RN's exiting from aged care postions

DAISY MAE 1 · May 12, 2002

Wow, finally someone to talk to about geriatric nursing! Why

does it seem like it is such a lonely field, or maybe it's just me!

I truly found that I love working in geriatrics but most recently

after only 2 years, I have gone to a hospital to work. As your

quote above says, I really found my niche but arrived at the end

instead. I think alot of what happened with me personally is

some burnout from being in a leadership position too long in my

career. It's just too sad that it had to occur when I found where

I really liked being.

I worked as a resident care coordinator of a 38 bed dementia/

memory support area. There were also 2 other units with the

same number of residents on each area, supervised by one

coordinator each also. Us 3 coordinators had 1 DON who was

in charge of the full 113 and also a new assisted living. She was

in short supply for availability to us middle managers. We each

did all our own MDS's, careplans and the whole rap process from

start to finish, supervised all the staff and did evals, etc. on all

3 shifts, did all incident reportsetc, coordinated care of the

residents, and assisted nurses in troubleshooting daily, did all

the prep for state, and JCAHO surveys and monitored compliance,

was on call every 2nd or 3rd weekend, and subbed in when staff

were sick if no one to cover. The saga goes on, and the list

could be longer. I don't like this to sound like a sob story, as I

know there is stress, and demand in all kinds of nursing. The sad

part is I think that there is a strong need out there for support,

and empowerment in middle management. I felt overworked,

responsible for everyone, my license was on the line much of the

time because of employees that would lose their common sense

at times--some more than others. I really tried very hard to

empower my employees as I knew that was the only way to get

them to give good care. I feel like I was achieving that by the

time I left, however all my energy was spent, and I felt as if I

could not give anymore because of all the demands. Budget

demands limited many of the choices such as an educator, or an

MDS coordinator to help us out. It is already very expensive for

people to be in nsg homes, and facilities donot want to be

continually raising costs. So what we always hear is "think

outside the box" for solutions , be creative. What I hear alot

from leaders is "don't add 1 more thing to my plate or I'm going

to crack!" I could go on and on. The sad part is that they lost

a good leader when I left(many employees told me) and I left a

part of me behind wondering why it had to happen.

1. Regs in nsg homes are horrendous and the paperwork with

them is unbelievable--I think some things are necessary to keep

things safe for residents, but when the gov. has to know what

kind of bm's residents are having is too far.

2. Middle managers, and DON's need more support and resources

available to them.

3. The rest of the healthcare profession needs educated on

geriatric care, regs, etc. There is a great lack of respect, and

medical understanding of geriatrics even by many doctors, and

nurses. I had a doctor tell me that UTI's have nothing to do with

new confusion in a resident!

4. Good CNA's are hard to find. They are not paid well in most

places, they need educated in their jobs too, and they need

leaders who have patience and who want to empower them to

succeed.

5. I was in leadership for over 15 years. I have worked in the

hosp. 3 weeks now, and have only seen a coordinator or director

once or twice on the floor. She had nothing to do with coordinating my orientation, monitoring my skills, and did not

know me from adam. I know now I was overworked at the nsg

home. I know there are demands in all jobs, but as a superv.

my belief was that you should always have contact with your

employees somehow on a daily basis. Maybe it's just this hosp.

I don't know.

6. My goal now is to enjoy going home and not worrying all the

time, leave work on time, leave work at work.

7. Once I get settled in my staff position, I am hoping to be able

to do some inservicing on geriatrics, cognitive impairment in my

spare time. I have always wanted to do public speaking.

8. I donot feel at this point I can even work in a nsg home as

a staff nurse, because I donot want to be responsible for other

employees anymore--many donot want to be responsible for

themselves. I commend all the LPN's, and RN's who are team

leading and practically running their nursing homes, and not

getting paid their full worth.

I am sorry I have gone on and on. This topic is still very dear

to me. I will be interested in seeing all the different responses.

Thanks for the ear. Daisy Mae

kdhnursern · May 12, 2002

I am the MDS Coordinator for a 120 bed facility in Kansas and I have seen the ebb and flow of many employees in the last few years. Long term care does not get the respect we deserve, the pay we should earn, or the help we need. What was always considered the last choice in nursing...if you can't handle REAL nursing, you can always work in a nursing home!!...is now a very stressful and skilled area of nursing. The acuity level of residents has gone up dramatically. People keep their aged at home until they can no longer care for them and by then they are in very poor shape. I hate to think of how many people I have admitted who have died within days, and sometimes hours, of admit. Why were they even moved???

As the acuity level raises, the staffing drops. Staff is tired of working long hours with minimal staff and made to do more care than is advisable in the time allotted. CNAs wonder why they should do this "glamorous" job for the same pay they could make asking "do you want fries with that?" As the CNAs leave or just don't perform up to standards, the nurses take on more responsibilities. Is it easier to push and push to get a job done by someone else or just do it yourself? If the other person does the job, how many times does the nurse have to check to make sure it was done right? And for all of this, the nurse makes far less than acute care nurses make and are not given the respect.

Out facility lost 10 people in the last couple months, half were licensed. We have only hired 2 replacements for those licensed and 3 unlicensed. We have been at minimum staffing for at least a month and aren't getting the applicants. We just can't compete with the hospitals and the LTC facilities have a steady flow of employees among them, after the bonus or higher wage until a better one comes along.

No, I don't have solutions. If I did, my facility wouldn't be hurting for help right now. I know my facility is a good one, I won't leave, but how to get others to see that?

Any suggestions out there? Sorry I ran on and on!

Tookie · May 12, 2002

I thank you both for your responses - it has given me a lot to think about - I am feeling a bit lost myself at the moment wandering if l need a change - at times it feels that the light at the end of the tunnel is dimmer - Anyway thank you for your opinions - I would vaklue anyone elses thoughts I will print thses answers and give them to the RN at work who is doing the research - I guess l need to say that as nurses who care for the aged and frail if we know that we are valued people we then value the people for whom we care.

Tookie

catlady, BSN, RN · May 12, 2002

Daisy Mae, I can relate. Until very recently, I was unit manager of a 49-bed SNF unit, lots of Medicares. I did all the MDS, PPS, RAPS, care planning, and was the head nurse of the unit. Upper management didn't provide any support, but constantly called me (you don't think they'd get out of the office, do you?) with their list of "I needs." I need this, I need that, stuff that they could often have done themselves but delegated every time. The DNS never missed a breakfast break, even though she rolled in after 9 am every day, never missed her eight thousand smoke breaks, while I'm holding it in because I don't have time to pee. When JCAHO came, we were choking back laughs when the DNS told the inspector that she and the ADNS made rounds every day. What a joke. Mind you, we're only talking a 98-bed building; it's not that far to travel.

I almost had an aneurysm the day that the ADNS rudely interrupted me and one of my nurses who were very busy sending out an unstable resident to the hospital--we needed to go to an inservice, because there was a guest speaker. It never occurred to her that patient care might have been the priority, or, gawdfabbid, that she could have made our apologies to the speaker, or she could have taken over for one of us so we could go to her bloody inservice (the first inservice in months, BTW. Of course she told JCAHO she did all the inservicing. I did more teaching than she did, and it wasn't part of my job. But I digress.) The CNAs were all standing there when she basically made a fool of herself. If I had to work the floor because a nurse called out, no one even checked on me or asked if I had anything urgent on my desk that they could clear up for me.

And at the same time, of course, the nurses and CNAs would come to me about everything. I don't blame them--it's not like anyone in the front office would take care of their needs.

Anyway, I jumped from this frying pan into a fire, where I lasted all of four days. It's going to be the same wherever you go, as long as you stay in long term care. Everyone is so terrified of The State, that they can't even think straight. The paperwork is horrendous, as you say. I did a couple of agency shifts this past week and I was horrified to see that other buildings had even more paperwork than we did! And so much of it is utterly redundant, such as charting I&O in three places.

But this week I was offered and immediately accepted a job as a nursing case manager for a major insurance company. I cry for happy. No patient care, no nights, no weekends, no holidays, no on-call, no state regulators.

I have learned from every experience I have had, and without those experiences, I wouldn't have been offered this job. So there's some value in the trial by fire. But at least now I know there may be life outside the trenches.

semstr · May 13, 2002

well. I think it is because our work in geriatrics is not being apreciated the way a nurse in ICU or OR is.

I hear that all the time, what do you with those old people, why do they need RN's, anybody can wash and feed them.

Lay-(wo)men have absolutely no idea, what it means to take proper care of the elderly.

Very frustrating and degrading for nurses working there.

As I wrote before, I always work geriatrics with my students and with some of them I really have a hard time, because they feel and (the ones who have the heart to say it out loud) act the same as the other population.

These students can't wait to get to a med/surg. or even better ICU, CCU. Now that is nursing for them!!

Sick isn't it?

Take care, Renee

VZ/res0ncqx · May 14, 2002

Well, damn, I guess it's the basic whine, but I just got here in LTC, and I gotta say, the people they hire and, more importantly, KEEP, as CNA's is appaling. We have one lady, I mean, grown-up female, who is abusive to the residents and has kept her post for 9 years. We have another who has a tendency to lie about the care he has given when he has not done so. The words of our DON: "It's a warm body". When will the lovely aides who bust their butts get paid enough and when will the assholes get the boot?

momrn50 · May 15, 2002

Yes it's true LTC Rns don't get the credit they are due, just ask the new grad in the ER when you call to give report on a resident yuo are sending out. I had one ask me once, How could you waste your nursing career working in LTC? Takes a special kind of person to care for the elderly..I love it and wouldn't have it any other way, but I do get tired of the attitude of other nurses who turn up their noses to those of us in LTC.

Tookie · May 15, 2002

Thank you for your thoughts - I will pass these thoughts onto my friend doing the research - does anyone know anysites out there that give any stats in this area - at the moment I must admit if l won the lottery l would be gone - right out of nursing and aged care - didnt feel like this a a couple of months ago - it just seems that it dosnt seem to get any better and I dont know what to do about it.

StormyCD · May 15, 2002

DAISY MAE 1

I agree with most of what you said. But the part about the Government needing to know what kind of BM our residents are having is just a safe gaurd. They need to know that we are addressing any cases of Constipation, Impaction or Diarrhea. Because these conditions are often a sign of other, possibly serious conditions. i.e. If a resident has had a history of bleeding ulcers, we need to monitor for blood in the stool, at the very least the color or odor which can indicate an exacerbation of the bleeding ulcers. Residents with a history of colon cancer should be monitored to prevent hard stools. Etc. Etc. I even have my CNA's record how many times a resident voids, color and if odor is present per shift because this can alert me to Renal failure, UTI's, Dehydration. When State comes for a survey and they look at our documentation thay are assured that these needs are being assessed and addressed. If they are not they are capable of fining the facility for substandard care. After all, I believe this is a quality of life issue. I know how uncomfortable I am if I have diarrhea or constipation. I was a nurses aide before I became a Registered Nurse and have always remembered to treat my CNA's with respect, help them with difficult residents, never ask them to do something I wouldn't do and back them up when they are in the right. In return I have CNA's that come to work on time and do the turning and hygiene care needed. They report and changes as soon as they occur etc. etc. I am sorry this turned out to be such a long reply. I really just wanted to give you a different way to look at some of the reasons why the Government does some of the things they do.

StormyCD

StormyCD · May 15, 2002

I thought I'd never work in a nursing home again after quiting there to go to nursing school. However my husband made the comment, "you can't change it from the outside"...now that really hit home with me because it is totally true. If I want to be sure these residents are turned and clean, then I need to be there to know it's getting done. We have had lots of staff turnover also but we are weeding out the ones that really don't want to be there. Yes we are short staffed, and like you I somtimes think it's easier if I just go ahead and do it. No I don't have any solutions for the shortage but at least the ones that are staying here are the ones that give the best care. I let them know they are appreciated. Sorry, I was just rambling on...lol

StormyCD

Fran-RN · May 15, 2002

wow, Sandra m Took, you touched a nerve didn't you? Most LTC nurses and cnas I'm acquainted with are frustrated with their jobs. Does LTC have more government regulation than acute care in other countries as it does in the States???