My almost venture into LTC! Verrrrrrrry long!

[Brownms46]

My Per Deim positions is nearing an end, as it doesn't offer enough hours. So I have been looking for a good reg PT position.

So I see this ad for a PT position in what is state to be one of the "facility of the year". So I check it out, and go for an interview. The money is good $25/hr until 2pm and then another $1/hr. But I'm not quite sure this is the place for me. So the NM and I agree on my shadowing a nurse, who is doing this Med/Tx position in a 20 bed TCU "supposedly"

Well the morning comes finally after the facility had to cancel d/t the nurse calling in sick, and so I rescheluded the date. Well I go in, and everyone seems very nice, but just a little too glad to see me! I notice somethings that bother me, but I just toss if off.

Then I meet this wonderful nurse who I'm to shadow! She looks professional, and was very knowledgeable. She states she LOVES working at this facility, and it is her PT position. The other place she works is a dump, and she admits it, but has been there since graduated 10yrs ago. So to her this place is a gem.

But as we go along, I soon discover, this is NOT the place for me! I'm not there 2 hrs, before I'm almost running ummm walking out the door! That is after this very sweet nurse finally let go of my arm:chuckle!!! She was pleading for me to stay, and telling the NM to offer me more money! But I'm sorry it's not all about the money!

I found out, that my duties not only were to be on this 20 bed unit, but that I would be responsible for treatments on another wing, that made the DFW phone book look small!! Not only that most of the orders were in cursor, and not even printed!!

One of the treatments was to wash under this lady's breast, dry it, and place a dry cloth there???? Another problem were skin assessments of pts. when most are already up by the time they were to take place. Second I watched her be called by a CNA to give a PRN to a pt on this hall, while the nurse was on break. Yet there was an RN who was sitting at the desk who could've given it, and who was doing nothing but yada...yada...about nothing!

Then we went to get supplies to do another tx. You got it, not there, but guess what was not there??? NO NASAL cannulas..NONE!!! Then we went into a room where a total care, very large man, was lying in urine, with a draw sheet waaaay up his back!! The CNA who answered the call bell, stated" just do the treatment, and will get him up, as "his" aide was on break!!! This man needed to be cleaned NOW!!!

How do you go on break and leave someone like that?? And the fact that his member was outside of his brief looked to me, like someone was in too big of a hurry, since the man had no use of his hands!

Now here is one more reason why I ran ...umm walk out the door. This large book of treatments was to be done in only two hours! After seeing the frequent amount of interruptions this nurse had during the hour that I was there, and seeing that that she had only been able to get to 3 or 4 pts during that time, I asked her what happens with the treatments that don't get done?? She said...they don't get done,and she doesn't sign them off, and "they" know about it!

Yes there were some unneccessary stuff, but I asked her if it frustrated her to not be able to do what needed to be done. She said it did, but that this place was a lot better than the other place she worked. And I will say, that I'm glad that she is there, at least PT. I'm glad these pts. have someone at least. But I couldn't be one of them!

Considering the money, would anyone else have taken this position??? I would have been working three days a week Mon -Thurs 10a to 6p

[Brownms46]

we_rn, I checked out the facility, and their state inspections, and, they were one of the best in the area. The only one who surpassed them was a hospital LTC, and they only had 6 pts!

This facilty was given the "Facility of the year Award". The position was supposed to be on an subactue unit, with only a 20 pts capacity, and was a short term stay unit. This is the only reason I even entertained the idea of taking a look see.

I have been in all kinds of LTC, and I have only found one that I would even do agency in. As a strict rule I have stay away from them as much as possible. I did sub as an instructors for CNAs clinicals in a Baptist NH, and I saw stuff that made me realize, I never want to be in one!

But you're totally correct sixes, it does take very special person to work LTC, and I knew long ago, that person wasn't me! I take my hat off, and bow to the caring nature of those who can do LTC:)! Those of you who give awesome care to the elderly are angels of mercy indeed:D!

I just hope and pray I never need you:)

[sashibeak]

Dearest Brownie,

What a scare you had! I am currently still a SRN, but all of our clinicals are in LTC facilities, up to this point.

From my experience, these places are crying out for RNs..........especially those with such work-ethics as yourself.

Give the patient-to-RN ratio, no-one can blame you for not wanting to take this on, however, isn't it time LTCs were fortunate enough in recruiting great RNs??

The CNAs in my facility work so damned hard, bless them, and are a godsend. But they are also overloaded and in need of more RN supervisors.

I love working geriatrics. I hope one day I can make a difference in a LTC facility, which is where I would like to be situated.

I nursed my Grandma through cancer at home. Everytime I walk into my clinical LTC, I think of her, and do my very best to give those old people the love, dignity, and care they deserve.

Brownie, you do what you think is best for you. But, like I said, LTCs need caring, responsible, experienced nurses like yourself.

Good luck and I hope you find something you enjoy!

[nurse62]

As an LPN in a LTC facility, I hear, understand, and deal daily with what you have experienced. As far as tx though, they are usually signed off. Never sure they are completed, unless a dressing is required and I can actually read the nurses date and intitials. Why do I stay, obvious enough, for the residents. They grow on me like a member of my own family. I can't turn my back on those who are desperate, and let me tell you something you already know, geriactric patients are desperate for care and respect they deserve. I have sat along bedside and talked many conversations with my dear ole patients, and the wisdom they have is beyond belief. And the thing is, they usually feel bad about taking up my time. Well dear, time is a issue for me, but more of an issue for them, for most of them don't have much time left.

[Buddha]

We-Rn

I totally agree with your post. I LOVE LTC and have no reason to leave it, I just placed my own grandma in mine for needed Rehab to recover from a two week hospital stay. If I coulld take her home believe me I would. Our goal is to be home with home health in less than 60 days. But believe me I am glad I am on medical leave and can devote my time to be with her as she recovers.

LTC will never improve untill the goverment implements a Nurse to Patient Ratio, the 1 aide to 15 residents is in effect but what is the LPN/RN patient ratio??

LTC is changing, no longer the days of sweet grandma's in wheelchairs. It's psychotics and homeless who are leaving in LTC.

And we (The LTC industry) needs to adjust. The corperations who run these homes needs to look a aquity not cencus and staff accordenly. Many a night we run short d/t needing to pull aides for one on one care for psych patients.

[Brownms46]

Sashibeak first I'm not an RN, I'm an LPN:), but I thank you for the kind words. For some reason your post made me sad, and proud at the same time.

Sad I guess because I didn't and don't have what it takes to be the kind of nurse you will be,. Or the one you already are in your heart.

But proud that you will be there for those of us who can't be, to give of your education, your skills, and your caring:D God bless you to learn all you can, and to continue to have the heart you have now:kiss

[Brownms46]

nurse62, I will say this again and again! My hat is off to you and those like you, and I will remain humbled by your devotion to those who need you, and find you willing to do what is needed. God bless you also to continue in your devotion to the elderly.:)

I have always believed that nursing is a calling, and I see that more evident more and more.

[pickledpepperRN]

Nursing Home Staffing Act

Rep. Waxman and other members introduce H.R. 3355 to establish minimum staffing levels for nursing homes.

Bill Text

Bill Summary

http://www.house.gov/reform/min/pdfs_108/pdf_inves/pdf_nursing_staffing_act_2003_summ.pdf

http://www.waxman.house.gov/

If the first link does not work you can find the bill on Congressman Waxmans site:

[LilRedRN1973]

I am doing clinicals in one of the nicer LTC's in the area. There are approximately 80+ patients split into 2 wings of 40-45 each. For each wing each day, there are 2 LPN's, 3-4 CNA's, and 2 RN's that are not there on a continuous basis (they seem to in and out of the facility and I rarely see more than 1 there at a time).

Not sure if this is a normal ratio, but it seems low to me. It seems difficult for 3 CNA's to get up all 40-45 patients for breakfast in the morning and be able to all the care for them. I'm sure they are glad to have the 4 of us helping out (we each now have 2 patients we are responsible for).

I think there needs to be more staff in this LTC, but then again, I'm just a student in my first semester. Maybe this is the way it's supposed to be.

[Brownms46]

Originally posted by spacenurse

Nursing Home Staffing Act

Rep. Waxman and other members introduce H.R. 3355 to establish minimum staffing levels for nursing homes.

Bill Text

Bill Summary

http://www.house.gov/reform/min/pdfs_108/pdf_inves/pdf_nursing_staffing_act_2003_summ.pdf

http://www.waxman.house.gov/

If the first link does not work you can find the bill on Congressman Waxmans site:

Thanks spacenurse, I got the last link to work. Unfortuantely this bill will do nothing to help those who are in areas, that already have difficulty in getting nursing staff, as the bill states it would allow up to five years for compliance! A lot bad things can happen in that time!

[Brownms46]

Originally posted by RNnTraining1973

I am doing clinicals in one of the nicer LTC's in the area. There are approximately 80+ patients split into 2 wings of 40-45 each. For each wing each day, there are 2 LPN's, 3-4 CNA's, and 2 RN's that are not there on a continuous basis (they seem to in and out of the facility and I rarely see more than 1 there at a time).

Not sure if this is a normal ratio, but it seems low to me. It seems difficult for 3 CNA's to get up all 40-45 patients for breakfast in the morning and be able to all the care for them. I'm sure they are glad to have the 4 of us helping out (we each now have 2 patients we are responsible for).

I think there needs to be more staff in this LTC, but then again, I'm just a student in my first semester. Maybe this is the way it's supposed to be.

The above staffing is entirely too few people to adequately take care of 40-45 residents! Just think of all that needs to be done to provide for all of them! And I bet ya there is only one LPN at nite!

[mattsmom81]

We've all been there to some extent...chalk it up to experience. I signed on to LTC's twice...both times with very nice DONs who I felt I would love to work with. Altho the DONs were marvelous, the rest of the place was a disaster on all counts, so I could not stay. We have to do what we have to do to protect our licenses, don't we?

I had to tell them both, in spite of their tears, I was too uncomfortable with all the liability to stay and help them 'fix' things.

Something good will open up for you soon Brownie!! :)

[Brownms46]

Thanks mattsmom, but a job at Wally World is almost starting to look good...:chuckle!