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!
I can't agree more with the title of this thread. I respect those who claim they love their LTC job. Frankly most LTC are a joke and dangerous to both patients and staff. I did it for 10 months as a LPN and fortunate to have landed a wonderful med surg job with max 7 patients and team nursing format!!
Half of the meds are unnecessary and are likely making the prescribing doc some money from the pharma company. The laws regarding ltc patient ratios clearly show that the government doesnt give a flying chuck about safety.
Proof on docs receiving kickbacks? I don't think so. The bigger complaint I have is the HUGE amount of vitamins/supplements that families insist their parent shave. Things that cannot be crushed or opened. Mom has a swallowing issue, meds are now all crushed in pudding but lets just keep force feeding them, after all, they are 95 and most surely need all this garbage!
Seeing a lot of comments about how some nurses give the important meds and about the title of the this thread. I have only worked LTC and I do LOVE it. I have never questioned my chosen career. I agree with other posters that you if you feel that you are in the wrong place...then its it is time to move on. If you feel your job is dangerous for you or your patient..then report it!! If you are in the spot where you cannot give your patient all of his medications because you do not have the time...then something needs to change. Ask for help from your co-workers...speak to your DON...talk to the nurse managers. Yes, you are late giving the med...but the patient still got his medication. If you are skipping corners..you are becoming part of the problem. If you finish with your med pass within the allotted time frame but did not give all the meds or completed the treatments; you are saying to the powers to be .."Hey, I can do this and if I can, so can everyone else." Its just like clocking out but then staying behind to finish charting. Nope ..no way. I do not work for free! It is very very vital for a nurse to have a routine and stick to it. Give room for those emergencies, falls ect...( I am sure there is a thread or two on nursing routines so I wont go into details here).
In most cases, it sounds like its time for a pharmacy review. But not to give a medication at all; that is very scary. At the most, I pre pull my meds ( I have med cards with names, med, dose, and time). This was actually a routine created by my DON and it saves a TON of time on the NOC shift. I was very worried at first, because I was taught that pre-pulling is a huge no-no. But it is written as a policy/procedure and if we follow it; we are good and never had an issue during survey. (This is for NOCS only). This allows me to start my med pass at 4am and for the most part I am done by 530am. This gives me 15 mins to get report from the CNA's and record my report for the day shift.
Not all nursing homes are a joke or dangerous. I am a proud LTC nurse.
Health care is a business, probably the biggest in the US. I'm older and I remember when you had a family doctor and he pretty much took care of everything. Now it seems all my pts have a list of specialists they see, but getting back to this business model- increase profits by minimizing expenses, you my friends are an expense and PT's are income stream. So the goal is to give the most pts the least amount of expense.
I've been through many inspections/surveys and they were all staged. It is known when the inspectors are showing up and everything is planned for their arrival and to put the best foot forward. If I were an inspector and I would do surprise inspections and probably on the night shift to get a true indication of what goes on, not during the day surrounded by an in-house team that guides me through it, but that's just me.
And if a survey were to show up during the NoC shift. .I would be proud to show you around and how things are done. The earliest I have seen state walk in is at 7am.
My experience tells me, nite time less staff but no less pt's, less experienced staff ( I never understand why all new hires are assigned to overnight when there is little extra support available).
When they arrived @ 0700, were they expected, was there preparations for their inspection, were they guided around by an inhouse team? As I said, I would do a surprise inspection when the facility is @ its most vulnerable to establish its minimal baseline. No offense to your overnite shift, just saying what experience tells me. If something bad is going to happen and there are limited resources- then its going to happen @ night. You can start calling in the on-call people but most times by the time they get in- its already played out.
On the rare occasion I'm in during a portion of the noc shift, I do the synthroids and omeprazoles as the aides are rounding. Empty stomach is what they're needing, 4am works just as well as 6am!!
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.
Health care is a business, probably the biggest in the US. I'm older and I remember when you had a family doctor and he pretty much took care of everything. Now it seems all my pts have a list of specialists they see, but getting back to this business model- increase profits by minimizing expenses, you my friends are an expense and PT's are income stream. So the goal is to give the most pts the least amount of expense.
I've been through many inspections/surveys and they were all staged. It is known when the inspectors are showing up and everything is planned for their arrival and to put the best foot forward. If I were an inspector and I would do surprise inspections and probably on the night shift to get a true indication of what goes on, not during the day surrounded by an in-house team that guides me through it, but that's just me.
Wondering where you work that you always know when surveys will take place? we have a 6 month window in which they can come any time. I have had them show up at 4am, on a Sunday and on a holiday.
We also don't have an in house team to guide surveyors through the survey process. As the DON of the facility I am less involved in the actual process that the nurses and STNA's working on the units. We have nothing staged and my facility has had 3 perfect health surveys in a row. I am fortunate that I work for a great company and I have awesome nursing staff that I get to work with.
As I have said many times on here - not all SNF's are created equally so please don't generalize about the entire field as if we are all the same.
NurseBinWA
11 Posts
I can't agree more with the title of this thread. I respect those who claim they love their LTC job. Frankly most LTC are a joke and dangerous to both patients and staff. I did it for 10 months as a LPN and fortunate to have landed a wonderful med surg job with max 7 patients and team nursing format!!