It really hurts my heart that these people can't get better treatment than this.
As you probably can tell, I work in LTC. And right now, I am wanting to turn some facilities in for unsafe conditions and deliberate understaffing. However, as we all know here, state by state nursing home inspectors are aware but turn a blind eye to the staffing guidelines of nursing homes. Who do we have to tun to if not the state watchdogs? Why is it acceptable for this to go on? I just got off of my 2nd shift where I just had 48 patients on a dementia/Alzheimer's unit. There was only 1 nurse and two CNAs to 48 patients. And to add to the equation, the moon is full. So, y'all already know the rest.
This was my night, last night (and on most nights):
I have 4 tube feeders, multiple diabetics, 20 of the residents are total care, the other 28 are walking "time-bombs" just waiting for a fall, or worse, to happen. I am trying to do med pass in only 2 hours for all these people. I have resident's that are sundowning and having some psychotic issues. I can't finish my med pass because I keep having numerous issues that interrupt me. I have mostly 48 people that you have to sit with for 10 minutes each to convince them to take their medicine due to their mental incapacity. You have 30 of them that will hold the meds, which are crushed in applesauce, in their mouths forever. You can't leave them because of fear of aspiration, so the clock is still ticking. You have the other residents that I have to keep running to check on every 5 minutes because I hear bed and chair alarms going off, all while trying to stay in compliance with med pass. You have only 2 CNAs that are working their butts off. So of course, I won't let them drown. I help them feed and do peri-care (they are lucky to get a bed bath tonight. Showers just ain't going to happen tonight). I have 4 tube feeders that, unfortunately, have not been flushed on the previous shift, so you know what's next. I spend 15-20 minutes on unclogging their feeding tubes just so I can give them their meds, not to mention feed them, flush them, etc.
During the first part of the shift, the doctor was in the building seeing residents on another unit. I have a couple of patients with issues that he wasn't scheduled to see today. Instead of him walking around there to come LOOK at these patients, as I begged him to do, he just gives me orders based on what I tell him. He won't even come and see them. Okay, that pushes my buttons even more. So now I have extra charting to do to cover my butt (and his), if anything worsens with these patients. And lastly, I have a man that was confirmed MRSA positive, but the DON refuses to move his roommate. This man is allowed to wonder around touching other residents because nobody has the time to keep him from coming out of his room. Not to mention that I am getting calls from other units to come and help out when needed.
I ask all of you. What can be done? I hate to refuse to work because this place has some nurses there that will work, but when they do work, they don't hit a lick at anything. I hate to follow them because I have to make up for what they didn't do. We have nurse supervisors that do the paperwork part of their job, but nothing more. They never work the other cart when there is no one else. They just leave you hanging out to dry. This facility does not advertise to get more nurses, so I don't know how they expect to hire any. And because a lot of nurses just accept these conditions, it continues to happen. It's not fair to the residents and it's not fair to the nurses. What can we as nurses do to make a difference and stand up for these patients? There has got to be a way to make these people's quality of life, during their final days, better. They have worked hard and made this country what it is so that we can live and this is how they are repaid? Something has got to be done about this. I'm pretty sure it's not just my facility, but others across the country as well. And y'all, with the baby-boomers growing older and living longer, it's going to get worse. But it has to stop.
Well I guess first of all I thank you for doing your best with what you have to work with. I'm a senior nursing student now and LTC is not part of our focus, but I was a CNA and part of our training was 2 weeks in the nursing home and 2 weeks at the hospital. I went home every single night in tears after working at the nursing home. They were so pathetically understaffed, undersupplied, overwhelmed. I told everyone I knew how I could not believe that this is what we do to our elderly in this country! With all of our advances shouldn't there be a better way? I vowed no matter what I had to do, my parents would NEVER be placed in such a facility and I hope to God that there conditions never become such that I cannot care for them at home or afford to shell out the BIG bucks for something better.
A solution? I don't know. I'd love to do my part to help bring this to the attention of people who might be able to bring a change, but I don't know where to begin. Maybe rotating nursing students through nursing homes more frequently could at least provide extra hands who are able to pass meds and perform other skills. It would be good experience for us and help relieve the staff. Although, I think a lot of my fellow classmates would probably shoot me for suggesting it. Across the board, I do not know of ONE single person in my class who wants to graduate and work in LTC, even myself. With conditions that deplorable and the nurses feeling SO overwhelmed, most who have another option are choosing it.
I'm sorry I can't do more than empathize with you at this point. I guess at the end of the day all you can do is remind yourself that you ARE making a difference just by being there and providing the best care you can. You choose to make a difference where a lot of us do not, and I hope there are some special blessings somewhere along the line for people such as yourself. Thanks for what you do.
Oh, thank you very much. I appreciate such kind words from you. I had a lot of my classmates to gawk at me for wanting to go into long LTC when I said that right before graduation. Especially being a RN with so many other options. However, instead of going into LTC right after graduation, i went into Med-Surg. I did and still do hate Med-Surg because I felt like a dirty puppet. All it seems that I did was push drugs all night and fetch "coke" to my patients. However, LTC isn't any better, but I feel that these people are so underserved. It's something that I don't mind doing. At the same time, I am mad at the local nursing home administrators for selling out these nursing homes to big corporations. Because it seems like before they were part of a corporation, the nursing homes were good places for patients to be. We actually has some darn good nursing homes. Then, when the corporations took over, all went to hell in a handbasket. So, that's what it all adds up to. And another thing is that I despise "state" when they come and do surveys. They will tag a facility for stupid things like not dating the applesauce, but they won't say a word about the staffing and other conditions that put these people's lives in jeopardy. It makes me wonder if they are being paid off by these corporations.
I worked LTC for 15 yrs as an aide before becoming a nurse. I have seen more then my share of this as well. It seems to be a problem even in the nicer nursing homes.
The one thing that seems to make any difference at all is if the families of the residents start to complain. It usually gets the attention of the administration and management. They usually want to keep these people happy for fear of losing the buisness.
I have been tempted in the past to make an anonymous call to the Department of Health (or the overseeing body for your state). I never did, but I know people who have. They have to investigate all complaints and concerns. The families need to know that they have the power to make these calls as well.
I'm sorry it is so terrible for you. I hope it gets better soon!
You are so right. If the family says something, then things get done. But, it's so sad that they will listen to the family, but not the nurses. I mean, we are the frontline and we see a lot. So why not listen to the nurses? Oh, I forgot, we are expendable. (Sigh)
Thank you for your well wishes. I hope it gets better, too, but the future looks grim right now.
I think the old story about the Eskimos pushing their elderly out to sea on a block of ice is pretty much overstated however I have to laugh when people gasp at that concept when what we do to our elderly is a lot worse.
The state doesnt care for the most part, sure if there is a complaint they will investigate to "act" as if they are doing something. All of these rules and regulations especially in regards to paperwork do not help as well.
There are things you can do, I give my personal opinions to people when they ask in a professional way. Support legislation that promotes paying for care in the home as opposed to only a nursing home. Currently it costs the state 55,000 a year to keep someone in a nursing home but as part of an aged and disabled waiver service it can cost around 20,000-25,000 to keep someone in their home.
Typically it is called something like "money follows the patient." It just makes sense to save 30,000 dollars and let someone stay at home. But long term care conditions are horrid in the US. I am surprised the AARP hasnt done more but for the most part these people in nursing homes are demented or have severe physical limitations hence they no longer have a loud voice.
That is so sad. So, the AARP may not offer much hope. Maybe if I remind them that this could be them in this condition one day, they'll listen. And you are so right about the state investigations. They are not very efficient. If they were, then nursing homes would not be allowed to go on like this.
I agree that home care is a good alternative. It does have the down side in that then those in nursing homes are only the very lowest functioning folks and so you need more intensive staffing. There may be less nursing home beds all around, but each nursing home would look like it was MORE expensive to run because you'd need more help per resident/patient. Actually, I think this has already happened to some extent. By looking at the staffing numbers, one might think it ought to suffice, but then one has to consider that these folks have tons of meds, need lots of assistance with ADLs, have several multiple health concerns, have dementia of varying degrees, etc.
And not to mention that they count the DON, MDS Coordinators, ADON, etc. in the staffing. And these people don't provide direct pt. care. So, I don't feel that they should count them. That's something else that makes no sense. And my DON is the worst DON that anyone could have. She does nothing but sit around assigning other people parts of her job that she doesn't do. I wish they would get rid of her.
Congratulations Kanani_Ikike for doing a great job. Nursing is ever unpredictable. We can have good days, and really bad days (mostly though). It is just sad that despite the obvious picture of a nurse struggling with 48 patients, still there is no action made to make work more tolerable and acceptable. That ratio is terrible, however, congratulations because you are a hero. Your patients may not be aware of that (and the rest of the people around you), but you should be proud of yourself.
Stress is part of our job, but too much though could really hurt. We experience a roller coaster of emotions because we know that we could do better, only that we are time constrained. It is sad to know but that's the fact. And I salute you for dealing with that.
Congratulations Kanani_Ikike for doing a great job. Nursing is ever unpredictable. We can have good days, and really bad days (mostly though). It is just sad that despite the obvious picture of a nurse struggling with 48 patients, still there is no action made to make work more tolerable and acceptable. That ratio is terrible, however, congratulations because you are a hero. Your patients may not be aware of that (and the rest of the people around you), but you should be proud of yourself.
Stress is part of our job, but too much though could really hurt. We experience a roller coaster of emotions because we know that we could do better, only that we are time constrained. It is sad to know but that's the fact. And I salute you for dealing with that.
You can do it! Go! Go! Go!
Thank you so very much. I don't like to think of myself as a hero, just doing what the Lord sent me to do. And at the same time, everyday, I am praying for Him to do something, anything, to make them see how wrong this is. This is indeed stressful. But you know what I think? I believe that I have adrenal fatigue because I don't even get a physiological response from stressful situations anymore. For that I'm glad because I used to get these tension headaches and heart palpitaions that I couldn't stand. But, on the other hand, my poor body is worn out. That's not good because I am in my late 20s and already have a gray hair or two. I pray to God that I can find a good, non-nursing job or that I can go back to school for something else. It's beginning to be not worth the stress and damage I'm doing to my body, physically and emotionally. Thank you so much for the support.
I doubt there's little one can do to change this problem across the board. However, if your heart's really in it, maybe you can find a way to carve out some time to participate in or help coordinate a larger effort to push for change. Maybe a political approach or a garnering more publicity on the working conditions in nursing homes.
I specifically note that attention needs to focus on the working conditions, not just the patient conditions. Some reports of poor nursing home care make it sound like the problems lay with uncaring staff as opposed to the staff being faced with impossible demands. How to pay for quality care can't be left out either. Nurses need to make a living, too.
This site may be a way to find others with a similar interest in trying to effect change beyond refusing to accept employment at subpar facilities or making do in poor working conditions. Whaddayathink?
Your state reps would be a great place to start and the news media as well. News people are always looking for a story and if you help the media and do a lot of research and work for them . . . you can get the message out. Also - Michael Moore just did the documentary "Sicko" and I bet a sequel might spark his interest. The LTC topic touches all of us and we are all paying for many people in LTC - especially when they run out of personal funds long before they die.
Staffing mandates need to be initiated by the state and not the kind that just say "adequate staff to patient ratio" - those leave the definition of "adequate" up to owners and admin people that are there to make the most amount of money in the least amount of time and keep overhead as low as possible.
Kanani - I think you deserve more than a hug!! I just retired from nursing. The last year that I worked was spent in LTC - and it was an eye opener!
The last place that I worked was probably the best place in our area, but they even had some issues that made me wild sometimes.
I don't know the answer - maybe like someone suggested, the LTC industry needs someone from the 'outside' to really investigate, because I don't think the general public has any conception of what it's really all about.
Specializes in Nursing Home ,Dementia Care,Neurology..
It's the same here. The NHS basically doesn't want to know when you get old therefore the elderly either have to wait for funding from their local council or ,if they have money, they have to pay for their nursing home care themselves. This means that all the hard earned money they wanted to leave their children instead goes to some profit making organisation. Considering most of the elderly now would have been the first to pay national insurance and have paid it all their working lives I think they are getting a raw deal from the NHS.
When they do get into a home then they find that privacy ,dignity, and choice are there but at the mercy of overworked and often undertrained staff. If they have no voice then they often have no choice. I definitely will come back and haunt my kids if they put me in a home:nono:
Granted if they are ill they still get NHS care but now we are finding more and more that doctors will not order tests or treatments when the residents begin to fail.Therefore sometimes we have to work in the dark knowing that there is "something" there but not actually knowing what it is.
It's the same here. The NHS basically doesn't want to know when you get old therefore the elderly either have to wait for funding from their local council or ,if they have money, they have to pay for their nursing home care themselves. This means that all the hard earned money they wanted to leave their children instead goes to some profit making organisation. Considering most of the elderly now would have been the first to pay national insurance and have paid it all their working lives I think they are getting a raw deal from the NHS.
When they do get into a home then they find that privacy ,dignity, and choice are there but at the mercy of overworked and often undertrained staff. If they have no voice then they often have no choice. I definitely will come back and haunt my kids if they put me in a home:nono:
Granted if they are ill they still get NHS care but now we are finding more and more that doctors will not order tests or treatments when the residents begin to fail.Therefore sometimes we have to work in the dark knowing that there is "something" there but not actually knowing what it is.
Wow! That is so sickening that they are treated that way. And it's not just in the US. I thought that othe nations might be better, but I guess it's a widespread problem.
Your state reps would be a great place to start and the news media as well. News people are always looking for a story and if you help the media and do a lot of research and work for them . . . you can get the message out. Also - Michael Moore just did the documentary "Sicko" and I bet a sequel might spark his interest. The LTC topic touches all of us and we are all paying for many people in LTC - especially when they run out of personal funds long before they die.
Staffing mandates need to be initiated by the state and not the kind that just say "adequate staff to patient ratio" - those leave the definition of "adequate" up to owners and admin people that are there to make the most amount of money in the least amount of time and keep overhead as low as possible.
So very true. Because the so-called staffing ratios that are in place now are a joke. How can they call this "adequate" and still sleep at night? I can't do anything but shake my head.
The national standards are shameful. My stste has good ratios for acute care.
It was RNs who did most of the 12 years of lobbying, letter writing, signature gathering, and educating the public.
Because RNs are the minority of healthcare workers in long term care we all have to work together. It will take many brave nursing assistants, nurses, and families to do this. I quit a job at a horrible nursing home almost 40 years ago. It was in a very wealthy area. Nice front and lobby where we were only to take alert, clean, dressed patients with their hair combed.
12 patients and six sheets are not OK when they are incontinent. I was a CNA. I reported them to the health department but didn't have an organization to help do anything else.
Are there patient advocacy, church, or senior groups who can help start a movement? We nurses need to do this. You are right
Kanani_Ikike
167 Posts
Oh, thank you very much. I appreciate such kind words from you. I had a lot of my classmates to gawk at me for wanting to go into long LTC when I said that right before graduation. Especially being a RN with so many other options. However, instead of going into LTC right after graduation, i went into Med-Surg. I did and still do hate Med-Surg because I felt like a dirty puppet. All it seems that I did was push drugs all night and fetch "coke" to my patients. However, LTC isn't any better, but I feel that these people are so underserved. It's something that I don't mind doing. At the same time, I am mad at the local nursing home administrators for selling out these nursing homes to big corporations. Because it seems like before they were part of a corporation, the nursing homes were good places for patients to be. We actually has some darn good nursing homes. Then, when the corporations took over, all went to hell in a handbasket. So, that's what it all adds up to. And another thing is that I despise "state" when they come and do surveys. They will tag a facility for stupid things like not dating the applesauce, but they won't say a word about the staffing and other conditions that put these people's lives in jeopardy. It makes me wonder if they are being paid off by these corporations.