LTC job from hell! Are they all like this?

[resilientnurse]

I think that I work in a LTC facility from hell. I accepted the position last month as an in-between gig. Having recently finished my graduate degree, I am in the process of moving out-of-state and while I am awaiting licensure endorsements, doing preliminary telephone job interviews, and organizing things I needed to earn some money. Admittedly, I have never worked LTC before and geriatrics had been among my least favorite populations along with drug rehabilitation and psychiatric, but because the place was being touted as assisted living and the facilities look like a resort so I felt it was more than manageable. After all, I was starting on the first day they opened. Everyone (including the residents) and everything about the place was brand new. No new nurse work politics to deal with because it's only one nurse per shift.

I currently have two residents, a third one due to arrive shortly. Sounds easy, huh? One of the two has serious psychiatric issues and was taken from a psychiatric hospital against medical advice and brought to the facility. I spend every minute of every work day (no time for lunch) being verbally insulted, fielding constant inquiries about what time her children are coming and an array of other make-believe plans, cleaning purposefully smeared feces or urine, guarding the elevators because she likes to ride, calling the doctor who rarely returns calls or shows up, hiding tooth paste, facial creams, nail polish, soap because it gets applied in god-awful places on her body, monitoring the water cooler because she likes to swim in it, trying to get her to put her clothes back on when she stands in the front door naked banging for help from passers-by, protecting myself from scratches and bites, administering medications, worrying about psych medications prescribed by the Internist because my nursing drug guide and Internet sources indicate they should NOT be combined, documenting, calling the pharmacy for refills, hounding the family to pay the pharmacy, pick up the medications, and bring them to me so I can administer them, answering the telephone (cell phone and land line), receiving food trays delivered from the local hospital, serving the food, making coffee, cleaning tables and putting away food trays, giving tours to potential residents that come in off the streets, supervising cleaning staff, assisting contractors and work crews all throughout the day, dealing with a temperamental, volatile, and racist owner who treats the sixty-something dark-skinned cleaning lady, who is facing a possible cancer diagnosis (biopsy next week--and he knows this) and works three times harder than I do, just horribly, in order to save money he hired a BSW/nursing assistant for the 3-11pm and wants me to leave prepared medications for her to administer AND when I get a moment to breathe I pump breast milk 3-4 times per day (I know I am forgetting something else off this list). I am too embarrassed to mention my hourly wage.

My goal is to stick it out one more pay period; hopefully I will have a firm job offer by then so that I can release myself from this job. Ironically, one of my potential offers is with a LTC facility. For some reason, I just feel like it's not necessary the field of LTC but the place that I work. Is this typical?

[wowensue]

no, they are not, even though i dont want to over medicate, this litlle ole lady needs an anti psychotic. diversion is always helpful. i have worked in private facilities when no psycotropics are given unless symptoms are severe to a reg snf where everybody is medicated into the stone age. sounds like administration is looking for a quick buck and taking everything that breathes. ask to see see beh notes from acute, meet with family and get a n idea of expectations, yup i ma a nurse and a social worker, be a patient advocate but cover your ass as well...

[Davey Do]

resilientnurse:

No, not all LTCs are like this. You're currently in the birthing stage of a new program. And, as you are well aware of, births can be painful processes. Take comfort in the fact that this job will someday be a memory. And you will have the oppotunity to laugh at it. However, the only thing we really have is this moment. So let's attempt to deal with that.

You've got quite a situation of an elephant to eat. So let's take it one bite at a time.

Your acting out Client with a psychiatric diagnosis is not stable enough to reside in a non-instutionalized facilty. She is currently meeting criteria for an involuntary admission to an inpatient setting. She has an alterd mental staus to the point that she cannot adequately function in society. She is also a threat of harm to herself and others. There is probably some kind of entity you can contact that has the means to assess and hospitalize her.

Take your med concerns to the Doc. Document your concerns, actions, and results. Consult with entities that deal with these issues regularly. For example, I'm sure there are other LTCs similar to yours. Do a little generic situation conversing and problem-solving. I realize your time is limited, but to distinguish priorities, such as meds, will work to serve you well.

It sounds like you're an "of all trades" Individual. Once again, priorities are priorities. Choose your battles and then fight for them with a vengence. Remember: You're a Nurse first.

I can commiserate. The best to you, resilientnurse.

Dave

[handyrn]

Ok, so I will admit, I looked at your profile to see if it indicated where you might be located because it sounds like you are working for the same person I did in an assisted living. He was an individual guy who owned some assisted livings (some with partners, some by himself). Anyway, he had me doing some of the same things, trying to cut back on staff when possible, very prejudiced toward african americans, etc. Anyway, I can't see where you are from to see if it could possibly be the same owner. Anyway, as far as the psych patient goes, here is my suggestion: make an annonymous call to your LOCAL department of aging-NOT the department of health. In my experience, unless you are in a large city, your local dept of aging personnel has more time to deal with these things. Besides, if it is reported to Dept of Health and they think it is serious but can't get there within days, they will send someone from your local dept of aging services. That person can make recommendations and/or report the person as not eligible to live in your facility.

Anyway, I feel for you after being in a similar situation. By the way, has your boss ever come and asked you to give him the patient's meds? I dealt with that as well. Guy wanted the patient's A/Bs and pain meds cuz he was sick.

[GLORIAmunchkin72]

"Guy wanted the patient's A/Bs and pain meds cuz he was sick."

Say what??:)

[handyrn]

Yeppers! The owner of the facility that I was the RN Administrator in tried to get me to give him A/Bs when he felt ill, IM cyclobalamin when tired, and pain meds when in pain. He didn't want to go the Dr. for his own perscriptions, just wanted me to "sneak" some of the patient's meds out of their supply and administer it to him. I tried to tell him it was illegal and unethical and he "promised" not to tell anyone so I wouldn't get in trouble. Being at a loss, I told him to go to a vet cuz I had heard a lot of people get A/Bs and the like from there. I did warn him, however, to do a lot of research on the dose as I imagine that a horse or cow requires a bigger dose than a human.

[CoffeeRTC, BSN, RN]

What the heck??? NO, NO , NO. All places are not like this! What type of place is this? Assisted living or LTC/ nursing home?

[GLORIAmunchkin72]

"Being at a loss, I told him to go to a vet cuz I had heard a lot of people get A/Bs and the like from there..."

:)This is getting better and better...

[mazy]

LTC can be bad but that place sounds like a whole new level of bad. There is so much going on that is wrong in that facility I wouldn't even know where to start, other than that getting out sounds like a good idea.

A lot of for-profit companies open these facilities with no interest in patient care other than milking the system for the medicare and insurance bucks. They've opened, now they want patients, don't care who they get in there as long as they get someone. And they don't care what happens once they get there.

A facility that doesn't care about it's patients isn't going to care about what happens to you.

This doesn't look like it's going to get any better, at least in your career lifetime. i think your instincts are on target.

Sorry that you're having such a bad experience.