iaejd

I am you right now! Yes to this. I've been at the LTC for 2.5 months and dread going into work every morning. I have 29 residents on my hall with all the insulins and nebulizers and dressing changes and falls it's impossible. Having competent CNAs is rare. I have to spend time managing CNAs because they can't get along and will refuse to provide care to residents because "that's not my patient. She should have done it." And there are never supplies available, and I have to spend an hour in a the dining room and get in trouble if I don't take my 45 minute break and the NP hangs up on me when I call to clarify orders and there is a ridiculous amount of double charting. I don't feel like I'm providing good care. So I don't have any advice for you, just wanted to say, you're not alone.

So I'm a new grad that's had a job for about 2.5 months now in a for-profit LTC. I've got really low job satisfaction right now and could use some information on what is normal for LTCs. Some of the things that are making my life difficult: * There are never supplies - tracheostomy care kits, ziploc bags for ice, medications are never there (especially frustrating since I work weekends and pharmacy only makes one delivery early into the weekend and then it's like "oh, pull from the e-kit" and then the e-kit is out) * People no call/no show or call out with little notice ALL THE TIME * The majority of the CNAs/CMAs don't do their jobs - I get VS that are incorrect more often than correct (think O2 sat of 60, BP of 199/110) - and there's a whole 'nother problem: nurses were expected to pay for and use their own vs equipment when I first started (thankfully this has gotten fixed but I am scared it will become the norm again when the new equipment breaks) * I spend a lot of time doing the CNA's jobs because of the above (retaking VS, answering call lights - and partly I think the facility really has the patient to CNA ratios too low so even the ones who are good can't get everything done) * Because of the staffing shortage none of the above is ever effectively addressed by management * I have 30 patients, at least two of which are getting multiple nebs a day, BS & insulins, treatments (2-5/day), all prn meds (and residents that use them all the time), a res that constantly tears holes in her colostomy bag (once a shift), all of which would be manageable except for the above reasons and that I always have falls. At one point I had 6 sets of active neuro sheets. * The culture is not one of politeness - I have been hung up on by my NP when I called to clarify orders, CNAs have screamed at me and my med aide is openly hostile. I've gotten a LOT better at time management, but at this point I really feel that the requirements (all the charting, med pass, treatments, nebs, dining hall duty that takes an hour and a half) are unrealistic. On top of them I'm having to do some intensive managing of my CNAs because very few of them get along with each other (There's been a lot of situations where a resident puts their call light on, and the CNA on the hall tells me "That's not my resident. So-and-so should have done it before she went on break. I guess they'll have to wait"). I'm trying to educate myself on how to do this constructively but I'm new and young and not good at it yet. Overall, I'm providing the best care I can and I feel that I'm letting my residents down. I can't see myself getting a job anywhere besides a LTC - I don't think my skills are good enough for the independent work of home health/hospice, and the new grad programs at hospitals are insanely competitive. Are all these problems above unusual or are they endemic to LTCs?