PRKD70

As a Response Nurse in an ALF I had about 240 residents. I was the only nurse for all of the 8 units. Meds were being passed by 'med techs' that are just resident assistants (no CNA training) that took a 3-day med passing class. Before accepting the position, I got it in writing that they were not working under my license. When I was off they would cover the position with one of the med techs(?!) because the nurses they hired rarely lasted longer than a couple months. This is a very expensive posh place and they are assured that a nurse is available 24/7 (never true). Some nights were quiet but others were full on chaos with multiple falls, changes requiring being sent to the ER, combative psych residents, etc. - this isn't what AL used to look like. What was the most troubling to me is the dramatic increase of hospice on these units. In some instances it was justified but in many others it simply wasn't. For instance, there was a resident in a dementia unit that would routinely come out of his room with his pants down and begin masturbating in front of whoever happened to be around. No interventions were helpful and this continued for quite awhile. Eventually the doctor put this resident on female hormones to reduce the 'hypersexuality'. This stopped the masturbating but the resident became dangerously abusive (even towards his wife whom he loved dearly and who visited daily). Suddenly, this man that was on very few medications and ambulated without assistance of any kind became a hospice patient. Within a week he was dead. This was a common scenario with any residents that were problematic. Those along with residents that had families that simply wanted them gone. I would have no problem with residents (of sound mind) deciding they were ready to go but family members constantly asking for hospice re-assessments in hopes that they could be rid of them? I had a family member come up to me one night and ask 'could you give him another shot of that stuff, we are really tired'. What?! I am a nurse, not an angel of death. The constant med errors/counts off (when they would actually count which was rare and not followed up on by the unit managers), falls that could have been prevented, influx of hospice, more psych and higher acuity residents combined with a lack of any support system caused me to resign. AL is no longer AL but they want to continue with the same staffing ratios. Utterly ridiculous.