Misery loves company?

notjustanurse · Feb 26, 2011

Med Pass: Talk to experienced nurses at your facility about what system they use to get organized and adopt a system that works for you.

How often are you required to assess/document on your patients? If you were within your guidelines, then the rigor is regrettable but not an offense.

You are within your rights as a nurse to tell your clients that inappropriate behavior will not be tolerated, if they are oriented. And a gentle reminder to some patients with dementia isn't out of line either. You are not required to endure abuse.

As for the derogatory comments by other nurses, it's BS. There are amazing nurses that work in LTC. It is not the bottom of the barrel, it is a specialized discipline just like ICU or OR nursing that requires a specific skill set and a special kind of nurse!

Columnist · Feb 26, 2011

Moved to Geriatric Nurses and LNC Nursing forum. Hopefully you get some replies from others working in LTC.

Esme12, ASN, BSN, RN · Feb 26, 2011

Hi,
I am a new grad who finally got this terrific opportunity at a Long Term Facility. Working with the elderly has always been my dream, ever since my granny died in one where they took such good care of her. I was given a lot of responsibility right off the bat and I feel so overwhelmed.
First: I have to pass meds four times a day and I just get so confused, I am sure I make mistakes. So far, no one has been hurt I don't believe anyway. I am just being honest here though I know I am going out on a line to tell this.
Second: I had two patients die at almost the same time three days ago. They were DNR of course, but the documentation shows that I hadn't checked on them in several hours. When the doctor came to pronounce them he said that both of them had the beginning of rigor mortis. That just can't be true. I told my aid to take vitals just a couple of hours before. I think that I am in trouble over this one.
Third, I don't know what to do about all the inappropriate comments made by the clients at this place. I know that some of them are senile and all, but it is more than that. I get my butt slapped, my breasts pinched, and called a whore almost everyday by older men who otherwise seem alert and oriented.
I have always wanted to work at a nursing home, but I keep hearing snide remarks by other nurses about it being the bottom of the barrel for nurses. They call it a pre-mortuary. They call it a death waiting room. I am not sure how much more I can take of this. Is it really true that REAL nurses don't work in LTC facilities? I hear it so much I am beginning to believe it myself.
I need some company in my misery. Anyone got anything positive to say? Words of encouragement?

Rigor Mortis....really??? I know I make med mistakes??? Really??? YOu don't THINK you've hurt anyone? The residents call you a whore??? Really??? Are you trolling for an argument? If it's that bad get out now!!!! Before they fire you.

I have to tell you I find your story strange strange. I have worked a many of inner city emergency departments and I have been called many things.......but I have always found the elderly gentlemen with the same gentlemenly manners that they were brought up on. Oh I've been "pinched" or grabbed opportunistically.....but I figure they're 90 years old!!! God bless them for still thinking they can! and a polite rebuff is usually enough...it's always been the drunks I can't stand.

If the place you work at is so bad...find another job. If sounds like a wild story to me......or......one to stir up a little controversy. Real nurses work in LTC and LTAC's every nurse has their niche but there are bad facilities and good facilities. Good nurses work at good facilities and not so good nurses don't.....:twocents:

Chin up · Feb 26, 2011

Laughing nurse, that's funny the name you created for someone so morbid. New grads always take longer to pass meds, practice only makes you faster. But first you need to get to know all the perverts you serve. Then you need to make peace with the fake nurses who work there...okay this is a sarcastic reply, but it is very hard to take this port seriously. If this is remotely true, rewrite it without your sweeping snarly comments. Peace.

sevensonnets · Feb 27, 2011

Are you saying you documented that you hadn't seen these two patients in several hours before they died? What an odd way to chart!

laughingnurse1 · Feb 27, 2011

NO! I did document that I had seen, bathed, and fed them. I don't think that they really had rigor. I think that because I am a new nurse people just think I am stupid and take advantage of that. This is not a troll, whatever that is. I am really unhappy at my job and thought I could get some solace here.

Mulan · Feb 27, 2011

You bathed and fed them?

Don't your aides do that?

GHGoonette, BSN, RN · Feb 27, 2011

Op, firstly let me commend you on your (at least initially) positive attitude towards caring for the elderly. Many nurses "fall" into LTC because they can't get work elsewhere, so I think it's nice that you yourself, along with many others on this forum, actually wish to dedicate yourself to the service of the aged in society.

Here's a link which explains the rigor mortis timeline:

http://www.google.co.za/url?sa=t&source=web&cd=3&ved=0CDUQFjAC&url=http%3A%2F%2Fwww.deathreference.com%2FPy-Se%2FRigor-Mortis-and-Other-Postmortem-Changes.html&ei=SuhpTZCmCI6kuAPDxuDjAg&usg=AFQjCNHijb1clUKKHGD9cauSBcERIIGSfA&sig2=FGaxVmn-x-C6lJgyMQAJNQ

If, as the doctor said, the patient was in the beginning of RM, then very likely only the jaw, eyelids and neck were involved, but the onset is also affected by the temperature in the room. If your heating system was set too low, it could happen sooner.

As other posters have mentioned, mistakes when issuing meds, or at least the fear of making mistakes, is fairly common amongst new grads. Just be careful and double-check yourself before giving them, and soon it will become second nature. There are numerous threads on nurses who have made errors, look them up and read some of the excellent advice given to help you avoid them in future.

Elderly gentlemen are usually just that-gentlemen. However, there are those who were perhaps not gentlemen in their youth, and may exhibit inappropriate behavior. Don't let it get to you; you will have elderly ladies who accuse you of stealing their bags or jewellery, and elderly gentleman who will claim that you are trying to seduce them; it happens. Don't take it personally.

Lastly, you will certainly find staff members who are negative about the kind of work they are doing. Such individuals are found everywhere, and not only in nursing. You will also find others who are truly dedicated to the senior citizens they serve, and it is for you to ensure that you remain one of the latter and avoid the company of the former. :)

rngreenhorn · Feb 27, 2011

What a sad commentary on our society. Whether it is a troll or not. You all know that an RN at a nursing home is responsible for 25 or more people. There is no way that one person can take care of that many people... ever. When things go wrong they go wrong quickly. Or slowly--- from neglect (because the person has no advocate)... don't be so uppitiy, unless your house is made of rock. You know what they say about people who live in glass houses.

agldragonRN · Feb 27, 2011

rigor mortis....really??? i know i make med mistakes??? really??? you don't think you've hurt anyone? the residents call you a whore??? really??? are you trolling for an argument? if it's that bad get out now!!!! before they fire you.
i have to tell you i find your story strange strange. i have worked a many of inner city emergency departments and i have been called many things.......but i have always found the elderly gentlemen with the same gentlemenly manners that they were brought up on. oh i've been "pinched" or grabbed opportunistically.....but i figure they're 90 years old!!! god bless them for still thinking they can! and a polite rebuff is usually enough...it's always been the drunks i can't stand.
if the place you work at is so bad...find another job. if sounds like a wild story to me......or......one to stir up a little controversy. real nurses work in ltc and ltac's every nurse has their niche but there are bad facilities and good facilities. good nurses work at good facilities and not so good nurses don't.....:twocents:

have you worked in ltc? i have been working in ltc for almost 3 years now and yes some of the things the op mentioned happened to me. still do actually except for the bathing part. i simply do not have time for that with 25 patients and the cnas do those. please remember the op is a new rn in ltc. to have 20+ patients right after school is tough!!

and yes a lot of people think ltc nursing is not real nursing experience. some hospitals in my area don't even look at you if you only have ltc nursing. it is absurd but what can you do.

agldragonRN · Feb 27, 2011

hi,
first: i have to pass meds four times a day and i just get so confused, i am sure i make mistakes. so far, no one has been hurt i don't believe anyway. i am just being honest here though i know i am going out on a line to tell this.
how long was your orientation? please ask some of the seasoned nurses what their routines are and if they can give you tips. you'll develop your own routine eventually. you are new, please give yourself a break. when you say you make "mistakes", what do you mean? you mean you are out of compliance with the 1 hour before and 1 hour after window? don't beat yourself up. i usually finish my 5pm meds at 7pm. there is no way to be in compliance with this so i gotta do what i gotta do.
second: i had two patients die at almost the same time three days ago. they were dnr of course, but the documentation shows that i hadn't checked on them in several hours. when the doctor came to pronounce them he said that both of them had the beginning of rigor mortis. that just can't be true. i told my aid to take vitals just a couple of hours before. i think that i am in trouble over this one.
again, please seek the seasoned nurses on your unit and ask how to properly chart. also ask your unit manager/supervisor on how you can improve your charting like what info to include in the charting.
third, i don't know what to do about all the inappropriate comments made by the clients at this place. i know that some of them are senile and all, but it is more than that. i get my butt slapped, my breasts pinched, and called a whore almost everyday by older men who otherwise seem alert and oriented.
you can set limits with these patients and tell them the comments are inappropriate and are making you feel uncomfortable. if they are really out if it, then document, document, document and just try to avoid the groping and ignore the whore remarks. but please chart their behavior. maybe ask the doctor for a psych consult? and or ask your unit manager to have it care-planned.
i have always wanted to work at a nursing home, but i keep hearing snide remarks by other nurses about it being the bottom of the barrel for nurses. they call it a pre-mortuary. they call it a death waiting room. i am not sure how much more i can take of this. is it really true that real nurses don't work in ltc facilities? i hear it so much i am beginning to believe it myself.
ltc nursing is tough. it takes some getting used to with all the craziness and having so many patients. unfortunately, yes some people think ltc nursing is not real nursing experience. don't believe it! you will learn time management and prioritization skills. you have to or else you will be passing meds your whole shift. you will learn so many nursing skills i don't know why some people think it's not "real" nursing. oh well ignorance is a bliss.
i need some company in my misery. anyone got anything positive to say? words of encouragement?
you are not the only one i can assure you!

good luck!