One Flew Over

Hello all! I have been working in LTC for 7 years now, 6 as a CNA and 1 as an LPN. I have seen a lot of management changes, and staff turnover. During the staffing and budget cuts we have lost a lot of really amazing CNAs and nurses. Over the past year I have worked as a nurse, I have felt a lot of hostility around me. The attitude, particularly on the floor I work on, is very negative. The nurses are out to get each other it seems, and dig fervently through MARS, TARS and documentation to find even your smallest error. They are also extremely passive aggressive, smiling to your face and then going around spreading rumors, gossip and just running their mouths. I've gotten yelled at and undermined by coworkers while counting at the med cart and even in front of family members and other staff. The person who yelled at me while counting said that if I had "anything to say, to say it to my face. Mind your own business." This same girl was the one that was sitting at the nurse's station the night before trashing all of the day shift nurses, myself included, with a large group of CNAs and another nurse. The CNAs are mostly new and partake very willingly in the gossiping/trash talking. Long story short, if I had to describe it here I would say that they smile genuinely to your face while they plant a knife in your back. I find myself becoming more hostile, and aggravated easily since entering this work environment. I even find myself beginning to take part in it a little (hence the med cart confrontation, I got flustered when I heard that she was talking so crudely about me and let a little of it slip, it's my own fault), which makes me very angry with myself because that has never been my philosophy. As an aide I was always happy, loved going to work and got along very well with my coworkers. Ever since becoming a nurse, and the staffing changes, I don't find that the case anymore.. I am currently pursuing my RN and will graduate in Spring; another job is not an option at this time. I guess I was wondering if anyone else has had this experience? My plan is to move on to the hospital once I do graduate, is it any better in hospitals as a general rule?

I'm in Massachusetts

I haven't really had a patient of this nature; it's always been easy to define whether they are competent or not. I guess that's why I was asking. I definitely see why he was seen in the first place, but I feel that other interventions such as counseling with our in house psychiatrist could have been at least tried first. His behavior has been at his baseline with no improvements. I also fear that with his already gait due to Parkinson's and desire to maintain independence he will be at higher risk for falls taking this medication. After further investigating I found that his PCP activated the HCP, however, he rarely comes in to see the patient and knows little about him. His reasoning was increasing forgetfulness.. the pt has a history of depression, though, so it could be related to that. I guess I just thought that occasional periods of forgetfulness in an otherwise AAO patient was not enough to activate a HCP but like I said, I'm not too fuzzy on the criteria. He takes his meds whole in pudding due to swallowing difficulties, so as far as I know, he didn't notice the addition of the medication. He has since learned that he is taking the med (through his daughter- HCP) and was a bit put off at first but OK now. But that still hasn't eliminated my feelings about the situation and how it was handled. Tea: We don't have an ethics committee unfortunately, however, I do plan to discuss things further with the social worker and charge nurse once things at my building settle down.

Hello all! I'm a long-time lurker and haven't posted in a while but I have an issue that's really been bothering me. So let me give you a background.. Pt has Parkinson's disease, AAO to person place and time, occasionally forgetful (but who isn't?). Presenting lately with slight paranoia and ?depressive symptoms- feeling staff does not want to care for him, hiding his call bell, doesn't want him around, "no one likes me". Investigated- found that call bell not being hidden but pt very demanding so it wouldn't surprise me if staff was a bit short with him at times. We decided to have psych see him to see if perhaps they could increase his scheduled anti-depressant. Psych saw him, recommended a new anti-psychotic TID. Pt very hesitant to start medication, and was his own proxy, decided to talk it over with dtr and get back to us after the weekend. I was off for a week, and came back. Fast forward to today. I come in and his health care proxy was activated (not per his request to my knowledge). Pt is baseline- AAO to person place and time. Still understands his condition, health status and medications. I am told by two nurses that since his HCP has been activated he has started on the anti-psychotic. However, if he asks, we are not to tell him that he's taking it ("because his HCP is activated, he doesn't need to know"). Two things sound very strange about this scenario, first of all, if a man can tell me his name, the town and state he is in, and what year it is, down to who the president is and what the score of last nights football game; how can his HCP be activated? Is occasional forgetfulness in the criteria? Secondly, does not telling him what meds he is getting sound appropriate? Even if his HCP were appropriately activated- if he asks, doesn't he have a right to know? I do plan to speak to the social worker, as well as my unit manager, but I was wondering if anyone had any insight? Or similar situations they could share? Thank you for taking the time to read this, I'm thoroughly exhausted, so I apologize in advance for any incoherent wording!

I believe it also comes in a liquid suspension form- obviously not time released so he would just have to get it more often. I agree though, don't hold.

Absolutely heartbreaking.. and working in LTC, it hits so close to home..

I was a CNA before I became a nurse, and let me tell you, most days I wish I was a CNA again. While the physical demand is much less, the stressful MD/family calls, changes in patient condition and constant worrying when I go home at night are extremely taxing. I used to go home at night after working a shift as a CNA tired but satisfied that I did a good job. As a nurse, I go home at night and wonder about all of the things I think I have done wrong, or could have done better.

I don't consider myself a great nurse and I don't expect anyone to describe me as such. That's not to say that I am completely inadequate or foolish.. I've been a nurse for about 8 months and I think I consider myself adequate, an average new nurse, bumbling, and having at least one 'aha!' moment daily.. Hopefully with some more experience one day I will be described as a 'great nurse' :)

You document what you saw, it's not your job to document what you assume happened. Like a previous poster said, I've had residents in LTC that sit themselves on the floor, crawl, slide.. etc.. so not every patient you find on the floor has necessarily fallen. Of course you still fill out the incident reports, update careplans.. etc.. but don't document something unless you witnesses it and know it to be true, it's not any different from documenting on anything else.

And if your patient begins to complain of nausea/stomach ache.. etc.. make sure that basin is front and center! And I mean a real basin (label it for 'oral use only'), not one of those tiny emesis basins, the elderly simply cannot aim into those little things! :)

Leave ASAP! And then after you've left and have a new job, blow the whistle on that other facility- it sounds like they need to be shut down.

I'm not at all bothered when a patient mistakenly calls a CNA a nurse.. it's when that CNA answers to 'nurse' and does not politely correct the patient/resident, that's when I get bothered because its deceiving. In addition, and just as an aside, when I worked as a CNA I always referred to myself as an aide because in the population I work with (the elderly) many get confused by the term CNA and don't seem too familiar with it. Most however know who the term aide means.

The only time I was told that it is inappropriate to use a name is when you are referring to another resident/patient (as in a patient-to-patient altercation) and I believe in that instance it's acceptable to use 'roommate' or room number if I'm not mistaken.

Not all LTCs. It definitely depends on the facility and region because I am on week 5 of my orientation and I will be finished next week which adds up to a total of 6 weeks of orientation. About 1 week of following a nurse and 5 weeks passing meds with the nurse nearby for questions/concerns.. etc. Additionally, I have been told many times that I am more than welcome to take more time if I feel unprepared. My facility seems to take an approach similar to Cape Cod Mermaid's. :)

I agree with the poster above, dry the floor as best you can and then put them on. Slipper socks should definitely be on in the hallways/rooms at all times, not only as a safety issue, but I shudder to think of the things that have been on those hallway carpets at my facility. I personally wouldn't want to walk on them barefoot! lol