IowaKaren

Yep, going through something like this myself but on a small scale.

Actually, I would say it is a typical age after starting a family and all. Or just having that feeling that you should be doing something different with your life. I was in my 40's and had pre-requisites before getting into ADN school. I always had worked in the blue collar field e.g. factories prior to nursing. Brief stint as NA's (before the C was added to the NA, LOL).

Give me 10 fairly heavy care residents WITHOUT major physical issues (eg. tube feeding aspiration precautions; unhealable open fractures that will get infected and the resident will eventually pass from it) and Less impaired cognition with 2 hardworking, caring CNA's, the staffing could be adequate, but certainly not the usual. Instead, it's no time to do anything with great care and without accidental neglect or nurses and CNA's not helping each other from shift to shift. I feel for the most part that staffing is not adequate in most SNF and LTC homes, more and more rules and regulations coming into play than ever before. It's a terrible responsibility for the Director of Nursing and being able to leave the job at work and for nurses to not question staffing limitations and getting everyone toileted and basically cared for like they are SUPPOSE to be without everyone looking like chickens with their heads just cut off. Patient directed care can be so unorganized even if you know your Ressies like family and with the day to day operations and then the disaster drills, mandatory meetings, everyday Dr. and family issues/crisis's (those everyday things that don't allow for a routine d/t another new rule or regulation becoming enacted on, etc.). I guess I am becoming a bite jaded these days with the nonstop stress from the moment you punch in until the moment you punch out in LTC/SNF because it's really got me down on how it's going in healthcare these days and really never gets better. I find myself trying to figure out how I can retire sooner than later. And please don't flame me for what I've said. I just feel every single person in healthcare has felt the same way as I do, especially as you get older and have seen these drastic changes.

Hope you wore that mask.

That seems to be the norm for overnights. Find a good sized, dark purple bruise that you have to figure out how they got it, when they got it, what they were doing, etc. at 2300 (an hour into shift). And you HAVE to get it figured out. Period. I almost feel like changing careers sometimes because of it, just because of my integrity. I certainly don't get any other suggestions from upper management. Of course everything is found on night shift.

The point is, in Assisted Living you do not need to be a CNA or CMA or have worked in healthcare before. You can come in off the street, get that bit of under training and call it good, your ready to go. Then you are the be everything to everyone and if you can't hack it, well then the cycle starts over. Assisted living is still kind of 'out of the radar' by the government at this point but give the government time, it will be looked at eventually. In my state, the facilities are surveyed every two years by one person, in my experience for smaller AL's anyway. Was interesting (scary actually) when trying to train someone to take a manual BP that had never had a stethescope in their ears, much less doing the BP properly. They depend on the auto cuff BP machines. And then to teach about diabetes, injections, etc. within a partial day and get your own work done,... yes, it is scary.

That seems to be a typical analogy if trying to reduce hours d/t census. As long as a nurse is in the building and narc's are counted with that said nurse along with reporting off, that is okay. Not ideal for you since you depend on those hours generally but that is the way of healthcare, especially in LTC setting.

Yes, and I do not believe it will get any better in the future. Such a sad state in many cases.

Also, some with major pain issues from surgeries come without prn pain med's, not even APAP. No pain all day but when trying to sleep at night, frustrating when a block decides to wear off. Lately I've been lucky with good repositioning to get me through the first night but shame on the discharging hospital Dr. to not include anything for the pain that will occur eventually. The admitting nurses are so busy getting things clarified as it is and in some cases is not taken care of right away or they did fax the admitting for orders which should have come back 3 days ago (Fridays/weekends are the worst, no on-call wants to sign admitting orders). They can call and talk to the Dr. or Dr.'s nurse with confirmation that it will be sent back 'today' but,... you have to call again and again. I digress, hopefully I won't have to call a Dr. in the middle of the night for a new pain medication that I would need ASAP, hopefully I could have a one time order for something or an added dose of something they're taking now.

I also thought in my state we couldn't add in Supervisor nurses either but the place I work at now does. Sure makes the 'numbers' look good.

I'm always told, "I remember those days too," like it's a right of passage or something, LOL. Just depends if it falls on my night off or my first night on.

Welcome to the USA. Everything is money driven and we are suppose to care even though the time allowed isn't enough in some cases, depending on the nursing home you are working in. Unfortuately, things are getting worse than better and if you are lucky enough to find that nursing facility that is running well, stay with it. They are keeping the residents at home longer so when they do come to the facility, they are either so demented that keeping them safe is the real task and or they are so demanding, you worry every moment if you'll be reported to state. I don't know what the answer is and know many nurses leave the profession d/t the way things are now.

Wages will vary from place to place, even amongst corporate NH's. BSN means nothing where I work and your not given a higher wage because of it.

I heard that my place of employment will not hire Agency anymore (agency nurses or CNA's) because it about broke them at one time (that's the rumor anyway). Only in very rare cases would a supervisor work a cart. If a nurse is not available, a CMA would be on the cart and the other nurse would have to do all the assessments, insulin needs, more complicated wounds (beyond buttock calmo treatements), etc. etc.. If this happens on evening or night shift, if no nurse will come in, then someone stays over for 1/2 the shift and the oncoming nurse comes in for the second half a shift. Or, a nurse will get stuck doing a double and still have to come in the next scheduled shift. Not ideal, that is for sure.

Late entry your next shift may be the only option.