New grad @ LTC/SNF/Rehab Facility. Hating it

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Hey, all.

New grad here. As a new nurse in Southern California, with only a two year degree, it is impossible to land a gig in the hospitals. So, I accepted a position at a SNF/Rehab facility. About 60% of the residents live there long-term or are on hospice. The other 40% are there post acute care.

I have been assigned to the most demanding med cart with 26 residents. And with 8 hour shifts, I simply dont have enough time to do everything I need to do. Pass dinner and evening meds, monitor blood sugars, check blood pressures, do rounds, answer call lights, chart weekly assessments, follow up on change of conditions, and assist with admissions and discharges.

During orientation I saw sooo many nurses document assessments they didnt do, pass dinner and bedtime meds at the same time, and document bogus blood pressure readings and pain scores. There simply isn't enough time or resources to do everything correctly. Soooo many corners are being cut.

It's in a less than desirable neighborhood and the company is known for being cheap. I feel so bad for the residents who arent getting the care they deserve. So many are neglected or their concerns brushed off because no one has the time to address them.

I am looking for another position. It's been three weeks and I already know I can't practice like this. I have stayed 2 hours passed my scheduled time since I have been left alone on my cart. I was giving my last meds at midnight.

Are all LTC/SNF facilities like this? Is this generally what nursing has become? Leaving the bedside to pass meds and chart? It's so disheartening.

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Specializes in Primary Care, LTC, Private Duty.

In all of the ones I've worked at, that's what it's been like...which is why I will get a non-nursing job before I go back to working another SNF.

As far as helping you in the here and now, I'll share my experience when I was a 3-11 nurse for 21 residents:

Start of shift: Come in, get report and do count, give report to the aides/fill out their assignment sheets, look through the MAR to formulate my med pass plan and to see if there are any new meds/treatments

Start the 3pm-4pm scheduled meds, any PRNs (this goes on throughout the shift), ask pain level on those resident that I interact with, start BPs (because even though the aides are supposed to do them, they never do)

Dinner at 5 pm, I'm expected to help with feeds but I'll also pass meds when I can for the 5-6pm scheduled meds (a lot are scheduled for 6pm), chitchat with the residents and continue to assess for pain

6-7pm: help clear trays, assist aides with the residents who go to bed super-early, finish up my 6pm meds, start paperwork (summaries, etc)

7-7:30pm: Continue with meds that are now slightly overdue from 6pm (I know we're taught in nursing school that we have an hour window each way, but 10 minutes +/- is not a big deal with this many people to care for, especially for regularly scheduled stool softeners, etc), paperwork (summaries, fall reports, start my notes) while I eat something, a quick pee break

7:30-8pm: continue helping the aides with anyone who needs a 2-person assist, start HS meds (because good luck waking up a resident who sundowns at 9pm or later for HS meds when they've already gone to bed at 7:30 and are fast asleep)

8-9pm: put my two residents to bed (assigned to me because we're so short staffed on aides), put out any "fires" from behavioral residents (really, I start this at 4pm), finish up HS meds on the residents who are late to go to bed

9pm-11pm: paperwork (summaries, finalizing incident reports if necessary, etc), charting, continue to help the aides as I can, coalesce my thoughts and the notes I've jotted down on my census sheet for when the 11-7 nurse comes on, sign for any medications that come in from pharmacy

Throughout the shift, whenever I am able, I'll answer call bells, as well. A serious enough fall/skin tear/behavior/having to send a resident out/having a new resident get settled certainly derails this "nice" schedule. On those days, all bets are off.

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Specializes in Short Term/Skilled.

Over time you get to know the residents, even the ones who are there short term become familiar after awhile. This makes it much easier, for example, when a skin assessment is due for a resident you know really well because you don't really need to do an entire head to toe if you see them every day and have good CNAs who report changes to you.

To be honest, this particular "specialty" is sort of a horse of a different color, if you will.

Some nurses are able to make peace with the fact that you simply can't do each and every task and assessment that is assigned by the book, and others just can't.

Personally, I try to do whats best for my patients. Sometimes that means I don't get to do a task or assessment on time. Sometimes that means I have to give meds a little early or a little late. The system is so broken and facilities have so many requirements for documentation that honestly have nothing to do with what the MD wants ordered or even what info he/she actually needs. It makes it really hard to do it all AND make sure the patients are getting what they need.

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I would probably still be in LTC if I had only 25 residents or so. I had 46 on the 2 - 10pm shift. It was hell and should have been illegal. I ran away and never looked back. If you feel it's a set up definitely leave.

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The many horrors of working in ltc/snf. It's like you risk your license the minute you clock in because of the terrible patient load you have and all the tasks that comes with it. I don't miss it not one bit. I'm in a rehab hospital which itself has problems, but i'll take that over a traditional nursing home anyday. I hope you can find a better place to work.

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Yep, this is the LTC norm. It does get easier but never better. Its sad. Something really needs tobe done about long term care working conditions. Alot of things really.

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I am amazed that our elderly continue to be in these situations. False documentation, meds not being passed, pt soaking in urine and feces......it is still a problem and has been in every SNF I have worked going back to 1998. The ratios will never change. Legislators approved these terrible ratios long ago. LTC is ran by corporations only concerned about the bottom line. When I worked LTC I always encouraged the families to sue over the horrendous conditions. LTC is full of nurse burnout. They move from SNF to SNF hoping for a better place. It's really sad to see actually. The more short cuts nurses take the more the owners think "the job can get done just fine."

The whole system needs to come to a stop and be rebuilt.

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Specializes in Gerontology, Med surg, Home Health.

Instead of protesting shoes, maybe the sports stars who are making millions of dollars should use their perceived influence to get more funding for nursing facilities.

in Massachusetts we use MMQs to bill for medicaid. The least we get paid for taking cate of someone is $123/day. The most, and this is a resident who is totally dependent for everything, is $278/day. As a business this isn’t sustainable and many many facilities are closing.

The public’s perception is owners are making piles of money. This simply isn’t true.

You think it’s bad now?!? Wait the the baby boomers start getting dementia. The system, if it keeps on like it is, will be overwhelmed and collapse. But let’s just keep giving money to people who sneak in the country instead of taking care of legal citizens who have paid taxes their whole lives and served their country

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It is truly frightening to think of the "care" that awaits the baby boomer generation.

Shortcuts in LTC consist of not turning the patients every two hours, not doing treatments, not passing all the meds, and leaving the residents in urine and feces......until state shows up and all the supervisors all now helping out. The fakeness of it all is a joke. Has not changed in over 2 decades.

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In this area the LTC/SNF are getting foreign nurses to work by granting visas and citizen path. They pay them peanuts of course.

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On 7/13/2019 at 6:42 AM, CapeCodMermaid said:

. But let’s just keep giving money to people who sneak in the country instead of taking care of legal citizens who have paid taxes their whole lives and served their country 

THIS IS WHAT MAKES IT EVEN WORSE AND SAD. Money given to illegals...and brinnging foreign nurses in and paying them peanuts and jack spit to take care of people. In my area, many nursing homes have closed, this is true, but these LTC facilities were closed by the state because of "unsafe conditions for patients" when in reality, they were closed so the state could save more money....because we all know 85% of LTC residents pay via Medicare/Medicaid and reimbursements from these 2 entities are so low. Really, its a lose-lose situation for all involved.

I still remain hopeful LTC will get back to the basics sometime sooner than later. (but hope breeds eternal despair, right?)

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Specializes in Med-Surg, Geriatrics, Wound Care.
4 hours ago, 819Nurse said:

THIS IS WHAT MAKES IT EVEN WORSE AND SAD. Money given to illegals...and brinnging foreign nurses in ........

Had a rant, but, deleted it. Seriously, though.


"Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!"

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