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!
Oh, how common that situation is. Your choice - leave your resident in pain or catch hell from an angry doc (who has the right to be angry). These kinds of errors became more frequent when the LTC's discontinued unit secretaries who were an immense help to the nurses in keeping everything up to date.
Oh, let me tell you, I have nothing but admiration for LTC nurses. I was sent as an agency nurse to a LTC a few years ago. It was a nightmare I can not even begin to describe. Day shift, 38 patients on 2 different wings. It was the first and last time I ever want to try that. At the end of the shift that I thought I would die on and they would find my dead body in one of the hallways, I went to the supervisor to talk about my concerns regarding the patient care (or lack of it). I was really concerned about my performance and worried for the patients. He just said, well you made it didn't you. And I said yes I did, but please don't ask me to come back. That was a day straight from hell and I never want to do it again. I wanted to report it to somebody, but I didn't know what to do.
The CNA's are the heroes of LTC. They are the ones who let you know when a resident is having problems. They are the ones who give and give and give. Without the CNA's we nurses could not survive LTC. Let alone the residents. Just wanted to say that.
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.
Oh god, I have to clarify myself. When I say ignore, I don't mean "don't give". I mean ignore the non-critical things like eye lubricants/drops until you have time. They're not time sensitive or critical... So give them later before end of shift. There is leeway with when you can give certain things. Real word nursing is not 100% " by the book" because those guidelines do not make sense in the clinical setting... They are the "in a perfect world" ideals that the system does not provide the practice supports to uphold. So, after time you learn from older Nurses that YES you give ethical care, but it has to be done a different way from how you were instructed in school otherwise nothing would get done at all. If we did everything BY THE FREAKING BOOK a bed bath would take 1hr per patient. It's just not realistic.
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.
From my experience we have survey window. State can come in anytime a month before or month after from last year survey. So yes...for 3 mos..we knew they were coming...but didn't know what date. The day they came at 7am; I had to call my DON and administrator. We were also in low census....so we cut staff as usual. I didn't stick around after my shift to see who showed them around, I assume it was the administrator . And yes, things happen at night..but no more than they do during any other shift. I have 60 patients and its me plus two cnas. We do have a part time cna who comes in at 5 am to help with lights until the dayshift comes in at 6. I think we are staffed fine for nights. I also had to earn my night position and I have support from the nurse on call and my DON also has an open door policy. I can call her anytime. 9 times out of 10, I can handle anything that happens during my shift. There was only one time (at this current job) that I had to call for help to come in and that is when I had two falls, and two hospice patients die within minutes of each other. I called the dayshift nurse to come in early to help pass 4am meds.
The facility I'm rotating in now charges between $5,000 and $8,000 per month per resident, yet there are only a handful of thermometers, blood pressure cuffs and pulse oximeters in the whole place. When we take vital signs we have to wait our turn because each hallway has many residents and only one vital signs cart. Also it's a long walk to find a dispenser for hand sanitizer. Seems like they cut corners everywhere. I sure hope I don't have to work LTC when I graduate as an RN.
I will say that once you pass the same meds to the same people forever, you become familiar with them. I pass to 20/25 people. I always do my checks by the book. When I first started it was nerve wracking. But the way the system is set up, it makes it much easier but could be very detrimental for the lazy or busy nurse. The meds come in packets. For example, pt. Bob Jo Bologna has packets for each time/day. So 0800,1200,1800,etc are all separated into packets. So in the 0800 there may be MPAP, Metoprolol, Simvastatin and Lasix. They come in one packet. Printed on the packet is pt name, time, date, drug name, drug dose and description. Based on familiarity I can look at the pack and say "all is well" or "wait a minute, something is different". Due to human error, sometimes a meds details are on the packet but the med itself is missing. But with familiarity and proper checks against MARs, this is not very time consuming. My by the books pass, with no other interruptions, takes about 1-1.5 hour. Sorry for the wall of text. I love my job and do not feel like it is a joke at all.
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.
Of course they know but do they care? All I ever see them is eat donuts and coffee with a stack of paperwork in a beautiful office. Then they do the walk through and all is fine and dandy.
I'm sorry to tell you, but sometimes it's not just LTC where you see those sorts of things happening. Everyone is pretty much looking to see where they can cut corners nowadays, especially at a time when the government is not refunding as much. I do agree though, that LTC are money makers which explains why they're able to pay so much. But that's basically where the money goes, to our paycheck versus supplies. Basically, having worked in an LTC myself, you truly learn how to improvise and make do with what you have.
Oh god, I have to clarify myself. When I say ignore, I don't mean "don't give". I mean ignore the non-critical things like eye lubricants/drops until you have time. They're not time sensitive or critical... So give them later before end of shift. There is leeway with when you can give certain things. Real word nursing is not 100% " by the book" because those guidelines do not make sense in the clinical setting... They are the "in a perfect world" ideals that the system does not provide the practice supports to uphold. So, after time you learn from older Nurses that YES you give ethical care, but it has to be done a different way from how you were instructed in school otherwise nothing would get done at all. If we did everything BY THE FREAKING BOOK a bed bath would take 1hr per patient. It's just not realistic.
+1 for this. Everybody misterpreted my earlier post and its so same like this.
Totally agree. In the beginning of my career as a licensed nurse I used to focus on what the CNA missed or forgot to tell me. Now that I've seen what a difficult job it is I am thankful for the times they found something and informed me...and I forgive the little things more.
Sixtyseven
47 Posts
Oh, how common that situation is. Your choice - leave your resident in pain or catch hell from an angry doc (who has the right to be angry). These kinds of errors became more frequent when the LTC's discontinued unit secretaries who were an immense help to the nurses in keeping everything up to date.