New job, new appreciation

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Specializes in vascular, med surg, home health , rehab,.

So; after 32 years as a nurse, 13 on a very busy med/surg unit I was burned out. Took time off. Thought LTC might be a little bit less intense. Was I ever wrong. 5 day hit and miss orientation, third day I get 30 demented patients with so many meds my head is still spinning. Half have no ID, so its guess the patient when meds are concerned. Most meds seem to be OTC stuff. Massive amounts. Quality of life zero. I could not hack it. The staff I have to say were amazing, came in unasked and helped me, but even so I was overwhelmed. Most of them are LPN's, the ones hospitals don't hire anymore. Let me tell you, these people are amazing. Same goes for the CNAs. I have a whole new appreciation for them. I always did, but this experience has opened my eyes. It disturbs me that in 2017, 30:1 for vulnerable people who need care, meds and treatment, that's an ok ratio. It isn't. Even California, land of ratios don't bother with LTC. They are still paying for a service, there is still need for care. Being told "just go in your diaper" instead of taking them to the bathroom. Its been an eye opener and a humility wake up for me; But is it just me, or is it time it changed? Just because they are old, DNR, etc, does it mean they get crappy basic care? Does the nurse need to be standing for 14 hours because there really is nowhere to sit and chart? Long term care gets a bad rap. It deserves more, as do the staff and nurses dealing with some of the most difficult patients in healthcare.

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Wholeheartedly agree. LTC nurses are a special breed. I loved spending time with the residents, but I would be hesitant to accept another job in LTC; not because of the facility itself, but because of the responsibilities of the LTC nurse! Soooo many people to pass meds to, assess, give treatments to, etc. All LTC nurses reading this post - you guys rock! :cool:

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I recently worked LTC/AL. I had a 38:1 ratio most nights with not NA. It was hard, and some nights impossible. I could have kept doing it had it not been for stupid policies, inappropriate admissions, and a LAZY/CRAZY DON and Admin. I liked my job and most of the residents were wonderful people (all low income and elderly/disabled/or a combo of both). We had people with significant dementia who wandered and we were a no lockdown facility, by a river, and by a busy road. It was ridiculous. Anything to make a buck off of these people who had little to offer anyway. It was sick.

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30:1 is quite normal. I left LTC as an LPN because I did get sick of the quality of care we were giving patients. Not because the nurses or staff were not doing their jobs but because upper management and administration would rather buy the facility a new TV than an extra staff member.

I left my last PRN LTC job last fall, I had 1:25 but 8 of them were rehab, and we aren't talking Mom fell down the stairs and now needs to be rehabilitate kinda patients, it was severely chronically ill patients we had no business taking care of. We were a low acuity facility, PICC lines, wound vacs, sepsis -- not low acuity.

And the aides are paid crap. $10/hour for 15+ total care patients? Yeah, your not gonna rope in the best employees for that wage. So that doesn't help with the "just go in your depends" scenarios.

LTC is a huge, freaking mess. I don't know how they would even begin to clean it up. But they should stop with the state of the art facilities, brand new rooms but having bare minimum staff.

I have been in one amazing LTC, just visiting. The aides were paid $15/hour +, the nurses $25-27/hr, and the outside was nothing to look at. But the care those people received inside was amazing. Their ratios depended on the type of patients they had at the time so they were not overburdened. The extra pay meant the staff felt valued which seem to have built a loyalty for their company and they all seemed to genuinely like working there. I wish they were all this way because the way we care for our elderly in this country is just heart breaking.

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Specializes in vascular, med surg, home health , rehab,.

It is sad that in the most developed nation on earth, the old are subject to this at the end of life. This place pays the CNA's well $14/hr. The nurses $28. 10:1 ratio which is comparable to the hospital. Just seems to me, to prolong a life that has no quality, is cruel. We pump meds into people. Why? I had one lady with contractures and decubs who just repeats "please god just let me die" endlessly. Hard to see.

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Specializes in retired LTC.

To OP - such is a sad reality for many a NH. But then I do have to ask.

Who is the responsible decision maker for that LOL who pleads to die?

What alternative method of care could you suggest?

I'm not defending LTC. But how does it change? I wish I had the answer.

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