LTC- What do you think the issue is?

BEDPAN76 · Dec 3, 2008

Two words: inadequate staffing. :smokin:

Nascar nurse, ASN, RN · Dec 3, 2008

Ok, I'll go first. I have 22 or so years experience in LTC. Started as an aide (no such thing as certification back then) and now RN.

First, I think the elderly are the forgotten generation. There is really no glamour in taking care of a room full of wrinkled, crippled people with drool running down their face calling out for Momma (and no hope of ever improving their outcomes). Therefore, we don't always attact the best and brightest of the nursing field. Meet a stranger and tell them you are a nurse and they eagerly ask "Oh what hospital do you work in". As soon as you tell them you work in LTC, their eyes glaze over and they no longer want to discuss. Ask 95% of the new grads if they want to work LTC and they are nearly disgusted with the question (Don't slam me all you wonderful LTC nurses and new grads, because there really are some great ones.. I have seen them and worked with them - it's just rare). When we do get those fantastic nurses, they often leave due to the constant short staffing, frustration with the process, etc.

Our system is broken and no one in LTC knows how to fix it and no one outside of LTC wants to admit it is broken. We are so over regulated with silly stuff that nurses spend WAY more time double/triple charting the same thing just to cover their orifice, that they have no real quality time to actually spend with the residents. There has to be a better way to ensure quality without so much darn ink involved! The whole survey process is punitive.. very little to no recognition for the good quality facilities. The whole mentality is that surveyors have to find something wrong because no one is perfect... oh come on.. if the facility is clean and the residents look well cared for and express happiness with their situation GO AWAY. As soon as they write a tag, then there is a plan of correction and endless audits to ensure future compliance. The more time we spend writing plan of corrections and doing cumbersome audits, the less time we actually spend with the resident.

This is just a start of the problems, but I will give someone else a chance.

nursejaybird · Dec 4, 2008

I've worked LTC since 1996. For me the main problem is always the corporate decision of not having a sufficient number of licensed nurses and nursing assistants. When I started in '96 I was usually assigned 20 patients on NOC shift; that number will keep you busy, but it is a manageable number most of the time. Over the past 12 years I've seen that number grow, and grow. My last LTC job had me caring for 80 patients on NOC shift and IF I was lucky there would be 3 nursing asst's - quite often I had only 1 or 2. This was the management's decision to staff it this way on a regular basis. I have friends who work as nurses at other LTC facilities here in Calif and it is about the same for them too. Corporate managers are much happier paying fines to the government for inadequate care and also bearing the expense of staff turnover than to hire more nurses and have reasonable workloads. I've known more than a few nurses who quit their hospital jobs so they could "try" LTC, thinking it would be easier - none lasted, and what do you think their final comments were on their way out the door and back to work at a hospital? "This is way too many patients and too much work for one nurse!" LTC patients need and deserve better staffing ratios :cry: .

sinursie · Dec 4, 2008

I love it, keep the info coming, I am trying to start a LTHC awareness program, starting in San Diego, but hopefully spreading the word.

sinursie · Dec 4, 2008

What do you all think about Physician workload? it seemed that they could not be there enough. We would have to do mounds of paper work to send the pt to the ER because the DR could not see the pt that week. Lord forbid any med changes...

SuesquatchRN, BSN, RN · Dec 4, 2008

Money. Medicare pays us $185 a day base per resident. You can't get a nice hotel room for that. That has to house, feed, and perform ADL's for that individual.

Lexxie, LPN · Dec 4, 2008

Staffing is definitely an issue! My former facility only cared to provide adequate staff when it was "about that time" for the state to make their annual inspection!

beckym · Dec 4, 2008

I work in LTC. The floor I work on is skilled, but when we have a low census, I have had to float to one of the long term floors. What a difference! I never get a chance to spend any time with the patients because I am passing meds to 26 to 30 patients. (and all of those are supposed to be passed within an hour either way of the time scheduled) Get real! By the time I'm finished with my 9 a.m. pass, it's time for blood sugars and, soon, another med pass. Not to speak of the treatment book, which is a joke! Three to four, sometimes more, treatments on 30 patients? When am I supposed to do them? After my shift is over, that's when. Then, the facility is complaining about all the overtime they are having to pay out. God forbid, someone should take a turn for the worse! Then, there are the dr. orders, charting, making sure all the appliances are in place (posey boots, gloves, air mattresses, wheelchair cushions, tabs alarms, etc.) UNDERSTAFFING!!!!!

FireStarterRN, BSN, RN · Dec 4, 2008

Working in LTC is backbreaking work, especially for the CNAs. I don't know how they do it, day in and day out.

People are living longer these days, in more and in more debilitated states with chronic illnesses. Many LTC residents are incontinent, which adds to the problem. Since the advent of group homes and assisted living, the nursing home population is sicker and more debilitated than ever and kept alive longer thanks to modern medicine.

Then, add on top of that the well intended government oversight that makes everything harder to do and is quick to dish out unfunded mandates, then point fingers when problems occur.

southernbeegirl, BSN, RN · Dec 4, 2008

I've been in LTC since 1992. I started as a CNA while in nursing school.

Staffing numbers tops my list. The building I have worked in for years was sold last year to a big LTC company. In this past year they have raised prices and cut staff numbers. Then they complain that our reputation is getting a bad name and we are giving bad care. well duh...what did you really think would happen???

Another thing I believe is CNA education would really help. Constant inservices on things that really affect their job. Teach them how their interventions help patients.

I have experienced how people treat you when you tell them you work in LTC. some of my family used to tell me "why dont you get a real nursing job?" I've experienced the treatment of "oh, you work in LTC and i'm so much better than you". to that I always say "one shift...come work with me one shift and then tell me that".

The problem with LTC is that to the corporations it is a business and the bottom line is all they care about. To us, all we care about is the patients. I know with this new company I am now working for, the main reason our staffing numbers were cut were "at our other facilities this is how many patients the nurses and cna's have so thats what we are going to have here".

Then they expect us to give 5 star service with 2 star staff!

nanae_snow · Dec 4, 2008

there's too many things wrong with ltc...

i wish they would do something with staffing ratios... 'cuz it sure is hell to work with 40+ people demanding pain pills and meds and falls and wound care and all the charting.. just thinking of it gives me SOB (and I just got of work too..uuggghhh)