LTC... Let's vent! Comments, concerns, suggestions?

NursingStudent50 · Dec 22, 2008

I don't have much experience in a LTC but my clinicals last semester were at one. I saw many

errors, and many things that just "urked" me. So did my clinical instructor. We spent a lot of

time during our post conference "correcting" the errors that we saw made by the staff. It is sad

to me that these places are so understaffed. There was 1 tech to 10-12 pts and 1 LPN throughout

the floor of 40+ pts and the LPN spent all of her time passing meds. There was many tasks that needed to be done, but didn't due to lack of time and staffing. Although there is an obvious lack of staff, that still doesn't leave room for neglegence

or plain disrespect that we saw on many occasions. I left there feeling so terribly sad for ... everyone.

I also found a lot of info I read in the charts were just simply "mistakes"

ex: I saw a lot of complete incontienence dx, when, in fact, the pt felt the urge, needed help to

the bathroom, functional, but couldn't get any help in response to the call light. Which, could in

turn lead to UTIs or lead to falls if getting up alone. This is only one ex of many. I wish something

could be done to improve the quality of life for the residents.

Spritenurse1210, BSN, RN · Dec 22, 2008

Well I have been working in ltc for the past 6 months and I have to say the nurse to patient ratio is horrible. Some places nurses have up to 50 residents! Maybe work on staffing ratios and definately employee morale.

NursingStudent50 · Dec 22, 2008

Like I said before, the LTC is the only place I have experience at so far and the ratio was

horrible. It effects not only the pts there, but the staff themselves. Do you guys find that this

is common??? Is it more common in certain areas more than others, like the LTCs? Not only is it

the nurses, but the techs. Is it mainly due to lack of staffing, lack of adequate pay, or both?

Thanks for the insight... Its nice to have a heads up before entering the working field.

Midwest4me · Dec 22, 2008

LTC is one of the most challenging nursing areas in which I've worked. The main reason for this is the staff to patient ratios. In our state, day shift ratio was 10pts to one CNA, evening ratio was 15 pts:1, and nights: 25pts to one CNA....all without regard to the acuity of the patients. And these ratios were considered the STATE'S MINIMUM requirements!

Some LTCs would staff better than that but you always had to deal with call-ins so often we'd still end up at the minimum. As a nurse, I helped out where I could BUT I always had treatments, MD rounds, MD calls, staff call-ins, incident reports for those pts who fell or got injured in some other way(i.e. skin tears), family calls, admits, discharges.

The pathetic staff ratios definitely contributed to poor attitudes amongst the staff and less-than-optimum resident care. My heart broke every time I worked. I lasted many years before I just couldn't handle it anymore and pursued a different specialty.

yousoldtheworld · Dec 22, 2008

I certainly don't have any solutions, but in my experience so far, most LTC facilities are in desperate need of:

1. Better dementia training programs for staff, especially informing them that "reality orientation" is NOT the most effective way to deal with a dementia patient!

2. Much higher staff to resident ratios. It might be helpful if more facilities were divided into clear units...if you contained the independent or supervision only residents to one unit where much less staffing was needed, it would enable more staff to be on the units with the total cares and major fall risks. I know some places do this, but around here, they tend to have everyone mixed together.

3. Adequate equipment. If a facilty does not have enough hoyer lifts, etc. to go around, people end up being lifted by hand, which is dangerous for the resident AND staff.

4. Better pay for staff. It would lead to less turnover each year, and that money that they have to spend on training new staff every few weeks could go toward the higher pay and facility improvements.

5. Revamped resident care. A "resident based" approach needs to be made. In my experience at a memory care center, dementia and alzheimers patients show far fewer behaviors if they are allowed to WAKE NATURALLY. Dragging these people out of bed at 4 a.m. is just wrong, in my opinion, especially since some of them are up late most nights.

I'm sure I'll have more to say on all this later, but I keep losing my train of thought. :)

Ms.RN · Dec 22, 2008

i would like to know from the people who know best what you think about ltc. i feel like something needs to be done. for everyones sake. please comment on this issue .i am tying to build enough facts, information, and statistics to make a difference where it counts. i plan on trying to come up with a plan to help the pt and staff in long term care but i need a plan... and i need to prove there is a need for change... please comment!!! you all are wonderful. i have a few more blogs i have put on here posted and your expertise and compassion are invaluable to my plight.:heartbeat:yeah:

to me my complain of working in ltc is not adequate staffing but the quality of care that is provided by the staff. yes, i have more than 30 patients but this is in long term care unit where patient's condition are stable and my work is the same routine everyday. what i hate is the bad attitudes from the staff, especially cenas. everyday i have to hear about their complain about how they have too many patients, they dont want to to extra duties like taking vitals, they dont want to answer the call light becuase they are assigned to that room. they are barking orders to the patient as if they are some kind of kid. not much team work among nurses too. there are always talking dirty about each other behind their backs, lot of blaming.

my another issue is from the management. in nursing home, its all about profits. one facility that i worked at locked all the supplies including briefs in the storage room, and have to ask supervisor if they need supplies. the corportate hates to lose patient so when patient becomes critially ill, they still dont want us to send patient to the hospital. i had many days where patient becomes sick and don was called, she says do this and do that and told me not to send patient to the hospital against doctor's order to transfer them to the hospital.

another issue is staffing, they ask you to work becuase they are short staffed, then after pay day they tell you you are working too many hours.

i dont know the condition of hospital because i've never worked in acute care setting, but i certainly need some break from ltc.

Eirene, ASN, RN · Dec 22, 2008

I know my feeling may provoke strong feelings, but this is MY view about the way LTC facilities are going to change.

I believe that there is NO nursing shortage. New grads (RN and LPN) are having loads of trouble getting jobs. This forces them to look elsewhere instead of hitting the hospitals pavement which in the past, was no problem in doing so.

More and more new grads are looking into LTC's to find jobs. I believe this is a blessing in hiding because RN's can demand safe working conditions. I also believe there are going to be an influx of nurses getting secondary degrees such as MBA's. If they turn around and apply for a higher management position at LTC's, they would be the key in actually making a change to horrific working conditions to provide these residents safe care.

PeacefulHeart · Dec 24, 2008

I am glad to see such a thread here as I have been discouraged for a long time now. I work in a pool postion in a LTC and had been staff prior to that. I sought out a different area in clinical reimbursement but after being so micromanaged I felt that I needed to go back to a clinical area. Being an RN, I am able to function in a variety of ways and recently I have been doing the unit manager position. I am sooooooo fed up with the blaming, inaccountability, and just plain miserable attitudes. It unfortunately has rubbed off on me and I have taken it as a sign that it is time for me to move on. I recently applied for a license in the state I live in and hopefully that will let some better opportunities come my way. I have heard that once one is in geriatric care it seems as though the hospital system doesn't even recognize you. I will see. I really need a change.

statphleb SN · Dec 24, 2008

I have to agree with alot of the others here---patient to CNA and LPN ratio. Bravo to you all who work in LTC! :bow:

gentlegiver, ASN, LPN, RN · Dec 24, 2008

In LTC you have to deal with staffing shortages, low pay, hi census with every morbidity known to man. Add lack of support, backstabbing, lack of needed supplies and the attitude from management that you have no rights or personal life. It was stated that there is no nursing shortage for LPNs, I agree, schools are pushing them out the door in record numbers. LTC's are just not hiring them. The attitude I saw was why hire new nurses when you can work short and get the job done? CNA's are overworked and underpaid. Housekeeping leaves by 7PM so the nursing staff become plumbers and floor washers, the kitchen rarely supplies snacks for residents and the kitchen is locked when they leave. A few places I worked at would supply linen for 20 beds in 40 bed units at night and were angry that you wanted more sheets and blankets.

How to solve the problem?? Beats me, I gave up trying to move the mountian.

sinursie · Dec 24, 2008

Thank you so much my friends I will keep you posted on my efforts!