My first ranting

Futterwacken · Jul 10, 2010

I feel your pain since I work in LTC too. It got so bad coz we were all leaving two hours past the end of shift, that management decided to hire med aides and free up a nurse for charting, and doctors orders and such. Maybe if you all do things by the book and work overtime they'll listen- goodluck!!

bubblymom373 · Jul 10, 2010

I will admit to prepouring some pills . Checking BPs and G tube placement yes, I always do that. The risk of something happening if I don't scares me too much not to. :eek:

netglow, ASN, RN · Jul 10, 2010

Awesome rant. Very high marks for you on your first venting. :up:

SuesquatchRN, BSN, RN · Jul 10, 2010

I do things the way they need to be done most of the time. I do things the way the surveyor would want them to be done if anyone is watching.

:)

CoffeeRTC, BSN, RN · Jul 10, 2010

I do things the way they need to be done most of the time. I do things the way the surveyor would want them to be done if anyone is watching.
:)

um, yeah. We had a mock survey a while ago and some of the stuff they caught/ saw was just aweful. (some of the stuff they found during an actual survey was no better)

When someone is looking over your shoulder...do the right thing. No shortcuts are not good to get into the habit of doing, but it is the reality of LTC. I'm not saying it is right, but it is reality.

fungez · Jul 10, 2010

You know how make a person crazy? I'm not being facetious here. I mean, really make a person mentally ill. You make that person a hundred percent responsible for something he has no control over.

Which is what they are doing to you. They are making you responsible for their unrealistic, unobtainable goals. If you pass your meds by the book, then they won't be on time. And if they're on time, then you'll have to ignore the residents shouting "help" in the hallways. And if you stop to help that resident, they'll be something else they think you should be doing. It's your fault, all the time, always.

Doesn't matter what you do, it's gonna be your fault. Which is why I hate administration and I can't wait to retire.

Forever Sunshine, ASN, RN · Jul 10, 2010

This is the first time I let out a pure personal venting on this site.
My facility is undergoing a stressful stage of preparing for re-survey, so consultants are often hanging around with hawk-eyes. I was followed by one today. One of the many mistakes I made: I drew several syringes of insulin, labeled by their room numbers as trays were being passed. I was caught with handful of them. The consultant said, "What are you doing? What's that in your hand? Go show them to your DON." I meekly opened my hand and showed those syringes to my DON who was sitting nearby. She looked at me and asked "Who oriented you? Is this how you were taught?"
To feel like a child caught doing something naughty, at my age...
Now, I love working there. I still can proudly say I don't regret a thing after working there for several years. However, the nursing practice as I envision it as opposed to what I'm expected to do from the corporate, there's so much disconnect that I sometimes want to say "The hell with it all!"
Is any of you working in LTC capable of doing everything by the book when you're responsible for the number of residents under your care? It's an open secret that we all take shortcuts. Do you actually take BP before every single BP meds every single day? Do you check placements of GT every time? Do you give meds to GT patients by gravity every single time?
For the 30-something number of residents I'm responsible for, it would be a miraculous day if I finish passing meds in two-hour period, doing all those above. And of course there's always something happening with residents that require me to engage in yelling contest with pharmacy people, lab people, doctors' offices, etc, on top of the frustrating amount of redundant paperwork. Then there are your superiors constantly on your back regarding overtime.
They talk of time management, so we learn to manage our time. We somehow learn how to do all the impossible things in the given amount of time. What I did -- drawing up all the insulin at once for the seven or eight people who needed coverage -- was one of them.
I worked telemetry floor prior to this job where any insulin had to be double-checked with another nurse. Believe me, I take insulin very seriously. Also, I take any med error seriously. And I'm always on guard, watching myself, second-guessing myself because I would not forgive myself if I made a med-error. So I devise my own way to do things correctly in the least amount of time.
Now, by taking shortcuts, do I make time to have my lunch? For idle-chat? To sit around? Ugh... I'm running around answering call lights, talking to the family, more importantly, talking to the residents. I have several residents who suffer from uncontrollable outbursts, panic attacks, to name a few. Every day I'm amazed how their symptoms disappear when some one-on-one time is provided, like this elderly lady who constantly calls out "Help Help!" with no apparent reason, but immediately calmed when I take her out to the patio or just wheel her around, talking.
Does the corporate want automatons of nurses who shove the impeccably prepared cups of medicine down the throats of the residents and no rapport? The perfect care plans and the correctly charted entries full of pretty words when none of it took place?
I'm not saying we should be allowed to take shortcuts. I'm saying we should be given the realistic amount of assignment for ideal nusing care, survey or not. Why must I be cornered into having to take shortcuts and then be punished for it without any real solution to do otherwise?

Well the insulin thing I would never do because I would mess that up so bad lol. But some nights I responsible for 50 patients. The B/P's I will sometimes take a shortcut with. I will look at their last B/P. If I don't like that number(too low) I will take it. If its within their normal limits, no I don't take a B/P.

I will do the meds by gravity with a GT. The first flush no. I will draw up the flush with a irrigation syringe and flush it through. The tube clears and the meds go down too quickly even by gravity to grab the syringe and push it all down. I also strongly disagree with giving each med separately because in the stomach its going to be all mixed up anyway. I mix them up in a cup with water and pour it in. Besides some patients with g-tubes are on 10 different meds. How the hell am I going to crush up all that separately and give it all with 20ccs of water in between?

wooh, BSN, RN · Jul 10, 2010

Well, when Joint Commission came to town, amazingly, we were staffed on the high side! We actually had time to do everything the right way! Then a week later they cut our staffing levels below what they'd usually been.

But yeah, you have to do it right when you're being watched. On the plus side, there will be someone in theory watching to see why it takes so long. Not that they'll care, they'll think you should just do it all at doubletime.

I do have to say that I'm impressed you labelled all the syringes! But we're going to be blamed no matter what we do, so I'd have probably asked the know-it-all that caught me to "please show me how to get it all done without this shortcut, I REALLY REALLY want to learn all I can from you and I just can't find a safe way to get it all done but I just KNOW you could teach me!" No, who am I kidding? I'd have probably stabbed the person with all of them at once.

SuesquatchRN, BSN, RN · Jul 11, 2010

Actually, I find it hard to have a lot of sympathy for the prefilled syringes deal even if they were labelled because it had been SO pounded into me that you never pour before you give, or carry two people's meds at once. I guess I'm surprised not that you did it but that you did it in front of someone critiquing you.

tokebi · Jul 11, 2010

Actually, I find it hard to have a lot of sympathy for the prefilled syringes deal even if they were labelled because it had been SO pounded into me that you never pour before you give, or carry two people's meds at once. I guess I'm surprised not that you did it but that you did it in front of someone critiquing you.

Err.. of course I wouldn't have done so if I was being watched. The consultant watched my AM med pass only and moved on to checking my med cart. I walked out of the med room with those syringes and she happened to bump into me... Anyways, don't think I do stuff like that habitually. Anything I say will sound like excuses but I'll just say it was a crazy day. As for taking BP's, I don't take chances either. It's just that after knowing my residents for so long, there are a few whose BP rarely changes.

Since this is my only LTC exposure, I don't have a comparison, but our DON and DSD keep telling us that nurses in other facilities have even more number of residents (we have 30+ per nurse for day and evening shifts) and manage to do things better. When I first started it wasn't too overwhelming. Now, the overall acuity seems to have risen as well as more residents with psychiatric issues. For example, I have about 13-15 people who need finger-stick AC/HS and about half of them will need coverage almost always. Then there are wanderers, screamers, drug seekers... ugh, I'll just stop here.

Anyhoo, I'll just have to try harder. Also, I've decided, I shall not feel guilty for overtime. I'll do my part in improving our facility, and the corporate should do their part in compensating us. Thank you for your various opinions and feedback. This forum is awesome!

SuesquatchRN, BSN, RN · Jul 11, 2010

Gotcha. I didn't understand how that happened.

If you work in LTC you work in a geri-psych facility. They're almost all demented, some with behaviors. It gets trying.