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!
It was not my intent to call nurses of LTC's or anybody who works in a LTC a joke. LTC nurses are hard working and commendable.
I am frustrated with the fact that workers in LTC's are held to impossible standards. Bottom line I feel like if the government truly cares for the elderly/residents in LTC's then there should be better staff to patient ratios. It just makes me angry that they expect so much, and know that a "show" is put on for them during survey. Why? My facility always knows when survey is coming, within a 2 week window...shouldn't it be more random so facilities will always be in "survey mode"?
So yes, wording of my title was bad. Sorry...love and respect to all who work in LTC's, we all deserve it!
I feel the title of this thread is harsh though the reality and standards are near to impossible that I will agree on having worked my share of LTC's as CNA, LPN, and RN. My hats off to anyone that does it full time for a living on day shift. I can see why many smoke and drink coffee by the pot. That stress is not for me and IF I was limited to LTC's I'd have quit nursing long ago. I think the only way its made better is to staff more RN's/LPN's to cover the med passes, assessments, breathing treatments, and wound care. Doing so would only raise the rate of rent at which residents can't already afford to a higher level and nor will the government, solely medicare and medicaid won't cover to begin with anyway. This system is broken. As I said hats off to those of you who still do it for the reasons you started.
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?
Two years ago, New Mexico's Attorney General sued a nursing home chain for Medicare fraud, based solely on staffing and the company's calculations of how long it took to complete certain tasks.
New Mexico's lawsuit relies on calculations for how long it takes to complete basic care tasks, from helping residents to the bathroom to feeding and bathing them.
By calculating the total minutes required to properly care for residents and comparing them with the actual number of hours worked, the state found deficiencies of as much as 50 percent in the total hours worked by nursing assistants.
Not only to the 25+ pts. but it is also what the medications entails. 5 of them on 3 different eye drops, 15 of them on blood pressure medication and everything they ask for 'in between', i.e. 'put me to bed', 'miss?..I need some help', family members come and say res didn't get a bath etc..all this with the DON don't give a %^&* .. Yes it makes for a joke.
My residents get every eye drop prescribed, every blood pressure med prescribed - as long as it's within the parameters. Not sure where you got that 'I just signed my name'.
You summed up just some of the reasons I STRONGLY dislike LTC. If I had a choice, I'd never lend my skills to any LTC unit. They're all run so poorly at the expense of ethical patient care, and contribute to Nurse burnout and horizontal/lateral violence... They treat their staff like disposable slave labour. LTCs are terrible places.
I worked in LTC 20 plus years. The problem is, the owners (corporation) will staff to the minimum state requirement. The minimum state requirement is far from adequate for the acuity of care most residents now need. The scheduler will fill the schedule with any name to make it look good, even with names of people who no longer work in the facility. Then there are the call-outs. What you end up with is an impossible situation for staff and a win-win for the corporation who save dollars by working with less staff. If the workers complain about staffing, the corporate powers that be point to the state minimum and say "we are above the state requirements". Poor old grandma and grandpa do not understand why they have to wait so long to be cared for! So they and their families become angry and the anger is directed at staff. I am so glad to be out of it now.
Yikes, wouldn't it be easier to call the Dr and get the "unimportant" ones discontinued.
Problem with this is only a few Nurses make the effort to do this...because in reality due to the volume of patients it's impossible to go through all their charts and MARs and evaluate evey single thing then request it from them MD then get new requisitions then get a new MAR from the pharmacy, etc... So, just give the important ones (ex. Beta blocker) and ignore the less important ones (ex. Eye lubricants) if you don't have time.
I worked in a SNF/LTC for 10 months after graduation. I hated it and it made me question my love of nursing. I felt incredibly unsafe with so many patients. We had a general nurse/patient ratio but that was almost never adhered to. One night I came into work and when I went to give a patient some pain medication, I found that no one had requested a refill, the patient was out and the day RN had just been giving it out of the facility stock, and the stock was out! I had to wake up a very angry on-call MD at 2am, request a refill they didn't want to give and then get it delivered stat from the pharmacy. It was terrible.
heronurse
135 Posts
Please read my clarification for this.