Zippy83

I have been a nurse for 10 years, I’ve done hospital (med/surg and DOU), LTC, subacute, home health, and hospice. I started out as a new grad employee and has to go through the whole orientation process before being let out in the wild. Then after a couple years I started doing per diem and agency/registry, and have been doing that almost entirely for the past 8 years. Before Covid to be registry you had to know your stuff, you had to have verifiable experience, and you were expected to be able to jump in and go. I am so sick now of working alongside registry nurses and CNAs who have no experience and/or integrity. Who on earth would go straight into registry after all that time and money to get your license just to probably lose it because you are taking jobs you can’t handle and are not safe for the patients?? I have had a change of shift in telemetry where I endorsed to a nurse who was obviously clueless but all bubbly and excited, stared she had never worked in a hospital before. She was acting like it was her first day of orientation in a new grad program but she was going to be taking on my 4 patients. Then a bunch of these nurses that don’t understand how 1099 works brag about how much they are making to staff nurses while not doing their job so the staff nurses and other registry like me have to pick up their slack, meanwhile causing animosity regarding pay when they are often clueless about how their pay actually compares to w-2 with benefits. I could tell so many stories but basically the bottom line is that these new agencies will take anyone off the street and these nurses will take any assignment whether they actually can care for the patients or not. And I used to be the one always standing up for the hardworking CNAs, and I still do stand up for the hardworking ones. But I have never seen so many lazy, entitled CNAs than the current crop from registry. In the break room on their phones all shift while the call lights go off AND THEN talk back to you when you had to go find them and ask them to do the job they are getting paid for. Arguing over assignments with the staff CNAs. Arguing when asked to do anything. Missing from the floor half way through the shift and then found sleeping in their car. Or, clocked in and signed in but never checked in for their assignment and literally no longer on the property. I can’t tell you the number of times I’ve seen that. Literally just there to collect a paycheck, not to work at all. While the patients they are supposed to be caring for are soiled or on the floor etc. I’d say I see this in about 50% of registry CNAs. I guess this is what happens when health care companies are all about profit over people for decades. Now they are getting a staff with the same values. The nurses and CNAs that care are burning out like always but now there’s an army of staff that don’t give a good GD about the people in their care to take their place. There have always been these types of nurses and CNAs with no business being there, but to me it’s the sheer volume now and the boldness with which they show up and refuse to do the job that I find shocking and exhausting.

Just did a registry shift where two CNAs didn’t show up and they couldn’t find replacements, and several of the nurses were already pulling doubles. An additional LVN stayed on a double just to help with CNA duties since there was a nurse for each cart. I had 19 patients and luckily it was night shift and the 6AM med pass for these patients was lighter than usual and only had one agitated patient and a couple wander/fall risks. This other nurse who also was on a cart and already on her second shift of the day came over to help me with patient care. I didn’t even ask for help, I knew they were all bombarded so I had already started on a couple patients and she saw me and just jumped right in. Out of my 19 patients, 12 were total care and at least 4 were 2 person. And again I am the charge nurse also, with several patients having PICC lines, foleys, gtubes. I thought it was going to be the nightmare shift of the decade but the other nurses were such absolute team players. Just wanted to share this in light of the convo and give a shout out to those who always give 110%

This conversation came up on a night shift where a fellow registry nurse shared an experience from last year during our regional Covid surge. They only had two nurses, one RN and one LVN, show up at a 120 bed facility. No CNAs. Multiple covid positive and whole facility was supposed to be iso/full PPE for each patient. They stayed and did what they could on that shift. A new grad LVN was part of the convo and she asked what would happen if you leave, and what happens if no one shows up for the next shift. We advised in this case, either don’t take the assignment, meaning when you arrive hopefully before the actual start of shift you call off and don’t take any endorsement or keys etc due to hazardous working conditions. Or if you choose to take the assignment, either way call the Ombudsman, your licensing board, your staffing agency, your malpractice insurance provider, and probably the health dept as well, and report upfront the working conditions, number of staff and patients, everything. That way you won’t get accused of abandonment for not taking the assignment, and protect yourself from liability if you do take the shift. This would be the facility failing the patients but of course they want to shift the blame everywhere they can, so protect yourself and your license first. Then by notifying the proper agencies such as ombudsman and health dept you are also advocating for the patients in the best way you can.

First off, I agree that CNAs are both overworked and under appreciated. I have always tried to show appreciation and respect to EVERYONE on staff, CNAs, kitchen staff, secretaries, maintenance. Everyone is critical to providing care. I also sometimes get laughed at by staff nurses (I’m registry) for being “naive” because I let my CNA team know to call me if they need a two person assist etc, and I am not above any care, I will change diapers, feed etc. But I also have the responsibility and obligation to manage my time and get everything done, and in the past have fallen behind by NOT delegating some of these tasks to free myself up for others that cannot be done by the CNA. As some others have mentioned here, there also is a tendency for everyone, because we are all burnt out, to feel that we are doing all the work and others aren’t, and sometimes it’s because we don’t know the exact ins and outs of others’ assignments. I am also night shift and day shift definitely often thinks they are busier and work more, but I used to do day shift and they don’t realize that night shift has left hands on deck AND you are fighting circadian rhythm, so it is just as hard, but in a different way. I would caution against phrases like “I perform all the duties of LPN except inserting/removing catheters”. That is the kind if statement that can rub people the wrong way, because it’s not entirely true, even if you can perform a lot of hands on tasks. The LPN is licensed and putting not just the job but license at risk every day. Even when you are passing meds as a med tech, you are taking on less risk than a nurse because if the nurse makes an error such as failing to notice an adverse reaction or checking placement of a gtube or giving the wrong amount if insulin etc, they had more education and training and were under license to administer correctly. I cannot tell you the number of times a patient or CNA or family member thought I was “doing nothing” and tried to talk to me and thought I was rude for asking them to wait a few minutes, while I was actually doing something critical with the eMar that could cause a med error if I get confused or off track. I promise there are many things the LPN does, especially in prevention and planning, that non clinical staff, even those who are very experienced and great at their jobs, simply aren’t aware of because it is different training. if the LPN you work with is really just on her phone and refusing to do basic patient care then she is a snob and/or burnt out, and I’m sorry that you are left holding the bag. It is so frustrating to have to do the heavy load when you truly care about the patients and just can’t do everything you know that they need. I commend you for hanging in there for the sake of the patients and I hope you are able to resolve this either through management or simply finding another place to work.

That's the thing though, the agency pay is still significantly higher than what places are offering to staff employees. It's just that agency pay is stagnating at pre-covid levels and the job offers I see on job websites are frighteningly low. I'm talking the hourly rate I was getting paid in 2013 with just a couple years experience, is the average rate I'm seeing offered now for jobs that require experience, not new grad offers. I am already looking to move out of this metro due to rising cost of living and other problems, and the wages I'm seeing offered is scaring me into making moves faster, since it will undoubtedly cause continued staffing shortages, burnout etc, beyond what already is happening. Just wondering if it's a nationwide issue but sounds maybe local, which is a relief.

I’m an agency nurse, and while some places did offer pay boosts during covid (while others had no pay incentives and you were lucky if they had any PPE), I have noticed in the last month, the hourly rate both through agency and on job offers through the big job websites are averaging around what I used to make 6-7 years ago. I am in an area that supposedly has a growing population of seniors which should also mean more chronic conditions and healthcare demands, and we have a nursing shortage supposedly as well, so how on earth is pay going down and not up? Where are they finding nurses to work for these pathetic wages? Especially after the year we’ve been through! Are you seeing the same thing in your area?

I’ve been a hospice nurse for about a decade now, and had good coping skills related to death and dying, but there was definitely context involved. Now that we are having this insane surge in my area, for the past month the majority of the patients assigned to me are Covid positive or had Covid in the last few weeks. Many of them were not terminally ill with anything else prior to Covid, it is Covid that is killing them. Some patients did have cancer or other illnesses and were recovering prior to the Covid infection. And these patients are much more acutely ill and difficult to get comfortable, and time on hospice tends to be short since they are either discharged from hospital when it is determined that treatment isn’t working, or in SNF and never sent to hospital due to no availability of beds. Ages vary from 40s and up, with many of them under 70. I now jump for joy when I get assigned to an elderly person with end stage CHF or Kidney disease etc. In addition to the patients dropping like flies in a way I’ve never seen before, I’m encountering SNF nurses who cry at the nurse’s station because they keep losing patients left and right, healthcare workers who have lost family members to Covid and still come to work because they feel bad for the overworked staff, mortuaries telling us they can’t take the bodies because they are full. Up until December I really only felt like we were Covid-adjacent at my agencies, with occasional cases among patient and families. But the last 6-8 weeks or so have felt like a war zone. Any other hospice nurses experiencing this in your area?

I said something casually about a hobby I’d pursue if time and money were no object, and my boyfriend of 8 years went off on a topic that has come up many times: if you really wanted to do it, you would make it happen. Why didn’t you do it last night when you were just scrolling on your ipad? Etc etc He has a desk job and is not the bio dad of my son so although he helps a lot, he’s not financially responsible for him, and his bio dad doesn’t help either. I’m a hospice and home health nurse, often on call in addition to visits, often working 2 weeks straight with no days off. He doesn’t understand that even if they aren’t full 8 or 12 hour days, your brain doesn’t get a rest from work mode. Even if you don’t get a call while on call, you are at a certain level of stress and alertness. I often do end up putting in 50-60 hours, on an always changing schedule. And driving 100 plus miles per week. After work and family, the tank is empty. He thinks that if he has time to pursue hobbies, that there’s no reason I can’t also. He has never experienced the mental, emotional, and physical drain of this type of work.

Isn’t this private duty, rather than home health? I don’t mean that you should have to do housekeeping, etc. But it sounds like you are there for a whole shift everyday, rather than intermittent visits to multiple patients?

I’m a hospice and home health nurse in a city with many celebrities and I’ve had patients ranging from fairly well known to notable in their field, as well as family members of celebrities. I can’t think of any of them who were rude or snobbish. Actually the opposite, often very humble and appreciative. I’ve had plenty of rude and entitled patients and/or families over the years, though, don’t get me wrong ?

I have done up to 9 visits a day if all were follow ups and relatively simple, and not too far apart. However that would be one long day in a week with other days being 4-6 visits. There’s no way I could sustain that. And of course the documentation would be done later at home, no time for that in a day with 8-9 visits. I have known nurses and PT who do 10+ visits a day routinely. There’s no way those patients are getting adequate care. But the agencies sure turn a blind eye.

I can see why HH would seem like a better option while finishing school, but just FYI there are scarier things in HH than dogs and cats. The flexibility can definitely be there in terms of your hours. But as a nurse who is just about to burnout and leave HH for the second time in 8 years, it’s not ‘easier’ nursing. It can take over your life. Some agencies do let you decline patients for things like pets, depending on their staff availability. If you turn down too many patients they may utilize you less (if you are per diem) or let you go if you are hourly and they can’t keep you busy.

To clarify, if I did see her first thing in the morning it would be Monday/Thursday, or on Tuesday/Friday I can see her with that other cluster of patients in the area. Those were the options I gave her, both of which she declined. I just wanted to clarify that because otherwise it could seem like I’m saying I will either go in the morning early afternoon and might not make sense.

Since I started in home health and hospice it’s gone from patients being OK with just knowing the day and whether it would be an a.m. or p.m. visit, to giving a two hour window, to now at best convincing them to allow a one hour window, but many patients seeming to think that the nurses are like Uber and they just push a button and we show up when it’s most convenient for them. Is this something you all are noticing to? I was also wondering if it’s maybe regional, I’m in a big city and maybe people are more entitled and demanding here. I’m from here, so it’s not like I just moved somewhere and have an impression of people, I’m just trying to think of why this is happening. It’s gotten to the point where I end up having to let the office know I’m not going to be able to see almost 25% of the patients that are assigned to me, due to the fact that the patients can’t make reasonable accommodations for my visit. For example, I have a patient who only wants me to come at 10 AM, because she wants to be fully dressed for the visit and receive me in her kitchen, but doesn’t want to get up too early, then wants to have lunch at a specific time, and doesn’t prefer any visits in the afternoon, which she also has several reasons for. Based on my other visits and where she lives, I would end up having to drive 20 miles out of my way just to see her at this preferred time instead of seeing her in the early afternoon with another a cluster of visits in her area, or as my first visit to get hers out of the way. Her visit is not time specific, a couple of the other patients in her area are, that’s why it would need to be early afternoon, or like I said I’d be ok with seeing her first in my day. But she’s firm on 10 am only. This is for a simple wound care procedure 2x a week. I used to give in when it was only one or two patients doing this, it now it’s the majority and it would be physically impossible for me to meet all of their scheduling demands. What do you guys say when patients are this demanding, and is your agency accommodating to you, or do they try to force you to accommodate the patients?

Also because it’s traumatic for patients and families. When I came in as a hospice nurse to see a patient at a SNF, the charge nurse there had some kind of beef with our hospice agency and was saying things in front of the patient like we didn’t send certain medications, didn’t provide an 02 concentrator, etc. etc. These things turned out not to be true. I didn’t argue with her in the room, I just quietly administered the medication that our hospice had supposedly failed to send while she berated me, found his 02 concentrator in a storage closet and set it up, etc. In this case, the patient had been there a long time and this nurse had a rapport with the wife, so the wife believed everything she said. This was five years ago and every time I think back to it I think how sad that the patient’s wife was under the impression that her husband was not cared for his last moments all because that other nurse wanted to prove that she was better or smarter in someway.