Long term care

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:(I know this is probably a pretty common post. I work in a long term care facility on a skilled unit. I administer my own medications, chart medicare charting on 18-20 residents and seem to be the only one that can answer call lights and the phone. I work weekend doubles at the present time. I dread going to work every Saturday and Sunday. The facility has a weekend RN that spends most of Sunday in front of the TV watching the football games. I have also caught him sleeping in rooms. The problem that I have is that the facility does not seem to care and retaliates against the person making the complaint. I just expect others to do their work so I don't have extra tasks to pick up. Every weekend, I say I am not going to go back. I spend my breaks calling my family and venting my hostilities. I have tried to get into the hospitals but have had zero success. I am working on my RN and will complete it within the next year. I know I cannot wait that long at this job. My CNAs last weekend thought that after 6pm there job was done. They spent the remainder of the time on the sofa watching the game. I listen to resident's complain about getting yelled at by the staff. I used to report these things until during a staff meeting we were told the person making the complaint would suffer the repercussions. Any advice out there? I had an opportunity to travel to Alaska last month, I'm not sure if it is still available. Oh , by the way, I went for my paycheck today only to get told we had to wait and maybe not get paid due to their sprinkler system freezing and bursting. The facility had limited electricity and floods in several locations. We eventually got paid but only due to the CNAs complaining and threatening not to work. What a place????:selfbonk:

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Oh my Gosh, where do you work? It's really horrible the things health professionals have to go thru at jobs where your suppose to be providing care to people. Sorry you have to go thru this, I hope you find another job soon, if that's your desire.

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Let me just say the facility looks nice on the outside. It was reopened after being shut down and remodeled only one year ago. I have had poor luck when it comes to long term care facilities in Texas. I know they are not all bad as I had a good job working for a private pay facility. I would still be there but I lost my job due to a back injury. Anyway, I wanted to start traveling but sure hate to leave my family for 13 weeks at a time. I have had no success with agency or hospitals. I am not a clinic nurse and since relocating to this area, most of my experience is in geriatrics/Alzheimer's. I dread going in tomorrow but it is Christmas and unfortunately I also I have bills to pay. I feel trapped and have felt this way for at least two months. I am a hardworker and am forced to work with some nurses that believe in the bare minimum. I plan on this being my last weekend but who knows. I just keep praying for an open door. Thank you for your response and I hope your holidays are blessed!

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I wish you the best of luck in your future endeavors. You deserve to work in better conditions and with better co-workers. :)

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Hope things work out for you. I have been in some of the situations you described and worse.I choose not to work LTC for some of these reasons...

I am also working on my RN for better job selection:rolleyes:.Good luck and dont give up Tee....

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When you are working in LTC you are not just being a nurse who is passing meds, doing treatments and making patients comfortable. You are also a charge nurse, a supervisor. Being a charge nurse does not involve expecting others to do their work, particularly your CNAs. Your responsiblity as a charge nurse is to supervise those aides and make sure they are doing what they are supposed to and not sitting on a sofa watching a game. When your residents complain to you about your staff, you cannot pass the buck and report this during a staff meeting. You have to address it right then and there when it happens and take care of the problem. These are not the kinds of problems to bring up at staff meetings. Talking about it at a staff meeting only makes the CNAs angry at you and makes the DON think poorly of you as a charge nurse and supervisor. Not only that, but discussing someone's bad behavior in front of a group of their peers is a violation of their right to privacy.

I would have told the aides that they were not to be watching TV while there were lights and rounds to be made. I would have gone back 15 minutes later and if they were still there I would have shut the TV off and told them to get back to work, there were lights to be answered, etc. When a patient complains to me that a CNA has yelled at them, I take that CNA aside as soon as I see them next. Out of the earshot of the others I tell them what the patient said and give them a chance to explain themself. Then, I tell them that if I ever hear of them yelling at a patient again, or a patient complains to me about it again that I am officially writing them up and reporting it to the DON. If you don't know how to discipline or how far you can go with discipline with the CNAs then you should discuss this with the DON or that lazy RN you work with.

I would get a disposable camera and take a couple pictures of this sleeping beauty RN. I'd wake him up and tell him I need him to help with a med pass or treatments. A skilled unit is extremely busy and his help is necessary. If he gives me a hard time, I'd tell him right to his face that I was going to report him to the DON. He's going to have a pretty hard time explaining why he's sleeping on the job. If I have to eventually write him up, one of the pictures would be included with the write up.

You are in a real pickle here because you have permitted the CNAs to walk all over you. It's going to take a lot of time and effort on your part to get your CNA crew back in shape. If you don't exert your authority as their charge nurse it is never going to get better and no matter where you go to work you will have these kinds of problems.

All that aside, I'd be very suspicious of a place that couldn't get their paychecks out on time. That is usually a number one priority of most employers because the labor board comes down on them hard if they don't pay their help like they are supposed to.

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Specializes in Knuckle Dragging Nurse aka MTA.

ONLY 18 - 20 patients!!!! LOL The lvn's here have 40 or more patients each in LTC. Ok a few comments from a long time cna at LTC. The cna's actually run the nursing homes. When they complain...things get changed, as you alluded to. CNA's represent the largest amount of employees. If they walk out, the facility shuts down. One unhappy LPN is easy to replace, especially if it keeps the majority of workers happy.

As far as your cnas not working after 6pm. There is a really easy way to fix that. Have the graveyard (10:30pm -6:30am) shift do rounds and check the patients when then get on shift. If the cna's really stopped working after 6pm, thier patients and thier beds would be completely soaked in urine. This is neglect, and graveyard shift would not stand for this as this would require a complete bed change etc. There is nothing wrong with workers watching t.v. if all there work is done, or they are waiting between rounds.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
ONLY 18 - 20 patients!!!! LOL The lvn's here have 40 or more patients each in LTC.
I even knew of an LVN who was responsible for passing meds to 70 patients in a 90-minute time frame every single day. So wonder the turnover rate is so terribly high in LTC. How do LTC facilities get away with having so few staff members to take care of so many patients? :eek:
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Specializes in Knuckle Dragging Nurse aka MTA.

"How do LTC facilities get away with having so few staff members to take care of so many patients?"

The facility knows that once thier lvn's quit due to being overworked, another lvn will apply for the position. Once this new LVN quits, the cycle will repeat itself. I ahve seen this so many times over the years. Good, hard working lvn's just get overwhelmed and leave the facility, or in some cases the nursing profession all together. I am doing everything I can to get a lvn position outside LTC unless they change the nurse to patient ratio.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
The facility knows that once thier lvn's quit due to being overworked, another lvn will apply for the position. Once this new LVN quits, the cycle will repeat itself. I ahve seen this so many times over the years. Good, hard working lvn's just get overwhelmed and leave the facility, or in some cases the nursing profession all together. I am doing everything I can to get a lvn position outside LTC unless they change the nurse to patient ratio.
Is the graveyard shift any easier for LVNs? You know, since the clients are all sleeping?
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Specializes in Knuckle Dragging Nurse aka MTA.

Yes, from what I heard GY shift is the easiest. You do pass prn pain meds, moring accuchecks/insulin and give the morning thyriod meds, but otherwise it isn't as fastpaced/overwhelming as am's or pm's. No unit managers breathing down your neck. No phone ringing off the hook while you are trying to pass meds. You will of course have more patients, but thats ok as many are sleeping.

If I oreintate at the TLC I am currently at, it will be on graveyard shift. But I dont want to work GY for a long time as it effects your health in the long run.

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I appreciate your comments. I realize it is a charge nurse's responsibility to ensure their support staff has their work completed. I have discussed the issues with the staff. The residents also have made complaints. I find out afterwards that everything wrong is covered up and/or blamed on the resident. After all, they are easy game especially when families are not attentive to their care. The RN unfortunately is a favorite of the DON. We were all told in a staff meeting-"If someone has a problem with someone else then I will handle it but just know the person that notices the problem may not want to hear the outcome." Several staff interpreted this as a threat. Unfortunately, nothing can be done. The only satisfaction I get from my job is the support and recognition I receive from my residents. I know at the end of the day that I made their day a little bit better.

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