TheMoonisMyLantern

Congrats on the job! It sounds like you've got some real advantages that you may not realize: people are there for 10+ years is a really good sign especially in LTC, you have experience as a med tech so when it comes to med pass (the bulk of your day) the learning curve shouldn't be as steep compared to others who haven't done an ALF or LTC med pass, and finally you know the charting system! Knowing the charting system is a huge percent of the battle during orientation and will allow you to focus on other areas of learning. Don't worry about looking incompetent, you're a new grad so you're not expected to know how to do everything, be honest with your preceptor, ask them to demonstrate or have them guide you through the task. As far as IV's and PICC's, see if your facility will support you in taking an IV certification class and even with that it may take some time to get comfortable with IV's etc and that's to be pretty expected as well. Usually the first day in most LTC's is doing paperwork, education, going over policies, meeting the department heads, getting your PCC access, things of that nature. Best of luck to you and let us know how it goes!

Ruby, I imagine it's not easy to write in such detail what you experienced. Over the years every time you have posted about the hell you experienced I have found it to be incredibly moving, informative, and effective. Keep telling your story, abuse is so so common sadly, but it is empowering to hear that abuse can indeed be survived.

While unionization won't solve everything it would be a good start in many areas. Unfortunately the propaganda machine is strong against organizing and many still have the misguided opinion that their company will watch out for them. Until we accept that we are not these saintly nun like angels of mercy answering to a calling to nurse but instead paid professionals there will never be any improvement in our power or working conditions. Whenever we demand ANYTHING management clutches their pearls and say "But think of the PATIENTS!" insinuating that we are monsters for requesting to be treated as human even though they do everything they can to undermine patient care all to spin a profit. Our compassion has been used to manipulate, brainwash, and disempower our entire profession. Bedside nurses have the least amount of say over healthcare yet we are the soldiers in the trenches believed by many to simply be too stupid to be able to find our way out of the muck into a lofty management or paper pushing job. Until we simply no longer show up for work nothing on a large scale will change. "But patients will die!" So? Patients are already dying due to the state of things often by inches over multiple years and millions of dollars worth of sub par care that never fixes a problem but simply creates new ones. If we are going to take on so much responsibility then give us a voice, not "nursing leaders" who haven't touch a patient in 20 years, someone who actually is at the bedside getting their butts handed to them on a daily basis. I love taking care of people, but I don't love being everybody's literal and figurative punching bag. I don't love working 16 hour days because the sheer volume of work won't allow for a shorter work day. I don't love being so mentally and physically exhausted all the time and so drained emotionally from the toxicity of human behavior that many days I feel dead inside. That's not what nursing has done to me, it's what our healthcare system and horrors of the past year have done to me. All so a bunch of jerks could make a buck.

Thanks for the article. I think that could be a helpful for families facing the loss of a loved one. DNR makes them feel like they are giving up on their loved one and didn't do "everything" to save them. For a while in my state our advanced directives and living wills were automatically having the patient/family mark Y/N to IV antibiotics, fluids, feeding tubes, Bi-pap, pressors, etc and it was really helpful too but for some reason it lost favor. Probably because it requires more extensive time spent explaining things.

That's the thing, not everyone has the things you mention and most of the things you mention are not luxuries, but considered essentials in order to function and get by in our society. 1. Indoor plumbing, I live in a rural area and the number of people out here that live without indoor plumbing is shocking. Urban areas have folks living without access to clean water as well, Flint, Michigan anyone? That never did get fully resolved by the way, costs too much money to fix. 2. Cell phone, they've become to embedded in our lives to not be essential, luckily there are actually a lot of options for people with low to no income to have access to a cell phone. This is a good thing, not a bad. 911 isn't just for people who listen to Dave Ramsey. 3. Everyone has a car? No, and in America that is a large problem due to lack of infrastructure in most cities and towns for public transportation that is reliable and can accommodate the type of crappy schedules that low income worker bees often work. In America, lack of car equals unemployment in most cases. It's a terrible cycle, can't get car without money, can't get money without a car. 4. Education for a career. Academia is practically as big of a business now as what healthcare is. Pell grants are bled dry by for profit schools that purposefully target people who are more desperate to change their life's circumstances and are less likely to look at the fine print of the tuition they'll be paying on for the rest of their lives. There's a LPN program where I live that is 50K same school has an RN program that's 75K, it's a national for profit college that is notorious for its "No one can fail" attitude to keep butts in the seats and money flowing. They're starting a nurse practitioner program soon... 5. Easy access to contraception- This made me actually laugh out loud. In order for people to get contraception they have to actually know what their options are when it comes to contraception and even how sex works. Sex education is heavily discouraged in most public school systems nowadays and when it is provided in many states the school can only educate on abstinence in order to prevent pregnancies and STI's. And please don't tell me you think that it is safe and appropriate for kids to be learning everything about sexuality from the internet. 6. Medicaid- So yeah, providers don't have to take Medicaid patients, it is not an uncommon story to not have access to the specialist you need within a 100 mile radius of where the patient lives. But everyone has a car, right? 7. Night shift differential- The studies have been out for years now about how night shift literally takes years off your life through the acute/chronic physical and mental diseases it puts you at risk for, so no, I don't feel bad for making 3 dollars extra an hour so that I can pay for the massive heart attack or cancer treatment I'll probably have at a young age due to years of living a nocturnal life. Sure, I chose it, but we can't all work day shift somebody has to take care of the patients at night. 8. Sign on bonuses- This is the danger of thinking that Dave Ramsey's financial advice is actually the best. See, sign on bonuses are a lousy deal for employees, payments are spread in installments, still taxed, and come with a contract which typically gets broken because places that offer sign on bonuses frequently don't have the best reputation. Now retention bonuses, that's a much better deal for the employee and probably the employer because they wouldn't have to churn through as many new hires if they actually put effort into retaining employees. People aren't expecting life to be perfect, but the Puritan expectation that suffering is "good for the soul" and the American myth that if people just worked harder their circumstances would change are hard to swallow when you're so far down in the mud that sheer mathematical probability won't even allow for you to raise your head. People do experience that in this country. Women, children, veterans, elders, mentally ill, substance users, a diverse group of people live in poverty and are low income in this country and the pandemic has only made this worse. Let them eat cake?

It's really only been in the past few years that I've come to accept that many of the problems in nursing will only be solved through activism and forcing the hand of politicians. In my young doe-eyed days I used to believe that if we just got the right leaders in place in these organizations that these facilities could change and conditions could improve. The truth is that most leadership positions that nurses have regular contact with are forced to manage with their hands tied behind their backs and have little to no real power. The whole system is toxic, the tree is poison and it's high time that we cut it down. Our nursing "associations" that charge us hundreds of dollars in membership fees each year have done a laughable job at advocating for us, they are either too out of touch/ignorant or too corrupt to actually fight for meaningful change in working conditions for nurses. The pandemic has truly proven that as a profession, we are on our own. Our "compassion" has been exploited to cripple us into accepting substandard working conditions and regular abuse from patients, families, doctors, administration, and each other. That will continue unless we say, no more. The impending geriatric invasion with our aging society, the dramatic increase in dementia, the lack of resources for the increasing rates of mental illness and substance abuse, the increase in co-morbidities within our patients, is going to destroy our healthcare system unless there is a strong workforce of nurses at the bedside providing advocacy and increasing the health of our patients. We keep going business as usual and no one will be at the bedside.

I've been on my unit for 2 months and now have the most seniority on my shift, that's how many people have left in the past few weeks. Pay is quite good. Benefits are very good. Staffing is kept dangerously lean on all units yet standards for care and mainly documentation continue to increase. Our 12 hour shifts become 16 hour shifts of non-stop running trying to take care of people without the resources to do it. Patients are becoming increasingly verbally and physically abusive and this is tolerated by the facility and by society as a whole. I don't feel burned out, I feel exploited, trampled on. I'm sick to death about how nurses need to be so compassionate, strong, selfless, and how nursing is a "calling". I feel compassion towards most of my patients not because I'm a nurse but because I'm a human and so are they. Notice I said most, not due to lack of empathy but due to too much empathy it becomes overwhelming caring for so many people so I do have to compartmentalize. We have been manipulated into thinking that the only way to care for others is to take away from ourselves and that simply isn't true. Why don't the CEO's and companies making billions in money off of people's illnesses, misery, and death get preached to about being "compassionate". Why don't they get told they need to have a "calling" to do what they do?

I moved back to acute care a few months ago, since then almost all permanent staff have resigned on my unit including the manager, assistant manager, and clinical team leaders. Some transferred to other units, most are becoming travelers, some are going to non bedside positions or advanced practice, some are leaving nursing altogether. Bedside nursing in acute, skilled, and long term care becomes more strenuous with each passing year and the pandemic has only compounded this problem. The money that is spent on recruitment and sign on bonuses needs to be spent on adequate staffing and retention, surely facilities would save money if they did this I just don't understand why the bean counters don't go this route.

Excellent article, definitely commonly used within the gay community here where I live and has been for as long as I can remember. Unfortunately the use has been so normalized that many people don't realize that poppers can be dangerous especially when combined with other drugs. I wouldn't be surprised if the increased hospitalizations and deaths are coming from mixing poppers with ED drugs as they are becoming more easily accessible and more acceptable to use among all ages of men.

I couldn't remember who had said that on here a while back, thanks for posting it again, I've used it a few times since reading it way back when ?

And of course the OP automatically goes for the "I hope you're never my nurse!" buckshot as though that should send a quake of dread through the community and cause us all to clutch our pearls having been given the ultimate insult by some random anonymous dude on the internet who got suckered in by his little princess into doing her homework.

In LTC the regulations actually require medications to be given individually through a PEG tube, which is absolute lunacy. Whether it's compounding or not I can't say either way. But the rationale given to nurses for this is often due to possible "interactions" and effecting the patency of the tube. Maybe we wouldn't have to worry about as many possible "interactions" if providers didn't overload our patients with 20 pills to take a day each one prescribed by a different specialist who only cares about the part of the body they specialize in and not the patient as a whole. But that's a thread for a different day As far as tube patency, as long as medications are coming in the appropriate form, being crushed very fine, and being administered with and flushed with plenty of H2O there really should be no issues with patency, even with NGT.

I wish patients understood that as nurses we are pretty much cogs on a wheel and have very little influence of policy and medical decisions In the hospital as bedside staff. I have this conversation weekly with at least one patient and I don't sugar coat or make it sound more palatable. I no longer lie about staffing shortages, equipment or supply shortages, or cover for physicians when they blow off a patients concerns or questions. I don't do this out of cynicism, spite, or malice but out of transparency. Maybe it is unprofessional of me and I shouldn't be so blunt with patients and families but I'm treated more like a child than a profesional anyway, so there's that.

Have you considered private duty? You would be with only one patient for the duration of your shift as opposed to being pulled into many directions between the care needs of multiple patients. Be aware that pay tends to be lower and there can be difficult families but many nurses find it less stressful than acute care or long term care.

At my facility (LTC) we began allowing visitation from families/friends a few weeks ago. Our residents had gone over 1 year without physical contact with their families, spouses, friends which had devastating consequences. Sure, we all know how "interesting" and down right abusive some families can be, but this past year has been so hard on our residents without them, their families are a welcome sight.