"Don't Send Anyone Out!"

morte, LPN, LVN · Aug 22, 2006

are you trying to tell me that there is ANYONE OF YOU that would actually ATTEMPT to place a urinary cath in a post op turp!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!yikes......as soon as had not passed urine in a few hours...palpate bladder....out the door.....at this point wouldnt have been an emergency, but you KNOW the uro isnt coming to YOUR facility.......frankly, sounds like he should have been turfed BACK when he came in......

TheCommuter, BSN, RN · Aug 22, 2006

LTCs (now) are the tele/med surg units of 10 years ago...w/ less than adequate nursing coverage

Last week I worked several overtime shifts in the rehab department of the nursing home where I am employed. I had five PICC lines to flush, several IV antibiotics to administer, eight G-tubes, multiple diabetics, one wound vac, one Jackson-Pratt wound drain, one colostomy bag, multiple nebulizer treatments, and many more things to do. Did I also mention that I am an LVN?

I agree that many nursing homes are accepting higher acuity patients that actually would receive better care on a Med/Surg floor. I had 20 of these rehab patients to care for, whereas a typical Med/Surg hospital nurse would have 6-10 of these patients.

Marie_LPN, RN, LPN, RN · Aug 22, 2006

I agree that many nursing homes are accepting higher acuity patients that actually would receive better care on a Med/Surg floor. I had 20 of these rehab patients to care for, whereas a typical Med/Surg hospital nurse would have 6-10 of these patients.

What is the DON's stance on this? That kind of assignment is just crazy.

ktwlpn, LPN · Aug 25, 2006

That really sounds like a heavy assignment. Our supervisors take the responsibility for all PICC and central lines in the house-they flush them,hang any antibiotics and change the dressings.I don't know if this will continue after the present administration retires next year but we are loving it now,I can tell you. Our cna's change appliances and empty catheter bags( I am loving my job!) Nurses are responsible for drains.Most of our GT feedings are hung late in the afternoon and run through the night-except for the few who can't tolerate more then 35 or 40cc/hr.I'd rather give meds via GT-it's faster then cajoling some confused L.OL. who is looking for her momma. When did you find the time to do all of your charting? Our DON has the final say over all admissions and she has turned many away over the years.Thanks to the "case mix" movement in the early '90's the higher acuity residents are all over the house now-they take all of your time and many other residents suffer because of it.LTC has really changed but often administration does not recognize this.

Abbies · Aug 27, 2006

I'm a newer LVN and employed as a weekend-double shift nurse at an upscale nursing home. My weekend RN supervisor has a happy-go-lucky, coolly unconcerned personality. He unrelentlessly picks on some nurses but tends to leave me alone.
He has made it crystal clear that we are to refrain from sending any resident to the hospital unless they are extremely ill. His reasoning is monetary: if a resident spends one week in the hospital being evaluated and treated, then the nursing home will lose one week's worth of money from that resident. Private-room residents pay $6,900 monthly and semi-private residents pay $4,600 monthly. This seems fishy and unethical to me. I usually will send a sick resident out because I want no person to die or worsen under my care. Any thoughts or comments on this issue?

It doesn't make sense to send a resident out for something that could be taken care of with an office visit. On the other hand, the resident is paying for and entitled to prudent medical care. The RN supervisor should be directed to the physician if he has any questions about hospital admissions and an emergency is an emergency so what about that?

txspadequeenRN, BSN, RN · Aug 27, 2006

They are not just accepting higher acuity of patients ,they are accepting anything that comes through the door or at least this has been my experience with SNF in our area.

Last week I worked several overtime shifts in the rehab department of the nursing home where I am employed. I had five PICC lines to flush, several IV antibiotics to administer, eight G-tubes, multiple diabetics, one wound vac, one Jackson-Pratt wound drain, one colostomy bag, multiple nebulizer treatments, and many more things to do. Did I also mention that I am an LVN?
I agree that many nursing homes are accepting higher acuity patients that actually would receive better care on a Med/Surg floor. I had 20 of these rehab patients to care for, whereas a typical Med/Surg hospital nurse would have 6-10 of these patients.

speckleddove · Sep 5, 2006

yes, you keep on sending them out!!

his butt is not on the line your butt is!!

i know that game too well. cover your rear end at all costs.

it is unfair to the patient as many need iv drugs when no rn or iv trained nurse is on duty.

i know of one nurse that lost her license over that crap.

a patient fell ot of bed, the night supervisor told the nurse not to send out & not to order anu xrays.

guess what, the male patient had a broken him and suffered 4 days and he even was forced by pt to endure rom exercises even though he was crying and begging them to stop due to pain.

how ###### cruel was that!

his wife came to vist and checked his complaint of pain & rightfully went balistic.

the hospital er dr. filled charges, guess who went to court!

she did.

no report, no x-rays, no call to his dr.

she was that supervisors escape goat, she claimed that nurse never called.

phone records proved she called the supervisor but she couldn't prove she had informed them.

she paid the price & so did that poor old man.

better to get fired for the right thing you did than to end up feeling guilty and ruined for life.

tell him to scew himself! send them out. call the emts and then see if he tries to stop them. get your butt covered & nail him.

CapeCodMermaid, RN · Sep 5, 2006

The PT 'made' him do ROM even though he was screaming??? Seems he should lose his license too!

speckleddove · Sep 5, 2006

yes, pt did and the guy in pt is in hot water as well.

i had been there 9 days when they told me about the incident.

i was hired as an adon for the first time ever.

the don caused me to quit when the state came in to investigate a complaint about insulin.

the don said 2 things that made me quit.

1. she was yelling at a midnight nurse because the state discovered that there had not been any glucose monitoring done for days.

when the state asked the midnight nurse why, she replied the supplies were never delivered and the don knew this but never bought the supplies.

the don wanted her fired for telling the truth.

2. the don came to the nurses station the next evening and told all the nurses that if anyone was sent out.

we were under no circumstances to send them to a specific hospital.

i told her that is against the law.

and that if an emt determines that taking a patient to that closer hospital was in the patients best interest, they would be taken to that hosoital.

she nor we have any say in the matter.

when i asked why she would make such a demand.

she informed me about the law suit and pt. with the broken hip.

she said that hospital had reported them on that case.

and the er dr. was now telling people not to send patients back to our facility.

that he also was charging the facility with abuse over that patient.

he was advising people never to send patients to this facility and that if they had family there to get them out.

then she told me she wanted me to stay over on midnight shift to force a nurse ( the one that told the truth) and involved in that broken hip inccident to take a drug test.

the don claimed that nurse had been suspected of being on drugs for awhile but until this inccident they had not pushed for a drug test.

i suspected this was their way of trying to discredit that nurse, so if the state asked her anymore questions; she would be dissmissed as a drug addict or a disgruntled employee.

no nurse should ever be punished for telling the truth.

that same day i also had a cna tell me that the don had left a patient on the floor, until the don finished a medication pass along with another nurse.

so apparently, there were 2 nurses (1 was the don) doing one hall med pass but neither nurse went to check on the patient on the floor.

she claimed this occured a few months before i started working there and not to trust the don.

i took this to the administrator and the don.

the cna testified to the admin., in front of the don; that this incident did in fact occur.

of course the don denied it, however; the cna had evidence and other witnesses to back up her statements.

when asked by the admisistrator, why she had not reported this sooner.

the cna replied i did but no one believed me.

so after a few days i let it drop because i have kids and i felt i would have been fired because you two are best friends.

the cna had enough proof this happened so the don began trying to find an excuse by saying she had the cna stay with the patient and that the patient was said to not have any bleeding, therefore she felt it could wait.

excuse me, wait on the floor?

i was told to dismiss this cnas story and drop the entire subject.

all i knew was i filed the complaint and handed it to the administrator.

what happened after that is anyones guess.

later that day, i was threatened with the possibility of being physically harmed, once i left the facility at the end of my shift.

why, i am not certain. perhaps because i supported the cna and i filed a report.

i quit when my shift ended.

nursing is not always a safe job in more ways that one.

telling the truth can be dangerous.

fear in employees, is a big factor in facilities like that not being closed down.

then there is the role state inspectors play in the existance of such facilities.

stopping admission of new medicare / medicade patients, does nothing to help the patients already in such a facility.

fines are the only things those places suffer, big whop!

now if those fines entailed a facility having to immediately tranfer and also pay for the resident being transferred and pay for their bill at a safe facility, then perhaps fines would mean somthing.

so kid yourself not, the state is at fault as much as the administration in such a facility.

most of the neglect or abuse is caused over some jerk wanting to save money to begin with.

a fine doesn't put a patient/resident back together, it doesn't heal stage four wounds, it doesn't help in hiring more or better educated staff, it doesn't ensure quality nor improved care.

it is a greedy money grubbing deal and the public, the patients, cnas and nursing staff are victims a well.

no one will act on reports in a speedy manner, too much paper work, too much time for state agenies, it interfears with their 9 to 5 shift.

they bury whistle blowers in mounds of paperwork until you feel defeated enough to give up.

most do but not by choice.

where do you go if your the good guy trying to clean up a h### hole?

go to the news media, that's where!

at least families will discover the missery a family member may be suffering and hopefully can afford to get them out.

call the state attorney generals office in the state where this crap is going on.

remember even state employees have a superior they must answer to.

you just have to work very hard to find out who those superiors are.

that doesn't mean anything will improve but at least you can look yourself in the mirror the next day knowing you did everything you could to protect everyone involved.

banditrn · Sep 5, 2006

speckledove - Wow, that place sounds awful!! :madface: How could they physically threaten you?

We have a big supply problem at my facility - things seem to get ordered in a very haphazard way, and we frequently run out of things we need.:uhoh21:

The thing that troubles me is our med pass on nocs - the shift ends at 6AM, but that is when the meds we pass are ordered for. To get everything finished on time, we must start at 4AM. In addition to meds, we do all the AM blood sugars, then the day RN gives the insulin.

I just KNOW state is going to come in some time and catch all this - but the DON won't change anything.

Markthemalenurse · Sep 5, 2006

...better to err on the side of safety

:yeahthat:

I have a simular saying, "I would rather get yelled at for being causious(SP) than being yelled out for not doing anything".

Markthemalenurse · Sep 5, 2006

The thing that troubles me is our med pass on nocs - the shift ends at 6AM, but that is when the meds we pass are ordered for. To get everything finished on time, we must start at 4AM. In addition to meds, we do all the AM blood sugars, then the day RN gives the insulin.

Sounds just like the old place I used to work at, except our ealy morning med pass was a 7AM. Third shift would have to pass the 7AM med at 5AM because shift report for first shift started at 6:30AM and wasn't over until 7AM.