Sixtyseven

Because we are tired.

What I have seen in my 20 plus years of nursing is that the men are consistently promoted to management positions over women with more experience. No sooner do they have their RN than management starts eyeing them. Women in management fawn over them. However, I have seen that gay men fare no better than female nurses in moving up the ladder.

I think that "management" nurses just become lazy and also jaded - they just give up because the staffing will never improve as long as LTC facilities are run by corporations whose main concern is the bottom line.

Really? You want to judge all LTC nurses from your experience with your own facility's unit? Of course we check BGs and of course we give O2. I might mention the times residents were sent to hospital and returned with Stage IIIs because maybe hospital nurses did not know about turning, etc. Basic nursing.

It's interesting but sad to hear that things are the same in the UK. Perhaps the problem lies in the fact that historically nurses have primarily been women - and women and women's work have always undervalued. Nurses are bullied more than respected.

Clarification: The prescribers are not making more money by ordering liquid meds - the liquids cost the resident or his/her insurance company more. Some insurers do not cover the liquids if the med can be crushed.

The liquids cost more. Also, many times the docs order meds that should not be crushed, however, the resident needs crushed - but the nurse taking the order does not recognize that, so either meds end up given crushed that should not be....or the resident is given a whole pill he/she cannot swallow - until finally someone notifies doc of the problem.....

Applesauce seems to be a rare commodity in LTC. I have used juice thickened up pudding consistency.

Of course do it! It is great experience that will give you confidence and insight into the nursing profession. You will understand and appreciate the responsibilities of everyone on the nursing team and it will make you a better manager. If time is limited, do it part time. Have a great summer!

The CNA's are the heroes of LTC. They are the ones who let you know when a resident is having problems. They are the ones who give and give and give. Without the CNA's we nurses could not survive LTC. Let alone the residents. Just wanted to say that.

Oh, how common that situation is. Your choice - leave your resident in pain or catch hell from an angry doc (who has the right to be angry). These kinds of errors became more frequent when the LTC's discontinued unit secretaries who were an immense help to the nurses in keeping everything up to date.

I worked in LTC 20 plus years. The problem is, the owners (corporation) will staff to the minimum state requirement. The minimum state requirement is far from adequate for the acuity of care most residents now need. The scheduler will fill the schedule with any name to make it look good, even with names of people who no longer work in the facility. Then there are the call-outs. What you end up with is an impossible situation for staff and a win-win for the corporation who save dollars by working with less staff. If the workers complain about staffing, the corporate powers that be point to the state minimum and say "we are above the state requirements". Poor old grandma and grandpa do not understand why they have to wait so long to be cared for! So they and their families become angry and the anger is directed at staff. I am so glad to be out of it now.

It sounds as though your facility lacks organization. I worked in a similar facility, much time wasted searching for supplies, etc. I would say that if it is your opinion that your resident needs the hospital, but the doctor or NP disagrees, I would cover myself by notifying the DON (regardless of time of day or night) and I would advise the family of the resident's condition and how the doctor has decided to treat this (without criticizing doctor's orders). This would give the family (or DON) opportunity to override the doctor's decision. I would also talk to the resident, if he or she is cognitively able, to see what his/her wishes would be. If a resident or family state they prefer hospitalization, no doctor should argue with that.

This is all about corporate America - people who sit at desks from 9 to 5 and take hour long lunch breaks, and earn 3-4-5 times what any nurse earns and make decisions about staffing based on their "numbers". They do not care about the human toll or the care and they certainly do not care about nurses. They go home at 5 o'clock on Friday to enjoy their "much deserved" weekend.

Of course, nothing is simple. This is Nursing. The question was whether it is the nurse's duty to bring this to the doctor's attention. The facility says it is, and is there another way to get an order from a doctor other than contacting the doc? My point is that we can maintain professional demeanor with the doc by just asking.

You can just say to the doc "Do you want to add a beta blocker". Simple.

Surely you realize that most of those nurses holding the "cushy" jobs have long ago paid their dues in physical and mental exhaustion and abuse. I do not believe there ever was a time when nursing was easy. Right now, it is the corporations making working conditions bad for everyone, not just in nursing but in just about every field. Corporations seem to always find the best way to save dollars is to cut back on the real workers, their pay and their benefits and then increase the pay for the CEOs who have done the cutting. This sets us workers against each other - we are at the bottom squabbling for the least obnoxious jobs and trying to make ends meet.

I am in long term care (an area you seem to fear greatly). I am both a supervisor and also a floor nurse. I really never wanted a "cushy office job". ( I did have one before going into nursing, it was rather a bore.) Right now, nurses in LTC are stretched to the limits. Usually 25-30 residents per nurse, 3-4 CNAs to do the ADLs. The acuity in LTC has greatly increased during my years in the field. I just do not think there is an "easy" nursing job to be had, and the low pay, lack in benefits, etc affect all of us. There never was a retirement plan at my facility - that, and the fact that my husband has been in poor health for years, is why I continue to work - it is not my intention to hold onto my job until dementia sets in, just to spite you in your quest for a "cushy" job.

Ouch! That hurts! Now that I have been working since age 17, and in nursing for the past 25 years, still working because I have to, you are waiting for me to be "carried out feet first" - and then you will resent me if my health fails and I end up in a nursing home! Scarey!

Corporations are the problem. Corporate big-wigs do not respect Nursing, therefore they cut expenses by cutting nursing staff. The "PPD" is their guideline (state minimum hours required for care per resident) and as long as they are at the minimum, the corporate people are happy. They can obtain bonuses by cutting expenses. They do not value the very product they are selling, which is NURSING CARE!

Although our nurse to resident ratio is approximately 1:35 in our LTC facility, there is only one CNA and one LPN per floor. There is an RN supervisor for the house, though usually the RN also has a floor. And, like your population, these are skilled care residents, also many dementia. The administration quotes the "state minimum PPD" as their standard, and apparently they can construe our numbers as above minimum. Of course, we all know that "minimum" staffing equals poor care. The attitude towards nurses and CNA's is abysmal. When falls happen, bruises and skin tears appear, residents and families complain, it is all blamed on Nursing, who are deemed lazy and incompetent. The staffing is equally poor on day and evening shifts, with two CNA's and one LPN. It is really sad. There are more administrative people in the facility than actual working nurses, and they seem to spend most of their time trying to find ways to cut staff and make our jobs more difficult. And, the more staff they cut, the more money "saved" by the facility, and up go the salaries and bonuses of the administrators.

Too Much Baloney said it all! As far as physical injury, I have seen a nurse receive a broken finger at the hands of a resident, which was, of course, blamed on the nurse. And, I have seen nurses and CNAs receive permanent back injuries, life changing injuries, which of course were also blamed on the nurses themselves. I really believe that the nursing profession is downtrodden because we historically have been mostly female. Unless we unionize, as teachers have done, this treatment will continue. (By the way, some of the commentators may need to review their basic English.)

We have new administration at my SNF (this is pretty much a yearly event) and one of their goals is to eliminate all alarms on residents - Tabs, bed and chair sensors. They claim that "studies show there is no difference in the rate of falls between facilities with alarms and those without alarms". They claim the alarms disturb the residents' sleep. It has been my experience that alarms save residents from falls every night (11-7). In my 19 years experience in LTC, probably not a night would go by without me personally answering an alarm and finding a resident either climbing or sliding out of bed, and my staff were very diligent in checking alarms and answering alarms. Already, in just about two months' time, we are experiencing more falls. But, the administration blames it on the staff, because they should have foreseen these falls on their rounds. Of course, the facility has cut staffing, too. I just feel that falls are often devastating to our residents, and that all efforts should be taken to prevent falls. Of course staff should be making rounds, but we all know that it takes only seconds for a resident to fall OOB, and the alarms sometimes gave us these precious seconds to prevent a disaster. Has anyone experienced the "no alarm" system? How did that work out?

So, so sad. I do believe we have all become slaves to the corporations.

All of that plus - years and years of missing out on holidays and weekends with your family.