LTC Nursing gets a bad rap!

[Gchr]

Let's be frank, some LTC facilities are ran well, some are average and some are poor.

I had the opportunity to work at two facilities during the past year that I would consider average or above. I never felt once that we did not have the best interest of our patients at all times. What I am challenged with, is that most family members of these patients have very little clue to the care that we provide or they are in denial of the patients condition.

First, we do have a lot of patients with dementia that we treat. As anyone knows that works with these patients, it is a progressive disease and these patients' reality is much different than the norm. I am surprised that family members expect that these patients will improve when in our facility. Again, as I point out that dementia is a progressive disease, family members find it easier to blame the facility of mismanaged care or improper medication. Obviously the prescription of medication is left to the doctor and not the facility. Second, as other nurses know, getting patients to take their medication can be quite the challenge. Believe me, we try numerous ways to get these patients to take their meds. Sure they will take them when family is around in most cases, but other times we exhaust every possibility before we have to document the patient refused.

Fall incidents....Oh my that is a big challenge! Like a lot of LTC facilities, we have 30 patients in a unit that one nurse oversees. Additionally, we have 3 CNAs. That means at any one time up to 26 or more patients are not being supervised one on one at a time. I cannot tell you how many patients that have not walked in years wake up in the middle of the night and try to walk to the bathroom. I am not sure what goes through their mind that they think they can simply "walk" after not doing it for such a long time. The end result is usually a fall. Again, the family members feels that we are to blame because we were not watching them.

The reality is, is that a lot of families come see their grandmother and grandfather for about 30 - 45 minutes once a week. (This is average. Some family members come longer, others don't come at all.) For that 30-45 minutes family members see the "best" behavior of patients. They rarely see the patients refusing meds, spitting medication back out, pooping all over themselves after the CNA just give a complete bed bath 5 minutes earlier or patients attempt to get out of their beds to go to the bathroom or better yet, get dressed to go home because their car is parked in back of the facility.

Family members need to get a true reality of what takes place in a long term facility. Yes we try to treat our patients with dignity. Unfortunately, we care givers are not given the same dignity in return.

[vintagemother, BSN, CNA, LVN, RN]

Yes to this. I've worked in LTC as a CNA and LVN. My loved one is in an LTC because of dementia. I try very hard to be unobtrusive and respectful to staff when I'm there because I know how it is in facilities.

Families typically don't have a clue about the pressure the staff is under.

[VivaLasViejas, ASN, RN]

There have been many times when I've wanted to tell a family member, "If you think you can do a better job of taking care of your Mom than we can, then by all means take her home!" But I think a LOT of their issues have to do with guilt---over putting their loved on in a "home", of perhaps dealing with that person's finances (or lack thereof) in less than a stellar fashion, of watching helplessly as he or she deteriorates.

That's what I tried to keep in mind whenever I was berated by someone's 70-year-old daughter or 40-year-old grandson for some real or imagined slight or lack of attention to their loved one. After a number of years it got to me and I couldn't do it anymore, but there were many other reasons for leaving besides this one, and that's a story for a different post.

[vintagemother, BSN, CNA, LVN, RN]

Viva---I totally think it is guilt also, that underlies their complaints! I get the psychological motives of that.

[Gchr]

I understand the guilt, and I don't say this to be mean, but most of the patients that I take care of cannot be at home unless they can afford care around the clock. We have a lot of patients that think they can go home. The reality is that they cannot feed themselves, bath themselves, or control their bowels. Additionally, since most of them have dementia, there is the additional concern that they might burn down the house or other safety risks. It is sad, but it is reality. I have seen enough that getting alzheimer is not a way to live your final years of your life.

[GermanicanRN]

Oh, yikes. I will be starting tomorrow at a LTC Place and I am a bit nervous. I'm a foreign graduate and I passed the NCLEX-RN last year, had twins in the meantime and now going back to work in a facility like that.

[Gchr]

GermanicanRN, I don't believe that working in a LTC facility is bad by any means. I happen to like the work and the patients. What I have a challenge with is the family members that have unrealistic expectations or are in denial about the patients care or condition.

[imintrouble, BSN, RN]

When I worked LTC we used to dread the holidays, because that's the only time most of our residents had visitors. So on that day family members we'd never seen, took the opportunity to tell us how awful we were, and how neglected their loved one was. (Let's overlook the fact you see them once a year).

I truly feel sorry for you if your families visit once a week.

Viva's right. A good part is guilt. Understanding that, still doesn't take the sting out of being yelled at, for being a bad nurse/CNA.

[Spangle Brown]

I think a brochure or flyer should be made up to deal with some of those issues in a tactful and informative way. The since you could not pass them out at your facility, Match up with another LTC and each 'visit' the other and pass them out to the families visiting that day. A little education would not hurt.

The other part is, there are some LTC that are bad. Shortage of qualified workers and working short staff. You can not do everthing that is expected in that situation. Yet who at fault do not get the blame if something goes wrong. And those that make it happen wonderfully, don't get the credit they deserve, cause it was suppose to be that wonderful in the first place.

[OnlinePersona, LPN]

Whilst i agree with your plight, I dont feel you expressed why LTC gets a bad rap. It kinda just seems you are directing this to family members. I appreciate you venting though

[Gchr]

Whilst i agree with your plight, I dont feel you expressed why LTC gets a bad rap. It kinda just seems you are directing this to family members. I appreciate you venting though

The purpose of my post was to express that family members don't have an understanding of the LTC facilities or are in denial. I worked today at the LTC facility and did not have any encounters with any family members whatsoever. Found out from a few patients that what I thought their ailments were, were confirmed by the doctor and treated appropriately. Therefore, it was a good day.

Maybe as nurses we need to do a better job of educating family members and the general public??

[vintagemother, BSN, CNA, LVN, RN]

Maybe as nurses we need to do a better job of educating family members and the general public??

At one not so good non medical LTC I worked at, we, as nurses, weren't really allowed to talk with families. That was reserved for our admins, who, believe it or not, were LVNs just like us floor nurses. It made things difficult that the Pts families assumed we were unlicensed med techs who knew nothing. But that was the way management set things up. We weren't treated as competent nurses capable of using nursing judgement. /sour face/