

wow, that's a sweeping generalization. i'm one of the mds coordinators, and yes, i am concerned with medicare coverage and payment, but never at the cost of patient care. the patient/resident comes first. if he/she needs that $1500 special brace or the $700/shot procrit, he will get it. we may lose money, but so be it. yes, i'm going to bug the floor nurses and cna's about coding accurately and charting appropriately, and i'm going to keep an eye out for unneccessary meds/treatments/tests, but shouldnt' someone be doing that anyway? and gee, i'd hate for our ltc facility to lose money constantly, because then neither one of us would have jobs......:angryfire

[CoffeeRTC, BSN, RN]

Any other facilities in your area? You can give them a try. Yes..I've seen good and bad ones too. All it takes is a few bad apples to soil the bunch.

Rexie....I hear your! Been there, done that. Lotsa respect for what you do!