Need help!!! Long term care NP

[lmccrn62, MSN, RN]

I currently work as a NP in LTC. Since I have been there I noticed a very reactive environment versus proactive. I watch staff and administration put out fires everyday. Despite any recommendations to help them improve they just keep the craziness. This mentality affects me tremendously as they expect me to work in the same way. I find myself overwhelmed and working late hours. The DON has stopped speaking to me and now reports any and all issues to my collaborating physician. How can I do my work and not let unsafe staff practices bother me. Staff turn over is about 70%.

I love my boss and the residents but I do not like the cover ups I see. Suggestions so I can work in peace.

[Hi2Jenn]

What sort of fires are they expecting you to put out? I would request a meeting with your collaborating physician and the DON. I would set up some protocols of when and how you want to be notified of issues and which issues you will see patients for versus just giving orders.

[MoChic1]

One of the hardest things I needed to learn as a NP working in LTC was that (at least in my case), these are Nursing facilities run by Nursing protocols and we (NP's/MD's/DO's) were just contractors to them. If we wanted something done a certain way, it had to be written as a patient order. Then they had no choice but to follow it. Know where they stand with state regulations/Medicaid audits, and gear recommendations as action items to those if you can. There is only so much you can do to change things as a contractor. You either need to accept that, or find a different facility.

[IsabelK]

Agreed. I work in LTC. I am not employed by the facility, but by a company that provides my services to a specific group of people. The facility is run by nursing protocols and policy/procedure is the bible. Not bad, not good. Just is. When I want something a little bit different from the facility norm, I have to write specific orders. It's taken about 5 months to get comfortable with this and even now I sometimes run into a wall (or at least a hedge). I'm finding that it's a learning experience on both sides and I learn something new each day. The challenges are amazing, but the rewards are even better, so I am trying to learn to go with the flow. I'm also finding that things are changing bit by bit for my group of residents because the staff is getting more used to me and vice versa. You cannot and will not make huge strides in change, or even small ones, if you try to push too fast.

One of the hardest things I needed to learn as a NP working in LTC was that (at least in my case), these are Nursing facilities run by Nursing protocols and we (NP's/MD's/DO's) were just contractors to them. If we wanted something done a certain way, it had to be written as a patient order. Then they had no choice but to follow it. Know where they stand with state regulations/Medicaid audits, and gear recommendations as action items to those if you can. There is only so much you can do to change things as a contractor. You either need to accept that, or find a different facility.