mellster

We were just told yesterday that we will have to use the same mask for several days and store in a paper bag. To me, that is just disgusting. I would love to culture those masks after a week to see what grows. I won't be back for at least a week though since I started having symptoms yesterday and got tested today. We don't currently have any covid 19 cases at my facility.

I have thought about trying Excelsior College for my RN for a while, but I'm afraid that taking the online classes will be too expensive. Excelsior charges over 500 per credit. That is kind of steep. The community college in my area charges half that.

Make sure you really know what you are getting into with nursing before you spend the money. I'm an LPN, and I have no desire to go on for my RN at this point. I make good money even as an LPN. However, after 21 years, I am burned out. I have done everything from acute care to Drs. office to rehab, skilled nursing, and assisted living. I'm actually going in the opposite direction as you. I have a previous bachelors degree from before I went into nursing. I plan to take some courses to update my business skills and go into a masters degree in health administration. I don't hate nursing, but I'm pushing 50 and the physical toll is getting to be a bit too much for me. I'm not trying to discourage you. Just make sure that nursing is what you really want before spending a bunch of money on schooling. Good luck with whatever you decide.

I had a job in assisted living for 2 years. I ended up going back to skilled nursing. In my AL, there were 3 buildings. 2 buildings were AL and 1 building had a locked dementia unit on the ground floor with 3 floors of independent living residents above. We had med techs and PCAs. Often, I would have a med pass to do for 25 residents plus I would be the only nurse for 3 buildings. There were a few times on night shift that I had to carry keys for 4 carts from 2 different buildings. It was absolutely insane and very unsafe. There needs to be more regulation in the assisted living business. Our residents were very sick also. We had diabetics, hospice patients, 2 assists, and wounds. I am much happier working in skilled care.

The reason why the regulations aren't followed all year in most cases is that the facilities REFUSE to staff in such a way that it is possible to do your job properly. I think it is a disgrace that all the admins come out of their offices and help only when the state is there. I have seen that at every facility I have worked at. State surveyers know what is going on, but they don't do anything about it and look the other way. It is totally obvious that the administrators don't help when the surveyers aren't there. They are funny to watch- don't have a damn clue as to what they are doing!! However, all the administrators and state people just stick their heads in the sand and pretend the problems don't exist. Most people in those positions should be very ashamed of themselves. Why do we not care about our elderly in this country?? It's not all about not having any money. I reasearched how much healthcare CEOs make, and it is sick. There is a special place in hell for someone that gets 7 digit per year compensation while our elderly suffer because they won't staff the facility.

Viva, I wish I could work at your facility. And it is so true about the DON setting the tone. If you don't have a strong DON morale really goes down!!

We had some of the same problems at the long term care facility I used to work at. We were also told not to chart supervisor aware. The supervisors were afraid they would be held liable if something happened. It is their job to be aware of what is happening on the units!! I think that we should have been able to chart supervisor aware, but we would be in trouble if we did.

Please don't leave since you seem to really care, and we need nursing administration like you. Nursing administration at my old job just kept throwing more and more work at us and had an it's too bad attitude. We really need people in long term care that care about things and want to make a difference. Unfortunately, reimbursements have gone down and often the money is not there to take care of our elderly. It is a very sad situation. The acuity of the residents (who should be called patients now since alot of them are short term stay) has gone up, but nothing ever seems to be done to get staffing at a reasonable level. State surveyers are more worried about nitpicking then about good care. Medicare and medicaid services needs to increase their reimbursements and make rules that these increases go to patient care only and not into the pockets of a facility CEO, COO, etc. My last job the CEOs expense account was way more then I make in a year. It is sad how a government in a country as advanced as ours cares so little about our elderly that they can't take measures to make sure they get good care. More than 20 patients to one nurse is ridiculous in any setting. I guess the only thing that we can do as nurses is to make sure we do our best to take care of our patients and give them the attention they deserve. I don't have any suggestions that haven't already been given. Please hang in there though. You sound like one of the better DONs.

It pretty much sucks in just about every setting, because it is all about the almighty dollar. It won't improve, because nurses don't have the cohesiveness to stick together. If you bring your concerns about the workload in any facility, you will have a target on your back and will eventually be fired for something stupid. Of course, if one of the suits needs help doing their job an assistant will be hired. I've never heard of an administrator having to run for 12 hours straight on only a snickers bar!!!

The problem is if you stand up for what's right administration will find a way to get rid of you. I have seen it happen too many times. Our job is one in which we have too much work piled onto us. No matter how hard you try to do things right, you will make a mistake. If you make waves, administration will find a way to get rid of you. Most nurses are too afraid for their jobs to stand up for what is right.

Not neccesarily. An LPN has the scope of practice to work on any LTC unit in my state including subacute rehab. This is a CMS thing. The rating system makes it so that a facility is rated better with more RNs. Of course, it depends on your state and scope of practice. If LPNs are limited, then more RNs would have to be hired to handle things like IV meds.

I am also a somewhat introverted person. I have been a nurse for several years now, and I am much more assertive. I am more outspoken with my opinions. The job will challenge you and make you grow which is really not a bad thing. I'm still very thoughtful and like my alone time, but I've become much more social too. Sometimes it is good to try something that makes you stretch beyond your norm.

We take IVs. I've noticed that back when the acuity was lower our facility did not allow us LPNs to do IVs even the our state nurse practice act allowed it. Now that the acuity is getting higher, we are all required to get certified. And I agree that the 5 star rating should be taken with a grain of salt. Unfortunately, most of the people who make the rules are administrative types who haven't worked the floor in eons. The state agencies that survey the facilities make the rules so broad that they can pretty much interpret them any way they want to. That is why the acuity in these places keeps getting higher while the staffing doesn't change or in the case of my facility gets worse.

Number of RNs is part of the score, but only part. If your facility scores well in other areas, you can still be a 5 star facility. Also, it doesn't have to be all RNs. My facility has quite a few RNs, but still is not 5 star since it is low in other areas. I think we rank average. We are low on staffing, but our core measures are at a 5 star level. Says alot for the staff IMHO.

Forgot to mention that my facility has a fairly decent 5 star rating, because the "higher ups" all come crawling out of the woodwork giving us the support that we don't normally get when the surveyers are there. Then when they are gone, supervisors all crawl back into their caves (offices) and we don't see them for another year unless of course they want to tell us what we are doing wrong.

Well, guess eventually I will have to get my RN now!! LOL!! I haven't gotten it yet, because I didn't want to work in the hospital. With all due respect, I know that there is a difference between LPNs and RNs. However, the nurse that currently works our rehab unit full time in an LPN and I think she does a better job then the other nurses who cover that unit on her days off (some of whom are RNs). I have a year of experience in the hospital that I obtained back when LPNs were allowed to work in that setting. I know that I am more than capable of caring for the acuity on the subacute/rehab units. CMS ratings are not always a good indicator in my opinion. My facility puts 1 LPN for 25 res on a rehab unit with no treatment nurse, no admissions nurse, absolutely no support whatsoever-you really are ON YOUR OWN. The funny thing is the RNs won't touch that unit with a 10 ft pole, because they all say they don't want to risk their licenses. Maybe CMS should focus on setting some SANE NURSE/PATIENT ratios instead of worrying how many RNs staff a facility. It doesn't matter whether you have RNs or LPN, what matters is that you staff appropriately for patient safety-something my company is not willing to do. BTW, I like to learn and would go back to get my RN if that is what I need to do to stay employable. I just can't believe that the government can be so stupid as to think that more RNs will matter when they are not willing to pass legislation that will really protect the patient.

The main concern that I would have about this job is why would the manager be instructed not to help you. I know management has other duties and are also busy and cannot "hold your hand", but all the good managers that I have worked with were willing to pitch in as neccesary. Other than that, good luck with your new job-it sound like you will have an opportunity to learn alot!!!

I wish there was a way to fix long term care, but I know that with the way things are not there are no easy answers.

Sorry-posted this on the wrong thread.

I wish there was a way to fix long term care, but I know with the current state of things there is no simple answer.

I would like to work for an acute rehab for better nurse/patient ratios, but I cannot find one in my area that hires LPNs. In my facility, the halls with the stable long term care residents all go to the RNs and the LPNs get the halls from hell. Two of the halls have only 18 residents that are all stable long term care-no rehab and they are RN halls. The RNs don't have any additional responsibilities. We have RN unit manager/supervisors. None of the RNs will work on the rehab hall since they say they will not risk their license. I think I will need to move to another job. I don't mind having 20-30 patients if they are long term with maybe a few rehabbers in the mix.

I would kill for a treatment nurse. My point is this unit is ALL REHAB with high acuity. I have been a nurse for 17 years and have worked on LTC units with 40 residents-difficult but doable. There is no "getting to know my residents". They come and go constantly with admissions and discharges daily.

I've been lurking for a while. I like to read this board to remind me that others have the same struggles as me on a daily basis. I am a restorative/float nurse in my facility. When I float to the floor, I sometimes have to work the rehab unit. I know that 25 residents is not unheard of in long term care, but this is a rehab unit with no support. We do not have a desk nurse, treatment nurse, or even a secretary to answer the phone. We get patients post surgery, orthos, CHF, COPD, IV abt. Thank god they haven't started giving us trach patients yet, but I wouldn't be surprised if that isn't coming. I have let my DON know that I do not feel this is safe, but I am just told "we are still working on it" or it "isn't in the budget." If I could afford to quit, I would. I cannot give the safe quality care that I want to give on this unit. By the way, we get no help with admissions or discharges or orders either. I'm looking for another job, because I want out!!!