Chrissy Lou

I loved my job at one time. Unfortunately, things have changed so very much over the last 10-15 years, it's no longer enjoyable. I don't like seeing my residents go without even the simplest things, so that I can watch home office people receive their large bonuses for "cutting costs". I am tired of taking away people's meds who truly suffer from psych issues, so that we can have another "star". I am tired of working 110 hours a payperiod only to be told I need to pick up more. I am tired of being told LPN's are worthless. It is time to move on, for me. I am currently searching for something non- medical related. Tough change later in life. But enough is enough.

I work LTC in Indiana. The company I work for is attempting to phase LPN's out of their LTC facilities. Many extra benefits (uniforms, pay increase, extra training, schedules and PTO) are given to the RN's only. The more RN's they have the more reimbursement they receive from the government, the higher their Star Rating. I hope this isn't a trend to continue. Unfortunately, the outlook is grim in my company.

It's not just hospitals, LTC is a mess also. I have worked in LTC for over 20 years, and what I have seen is very, very discouraging. Large Corporations buying up homes, cutting staff to the bone, the workload is insurmountable. I loved LTC because of my residents, I loved getting to know them, their families. There is no longer time for that, money is the bottom line, and the stupid decisions go with it. Still someone has to advocate and protect the patients/residents, and yours sound lucky to have had you! Nursing as it once was is dead. Now we are budgeteers, concierges, customer-service reps. I know I sound jaded. But I remember when things were different. I miss those days.

Wow. I have dealt with drainage tubes, wound vacs, IV's, peritoneal dialysis, etc., in LTC, as a well-trained LPN. After years of dealing with all that, I am now the Staff Developer, which I love doing! So many options, so much to learn everyday. RN's are scarce, most want nothing to do with LTC as you have read above. Someone has to care for these folks.

You are exactly right! In the State of Indiana it is the same scenario- few RN's will ever cross into LTC- by a good majority, LPN's run the LTC Sector. IF by chance an RN ventures into a building, typically they are often on the floor for doing direct care- that's a reimbursement gain for the facility. Just being an ADON does NOT typically mean you are in charge when the DON is out- here it is often the MDS Coordinator who steps in that role. LPN's here have a very wide scope of practice. You can do anything you have been trained for skill-wise, and there are many certs out there to pick up. Teamwork is expected no matter your designation. Our purpose is to care for our residents to the best of our ability, as licensed nurses. But, that's LTC. Who's got time for anything else?? :)

It's sad isn't it? I love and hate my job at the same time. I thought that by moving up it would give me more opportunities to really make a difference, to help further training, mentor.....instead I crunch numbers, am told to ensure compliance or it's my job.....I am sad for our residents. I keep trying though, for if we don't keep speaking out, who will?? Who will be the advocates for our elderly?

It is true- so many have no idea what LTC nurses do. LTC care nurses must have superior assessment skills, be very quick on their feet (wanderers, falls, aggressive behaviors- they keep you on your toes), and MUST be organized. (20-30 residents, glucs, nebs, g-tubes, drains, dressing changes, and lets not forget all the charting! Hours of charting!) LTC nurses wear many hats, (activities, laundry, dietary, housekeeping). I remember during my clinicals, so many of the other students could not believe I would "waste my time" and go back to the nursing home. I just told them, "I can't believe you would waste your time in OB"! (Not slamming you OB nurses out there, but it's like everything else- you either have a gift for it or you don't- I DO NOT have the gift for OB- I am where I belong! ) I wouldn't trade my resident's for the world! It is a hard, sometimes heart-breaking, place to be. But it's where I belong.

Unfortunately, my job as the ADON is pretty much.....everything that no one else wants to do plus a little more-whatever I can fit into a 50-60 hour work week...lol! (Yes that is for real-every week- hence the reason I do not fill a hole on the floor- it's also because I am "salaried"- I am not paid overtime to work the floor) Seriously though, my job does involve working with the scheduler to cover the units, (again, another job that no one wants), and there are days I could pull every hair in my head out trying to do that. There are times when no one, and I mean no one wants to pick up a shift or even a half shift. We do "mandate" people to stay over a few hours when people call in to give us time to find replacements. Also in our building, once we hit a "critical level", all managers are called in to assist, even if they aren't nurses. (Therapy, MDS, Staff Educator etc.) The thought is that EVERYONE can answer lights, pass ice, adjust blankets, help with phone calls etc, which helps free up the direct care staff to focus on patient care. Now, I can tell you, that if I put out a warning that we may "mandate managers", everyone sure jumps on the bandwagon to help find staff to fill the holes. It helps, and it also helps those managers who have not been aides or a nurse to appreciate the direct care staff more. Unfortunately, the other part of my job is to pick on the "petty" things, but experience has shown me more than once that those "petty" things are often what trips up the staff when State is in the building- you know tags for "holes" in the MAR, not bagging linen, the little things. Yes, I am not always the most popular person in the building, but I am forever watching out, being an advocate for our direct care staff- pushing them to be the best caregivers they can be, and searching out little ways for them to feel appreciated.

Our LTC hall typically houses 52 residents when full. That hall will never have more than 4 aides/2 nurses days and evenings, 2 aides/1 nurse for the night shift. It's never easy, and when census drops on the Rehab hall or our Dementia Unit, staff is cut across the board even though LTC is the steadiest when it comes to census. You are not alone, staffing is tough in LTC all over. The sad part is, overall the typical acuity these days in LTC/Rehab buildings has gone way up from days past. We have many g-tubes, IV's, chest drains, wounds, trachs, etc. on a daily basis than ever before, yet staffing is still as it was years ago. The least amount of residents any nurse has in our building is 25, many with the issues I just mentioned. and 8x the paperwork. Oh the frustration!

I am jealous....it seems I have the same thoughts myself. Nursing is not what it used to be. After many years of doing something I once truly loved, I know dream of new avenues, things I can do AWAY from nursing. I am saddened, as I always thought there would be nothing else. But doing more with so much less, knowing that money, not patient care, is the priority, I just don't know that I can go much farther. I was not trained to ever think that spending a few extra minutes consoling a family, a patient, or helping a fellow co-worker with a fall at the change of shifts was wrong. I am tired of being frustrated, feeling guilty because I can't offer snacks or extra lip balm because it is "not in the budget", or not being able to offer coffee to a family while they are keeping vigil at a dying resident's bedside because again, the kitchen is locked tight to safeguard the "budget". I am tired of too many chiefs and not enough Indians. How sad our industry has become. Kudos to you for taking the plunge!! I wish you all the luck in the world!!

I am so glad to see that not everyone in the medical world has lost their minds-I 've been drowning in whiners.

LOL...had the same thing!

LOL....."Should I tell my DON that those old LPN's are trying to tell me what to do? Surely she can't mean for them to help train me?!? What do I do?".......lol.....Too many times!

Really? I am currently the ADON/Unit Manager/Wound Nurse- and I AM also an LPN. (In fact, our other 2 Unit Managers are also LPN's) I EARNED my spot, having been in nursing longer than most of the people in my building. In our state, it is perfectly legal- I know my regs, policy and procedures very well I can assure you. We do have RN's floating around our building, many of them are new, coming out of school without even having changed a foley on their own- or having done a med pass to 30 residents- and we even have those "CNA medication aides" around to help train them! So, I am guessing if the State Board of Health doesn't have a problem, why does everyone else? I agree with another poster here who stated that nursing should go with one certification- period. Then people would be hired by their proven worth and merit- not just because they have the right letters behind their name. Work together, get the job done. LTC is a whole other world.

You write very well! I too am an LPN/ADON, soon to be an RN. I have worked for my facility many years, and was told when I was promoted (from Unit Manager) that I had been chosen for the position because of my ability to get on well with the staff, as well as the fact I had proven myself worthy of the job. In LTC things are a bit different than in the hospital setting. The RN's and LPN's exist together, no one pays that much attention to the letters. Many of our RN's are new and inexperienced- there are many tasks they have never done alone. (Many have graduated without even having put in a foley on their own!) The LPN's are experienced, many of them with 20+ years under their belt- now logically, I don't care what your letters are. If you have the experience, you are who I want to train me. There are good and bad nurses period, no matter what their letters say behind their name. RN does not make you all knowing- not one of us are- RN, LPN or otherwise. I am the ADON, and I do get out on the floor EVERY single day- I help the nurses write orders, work on the daily scheduling, give baths, feed, do wound care....all of it. How else can I know what is going on in the building? How else do you get your staff to relate to you well, and gain their respect? On a final note, when my DON was out of the country, I dealt with the State on a complaint, and did just fine thank-you!