My LTC nightmare continues.......

Specialties Geriatric

Published

Specializes in Psych, Addictions, SOL (Student of Life).

Ok - I took this job because I had been away from the bedside for a couple of years and that may be the problem but I was having a hard time finding a job so I took it. I am just a bit amazed at how disorganized this facility is. It's huge national corporation with all kinds of rules and standards on the books but what actually goes on is deplorable. There's not ratios for staffing which I knew going in but it's not unusual for the RN to have charge of 30 patients with full nursing care of half of them. The RN takes the new admits as well. Med pass is sloppy with nurses leaving meds at the bedside and often taking two to three hours to pass the meds for a 1 hour window. Ie 5:00 pm meds being passed as late as 7 pm. I get off at 11 pm, that is if my relief shows up on time if at all. Last Sunday I was there until 1:30 am as the third shift didn't show up and the DON actually came in to cover but it took her 2.5 hours to get there.

I am also attending Grad school so my sleep is precious. One thing I have proven to myself is that I haven't lost my bedside skills - I can still do IV's foley's etc like a pro so I have once again put out my resume. I like the residents a lot but feel this job is dangerous to my license. I'm no quitter and will stick it out until I find something better but sheesh - are all LTC's this way?

More of a rant than anything - but feel free to tell me what you think.

Hppy

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Don't you have home health experience? I'm curious why you chose LTC regardless.

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.

I'm an LVN & every LTC facility I worked at was that way. So, unfortunately, it left a bitter taste in my mouth. If I ever work again I will never work LTC. I always tried to go back to a different facility but it was always the same.

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Specializes in ICU / Urgent Care.

Well it's your judgement call, but being in a environment that consistently endangers your license is perhaps best left behind. While having a fighting attitude is advantageous in a lot of situations, this is a more delicate issue where you must choose your battles wisely. I say start looking for another place of employment asap, chart extensively to cover your behind, and roll with the punches as they come. It's a dog eat dog world out there.

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Specializes in Psych, Addictions, SOL (Student of Life).
Don't you have home health experience? I'm curious why you chose LTC regardless.

I worked for 6 years in ICF-DDH group homes which have their own set of procedural problems. I left when my boss tried to get me to sign off on documentation from a Physician that I knew was bogus and the company came under federal investigation so no reference from that employer.

My job struggles are no secret - I was in diversion for 5 years in California after a suicide attempt due to depression and alcoholism and the main hospital system in my area has effectively black-balled me even though I have been sober since 2004. It's ok that's the price I paid for my addiction and behavior. I really liked doing L&D which was my first nursing job but would have to take a bunch of classes to re-certify and I am already in an RN-BSN program. I also have extensive experience as a psych nurse but those jobs are few a far between. I just keep my resume out and keep pushing.

Like Dory the fish "I just keep swimming"

Hppy

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I'm at a non acute facility as well working as a nurse. I feel similar to how you feel. I frequently have to stay over my shift period bc either I haven't addressed everything I was supposed to do during my shift yet or the person I'm supposed to change shift with is not there or stalling. It's mostly the former though. However as rn I'm not only responsible for patients but I feel I'm involved in human resource tasks, staffing, scheduling, overseeing aids, secretary work. The notations/nursing documentation seems to be overkill and the med administration process seems to be antiquated. I'm curious do you receive orders electonically or the old fashion way? I take issue with something you wrote. You stated that 30 patients and it takes hours to pass meds. Don't you think it should take hours for up to 30 patients. You can't expect to pass correctly all meds so rapidly and not make a med error. I have 20-28 patients to pass too. It takes 2 hours if I rush. The hour window can only be a guideline. You definitely need more than 2 minutes per patient and the facility u r at and other nurses know that and that is why med pass takes so long. If it's the only time a patient takes the med how much does it matter if they take it at 2pm or 4pm.

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Specializes in Psych, Addictions, SOL (Student of Life).

I get what you are saying and if the med is daily at bed time or Q 12 that''s one thing but when you have 13 blood sugars to check and dietary or CNAs won't hold the tray until you've determined if insulin is needed that's a problem. Also some of them have meds at 5, 7 and bedtime. so in essance we end up giving them all at one time just to keep up. I have asked if the orders can be adjusted as the meds do not seem time critical - but am told that's the way the resident or resident's family wants it.

I'm just frustrated - I do know now for sure - I will never let someone I love go into a LTC facility

Hppy

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From what I've read on this forum, I wouldn't want one of my relatives in a LTC either. Maybe the general public just doesn't realize what goes on in there.

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Re: the one hour before or after window for meds thing....

I'm going to make some here gasp and clutch their pearls, but the only reason I care about certain 5pm meds being passed at 7pm is because the State says I'm supposed to care. Do I really care if I had a busy night, and Mrs Smith didn't get her 5pm Calcium and colace until 7pm? No, not really. I don't feel like a failure, nor do I go home worried that I falsified anything.

Frankly, I find the idea of all meds having to be passed within such a window in a LTC setting to be an insult to my common sense and to my critical thinking and nursing judgement. The patient on anti-Parkinson's meds? Yep, I make sure she gets her 5pm dose close to 5pm. Ditto for the patient on scheduled pain medication. The vitamins and routine, non time sensitive meds that make up the bulk of the pass? I try to get those as close as reasonably possible. If some crazy nights more pressing matters make it so that these routine meds are an hour, or even two hours late.... so be it. I don't stress about it, and I feel I'm much better at my job for doing so.

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From what I've read on this forum, I wouldn't want one of my relatives in a LTC either. Maybe the general public just doesn't realize what goes on in there.

Actually, my perception is that the general public tends to think nursing homes are much worse than they actually are. I think they often project their own personal distaste for the elderly and disabled onto the facility, and have thus judged it as a hellhole before ever stepping a foot inside.

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It's huge national corporation with all kinds of rules and standards on the books but what actually goes on is deplorable. There's not ratios for staffing which I knew going in but it's not unusual for the RN to have charge of 30 patients with full nursing care of half of them. The RN takes the new admits as well. Med pass is sloppy with nurses leaving meds at the bedside and often taking two to three hours to pass the meds for a 1 hour window. Ie 5:00 pm meds being passed as late as 7 pm. I get off at 11 pm, that is if my relief shows up on time if at all. Last Sunday I was there until 1:30 am as the third shift didn't show up and the DON actually came in to cover but it took her 2.5 hours to get there.

I am also attending Grad school so my sleep is precious. One thing I have proven to myself is that I haven't lost my bedside skills - I can still do IV's foley's etc like a pro so I have once again put out my resume. I like the residents a lot but feel this job is dangerous to my license. I'm no quitter and will stick it out until I find something better but sheesh - are all LTC's this way

Hppy

I just received a 6 figure settlement from a huge national corporation that is one of the top owners of LTC facilities in the US because of negligence and wrongful death. The administrator of this home is highly unqualified and was running 1 RN for two sections of the NH during the incident involving my LO which was over 60 residents I believe. There were times when the cleaning lady was the only employee in the unit. People were Falsifying documents on orders from the DONs and admins. Several of the DONs were not qualified to be DONs because of their experience. The staffing ratio to patients was unsafe.

So yes, a lot are as bad as the one you work at. Especially if they are run by the huge for profit corporations.

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Actually, my perception is that the general public tends to think nursing homes are much worse than they actually are. I think they often project their own personal distaste for the elderly and disabled onto the facility, and have thus judged it as a hellhole before ever stepping a foot inside.

I don't blame the employees who provide the direct patient care for the problems at the NH I sued. Most were wonderful people who truly care about the residents. I blame the higher ups in the big corporations that dictate policy and make millions, if not billions of dollar a year.

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