Quitting...are they all the same??

nrsang97, BSN, RN · Nov 19, 2007

I have never worked long term care as a RN, but I did work as a assistant and the staffing turned me off from doing LTC. Have you ever thought about rehab? I mean like physical rehab for post joint replacement and post CVA. The patients stay for weeks at a time and this is usually in a hospital setting.

Also what about working in a place like Select Specialty hospital? The patients are too sick to go to long term care but not sick enough to remain in a hosptial. Pt stay for extended periods. Staffing seemed well with the one that was inside the hospital I worked at that had one. This is a independent hospital that rents floor space inside a hospital and uses their radiology and pharmacy and doctors, but has different policies.

I hope you find something you love. Glad that you love geriatrics. Those that are in long term care are lucky to have the ones like you that truly care.

CoffeeRTC, BSN, RN · Nov 19, 2007

No. I work PRN and have looked in a few area places. I keep retruning to my home. They are not all the same. Good and bad everywhere. I "only" pass meds for 4 hrs of a 3-11 shift. 3/4 of my CNAs really do care and I do get time to talk with my res. As far as getting all of my tasks done. Nope. Not every shift.

RN1989 · Nov 19, 2007

Unfortunately, this is the nature of long term care. There are some better than others, but what you are describing is pretty much everywhere. With so many debilitated and or confused residents, so many regulations, it is nearly impossible to do everything that needs doing. This is all types of healthcare in general. You will have to find a happy medium of what you can an can't work with or you will not be able to work in healthcare without feeling like this. This is why so many are leaving these occupations.

ktwlpn, LPN · Nov 19, 2007

I am quitting my current position in a LTC facility because
1. I give meds for 7 hrs on a 8 hr shift.
2. I can't stay in compliance
3. I believe that 1/2 the LNAs I work with don't care about the residents needs.
4. I can't say no to a crying resident's request and no one but I seems to hear them.
5. I don't have enough time to complete all of the assigned tasks.
6. I cry everynight when I get home.
I like geriatrics and like knowing my patients. Should I look at other facilities or are they all like this one? :uhoh21:

All LTC's are NOT like that...If you really enjoy that population keep looking..Maybe go with an agency for awhile so you can check out the facilities in your area. I'll give you a few examples of how the problems you have listed were solved where I work... First-several years ago administration realized our med passes were off the hook and we could not possibly be compliant.Each unit got 2 med carts-our 40 plus bed units run with 2 nurses always and usually 3 on day shift.We are in compliance and even have time to cajole the most difficult dementia residents into taking their meds and even give them their nourishments ourselves. We have great bennies (it's a county run facility) and our retention rate is high-I regularly work with cna's that have been there 10 to 15 years or more.And they DO care...Our current DON and ADON are both relatively new to their postions and have made a big difference.If we get a nurse or cna in who is a problem they are dealt with promptly...They have developed many new protocols,re-worked lots of the paper work and we actually HAVE TIME.I sometimes do manicures!Or just sit and chat for a few minutes.....I still have crappy days now and then but they are really few and far between ....The only time I get stressed is when I have to deal with unrealistic family members or residents that I feel are suffering in some way.Our supervisors are great at listening to everyone's input regarding a resident's care.We are all encouraged to participate... Keep looking-I believe there must be many facilities like this -it's sad we only hear about the crappy ones....

angel337, MSN, RN · Nov 19, 2007

honestly i get depressed when i think about LTC facilities for the reasons you described. as a student i remember doing a rotation on the subacute care/ rehab unit that was mostly geriatrics and it wasn't too bad. the nurse/patient ration was something like 1:7. try that. i admire you for your desire to stick with geriatric care. that takes a lot of patience and dedication.

fultzymom · Nov 19, 2007

Most long-term care facilities do have high nurse/patient ratios. If you like geriatrics why not try a Rehab Unit. Most of the Rehab Units I have seen have a lower ratio. Ours is half of what the ratio is for the floors with LTC patients.

Passing meds in LTC does take a long time. I remember when I first started I finished my 8am med pass and it was time to start my noon pass in 1/2 a hour. Then my 4pm med pass took another 2 hours. It takes a routine down and get things worked out so that it is not difficult anymore. Please stay in LTC if you love it. Not very many nurses like it very much.

Simplepleasures · Nov 19, 2007

The basic problems that plague nursing homes ARE THE SAME EVERYWHERE.The facility may have beautiful furnishings and be a non profit, BUt it will still have th problem of understaffing and retaliation from management when nurse follows nurse practice act.

Hospice Nurse LPN, BSN, RN · Nov 20, 2007

I am quitting my current position in a LTC facility because
1. I give meds for 7 hrs on a 8 hr shift.
2. I can't stay in compliance
3. I believe that 1/2 the LNAs I work with don't care about the residents needs.
4. I can't say no to a crying resident's request and no one but I seems to hear them.
5. I don't have enough time to complete all of the assigned tasks.
6. I cry everynight when I get home.
I like geriatrics and like knowing my patients. Should I look at other facilities or are they all like this one? :uhoh21:

You sound like a wonderful, caring nurse. It was a big adjustment for me to change from hospice to LTC. There's a TON of meds to pass on my shift (but not as bad as days). I work 6p to 6a. There are a couple of CNA's that don't give a rats *** but some of them do. I was very spoiled in hospice with EXCELLENT CNA's who had great assessment skills. But I've been really working with 3 of mine on slower nights. Just some patience and teaching was all these young women needed. One didn't even know how to take a B/P! But she had a pulse, so they hired her. I've found that the more I expect from and praise them, the more they do. I do like my 12 hour shifts because it gives me time to get ALMOST everything done. The shift that relieves us is also great and they know I'll finish up the next night and I repay the favor. I also wasn't used to calling the doctor for EVERY LITTLE THING! I, also, love geri patients! As another poster wrote, you may want to try agency and check out several facilities. You'll eventually find your place. Good luck to you!

AimeeJo RN · Nov 20, 2007

Your description is exactly like that of a friend of mine who is a new nurse and she just got her first LTC job. All the things you listed seemed to be the case in the few facilities I was in as a student. (I havent gone to work since graduating) There are probably some decent places out there but I personally would not go to LTC unless it was the last place to work. Are there any assisted living facilities in your area? I have found them to be a lot more pleasant. I also enjoyed my time at the veterans home as a student, they had much better staff to patient ratios and the benefits are great.

Xbox Live Addict · Nov 20, 2007

Sadly, this is the nature of the beast with regards to LTC. Today's LTC patients generally require as much care as yesterday's acute-care patients, especially when you work at a Medicare facility, yet the NH is staffed as though the patients are generally ambulatory and need minimal ADL assistance. You have too many residents to be responsible for, especially when you want to give them the care you know they should be getting. Unfortunately, the realities of LTC often force you to prioritize what care is absolutely necessary, and what can be blown off, at least short term.

You cry because you know these residents deserve better, and you want to try to pick up the enormous slack left by the industry as a whole. Unfortunately, you are only one person, and you're not going to be able to do it. A DON that I respected greatly told me one time that there never is, and never will be, enough staff in a NH to give truly adequate care to the residents. She was truly sad about this, and she eventually burned out of LTC.

As far as your staff goes, I don't know what to tell you there either. A CNA's work ethics greatly influence the quality of care that you CAN give. An awesome CNA will walk on coals to ensure that at least the resident's basic needs are met, will function as your eyes and ears on the hall, yet not step outside of their scope of practice and create more headaches for you as the nurse. A bad CNA will just frustrate the hell out of you, since disciplining CNAs is extremely difficult in what is essentially a "buyer's market" given the chronic short-staffing in LTC and in nursing in general. Time you spend counselling or writing a CNA up is time away from patient care, and in the people that really need discipline (those willfully not doing their jobs), it doesn't do much good.

In my state, we use CMAs in LTC, and they have a fairly broad scope of practice for UAPs. CMAs are definitely a double-edged sword. While they take a huge routine task off of the hands of the charge nurse, there is plenty that can go wrong with medication administration, and a poorly-trained CMA not only makes more work for a charge nurse, but can be an absolute menace. But for better or worse, LTC nurses here are dependent on them.

deleern · Nov 30, 2007

Try a different shift. I worked t he NOC shift and loved it as an LPN, now I work 7:30 to 4 and 1 weekend a month I love my job. I work Hard do a ton a charting as I do all the patient assessments. I am Charge nurse and assistant Care manager