Don't state surveyors know that med nurses (and other nurses for that matter) cannot possibly do everything the job entails? That it is impossible for one nurse to pass meds to 25+ plus patients within the 2 hour window "by the book"? That the facility basically puts on a show once a year when they arrive?
I especially feel for CNA's. Its bad enough to be on the bottom of the totem pole, so to speak, as far as pay and "status". Its such a difficult job, especially when there are so many patients to care of in an 8 hour period. What makes the department of health think its okay or feasible for one nurse to care for so many patients?
It almost makes me sick...it really takes a special and strong person to work in LTC's for many years. Okay...rant over!
Specializes in Allergy/ENT, Occ Health, LTC/Skilled.
I find the standards of care to be the joke, not the actual profession. I also find the nurse to patient ratios a complete joke. I now only work PRN in LTC while I finish up my bridge program, and those few shifts a month are more than enough. My DON is understanding and it is a non traditional nursing home (example: No med times unless time is of essence like insulin, just after waking, before bed, etc) is the only reason I do it. The families now expect one on one care for some reason -- they seem to forget I have 25 patients and become belligerent if you can't give mom round the clock attention. If they want that kind of care, they need to pony up the cash for it. But no one ever wants to do that. I love my residents but they could never pay me enough to do it part/full time with the kind of demands that are placed on us now, now to mention the residents are sicker than ever now. I regularly have PICC lines, wound vacs, g tubes, and IV fluids in the rehab portion. Its to the point you largely ignore your long termers other than their med passes because you have to deal with rehab mostly.
I refuse to ever work in LTC again. They treat their staff with absolutely no respect. The amount of work expected for nurses to complete in the allotted time is unrealistic and unsafe. I first started off as a nurse working as a LPN. In my first job ever, I was only given two days orientation. I had 40 residents on my floor. I had to give them all medications, and administer treatments. More than half of them had pressure ulcers. Some pts had 3 ulcers. B/l heels and sacrum. It was a nightmare. And to top things off management then had the audacity to ask why are you leaving late daily? Its not like they were paying me for it. I worked 8 hour shifts and got paid for 7 hours. It didn't matter if i stayed 1-2 hours extra. I wasn't getting paid so idk what the problem was. Its not like I wanted to stay late. Its just that it was impossible to me to complete all of that work in the given time. I never even took breaks. And out of those 40 residents, so many had GTs, JTs, eye drops, suppositories, nebs. So many needed BP and HR checked. Half the time the BP machine was MIA or not even working. I started bringing my own manual BP cuff and pulse ox. Everytime atleast 1 tube was already clogged when I went to give meds and feedings. It took forever to unclog them. Sometimes they didn't even unclog and the pt had to be sent to the ED. Ugh it was such a mess. LTC is a joke. I honestly applaud anyone that can work there for so long. I worked in LTC for about 2.5 years on a part time basis (2days/week) and completely lost my mind. No idea how people do it on a full time basis and for 10+ years. I'd shoot myself.
Re: xxMichelleJxx's post - Good God, I consider our situation at work (i.e. not just mine) 'too much to do', but that's even worse. No one can do all of that. And as you say, then mgt. is insane enough to ask why you're staying late.
Specializes in Ambulatory Care, LTC, OB, CCU, Occ Hth.
Those of you who discovered LTC was not a fit for you and left it, bravo. Bluntly speaking, you have no business working the specialty if you had such a powerfully negative response to it. Others still working in LTC and sharing similar adverse responses to your work, it might be time to consider another specialty.
I disagree that the standards of care are jokes. They are the ideal to strive to; they are certainly how I'd like to be treated were I the patient. And not following the standards and arbitrarily deciding what meds and BP checks are unnecessary and withholding or delaying them are actions that put otherwise good nurses at liability for negligence and could be argued as practicing outside their scope.
My greatest annoyance is with LTC facilities that shape up for survey, then return to their typical dysfunction. Survey should not be a matter for fear and anxiety if the staff and facilities do their jobs right.
That means documenting, advocating for their patients, promoting resident dignity and autonomy, speaking up and making it known to any and everyone in the administration if there is an issue you see and offer a solution - go so far as to frame it as a patient safety issue, few administrators can argue with a nurse who opens with "This is a matter of patient safety; let's come up with a solution."
Some LTC facilities suffer from poor leadership and toxic staff which contributes to high turn over and over worked aids and nurses. But in my experience a lot of the headaches we nurses complain about stem from poor time management, poor prioritization, not delegating or not understanding delegation thoroughly, miscommunication stemming from communication skills that aren't as strong as they could or should be, lack of assertiveness, and/or a lack of dedication to advocating the patient's best interest in every sense of the meaning.
It's easier to complain than put forth effort to speak up and try to affect a change that might include reporting the facility to CMS
And I don't mean any of this to be judgemental or offensive to anyone - we're all human and I don't think there's one of us that can't hang their head in shame thinking about at least one situation where we could have done more to improve our situations and our patients' situations more, but took the easy path of least resistance instead.
Specializes in Ambulatory Care, LTC, OB, CCU, Occ Hth.
Does that mean that the meds just didn't get passed? Or if you didn't meet the 2 hour time frame that you were penalized? When I worked critical care, there were periods of consistently being short staffed and I have to tell you, my eMAR flagged me and my co workers constantly for being even 5 mins early or late, but we also had a spot to document the reason and every time I documented "Workload/Staffing issue" and I filed an incident report. Every time.
Does that mean that the meds just didn't get passed? Or if you didn't meet the 2 hour time frame that you were penalized? When I worked critical care, there were periods of consistently being short staffed and I have to tell you, my eMAR flagged me and my co workers constantly for being even 5 mins early or late, but we also had a spot to document the reason and every time I documented "Workload/Staffing issue" and I filed an incident report. Every time.
So, Im curious. Have you actually worked in LTC? Have you ever tried to pass meds to that many patients in that kind of a time frame. Trust me, they can't just write "workload/staffing issues" as a reason for not getting done on time. Technically it is a med error and I have seen the department of health tag a facility for being 5 minutes late on a medication.
Specializes in Ambulatory Care, LTC, OB, CCU, Occ Hth.
Yes, I work in LTC, and am familiar with survey inspections. And yes, I have been in some of the most God forsaken situations having to juggle critically ill patients, pass meds, and sometimes even get caught up in a tsunami of a code, and still be expected to have meds administered within a 2 hour window. I read what you're sending here.
I merely shared what I see as a similar predicament that I encountered in another specialty, since I am fortunate enough to work in a LTC facility that actually places safe care as priority one.
It all comes back to documentation though. Department of Health pores through charts and records and staffing schedules, etc. If the "med error" is a matter of a facility's inability or refusal to staff adequately, then they deserve the tag. That tag is a sign to the administration that that things gotta change or they need to reevaluate their ability to operate as a LTC facility. Too many patients or medications is not an excuse.
The facility has a duty to its residents and staff to provide the means to safely carry out care- be that by hiring more help or making available to staff additional training or continuing education on topics of delegation, time management, etc.
The sad fact is that too many LTC facility administrations are blind to what these surveys actually are, and use them as regular occasions to come down on hard working staff instead of carefully examining the way the facility runs.
So, Im curious. Have you actually worked in LTC? Have you ever tried to pass meds to that many patients in that kind of a time frame. Trust me, they can't just write "workload/staffing issues" as a reason for not getting done on time. Technically it is a med error and I have seen the department of health tag a facility for being 5 minutes late on a medication.
And this is why I work nights!! I have worked days and pm shift before however, I found that for my sanity...NOC shift is best for me. I have four residents that get meds at 2 am and 15 residents that get early morning meds. I usually start my med pass at 4 am. I have 10 residents that I need to get blood sugars on. I also have 6 residents that I do the treatments on (really quick dressing changes). At this time, we currently do not have any trach residents but have in the past. That being said, I have noticed a trend with the doctors, the pharmacy rep and the nursing homes. Most long term residents are on as least meds as possible and nurses do not need to take a BP or HR for a medication the resident has been taking for years. At my current job, most LTC residents are on weekly vitals and are usually done on their bath days along with their skin assessments. Now for TCU side, things are different. Most residents are only there for 6-8wks and we monitor their VS daily. They have a heavier med pass than the LTC unit and those residents tend to be the sicker/needier ones.
We have 20 TCU beds and 40 LTC beds. We are currently at full census. There is one nurse for the TCU with 2 CNAs and for the LTC there is one nurse, TMA and 5 CNAs both during the day and evening shift. At night its just me and two CNAs. Fun times!!
Couldn't agree more! I try not to pick up the slack, but sometimes it's hard not to. For example, the EMAR states that a PICC line dressing was changed today, and while administering next IV dose, I assess the site, and see a date from a week ago! Ugh, that makes me want to scream. Sure, I will then take time to change the dressing for the patient's sake. First offense, I give the previous nurse some slack, but if I see it the second time, it's a reportable to the DON... As for missed skin checks, I do not pick up THAT slack, just do the ones due today on my shift, and the DON can go to hell on this one: oops, go scream on the one who missed skin checks yesterday.
Having to pick up other people's slack isn't just in LTC, or even just nursing. This is in any job you have to work with other people ever.
I work night shift and when I am assigned the LTC section, I have 70-75 residents to myself and 2 CNAs. There is a small 12am med pass of about 7 people. Then there is the 5am pass of about 30 residents. If I start at 0330, I usually finish by 0600 when morning shift comes if nothing crazy happens but that is rare. I prefer to start at 0300 in case someone falls or cant breath or else its impossible to finish on time. I always give pain pills and important pills within the window, but omeprozoles and syntroids I will give hours early.
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LPNtoRNin2016OH, LPN
541 Posts
I find the standards of care to be the joke, not the actual profession. I also find the nurse to patient ratios a complete joke. I now only work PRN in LTC while I finish up my bridge program, and those few shifts a month are more than enough. My DON is understanding and it is a non traditional nursing home (example: No med times unless time is of essence like insulin, just after waking, before bed, etc) is the only reason I do it. The families now expect one on one care for some reason -- they seem to forget I have 25 patients and become belligerent if you can't give mom round the clock attention. If they want that kind of care, they need to pony up the cash for it. But no one ever wants to do that. I love my residents but they could never pay me enough to do it part/full time with the kind of demands that are placed on us now, now to mention the residents are sicker than ever now. I regularly have PICC lines, wound vacs, g tubes, and IV fluids in the rehab portion. Its to the point you largely ignore your long termers other than their med passes because you have to deal with rehab mostly.