ebony2

Look at what we are dealing with here. growing numbers of seniors, closing of nursing home beds(at least in New England where I am from). Major issues with no long term solutions. The cost of providing care continues to escalate out of hand. People so removed from the actual problems trying to devise action plans to solve the problems. DO ANY OF THESE IDEAS SEEM PLAUSIBLE.... Taking care of people in needing their own homes instead of an facility. Having families involved in this process to the extent they can. Implemantation of regional casemanagers to triage services needed by elders and having a larger staffing pool through combining home-care LTC and rehabilitation services. Something along these lines would have to be more cost effective. As far as who dies and when. Who better to make that decision than thos who are facing that situation. I all my years of practice I have only met one patient who wanted life under any circumstances. Most other s know exactly when their quality of life would no longer be acceptable to them. By expanding advanced directives options could be included for just these types of sitiation. Fear of making the wrong situation and guilt could be virtually eliminated. Tightening of eligibility for nursing home placement to those cases requiring skilled short term care or chronic care needing behavioral management(uncontrolled). Would this b easy to accomplish, no change ever is. We all have ideas on the subject. No one to take them seriously.

Marjorie you are right. Is it ever about the resident? I know that is what facilities claim their credo to be, but is it? They are rarely involved in decision making concerning their care, When seem to over look this need and present care needs to others(family, guardians, POA's).Often they are just caought up in the system with all control of their lives in the hands of others. So when I hear one of my resident's say, "please stay with me awhile" , "don't leave" or the just need to talk a minute I try very hard to take even a little time to do so(there is never enough time). The human touch and humor also work well for me. I wish time allowed more.

Tell the physician to not be such a tight-wad and if he chooses to over-extend himself than he can atleast have the decency to hire a partner. However, in many states the parameters for what nurses can and cannot do is widening. Know your particular scope of practice. If there are concerns you can gain clarity through your board of nursing. No matter what, if you still feel uncomfortable I would look elsewhere for employment. It sounds to me like your future employer is a DINK!!!!!!!!!!!!!!!

surgical preps by nurses prior to surgery providing care to same peds patiens each year while parents went on vacation inpatient stays for routine diagnostic testing (usally 3-5 day stay) restraints on the units for patients with behavioral problems high hot and soapy enema's isolation up the whazoo(enteric.contact,respiratory,reverse) fingerstick accidents not a problem mixing your own IV additives dress codes in some form or fashion during some dressing changes tapping patients buttocks to the side rail for that previously mentioned heat lamp treatment informaition on a need to know basis was everyone knew everything aluminum paste for dressing changes bolus tube feedings DRG's team approach nursing police or ambulance providing transportation to work in bad weather conditions

Wow, that's a loaded question! I think the nursing experience is somewhat different for all of us. I think you pretty much get out of it what you are willing to invest. That rarely includes accolades from outside sources. It's the satisfaction of knowing you did the best job you could for those who look to you to assist them through difficult times in their lives. It's the heart felt thanks given from those whose trust you have gained. If that expression of gratitude continues to feel as good to you the 100th time as it did the first time. You will understand why you do what you do despite the stress, overwhelming sense of responsibility and unwavering frustration. You may have to try on several pairs of shoes to get the right fit. That's another beauty of the profession, its diversity offers many shoes for you to try on for comfort. Good Luck in your search

Thanks guys! As unlikely an experience in the scheme of things as this was for me, it's nice to know that the unexpected has happened elsewhere. To answer all the questions about unwanted gifts these animals were housebroken, no mishaps and had eyes that seem to hold the knowledge/wisdom from the beginning of time. We humans could have learned quite a few lessons from them concerning good behavior.

I Greg it's nice to know you are interested in LTC. It has been very rewarding for me. However don't even think about opening yourself up for such vague sets of responsibility. If you are still interested have them spell out the real deal and hold them to it. There is absolutely no way one nurse can be responsible for the well being of 80 residents unless its strictly at a supervisory level. Making assessments. guiding others how to proceed, conflict resolution, interventing with difficult residents and familes. covering the lunch breaks etc. If it involves med pass, transcription and treatments and these tasks cannot be delegated to others, no way. If I were you I could not attempt what is humanly impossible to do well. LTC needs you but don't set yourself up to fail Good Luck

Hi all, Just a very different experience I thought I 'd like to share with you and hopefully bring a smile to your face. I thought I had just about seen it all. Years ago a resident I was caring for wanted to go to bed, he was seated in a high-back stationary chair by his beside, with a posey vest restraint in place(remember them). No one came quick enough and the resident was found in bed lying face doen with the chair stll attached to his back! Now this incident only happened a week or so ago. Imagne if you will having a fairly hectic day and just as you are beginning to gain control you start to pass some of your evening meds. As you are focusing on the task at hand, you look up to see a resident's familiy members walking down the corridor with TWO not ONE fully grown LLamas. They were walking them with reigns. The animals were well groomed and beautiful. I stood there trying to haul my bottom jaw up off the floor. Suddenly, the staff gets into it, taking the visiors from doorway to doorway sharing our( a bit out of the ordinary situation) with other residents and visitors alike). I'm running ahead talking to my resident's inqiring of they had a fear of animals and what they could expect to see the corridors in a few minutes. Vistors and residents alike were entering the hallways with a look of awe on their faces. Some of the residen'ts became over exuberant hugging and kissing the llama's(I'm thinking, is mad cow disease anywhere in the picture ) While the resident whom the family was bringing the llamas to see kept yelling "I don't like the llamas." "I don't like the llamas." I'm still in the process of composing myself when I see a light flash. I turned to see what was going on and yes, you guessed it, they were having their own photo shoot with the celebs. One resident even pulled an the reigh, the owner was holding , so that her picture could be taken with the llamas face right next to hers. Everyone was all smiles and having a good time, while visions of licensing boards, unemployment lines and an award for nurse dummy of the year, danced through my head. A visitor walking by, snapping me out of my nightmare with the comment ,Well you don't see this every day, do you? I still stood fast, insuring no one was being hurt and devising the master plan for (if/when ) the state walked in and requested a resonable explaination about why every known regulation in the book was being broken here. They never did come by and the residents speak fondly to this day about the llamas who came to visit. I guess it just goes to prove somethings you just can't plan for, control or MAKE UP !!!!!

So Sad and so true ingelein...we need avoice and to be heard about LTC expectations. I have gound no easy way.organization and having an initial plan for the day is helpful but even with all of that you never know when you get on the unit what interruptions are going to come your way. I fifnd after many years it's all about taking the ball and running with it always hoping one problem is solved before the next one starts. Factors that will also crimp our style are those patients who just hate taking their meds, never-ending skin issues you need o stop and assess and the telephone. Oh there is alo a rule to never interupt the nurse giving her meds and if you or anyone can solve that one.........please let me know

Abuse? No doubt. Agree 100% with jonamb....taking a few minutes to get a quick assessement and offering a little reassurance would probably have gone a long way.... Make no mistake we have all been pushed to the limits of our tolerance, but learning to cope with situations effectively is the way to go.

I just don't know why the use of these strong arm tactics continue to exist in LTC. There is no respect for the people working on the floor from nurse to CNA. You don't get support from supervisors to DON. Maybe it's because as a group we have no representation. No clout. No one seems interested in US as a integral part of the work force. Many moons ago when I first started to practice nursing, EVERY NURSE KNEW, you don't leave unless your replacement relieves you. In LTC this is a dirty word. When your 8 or 12 is over many nurses are out the door and who is left to cover the floor is up to someone else. Nurses are not vested in helping out. Maybe it's because of these kinds of reponses when they are in need, "Its your problem", "Find your own replacement" and "Wear an incontinent brief but get your a__ in here, for God's sake. Until we can give respect to others and receive it in return, facilities will continue to reap what they sow. For the DON who solves the problem by using a broad brush approach to evaluate the problems of a few, instead of addressing the frequent callers individually, will continue to wonder who has a beach day concern vs. a real illness. Job or no job, nurses like all other professions get sick, and I for one refuse to subject frail, elderly residents with health problems that could heve been avoided. My approach will continue to be I am ill and cannot report to work today.

Blee, I thinkyou are right and the only reason that Full code be designated for that particular scenario is if the patient wants it that way. I think as nurses advocating for our patients rights we need to do more to prioritize gettig thid infowhen patients are capable in making their wishes known. In MD offices, inpatient stays, when entering a SNF thiw discssion needs to happen. There are many things alredy in place but if they are not consistently utilized what good are they. It gets even more convoluted when you add spouses, kids, HCPOA's and guardians making these very difficult decisions. Cut out the middle men like guilt and second guessing(am I doing the right thing). We could be ready for the end of life situation rather it be sudden or unexpected with just a little more foot work up front (throughout the entire health care system). Dying with dignity and having the person's wishes carried out I think would become the norm and "keeping people alive " if it works for them or not woud not be as common as it is.

Hi all, I was wondering if I could get some feedback from you. This is the first time I am posting a thread so bear with me. I have been in nursing in many divisions and posiions for many years. I consider myself a competent nurse who takes her job very seriously. I currently work in a SNF facility on the Baylor Program(12 hr. shift on Sat and Sunday every week). I find myself in a position that puzzles and annoys me. Approximately 3 months ago the facility made the announcement they were over stafffed and had to let some people go. In doing so they restructured the nursing staffing pattern. I am responsible for 25 patients with 3 CNA's The next shift has 2 nurses and two CNA's for both units, they are separate during the day. After the restructuring there remained 1 nurse and 3 CNA's first part of the shift and 2 CNA's for second part of the shift.The next shift has 1 nurse for both units and 2 CNA'S for 55 patients on both wings. Also as a result of the change my CNA's are required to do showers, which they never were before and to put 12 patients back to bed in the hour left before the shift ends at 7pm. I am also now responsible for giving half of the meds for the next shift scheduled while I am no longer on duty. During the last month I had a meeting with the administrator and DON that went something like this. I had a med error (wrong drug sent by pharmacy) dispensed for a week before being caught. This was glossed over lightly and I was given a warning for not getting out on time. The administration( I was told) is trying to hire another nurse and my extra hours was preventing that from happening. Less than two weeks later I had a note posted on the bulletin board and it was another warning, this time saying I did not take a lunch last Saturday or Sunday and I will sign in and out for lunch and leave on time. I was stunned. In all my years of nursing I have never left on time. I don't waste time and am totally focused on the tasks at hand. One nurse, 25 patients, meds and treatments,assessing sick residents, providing oversight to other staff, rounds with physicians, following up on patient issues doumentaion etc. But I am now forced to worry about what's for lunch and will I make to the punch clock on time.t. This goes against all guidelines and regulations which guide my scope of practice. Yes you guessed it I ill be in search of new employment...but is it me and I have just been doing this too long?

generic drug names..hated it upon it's inception and still do then and still do :). abbreviations that have multiple meanings and facilities and nurses that make up their own abbreviations. Seeded joint replacement( is that your normal garden variety), and I agree with the negatives non-compliant, morbid obesity and there is always one that makes u smile pulmonary toileting is it for me

Kudo's to you. It does my heart good to know that integrity is alive and active. Hold on to it because wyou will probably have to go to that well again, both in your professional and private life!!!!!!!!!!

Maybe looking at what makes you high on nursing will help with your decision. Is it the comforting of another through listening. relieving their pain. teaching them about thier disease processes and how it will impact thier lives? Are you more interested in improving and evaluating the way things are currently done. Does improving efficiency while keeping quality intact peek your interests? Nursing is steeped in diversity, and with 1.5 yrs.exp. have your given yourself time to know what is out there for you? "No one else wanting to do it, "...........Is that a valid enough reason for you to want to.? You have previous management experience in your other field, so the shock will not be too overwhelming. You have good skills they can only improve over time and upward mobility is always there for those who qualify and what to expand upon their responsibilies. Just a few things to think about. Good Luck

Hi Sunny, I have been in management in a LTC setting for 7 years. I have been a DON, ADON and Unit Manager in several corporate facilities. I do not know of a site where you can find out what your specific job criteria . I do know your State Regulatory Gudelines Manaual provides you with their expectations for a DON. I also know that the regulations state that the DON should not work shifts. I must be honest with you, however, in my ecperience many DON's and Adon's have no other choice but to do this secondary to stafffing crunches, call outs and unfilled positions. Administraative call also often ends with a call announcing a whole in the schedule and unless you have a plan in place for such occasions you may be the only option to fill that hole. As far as assisting CNA's, helping make beds, pass trays, feeding a resident or assisting in the main dining room at mealtime may be something you could do to ease the work load. Only you knows your schedule for any given day and if you can free yourself up ding times when things are going haywire ,on the floors, I'm sure your staff will greatly appreciate it and consider you a real part of the team. They will consider what ever you do as a form of support. Remember ,however, your administrative duties are your first responsibility.When all is said and done your boss is unlikely to consider poor outcomes or missed deadlines because of helping others as a valid excuse. These of course are my opinions hopefully it helps in some way... Good Luck in your new position

Having worked in long term care for many years I woild just like to say that the care in some facilities is excellemt. You have a group pf nurses, therapist and activity directors who dedicate themselves to the residents entrusted in their care. You have nursing staff to take care of the daily needs your father will have, nurses assessing the resident for progress and potential problems that are identified early and addressed quickly. Your dad will have the opportunuty to meet new friends that may have the same or similiar problems as he does. His therapist will progress him to his former functional status according to his abilities. When dad goes home he will have had time to adjust to any changes presented after surgery. Many people do not want to impose on their family members and this eliminates this potential guilt. Home care is an option but depending on how much and how long your father's recovery takes that may place added pressure on family members. If you plan to persue Skilled nursing facilties familiarize yourself with the facilty prior to committing yourself. Tour the grounds. Observe how residents look, and interact with staff and each other. See wht residents are doing in the gym and take nte of the interaction in that setting.Take note of the esthetics of the facilty and ask questions to get a feel for how the staff reacts to you, Hope this helps.......GOOD Luck with your decision

Hi Kristy, I'm very sorry your first nursing job experience has been so hard for you. The advice given on submitting your resignation is very sound advice indeed. I know making a decision regarding where to start your nursing carrer is a tough job. Your are at the most gung-ho period of your carreer. You're evaluating the wages being offered, shifts available , you may even feel that you are ready to be supernurse and ready to save I also would suggest you to consider what is best for you during your carreer. It is my experience that every new nurse needs to strenghten her basic nursing skills in an acute care setting, this gives you the foundation to broaden your assessment skills and allows you to better understand where you want to go. The tendency to get thrown to the wolves is less likely to happen because the setting is more enlightened and more vested in you succeeding and not setting you up to fail. When I graduated many moons ago my first employment was in a community hospital. I was hired as a 3-11 staff nurse on a med-surg unit.I was told as a new grad I would not be left alone. My first night on the job there was myself and 3 na's. I was forced into a sink or swim situation. That would never happen to me today, thank goodness for progress. Whatever you decide to do good luck and remember while interviewing it's a two way street. They not only have to like what you have to offer but YOU also have to like what they are selling so don't feel shy in asking the questions you need to get the best picture you can. Go for the gold.............Good Luck

It sounds as if you are dealing with a difficult situation. All of the respondents seem to have touched on the many facets that create this situation. I have been a nurse for many years and have found that in dealing with those of different personalities and status, the one thread that creates the best results is respect for others. Resident abuse is not an option for any facitlty. Employees should never have to come to work in fear. Every employee needs to know and understand what is required of them and what will not be tolerated. The lines need to clear and any violation of this lines needs to be handled consistently for all. I have worked with others who have difficulty with authority. A lot of this stems from a lack of understanding of what is being asked of them, feeling devalued and feelings of having no say in what is going on. Validation of feelings and working as a team to resolve issues works very well. Having an open door for venting, holding regular staff meetings attended by each position from every shift helps people to become vested in making things better . Even with all of this done,there will come a point where those whose main goal is to keep and make bad situations worse, will have to go. If you are witness to these situations you have to step up to the plate and reveal what is happening. You have to stand by your principles, rock the boat if it needs rocking by whatever means necessary and abide by the Nurse Practice Act and the regulatory guidelines which drive our performance as nurses. Remember ABUSE(physical/mental), NEGLECT are never okay and neither is silence. Our resident's have placed their trust in each of us to provide them with the best care possible. Stand firm and don't compromise your values. If you continue to run up against a brick wall with support from the administration, If I were you, I'd run the the next job opportunity. I have been there and done that- Good Luck!