LTC is getting the best of me!

TELEpathicRN · Jun 4, 2004

I feel your pain!! I am a unit manager for a 58 bed unit with usually 10+ Medicare residents. Everything falls on me! I am responsible 24/7 for the operations of the unit. I was supposed to be M-F 8-4:30, but our admin has decided that we need nursing mgmt in the building on the weekends. Just to enlighten you, this facility only has 1 RN supervisor!!! and that position has only been in effect for about 3 or 4 months!! So, now we are going to have to start doing weekends too. When I first started, I was doing at least 60 hrs/week, but now I just say "screw it" as long as nothing is going on with a resident that needs my attention, I go home on time. I don't worry about the paperwork, it always can wait, residents cant. I do alot of my paperwork at home also. My DON/ADON are very realistic and don't get upset if the paperwork is late. I am very frustrated with my job and am about ready to go back to hospital work. I just want to be responsible for my own actions and that's it!!! Thanks for listening

BHolliRNMS · Jun 4, 2004

Er nurses dismiss nursing home patients instead of treating them in the same manner as other patients.

1. Resident sent to ER during the afternoon after a fall. Report comes back "nothing's wrong." Resident dies during the night from a broken neck...undiagnosed.

2. Resident sent to hospital for fever after a surgical revision of a wound. Go to check on resident in hospital and she is undergoing unnecessary vp for blood cultures, etc. The hospital staff cannot figure out why she has a temp. I ask about the wound and the response is "what wound" When I show it to them, it has MRSA from their OR and stool is in it.

3. Yesterday at 4pm, send resident to ER when she returns from dialysis due to increased temp and mental status change. ER performs chest xray, blood cultures, u/a, CBC..etc. Return resident to the facility. DX: UTI. ER gave resident one dose of IV levaquin and said no further txment required til next dialysis day. This am, resident septic and sent back to ER, had to be intubated, O2 sat at 70%...oh yeah, the xray last pm, showed pneumonia.

4. Resident falls at nursing home...sent to ER FIVE separate times due to severe pain. On the fifth visit, finally diagnosed with fractured vertabrae.

I could go on and on with above incidences. Why do we need all the bad competition between nurses? We should all be working toward a common goal and support each other. People get sick. Accidents happen. Nurses and even Drs are human and make mistakes.

NursesRmofun, ASN, RN · Jun 4, 2004

I am quite certain that if your concerns were found to be justified by the investigators the homes in question would be fined or closed-at the very least it would be front page news in your community..........
>>>>>>>>>>>>> Yes-I have had to do this in my nursing career-those big old prostates,ya know? The UROLOGIST gives the order to send the patient in.......
>>>>>>>>>>>>>>>>>>Can't say I have ever done this in the middle of the night but have had to send pts out-and was thrilled when they came back with g-tubes that we can then replace as needed....
>>>>>>>>> I find it hard to believe that full codes are run on DNR's often-but we DO have to code them as long as the advance directive and the loved ones tell us to.....
>They send the lil ole pt who had fallen 3 days ago at 2 am, after they finally got the xray report back saying the hip was broken.>>>>>>>>>>>Having no in-house radiology dept does make for delay in treatment...If the xray report comes back at 2am and the resident is in pain that the home can not relieve,shouldn't they come to the er?We have a limited supply of meds in our emergency boxes...
Now it's my turn-things that happen to my dependent and helpless residents when they are in the hospital......#1 Pet Peeve Pressure ulcers and raw excoriated peri-areas...Or-foley caths and a resulting UTI....Weight loss from nurses dropping the tray off and never coming back to feed them.....Numerous skin tears from restraints....Increased confusion from the massive doeses of haldol given to sedate them into submission....Back to the pressure ulcers---I have lost count of the number of residents that have suffered and DIED from the sacral or heel ulcers they obtained in the hospital...You have to remeber that the nursing home is the person's home and they have the right to refuse treatment.That includes a bath...It's assault and battery if we try to throw them in the tub....or brush their teeth against their wishes..Remember there are 2 sides to every story

You made so many good points! Especially concur with the prostate problem that is beyond our control. Most LTC facilities don't have curved tipped caths due to the cost. I also agree with the fact that we cannot force people to shower in LTC....You can't legally in the hospital either. But when you are in the ER, you just don't have to face the same problems as nurses in LTC or the hospital Med/Surg units do.