I think I made a mistake

[Aunt Slappy]

I left my first LPN job a couple months ago, moved from night shift inpatient hospice to day shift LTC. I knew that was a lot of change all at once, but I'm usually pretty resilient.

The first few weeks, I attributed all my stress to being new, trying to learn my unit, and getting familiar with the residents. And most of it was. Most of my coworkers, nurses and CNAs, are good coworkers and were supportive of my learning curve. I've realized that I got the best unit supervisor in the building, so pure luck on that one. There are a couple people I don't like all that much, but I don't need to like everyone and I can work alongside them just fine. There's one person who is truly unpleasant and who makes me grit my teeth every time she opens her mouth, but thankfully I haven't seen her much recently.

One benefit to this job that I still appreciate is using EMR over paper charting. One of the reasons I left my former employer was their total incompetence at IT. I lived through one failed EMR implementation, after which we returned to paper, and they were gearing up for another one, and I just decided I couldn't face living through it again. Funny thing is that former coworkers have told me that the EMR implementation has now been pushed off until next year, after already having been delayed several months. So it seems my estimation of their ability to actually get it up and running was accurate. There were other issues there, too, but no need for too much detail.

Anyway, now that I'm a little more comfortable and familiar with the new place, I'm coming to realize that it's very very dysfunctional. I have heard conversations had openly and loudly at the nurses' station among staff about how no one loses their job here for poor attendance, because they're so desperate to hold onto the people they do have that they won't fire anyone. Gee, I wonder why they have so many call offs all the time then? I told my supervisor what I had heard and she was like, "They're not wrong." I wonder how they don't see that this is why they constantly have to announce open shifts and try to talk people into staying over into the next shift.

We have a "wound nurse" who is not even wound certified and who is driving the supply director crazy writing orders for dressings that should stay in place for 72 hours to be changed Qday. The CFO is, in turn, riding his ass over cost. Also, I seem to be responsible for a lot of fairly involved dressing changes for supposedly having a wound nurse on staff. The census of the whole building is less than 200.

We recently got a pretty major survey ding over an incident of actual harm to a patient and what it looks like to me from outside (origin is from before I started and not on my unit) is that extremely poor leadership allowed to continue being extremely poor, combined with several nurses who did not do their jobs and notify the MD in timely fashion, is the root cause. Recently, the ADON printed out three packs of papers, supposedly an "education" that all nurses are to sign and acknowledge, one of which contains an explicit threat of discipline memos to employee files for noncompliance, and left them on the desk after just saying "read and sign these." One of them has to do with skin protocol orders that I have never been taught to use, and which DID NOT APPEAR ON THE LIST OF AVAILABLE ORDERS THAT I COULD ADD UNTIL THIS WEEK. A more experienced nurse who has kind of taken me under her wing pulled me to a workstation this week and said, here, I want to show you how to use these now that I've been taught. As she led me through the process, she asked me, were these orders here on this menu before? And I told her no, that this week was the first time I've ever seen them. So now I'm both angry and concerned because it seems to me like they're going to try and throw nurses under the bus to cover systemic deficiencies in this place that are long-standing, and make us the scapegoats.

Am I overreacting from inexperience? I only have a bit more than a year of experience as a nurse and about 5 as a CNA. I have heard and read enough about LTC to know that it is a care sector that suffers from a lot of dysfunction. So is what I'm seeing about par for the course, or should I trust what my gut is telling me and get out ASAP? I've become fond of many of my residents, but I can't allow that to stop me from protecting myself. I've thought about staying at this facility and going back to night shift, because much of what I'm hating about the job, I've come to realize is the overwhelming demands, fast pace, and presence of all the muckety mucks that comes with day shift. I'm also not really sleeping any better than I did before, so my assumption that I'd get more sleep if I obeyed the circadian rhythm has not come to pass. I used to like being able to do my job and fly under the radar most of the time on night shift. Plus, night shift people are just different and it's fun hanging out with your fellow vampires. But the systemic, structural problems in this place make me wonder if that's wise, because even flying under the radar on night shift, I could still get snagged if this place is looking for scapegoats. In some ways, being a night shifter might even make that easier.

Sorry this got so long. I'm open to any and all comments and advice.

[NotYourMamasRN]

I had a very similar experience when I did PRN at two different LTC/SNF facilities. I really thought the problems at the first could not possibly exist at the second, I was wrong. Dead Wrong! Everything you have described sums up my entire experience in these facilities. Like you I became attached to my patients and that is why I stayed as long as I did. I tried to fight the system to improve it. I tried to implement new policies, root cause analysis, and attendance policy implementation. But no matter how hard I tried, nothing ever changed. I left before a really horrible sentinel event occurred on a floor I could likely have been working. Even as someone looking to get out of nursing, I still don't want to jeopardize the license I worked hard to get. And I definitely don't want to be part of a system that harms a fragile population. I will never go back to that setting, never ever!