nutty netty

I would check out the rcw's-wac's for nursing homes, you could get a lot of ideas from those.

that was for pink fish, not me. Am I doing this wrong?

I absolutely agree, it makes me feel really good to hear this and cudos to you for your dedication

Yes I am familiar with the privately owned and the not for profit facilities and how staff is or maybe treated differently, as well as staffing ratios. Unfortunately there doesnt seem to be to many of those out there these days. I am going to go off a little from my last post and descibe what I've seen, experienced. Over the past 20+ years that I have worked as a nurse in LTC has been with big corporations. My employment history for the most part has been on avg. 3-7 years with each one. A lot has changed over those years and not to the positive unfortunately. When I first became a nurse our house supply meds consisted of doss and tylenol. Now the top drawer of the med cart is packed with house supply meds/supps ie: numerous vitamins, various stool softeners,diff doses asa and tylenol, just to name a few as they are no longer formulary. Dressing supplies, over the years, I've noticed is either charged out to each individual resident, or not at all, or there has been a poor system overall. I worked with one administrator that was anal about these charges, we were constantly being dogged about not keeping track and not charging these supplies out as we should. During a staff meeting he informed us that close to 48,000.00 had been reimbursed to them and that was not for a full year. And went on to explain that with this, their budget could be better utilized to benefit both residents and staff. Well after he left or should say was asked to leave, we had an interim admin. from corporate and needless to say we had slacked on these charges, so I inquired to him about this,[charging out supplies] to which he stated "oh that was stupid" and the charge book was eliminated. I still question to this day,. why? I'll have to say that some management has been approachable and some not. One proactive administrator at a facility that I worked for for 7 years was always informing us of government changes, cuts, what was to come and that it would be getting worse. Informed us what we could do [write our congressmen] He was always fair, approachable, organized and encouraged out of work activity for staff, such as forming baseball teams and competing against other facilities, bowling, staff recognition and appreciation. At this same facility the DNS was forever calling me to her office, I will admit that I didnt have a problem voicing my opinion and standing up for what I believed in when it came to resident care, and we frequently did clash. Half the time, no three quarters of the time it was an issue that needed to be resolved, and usually was, but., what I will always remember is that she always complimented me on my work when the meeting was over. One time I asked her, "why do I seem to be such a thorn in managements side?" To which she stated " you are a good nurse, and we as managers need to learn and know how to work with all different personality types, work styles and such and by no means are you a thorn, you are just a good reminder to us why we are all here and love what we do" [i'm glad that she left out that yes I was a thorn, but.,ha ha] She will never know how much her statement impacted me, and it is truly unfortunate that I have never had the opportunity to work with the above type management style again. That was my first 7 years as a nurse. During those 7 years we had 2 near perfect surveys, 2 perfect surveys. 1 of those surveys was almost immediately followed by a federal survey to which we also passed with flying colors. Well, a new corporation took over and things changed up real quick and the management that I spoke of was pretty much eliminated. I left shortly after that. Why things changed so quickly and drastically I will never know especially when the facility had a very good track record. I can only owe it to, because at the end of that time was when government changes/cuts were really kicking it up and possibly a new breed of CEO's, CFO's and large corporations in general had a new idea of how to deal? I will blame my burnout mainly on government cuts as it has forced corporations to do what they do, [i think] I mean, if I had a business I would want to make money, wouldn't you? Unfortunately, of course those big corp. people have never worked the floor and have no idea what its like to witness substandard care, and struggle with those feelings when they get home at night. I did a lot of research on the corp. I was working for and it made me understand what and why certain things where occurring. Very, very deep. Needless to say it made me ill. But that's a whole different story. Also contributing to the burn out factor, the industry's inability to see and acknowledge my experience in this field as a real professional that is entirely capable of fulfilling a job role just as well as an RN, if not more so. [have been applying to jobs that I very well qualify for that require RN and up, guess what? thought so] So from years 8-20+ I have in general, have just seen a change and general decline in healthcare in the LTC setting. As well as a change in these large corp's that would just as soon throw you out the door than acknowledge resident care. And government continues to cut the benefits of the population that us LTC care workers love so much. I also would like to see that the LTC logo be renamed. It is by no means long term care anymore, [it is for some] In the last 5 years, with changes in medicare funding, not to be confused with medicaid, hospitals are discharging sooner and are dependent on "skilled nursing" facilities for continued rehab/recovery, LTC facilities are admitting a broad range of age groups, anywhere from 16 and up. In the past year I have cared for more 40's age group than I have in my entire nursing career. Some facilities will no longer accept medicaid funding. Very scary. Enough about that, now on to next. With reguard to working in this type of facility. Other nursing areas need to acknowledge what we do without reguard to where we work. I will be the first to say that this area is the best learning area to be had, going back to what I said before, we have no support staff, you will learn how to be a respiratory therapist, social worker, rehab worker, SLP, maintainance, dietician, and toilet plungin fool. You will learn how to confidently assess a resident and have the dr. treat based on YOUR assessment. And most of all learn that it is a great feeling that you accurately diagnosed,[did I say diagnosed, shame on me] a problem and anticipated what the tx would be and thats exactly what the dr ordered. You will learn to be organized, multi-tasking definitly will be enhanced. You will learn how to gain the trust of dr's, and family members. You will learn how to deal with end of life issues and provide the psychosocial support to their family members, which will be very challenging at times. You will learn IV skills, wound care assessment and effective tx. You will learn empathy, sympathy, commradery. You will experience and learn all you need to to make you a successful nurse in this and any other industry . The drawback from what I have witnessed is that those who intend to move on and broaden their skills. horizons, whatever you want to call it, don't. Don't get me wrong, nothing wrong with that. Its what I chose to do for the past 20 years, I simply love that particular industry, its my specialty. But a word to the warning, if thats all the experience you have for an extended period of time, it may be difficult to get other fields to accept you, unfortunately. Had enough? ha ha I can and will prob find other posts to comment on, hopefully I will gain some followers. Please everyone dont get me wrong, just dissapointed, unemployed, confused on? my profession perhaps. I do love to write and you know, its a great outlet, thanks for reading and hopefully listening and getting my drift. and excuse the spelling ha ha Sincerely, LTC "skilled nurse" at heart

I entirely agree with you artsmom. I too love the elderly. When speaking of nursing home stigma, it ****** me off to no end that when speaking of LTC to others, whether it be fellow nurses, [who do not work in this field] potential employers and general public, that they assume we have no "real nurse" experience. Little do they know how much we actually deal with. The residents they are admitting these days are getting quite technical, ie; wound vacs, TPN, to name a couple, as well as very acutely ill people that are being discharged from the hospitals too soon, being spread too thin by employers. Meaning having to take care of up to 25-30 residents at a time. This may include several medicare residents, hospice care, in addition to the ltc residents. I got a kick out of receiving a call from the hospital as one of our residents they admitted had a wound vac and they didnt know how to change it. Also the nurses who left the hospital setting to come to LTC because they were overwhelmed and thought it would be easier. Couldnt help but chuckle under my breath when they had that bewildered look on their face during orientation. People in general also do not realize that we do not have the luxury of having a lot of the support staff that the hospitals do. The responsibility in LTC is tremendous. LTC nurses are anything and everything from maintenance to dietary, respiratory to social services. I was struggling with burn out to begin with, but my last employer [a very large corp] was the last straw. I have never witnessed such chaos, lack of support, total disreguard for the residents wellbeing and failure to acknowledge the substandard of care that was occurring. Rather than address our issues of concern, blame was placed on us when state came to visit. And god forbid dont speak out to your employer about substandards as you'll pay for it one way or another. Needless to say I quit, was denied unemployment [lost appeal] Everyone seems to believe there is a lot of work out there, well not if your LPN with only LTC experience. I loved what I did, I miss those demented, cute old people, and yes even the harborview rejects we were excepting. In a sense I hate what the LTC employers have done to make an almighty buck, and what they have done to my livelihood as a nurse. I am reluctant to go back to this setting. I live in a rural community so resources for jobs are limited. OK I'm done venting now. If anybody has a solution to my current feelings please give me some input.