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Need validation ASAP!

Nurses   (409 Views | 8 Replies)

yadda_yadda_yadda has 27 years experience as a LPN, LVN and specializes in LTC, SCI/TBI Rehab,RX Research, Psych.

2,758 Profile Views; 103 Posts

I have been an LVN/LPN since 1993, with vast experience in geriatrics.

Last week, 3/31/2020, I started a new role as "the lead nurse" over an assisted living facility. One Day #3, I had cause to check on a resident as part of alert charting & "skin reports" from a shower the day prior. I arrive to check this gentleman, that I had never seen face to face...with a DTI / unstageable decub to his coccyx.

I immediately went to the ED...and this resident was sent out via 911...He was kept in the hospital until 4/8/2020...returned on hospice care, with a discharge diagnosis of "osteomyelitis R/T coccyx ulcer" ---I did some research (already knowing what I would find)--and the word, "NEGLECT" appeared in every....single....article.

As the "new Sheriff in town", this should not be on my shoulders. I don't want my name on anything associated with this...I have an absolute lack of trust in the caregivers, who all vehemently denied any skin issue prior to 4/3/2020...Their statements are obvious CYA and a facility-wide lack of accountability under the previous nurse.

Would ANYONE out there stay @ this job? ---- I've already "made up my mind"...but I am wanting to hear other viewpoints, in case some would feel inclined / compelled / obligated to remain there.

I'm appalled...and disgusted...and find it difficult to imagine diligently tending to something, in complete futility...alongside the very people that CAUSED it...and being their leader and supervisor...and the ultimate person of accountability & ownership of every bit and piece in the building moving forward.

Edited by yadda_yadda_yadda
typo

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RNNPICU has 13 years experience as a BSN, RN and specializes in PICU.

1,138 Posts; 12,680 Profile Views

I am not sure how your name would be all over this.

You assessed a patient, found an emergent need, got the patient to the appropriate level of care. You can only rely on what was previously documented and what you documented and what actions were taken.

You don't know what caused it and can only move forward from here.

If anything comes of it, they will look at what was documented and what actions were done.

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yadda_yadda_yadda has 27 years experience as a LPN, LVN and specializes in LTC, SCI/TBI Rehab,RX Research, Psych.

103 Posts; 2,758 Profile Views

NOTHING was documented...NOTHING...I had 2 skin sheets, saying, "Please check xyz...it is getting bigger" (which indicated (to me) that someone had seen/documented some sort of care...nope.

The ED has a blank look on her face...is acting clueless as to how to file the State self-report (really, lady?)--- wanting to know which names to include in it---Hmmmm....the staff that were WORKING that part of the building? She is looking for support and wanting someone to say that this happened due to natural life events...and it didn't.

I have ZERO intention of offering up some fairy tale, professing that the staff provide vigilant care...because 1) I haven't seen that to be the case....and 2)--- this matter, that proves neglect.

ED is saying that she now (4 -5 days after 911 was called) has texts and "statements" that caregivers reported this to the previous nurse on 3/20/2020---2 full weeks before I visualized it....yet, no skin sheet, no chart notes---nothing.

2 weeks of inattention is about right for the condition of this wound.

Would anyone want to be a part of that? The citation will get to bear my signature...and interacting with this resident's family will be a professional angst unlike any I've ever experienced...pretending as if this was a natural occurrence....knowing full-well that it wasn't/ isn't...and those that caused it still tend to him...as he dies because of their actions/ inaction.

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juniper222 has 2 years experience.

382 Posts; 2,668 Profile Views

Because you are the "new sheriff" why don't you make heads roll? If someone put me in that situation I would fix what is broken. Sounds to me the reason they hired you is to deal with this issue. I would have a sit down with the management and let them know what is happening and what you intend to do about it or that you will be leaving if they don't support you in this. There is an injustice here that needs attention.

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Delia37 has 15 years experience as a MSN and specializes in Critical Care.

94 Posts; 1,725 Profile Views

Why don't you use this situation as a learning opportunity for ALL your staff? Obviously, more that one shift dropped the ball on this one, take this opportunity to re-educate your staff regarding skin care policy and expectations and use that unfortunate situation as a case study, worse case scenario of what can happen when staff fail to assess and intervene with a skin issue (the fact that several shifts failed to intervene makes me wonder if your current skin care policy need to be revised/updated).

Edited by Delia37

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4 Followers; 37,681 Posts; 103,057 Profile Views

If you want to deal with it, suggest you follow juniper’s and delia’s advice, or you could just wash your hands of everything by resigning. Of course if you resign, you need to CYA on your way out the door.

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VivaLasViejas has 20 years experience as a ASN, RN and specializes in LTC, assisted living, med-surg, psych.

8 Followers; 142 Articles; 9,775 Posts; 251,445 Profile Views

I worked in assisted living for many years, and I saw it all. Caregivers without high school diplomas giving meds and insulin, skin issues never identified until they were almost beyond help, documentation either poorly written with many spelling and grammar errors, or nonexistent. I'm sure they did their best with the training they received before I arrived, but even with proper instruction and delegation they struggled to understand the complex medical conditions most of the residents had.

Every time I went to a new facility, the place was a wreck and it was my responsibility to fix it. I wrote countless plans of correction and made sure the problems stayed fixed...which was much more easily said than done. I felt bad for the staff because they weren't paid anywhere near enough for the work they performed and they were overwhelmed with the residents' needs, many of whom were nursing-home candidates and others should have been in memory care. But the almighty dollar was, and is, the driving force behind understaffing and lack of proper equipment.

To be honest, I wouldn't work in AL now if it were the last job on the planet. I didn't realize how much I was risking my license until I went to the dark side and became a surveyor. That was a real eye-opener!

You have quite a mess to clean up if you stay at this place. There's nothing you can do about the prior lack of care regarding the pressure ulcer, all you really can do is teach your staff to be observant and report any signs of illness or skin issues to you IMMEDIATELY. There are few situations in nursing that are more uncomfortable than standing there with egg on your face when a surveyor points out a problem you were never told about.

I wish you the best of luck in all you do. Viva

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4 Followers; 37,681 Posts; 103,057 Profile Views

Just reading Viva’s description here, as well as previous posts about AL, along with my experience in LTC, which is similar, convinces me that I will never try to work in AL. All of this contradicts the experiences of one of my classmates in nursing school. She had a part time night shift job which she liked in AL at the time. But then her facility was not filled with problems requiring her to intervene in the middle of the night.

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yadda_yadda_yadda has 27 years experience as a LPN, LVN and specializes in LTC, SCI/TBI Rehab,RX Research, Psych.

103 Posts; 2,758 Profile Views

Thank all of y'all for your insight & supportive views.

Yesterday / the day after this gentleman returned to the community from a 5-day hospital stay, Hospice care had been initiated.

The assigned RN came out to assess and measure this wound "officially", before ordering supplies, etc.

Unstageable... 3cm x 2.5cm --- with undermining all around...and a depth of 1.5cm

Given the absolute denial from the ED and all of the caregivers, this was destined to cause a situation where my allegiances were tested....and my allegiance was OWED to this resident...and to the State investigator ONLY.

I assured that care was in place for this gentleman (through a Hospice team that I have a long-standing rapport / trust with)---and I resigned immediately. --- I'm perfectly willing to occasionally "take one for the team"; however, this is a team of unethical people, who falsify documentation that is so outlandish, they should be fiction writers...especially, if you are being prompted/ compelled to produce statements 14+ days after-the-fact, to create a back-story that is ...in no logical way, even remotely believable.

This facility is in panic-driven "CYA-mode", and there is no way out of what they've created. --- I found out yesterday, that State investigators have been out on site, every month, for the past 2 years...and that the building was in complete stop- placement, less than 6 months ago.....So...there is the complete deception element during my interview and tour of the building.

100% of the staff assigned to that area warrant termination. I let her know that. Corporate needs to bring in agency resources to seize control of the situation and contain damages...and that was not an option to them. --Given that I do not/ did not know this team, options to enact immediate damage control were hard to identify, aside from wiping that slate clean. Everyone assigned to that area...all of them...are culpable. Period. Every single one of them contributed to this situation.

I was transparent in my abilities...and entered into a workplace agreement, to work honestly, ethically and diligently...Transparently...side by side...to accomplish the delivery of great care-----yet I was lied to from the word, "hello" (it is a pity that COVID-19 prevents handshakes...I'd have possibly picked up on some sort of deception through a shady handshake, had I received one).

I resigned...only to receive a flurry of frantic texts, pleading for me to "turn this around and help fix it".... No, thank you. I received nothing but lies, inaccuracies and someone good @ white-washing the situation, hoping to sell it to a person who didn't know the staff.

The State investigator can have this place. I value my career...and refuse to budge on my ethics.

Edited by yadda_yadda_yadda
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