Longterm care nightmare job

[RNlvn]

can't you look up the LTC's on the state website to see their status?. If you need the money stay till you find suitable (good or better ltc with a better state rating) work environment. When you fina good place to work take a tour look at their state book thingy. The LTCs in Texas are required to have a big book sitting out with the state audits in them.

[blondegenes]

Been there and done that!

At a certain skilled and acute care nursing facility in Kansas City, KS, anyone who actually does their job gets brow beaten and their hours cut if they work overtime charting so the facility can get paid by Medicare.

Employees jobs are perpetually threatened who are actually doing the work. Management style is to emphasize the negative and downplay your hard work.

It gets old real fast.

If you actually clock off your shift on time it's either because;

1. you've worked that hall so long that you know what everyone's needs are and where everything is and/or

2. you don't actually do vital signs, finger sticks, skin assessments, G tube flushes, bolus feedings, IV anti-biotics, treatments, or pass everyone's meds and insulin, etc.

For the unlucky nurses who have to switch working on North and South halls all the time, if you aren't working overtime, you're not doing the work. Period.

The med carts are not uniform and the carts and med rooms are a complete and utter mess. Treatment supplies are routinely missing, unordered. Necessary supplies and pharmaceuticals are always insufficient to get your job done. There is one working vital sign machine per hall for two nurses to share, which means one nurse or CMA has to do something else while you wait for the other to finish. There are never enough glucometers to go around. These things eat up your precious time and are always YOUR fault. Some people who are actually doing their jobs buy their own equipment just so they can do their jobs in a more timely fashion.

The facility requires you to sit through moronic meetings on payday that will bore the snot out of you, before they "give" you your paycheck that you've already worked your butt off for.

For example; body mechanics to save your back from chronic injury. Most of the beds in the facility are the old fashioned crank-on-the-end-of-the-bed type. You're left with the option of wrecking your back to constantly get down low enough to crank the old timey bed, or getting down on your knees to work with the patients, because, remember, time is of the essence. What a joke.

Incident reports are not made if the bruises are not "fresh" and can be qualified as "healing". Therefore, it's advantageous to belong to a group of slackers who will cover for each other, look the other way, and only report "old" incidents so you don't have to take the additional time to write an incident report and be bothered with things like neurochecks.

If you're a nurse who actually does the work, expect the nurse who caused the neglect accident to call off work the next day to call in sick, and their CMA partner-in-crime to "discover" the injury so you have to write an incident report. They will also bad mouth you and cast dispersion on your character to put blame on you and take the focus off of themselves.

I don't know of any similar facility where this kind of thing is not happening.

But it gets worse.

Forget about giving the prescribed psyche meds to patients who are agitated and up all night. The nurse is too busy chatting on her laptop and conning other people to do her work for her on 12 hr shifts, to be bothered with a resident. Just put the resident in a wheelchair with a "lap buddy" to keep them somewhat trapped and turn off their wheelchair alarm and leave them alone. So when the resident worms their way out of the wheelchair, and falls on the floor, their chair alarm won't alert anyone. Any other resident who witnesses abuse and neglect knows that they are subject to the same kind of mistreatment.

Many of the employees get even with the administration by getting "free" food from the kitchen and taking supplies from the facility, belongings, and large sums of money from the resident rooms. Employees have been warned not to carry ID, money, keys, etc., because, as I was told, they WILL be stolen and your vehicle entered and other things stolen, too. Although I never heard of it happening, it's not a stretch to say that, once they have your car keys and/or house key, they could steal your vehicle and/or enter your home, too, or hand them off to someone else who will.

The real hardworking employees are so afraid of losing their jobs working overtime to get all the loose ends tied up according to law, that they clock off and finish up working for "free" on their own time. The DON would love it if they clocked off at the end of their shift and work doing the rest for "free" and have zero overtime, I'm sure.

Employees are required by company policy to report abuse and neglect, but if you do, you are the one who becomes the target and you will be verbally beat up in front of your coworkers and your life made hell until you either quit or you get the message that some bosses don't want to know anything that they will have to deal with. Especially if you're reporting offenses that their favorite brown nosers have committed.

If you report a real offense, look to be set up by the offender/butt kisser/slacker and their cohorts who have found themselves a slacker niche where they can slack to their little hearts' delight.

Somewhere on this website there are other posts about how the emphasis is placed on charting for Medicare and MDS so the facility gets paid, over actually caring for the patients.

Relatives and "friends" of employees have been found roaming the hallways of the facility and in the rooms of the residents and it is common knowledge that the residents are allowed to keep their wallets, purses, and large sums of money in their rooms and on themselves. This is not an isolated incident. There was an old warning sign in the break room warning employees that their friends and relatives were not to go beyond the entrance. I doubt that any of this has ever been reported to the police.

The worst? The parking lots were poorly lit. There was no security. The facility can be entered by anyone who has obtained the lame code from a former or current disgruntled employee who wants to steal the narcotics.

The solution? We were told to call 911 if you see a suspicious person.

So many people come and go, who would recognize a suspicious person before the

staff were overpowered, outgunned or murdered?

Complaints about serious concerns like this fall on deaf ears.

You risk being fired just for bringing genuine concerns to the attention of anyone in charge.

The whole thing is a huge lawsuit waiting to happen. I just hope no one dies over it.

Another center in Overland Park is under scrutiny for pretty much the same.

Whistleblower protection? Good luck with that. If anyone knows more about that subject I'd appreciate the input. I can't tell you what to do about that.

Remember this, it's a lot easier to get a job while you have a job.

Some facilities/hospitals won't even consider you unless you're currently employed.

Good luck!

[blondegenes]

I'm confused and maybe someone could explain it. Back when I was in nursing school I had a fellow student who worked as a med aide who passed meds at a nursing home (what they used to call LTC). Do they not have those anymore and why not?

Some acute care/skilled and LTC facilities use CMAs or med aides to dispense some meds, take vital signs, and do finger sticks.

LPNs with IV certification are more desirable in those facilities at times, only because they have a broader scope of practice of things they can do, but are cheaper to pay than RNs.

[Ms.RN]

ARe you guys saying that hospital jobs are easier than nursing home jobs?

[IHRRN]

I have been a nurse for 17 years and worked in many different areas, LTC included, and will never do it again, what you experienced is a commen practice in that venue of nursing, Unfortunally in this job market nursing jobs are not that plentiful. If you have to work and have been out of nursing for a while try med surg it will give you good experience and help you get back in the swing of things, I would leave that facility, losing your license is not worth the job. My mom was in nursing management for 17 years and then took a job in LTC working for Genesis, similar story, was there less than a month and was misguided by her preceptor as to policies and procedures ie: using shortcuts and was then thrown under the bus when a med discrepency occured. She was lucky not to lose her license, she now does VNA and loves it, TRY THAT. Good luck to you.

[neutrophil]

I work in an LTC, the first thing that I believe I should say is that, these people need someone to care for them. The hard part is the bureaucracy. I don't believe that nurses should just say, "I will go with what is easier." Then just walk away.

I've worked at hospitals my entire CNA career. So these nurses walk around as though that is real nursing as if people in nursing homes are not people. No disrespect intended to hospital nurses, most do a wonderful job, and most are given excellent working conditions.

It is very difficult in nursing homes. If you have over 20 patients, you have your work cut out. God forbid there is an incident or an admission. Learn the patients. If you work the pm, learn who goes to sleep early, try to get orders that are given at 1700, by 2100 they are sleeping and won't take them even if they wanted to. If you have eye drops, spread them out throughout the shift, you cannot spend a half hour with one patient giving eye drops. You can do your weekly summaries at the beginning of the shift before the med pass. It is for the week not for the shift. If anything comes up during the shift, you can add it in 1 minute. Get your CNA's nicely, to get the vitals in the first two hours. Do your assessments on those on charting, as you do your med pass. So you don't have to run back and forth. I am sure that new to your med pass, you can't find some meds. You will learn where they are and pour them with your eyes close. You will learn to rock and roll. The one and only thing is, the patients, they need nurses, no matter what. You might be a floater at first, very hard. Try to get your own run. It can easily be done. But yes, one incident. Things change. You might have to stay late to chart. Not everyone can be a SNF nurse. Not a good one. Take care and good luck.

[neutrophil]

A note on CMA's. They are not nurses. In most states, if not all. They only work in units governed by the department of social services not department of health. So not at snf's. Some dementia units and also RCFE's, (assisted living facilities). The do not do assessments, they don't do invasive procedures. It is good training for those that want to be nurses, but some don't even know how to do vitals. They can pre pour, even a day in advance in some places. Not a good practice for hospitals or Snf's. CNA's are completely different, they get in with more of the thick of things, right along with the nurses, (nurses aids).

[BoopetteRN]

I could not imagine going through what you have been through. I have worked in the same place since I was 18, it is large, 304 licensed beds-4 neighborhoods. Each is different and each has its problems, but not taking off patches, giving medications or doing treatments is unacceptable. I have noted one thing over the years, teamwork is not what it used to be, everyone does not pitch in to help like in the past. Jobs are not as plentify as before, so if you feel that you need to go somewhere else get another job first, but have an exit interview and tell them what is going on and why you are leaving, perhaps that will help change things so the residents get the care they need.

[catlvr]

I am sorry that you (and so many other people) are in such bad situations. I am really sorry for the residents who have to endure such bad care, but that's another story.

Definately do what others have said - find a new job. You are fortunate that there are lots of jobs in your area, but please be very selective! I would spend as much time as possible searching for a facility that you feel you can practice safely in. Start with the medicare.gov site, talk to other nurses in the local forum, ask relatives/neighbors their opinion, and maybe even sign up with an agency so that you can get an flavor of the different facilities. You might have to get a job that pays less, but it is worth it.

Good luck,

e

[cecilsgirl]

I was wondering how does that one Nurse just sign off meds but does not give them all? Do you have the bubble pack system where you work? That is so wrong on all levels!! Also someone is paying for those "ungiven" meds.

[catlvr]

It is a mystery, how some people manage to sleep at night. How can your brain rest while you know that you are lying, cheating, stealing, and mistreating your patients? HOW? I hope that if I ever reach that point in my career, that I can recognize it and find a new job where my work doesn't matter.

e

[Ms.RN]

Do you really feel like you are going to lose your license if you keep working in that place? It depends on the unit and the number of patients. Is this a long term or the rehab facility and how many patients do you have? In rehab place, you shouldn't have more than 20 patients and in long term 25 patient is the average. I think you are always going to feel like your license is on the line where ever you work. In long term care its only a matter of getting the routines and knowing your patient. In about 3 months, you are going to be used to the medications patients are taking and what kind of treatments they are getting. Let your CNAs know ahead of time that they need to help you to turn the patients when you are doing the treatments. Just dont take the short cuts or do things that you think are unsafe (ex, giving meds when patient is lying flat) I think you are going to be okay. Since you just got back to nursing I would stay in your job and find a better job instead of quitting your current job.