Need advice from experienced LTC nurses.

Posted
by arelle68 arelle68 Member Nurse

Specializes in Mental and Behavioral Health. Has 3 years experience.

I am a new registered nurse on my first job. I have been there about six weeks, and I love the work. I don't get a lunch, and hardly get to eat or drink on my shift, because it is so busy. (I'm not complaining about that, though.) I'm responsible for 23 residents on an Alzheimer's unit.

My supervisor came and told me that I have to clock out after only 6 1/2 hours. (Of course, they take half an hour of that back for the lunch break I don't have time to take) Problem is, there is a good 8 hours worth of work, 10 if there is some kind of incident. This is not a lack of wanting to work, or a lack of organization either. I work harder than anybody, and I like it that way. If I can't get it done in that amount of time, then I really don't think anyone can. How can I be expected to clock out at 7:30 when I have meds due at 9, and no one to relieve me? They want me to leave work undone that I'm responsible for. I can't. They want me to go and find another nurse to count with me and take my keys. The nurses on the other units are dealing with the same crisis-a-minute stuff I'm dealing with. How are they going to leave what they are doing to come and do what I'm doing?

Look, I just want to take the best care of my residents, and go home and sleep good knowing that I gave good care. What if management makes that impossible? I'm sorry they are low on money, but I don't see how that is my responsibility.

I'm really thinking of trying to find another job. This is a shame, because I would be an excellent nurse for them for my full career, if only they would be reasonable with me.

Someone tell me what to do here. I would like to hear your perspective veiws.

FLArn

FLArn

Specializes in Hospice, LTC, Rehab, Home Health. Has 20 years experience. 503 Posts

If I'm understanding your post, the administration wants you to leave your shift 2.5hrs early without anyone to relieve you? Are you to give the nurse who is counting with you a report on the patients or just the count and keys? Are the CNA's in the Alzheimer's unit also med techs and does your facility allow med techs to pass meds? If you are not giving report to anyone and no one is by policy in a position to do your med pass ---my advice is to RUN FAST and NEVER look back. It sounds like they are setting you up to lose your license

CoffeeRTC

CoffeeRTC, BSN, RN

Has 25 years experience. 3,734 Posts

WHAT??????????????????????? Who is to be responsible for these pts when you leave? What are the ratios in your state? (check the state's website or give them a call to find out)

Put in your notice and leave. I'm not a quiter, but if they aren't going to change this, then you need to.

There is so much work to be done, I'm just flabergasted by this. How?

There are plenty of LTCs that would be more than willing to take you.

arelle68

arelle68

Specializes in Mental and Behavioral Health. Has 3 years experience. 270 Posts

f I'm understanding your post, the administration wants you to leave your shift 2.5hrs early without anyone to relieve you?

They think nurses on other units can handle their unit and mine. This is not really a reasonable expectation.

Are you to give the nurse who is counting with you a report on the patients or just the count and keys?

I'm supposed to write out a report, and tell them that I'll report them to the DON if they won't count with me.

Are the CNA's in the Alzheimer's unit also med techs and does your facility allow med techs to pass meds?

No, and NO

If you are not giving report to anyone and no one is by policy in a position to do your med pass ---my advice is to RUN FAST and NEVER look back. It sounds like they are setting you up to lose your license

Thank you so very much for you valuable input.

puddingpie

puddingpie

86 Posts

I understand all too well... They want you to leave even thought there there is RN assigned to the unit you are on right? no one to relieve you. It comes down to ratio and money. I would have stayed too, if the ratio was reasonable.

I worked in 2 nursing homes and from my experience they are all the same... please someone one prove me wrong. I would give it another chance if the working conditions were right.

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience. 6,089 Posts

Am I missing something? You work a six and a half hour shift and you have no one to count narcotics with? 25 residents is more than doable. Most of the dementia units around here have 40 residents and one nurse on 3-11 so it can't just be the number of residents you have. They can't leave the unit unstaffed or only staffed with aides who can't have the keys to the med cart. Have you had a discussion with the management about this? There are good facilities out there. My day and evening nurses only have 20 or 21 patients each, they don't do MDSs, they don't do quarterly assessments (they SHOULD but that's another whole story), but to be told to leave and not have anyone to count off with????

Jo Dirt

Jo Dirt

Has 9 years experience. 3,270 Posts

This is the nature of nursing home work, unfortunately. It works kind of like the sale barn. With the people very needy, there is ALWAYS something to do, you will always leave thinking of things you needed to do. I've seen NHs so hard up the nurses would just do what they had to do...they, WE, weren't bad nurses, we were in bad situations and put in positions of defeat before we would even hit the floor. It takes a certain kind of nurse to accept when it is "good enough." Some nurses can't deal with that, but that's okay. We had an ICU nurse quit after a few weeks because she couldn't deal with it. She was used to having two patients and things being much more organized and precise.

You hit the floor in a nursing home and have a pill passing marathon, with all kinds of distractions, if you get a new admission or have to fill out an incident report that can set you back a good hour. One thing they have never told me to do though, is leave before I feel like I've done all I can do.

The nursing home where I work now is like heaven. We have 1 nurse to 23 patients (used to be 1 to 42). You actually have time to care about what you're doing. You get to spend more time crossing the t's and dotting the i's.

arelle68

arelle68

Specializes in Mental and Behavioral Health. Has 3 years experience. 270 Posts

Am I missing something? You work a six and a half hour shift

What they want me to do it all in 6 1/2 hours (Really 6 because they expect me to take a lunch, and they take money out for it. However, I never have time for a lunch.) Everything they want done takes at least 8 hours to do, and longer if someone falls, or some incident occurs. This is partly because I am a brand new nurse, and don't know how to do, (or even how to find) every peice of paper that they want filed on everything. Nurses with more experience are faster than me, but I'm trying as hard as I can, and getting better and faster all the time.

and you have no one to count narcotics with?

For me to have someone to count with me before 10, I would have to go and pull a nurse off of another unit, and threaten to report them if they won't count with me. She would then have to count with the night nurse at 10 when she got there.

25 residents is more than doable.

It is. It's intense for me, though.

Most of the dementia units around here have 40 residents

Dear God!

and one nurse on 3-11 so it can't just be the number of residents you have. They can't leave the unit unstaffed or only staffed with aides who can't have the keys to the med cart.

The dear little CNA is there on the unit all by herself (Not every time. There were two aides there the other night.) once I leave. If she needed help, she would have to run off the unit to find a nurse. She doesn't have keys, and isn't allowed to.

Have you had a discussion with the management about this?

It didn't sound like there was room for discussion. My 90 days isn't up yet, and to tell you the truth, I feel intimidated.

There are good facilities out there. My day and evening nurses only have 20 or 21 patients each, they don't do MDSs, they don't do quarterly assessments (they SHOULD but that's another whole story), but to be told to leave and not have anyone to count off with????

They told me that if no one will count with me, to just give them the keys, and tell them that they will be reported to the DON. The threat is necessary because the nurses on other units are just as desperately busy as I am.

Thank you so much for responding to me. I want to understand your perspective on this, so that I can be reasonable and balance with my response.

Valerie Salva, BSN, RN

Has 19 years experience. 1,793 Posts

It sounds like your facility is trying to get you to abandon your pts.

I have worked in a lot of LTC facilities (as an agency nurse) and I have never seen a good one.

I would find another job.

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience. 6,089 Posts

I think you misunderstood. In your situation, there IS no being reasonable. The DON has no business threatening another nurse or you for breaking one of the cardinal regulations...you DON'T just hand over the keys to the narcotics without counting. If you do that, the last name on count is yours and if things go missing, people will be looking to YOU to explain. I've worked in this business, and yes that's what it is, for more than 25 years. I would never ask one of my nurses to put her license and reputation at risk by handing over keys without counting. Good luck. If I were you, I'd look for a better place to work where intimidation isn't used by management.

achot chavi

achot chavi

Specializes in acute care and geriatric. Has 20 years experience. 980 Posts

My vote is with those who say, find a better place to work, what they are asking of you will only backfire.

Have faith, there are better places.

Good Luck

Jo Dirt

Jo Dirt

Has 9 years experience. 3,270 Posts

It sounds like your facility is trying to get you to abandon your pts.

I have worked in a lot of LTC facilities (as an agency nurse) and I have never seen a good one.

I would find another job.

I would challenge you to come work where I work. Other than that, this kind of statement will only perpetuate the myth that all nursing homes are horrible. Nursing homes are a fact of life. People go there and that is usually their "last" address. They are at their worst in life, they need more than anyone can truly do for them and it's often not a pretty, romantic end. When nature fails to take its course, what else should should be done with these people?

A NH is a NH, a person can make what they want of it. I have the same patients and I've grown attached to them. I actually look forward to coming in every morning and seeing them. We laugh and talk and make the best out of a sad situation. We have one stroke patient in his 40's who is such a clown they made a name tag for him in the front office that says "(_) Nursing Center, John Doe, Handyman." He gets a lot of attention with that and he loves it. There are times that are sad. His wife will come see him and he knows she has a boyfriend and he cries everytime he sees her, and we want to kick her to the curb but can't. Yes, it's sad, but he knows we love him and in a way we are his family.

The patients stay clean and well-fed. They get a lot of stimulation and attention they wouldn't get anywhere else. We only have one in-house decubitus and it's very minor. We have a low turnover. I love where I work.

Not all Nhs are "bad."

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