New Grad nurse @SNF...now on verge of quitting.

[iamNurse23]

Quitting while still in orientation: (After reading this, I hope I'm not alone regarding my experience and feelings with SNFs)

I've asked for advice. Friends have told me to hang for now, fellow RN friends/peers who have heard more of my experience in detail agree that its not worth the risk. Morally and ethically I'm against what I've witness and expect to witness in a SNFs

I am a new grad nurse and passed the boards in the early summer. I sent over a hundred applications for acute-care positions, but due to this difficult job market, I wasn't successful. So I went to my last resort which was applying to a SNF. The day after I applied,

I was called in for an interview and hired on the spot. A couple of my other friends were hired at different SNFs prior to me and told me how much they hated it and one even told me how he get nauseous before going to work because of the stress load, but I was really excited just to have a job and the salary $35/hr was much more than I was making. (The money is definitely not worth losing your license) Here are the problems I am experiencing

1) Two weeks into my orientation, It is safe to say I hate this job. The nurse to patient ration is from 1:15 to 1:25... average is over 20 patients per nurse. I don't know if its all nursing homes but it seems to be more emphasis on paper work than actually patient care. I am a very personable person and love talking and building a rapport with patients. However, with this patient load all nurses seem like all they can pass meds. The quality of care these patients are getting is pretty bad, the nurse I shadowed the other day asked why did I apply to a SNF, its not the place to be, and she worked in a hospital prior to moving to this state, and applying here was the worst decision she made, with 20 patients per nurse, an average of 10 medications (not including treatments) per patient and charting (tons of paper work) on each patient, she said she's lucky if she see's a patient for longer than 5mins in her 8 hour shift. One of the patients even made the comment "It seems like you are the dope dealer and I am the drug addict" And it sure feels that way, all we can do is say Hi and Bye.

2) Again, I'm not sure if all nursing homes are like this, but nurses take a TON of shortcuts and are pretty nasty individuals. I rarely see the nurses I shadow wash their hands, put on gloves, or verify the patient before administering medications. One of the other RN supervisors came and told my nurse "the state is coming soon to do surveys so we got to step it up, make sure we don gloves, wash hands every time, and ask the 2 patient identifier before giving meds" and my nurse said "what is the 2 patient identifier" .....i was in disbelief and I shook my head. Every nurse I shadowed has taken shortcuts and said that they have no choice and its so much for them to do, and they tell me "you didn't see me doing this or I didn't tell you this ok, ..but you'll see once you start working on your own".....I don't blame the nurses more than I blame the system itself, but at fault.

3) The DON pulled my supervisor to the side and was pretty stern about an incident. Long story short, the DON was upset that she didn't transcribe an order into the computer to be carried out, but the nurse reasoning was that she didn't receive an "ok" or Dr. signature approving her request. The DON said that the request for application of a certain ointment could of been carried out and transcribed without a signature. BUT! he said if the state comes..don't tell them I told you that, and tell them we always wait for a Dr.signature or "ok" in every situation. (My problem with that, it'll be just my luck that I apply that ointment without a Dr.sig (just approval from DON) and the patient have a major reaction to it)..ITS MY LICENSE AT RISK.

There is alot more things that I can go on & on about. BOTTOM line. This is definitely not safe, the patient load and responsiblities are insane and the stress level is high and mistakes are made daily. Its only a matter of time due to the high stress level. You just have to hope the mistake you make is not the BIG one. I didn't get into nursing to become a med passer, I don't enjoy this at all. I feel like me and the fellow nurses are only there to collect a check.

Lastly, my position is ON-CALL and I currently have less than a week of training before I'm out on my own. I'm definitely don't feel ready, and I have no interest nor passion for this. I pretty sure that my next day of orientation will be my last day. As crazy as it sounds, I would rather go to work making FAR less money doing something "i don't hate" than making more money, everyday risking my license. On the bright side of things. I have an interview for a RN position next week, and I have had 2 recent interviews that went really well and the managers told me the dates for the program (1 in Dec) and (1 in Jan) and they are just working on the exact dates. Nothing was officially signed, and I'm the "got to see to believe it" type of person.

[ICU_RN2]

Working in LTC facilities can be tough for sure! I worked as an RN at a facility just prn for about a year, however I worked there for 4 years prior as a CNA and was somewhat comfortable with the place.

I had a FT acute care job at a hospital, went through orientation, then starting picking up shifts at my LTC job here and there.

I will agree with you that it is much more paper work and much less patient care than you'd see in a hospital with only 5 patients. As a new grad, at a new facility, I can't imagine orienting and feeling competent in LTC. I barely felt okay in my situation, and a lot of times only because I had a boat load of experienced LPN's and CNA's that I already trusted and had a rapport with.

Good luck in whatever you decide! Make sure you leave on good terms, you never know when you'll want to go back to that $35/hour job in the future!

[Glenna, LPN]

my jaw has dropped reading about your experience in snf. with what you are saying i think it is a good thing that the state is coming for a visit because those things have got to change! do they not have cma's to help pass out the meds? sounds like you have a few interviews going on that is working towards your favor and you’re working on-call at this snf. i think you should hang in there, do things the way you learned how to do them in school, and once you get hired on somewhere else...say good bye to this snf.

now i don't believe that all snf's are the same in the kind of care that is given to their patients. i just recently got my lpn and i'm still looking for work but i've been a cna since 2007. i worked at this catholic nursing home which was just a great place to be. it was clean and i felt that the care the nurses gave were wonderful. i always saw them chatting and spending time with the residents and if they needed help they could ask the rcm or another nurse from another unit for help. we had cma's to help pass out meds. i later on got my cna 2 and worked at a hospital in the surgical department. i did clincial's at this one snf which was third rated. i felt so spoiled after working at that catholic nursing home because some of these other places for a lack of better words was a hellhole. my heart goes out to those residents who don't get all the care they really need.

i hope this somewhat helps.

[dblpn]

Wow sounds like where i work. when i'm out of rn school it is good bye to nursing homes, hopefully that is i can land a job somewhere else. in my facility i was told there are no 2 pt. identifiers. the pictures in the mar are not up to date and None of the residents have id bands because its 'there home'...we dont wear id bands when we're at home. this was said by the don & admin. dont get me started with doing things w/o a drs. order. please! everyday this goes on. they're starting someone on zpak for RI or straight cathing for a UA then its oh dr. so and so will approve it. really? it is so sickening i just cringe everytime i see this.

Hope all goes well for you. Good luck :hug:

[samirish]

Welcome to SNF's.

[eslvn]

The SNF's get funding from medicare, so a licensed nurse must give medications. The patient load is very high and near impossible, yes something has to change. But please dont judge all SNF nurses, because most of us love our residents and do our best to care for them, so please dont say we are nasty people. Maybe the ones you work with are, but not most of us. How did acute care nurses obtain their nurse/patient ratio? They fought for it, so maybe its time for us LTC nurses to fight for one...

[caliotter3]

I would quit the job because of the oncall status.

[mazy]

It sounds pretty typical of an SNF and if you can find something better, go for it.

But a couple of things I don't understand. Why is it necessary to use a two patient identifier every time you give meds to the patient? Those patients are usually there for longer than in a hosptal and nurses get to know them very well. If I were a patient and every time a nurse walked in the room and did a two step identification, I would be upset and discouraged that the nurse didn't know who I was.

It is true that State may ask the nurse how to identify the patient, so the nurse should have known that when walking into the patient room with a surveyor, that nurse might be asked how the patient is being identified, but it's not something that would routinely be done with a known patient.

Also, I don't really understand the issue with the ointment. Why didn't the nurse just call the Dr. and get a T.O to OK the ointment? There are some standard treatment issues in these facilities that are protocol, and all you have to do is call the dr. and leave a message that X has occurred and that Y treatment, which the Dr. has ordered for those occurences, (i.e. a standing order) will be implemented. You don't need to talk to the dr. at that time, just sign off that the dr. has been notified that the tx will be implemented and then start the tx.

I have on occassion called Drs. for certain tx or meds and have them scream at me why am I calling about this, these are standing orders.

But it depends on the tx and I can see that certain meds might not fall into the category of standing orders, so definitely it's important to learn protocol. You will need to do that wherever you go.

So these specific issues will come up wherever you go, and I imagine that there are many other more ethically dubious issues that are going on at that facility.

As far as the reminders to wash hands, don gloves, etc., the fact is that whenever state comes in people get nervous and forget the basics. I've seen nurses walk away from their carts with them unlocked when they would never do that in a million years, leave charts wide open on the desk, forget to sign off on meds, forget to wash their hands or change gloves, it just happens.

Repeating those instructions time and time again is sort of like telling your friend to be careful driving home. You are not really expecting her NOT to be careful, it's just one of those things we do, fingers crossed, fingers crossed.

Learn your facility policy. And don't fret so much about your license. Focus on providing good care to your patients, which it sounds like you want to do, and the rest will eventually work itself out.

[iceprincess492]

It takes a special person to be a happy and successful SNF nurse. It does not sound like you are cut out for this position. You should find a position in another setting where you are more comfortable. The residents living in a SNF deserve to have someone happy with their job taking care of them.

[QuenymamiRN]

I work in a 5 star SNF. My nurse to pt ratio is 1:52. I would take 1:20 any day!

Even if I worked on day shift when there are more nurses I would still be 1:52. There is one med nurse and one treatment nurse. If you are doing treatment theoretically the ratio could be 1:104. It is impossible to do treatments on two wings but you have to do it and then you have to write nurses notes. Everyone finds shortcuts. If you are doing meds, you are just a pill popping machine and you won't have time to urinate. Fact is no matter where you go it's hard, just in different ways. The country is poor and there is no money in healthcare. The patients/residents end up suffering and the nurses get burnt out. The only state with happy nurses is California.

[tothepointeLVN, LVN]

If this is the only job you were able to get after 100 applications ( not your fault I know ) then I would hang out. Quiting might just put you out of the nursing industry altogether. Even 3 months of on paper experience can make a big difference in your job opportunities.

The ratios in CA don't apply to nursing homes so they still have high ratios. I do have to agree for SNF 1:20 doesn't sound so bad. I think for LVN/LPN that ratio doesn't seem so bad since we train in that environment at for a few weeks. If all your clinical experience was at the acute level then eeek.

Regarding shortcuts. Just because your coworkers do it doesn't mean you have to. You can always take a few seconds to clean your hands glove etc. Now I don't work in a SNF but I can imagine that if your giving meds to Mrs Smith everyday for the last 2 years you might not want to verify her identity everytime.

[RN_PICU]

I am still working nursing homes per-diem just because my responsibility for child support, but one thing I have to tell you. If you make it in any nursing home, you'll be able to make it after in any other nursing environment. You can learn from any nursing job, but no other place would teach you time management and prioritizing like a work at nursing home. Always remember to put the patient first, even if its 20 or more of them (last time I had 29) and give them all you can in the time given. We are there for 8/12/16 hrs a day and that time should be dedicated to them: every single one of them!!! What others do shouldn't influence you in any way, you be the nurse just the same way you would like to be treated by one when you need her/him. Good Luck