Hi all, I am a new RN and am curious about some experienced RN's perspective on this topic. My dad recently had a very debilitating stroke. We have been to 6 facilities in 5 months and I have seen the good, the bad, and the ugly of nursing staff.
Often I find myself having to remind the nurses to float his feet for pressure wounds and turn him every 2 hours. He has been left in soiled diapers for longer then is acceptable among other communication issues.
I draw a line this past weekend when I went and asked to speak to the charge nurse just to get more info since his assigned nurse was an agency nurse and didn't know much about his history or long term care plan. She acted so unprofessionally. If you have a moment to read our dialogue it is below. (It is typed because I intend on sending a complaint to the company.) If you want to skip that part I totally understand.
[[[Nurse entered his room and immediately had an attitude which was demonstrated in her tone of voice and dismissive body language. She stated You asked to see me, what can I do for you?†and I responded by stating my observations of the treatment of the heal. I stated that there were 3 nurses sitting at the nurses station (one of which had their phone out) and she immediately interrupted me by saying I don't have 3 nurses so that's not true.†I responded by saying Well I saw 3 people at the desk none of which offered to assist with my concerns.†She interrupted me by stating What is your point, get to your point.†I stated My point is I came in and his heal was flat on the bed with a soiled bandage and I want to make sure it is off the bed as prescribed. There is available staff that are capable to attend to this task.†She interrupted me by stating I know you're a Registered Nurse so you think you know but I know how to run my floor and we are doing everything we can to assist him.†I asked to then speak to her manager who was currently unavailable. I asked her to please stick to the concern which was the wound as it had a green drainage that could indicate infection. She stated If the patient had an infection he would have a fever.†I responded by saying A fever is not the only systemic change a patient will have with an infection.†She interrupted me and stated I am not going to play this game with you. What else do you need?†I was completely floored at this point and requested she leave the room and please remind her staff to keep his extremities elevated.]]]
None the less, how do you balance being a nurse and having knowledge on how things should be handled versus being a concerned family member and letting things slide because you know how the system works? I am so disappointed in how some nurses have acted and feel sometimes (with any job) when you have been doing it for so long you really probably shouldn't do it anymore if you lost your passion.
Not really, my post is pretty accurate to his current condition. He currently has the cdif and 2 pressure wounds. He had one of the worst strokes the doctor has seen (his words, not mine). We are just trying to take it day by day.
The crazy thing is is that when I walked into his room and saw his feet flat on the bed his heel suspension boots were on the floor! I know I am not perfect and definitely can say I am stressed and emotional but it is hard to not be so frustrated when there are little mistakes like that being made.
He may not be tolerating them. Is he restless? Does that need to be addressed?
Or is the staff just non compliant, (I mean non adherent ) in applying the boots?
And are they the good boots or just the cheap ones?
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Thank you everyone for your responses.
It is really hard to try and relay an experience that has been going on for months especially in text. When my dad first had his stroke I took a 3 month leave from work to be at the hospital with him and take care of him. In the time I was off the nurses LOVED us. They loved us because we brought donuts every morning and fraps from Starbucks for the floor. They knew they didn't have to worry about the patient because there was always someone there. I did his bed baths and turned him. I provided pretty much all care that didn't require an order and built a relationship with the nurses in a way that they all rooted for me as a Nurse. I did not have to hide the fact that I was a nurse. It was great!
As soon as I went back to work and could not follow him to every facility (again due to insurance coverage) is when we started having problems. 3 bed sores, 3 rounds of Cdif to date, fractured legs, 2 falls, pneumonia. As a family member who has some knowledge of nursing (I agree I am new so not a lot but at least some to get me by) it is extremely hard to watch him deteriorate and not be able to do anything about it. It is even worse that I have to fear saying anything because I am a nurse and have no right to judge the care he is given.
I have experienced lack of empathy and robotic care from nurses and while again I totally understand I am a new nurse and cannot possibly understand yet what it feels like to have 5/6 patients a day it still makes me sad for my dad that the people he sees everyday treat him like a number instead of a person. This is not every nurse as he has had some wonderful nurses. I am so thankful and blessed to have met some of the best nurses to date through this experience. It makes me sad that some nurses have responded on here with such a lack of empathy or remorse for the patient rather just defending why the scenario I described is acceptable and how I was out of line for bringing it up with the charge nurse.
Maybe I am naïve but I became a nurse initially to help but now after this experience I have been more determined then ever to be a nurse so I can hopefully make someone's worst day a little better. I just ask that some of the tenured nurses who have made some pretty harsh comments on here step back and think about the patient for a minute and not the job and try and put yourself in the patient's and their families shoes.
I have learned quite a bit about how I will react moving forward from these great responses and I appreciate those of you who have provided gentle constructive coaching versus those who seemed fairly malicious in nature. I truly appreciate it. I hope I encounter wonderful nurses like y'all in the future!
Sorry, LONG POST!!!! :)
I'm sure I'm one of those horrible nurses you've posted about with "such a lack of empathy or remorse for the patient rather than just defending why the scenario I described is acceptable and how I was out of line to bring it up to the charge nurse."
The first thing is that while you may have had good intentions, but your execution was faulty. You were behaving like a nit-picking know-it-all, and that rarely gets a good response.
Your assumption that I have no empathy or compassion is faulty. I've been where you are, with an ill parent in rehab. I've had an ill patient in the ICU for weeks on end, an ill spouse, an ill best friend and I've been a patient myself more often than I care to contemplate. Most of the care was good, some was excellent and some was . . . . not. The thing is, you cannot motivate someone into caring to YOUR exacting standards, especially not by being nasty. You can only motivate them into caring to the best of THEIR standards, and being nasty won'd do that.
You say that you know you don't know what it's like to have 5 to 8 patients at a time and try to do your best for each of them. But you don't truly understand that, you just don't. You don't get it. Your advice that "Some of the tenured nurses on here who made some very harsh comments need to step back and think about the patient for a minute and not the job and try to place yourself in the patient and family's shoes" is based on a faulty understanding of the situation. Most of us don't have to "try to place ourselves in the patient and family's shoes" because we've actually BEEN there. Many times. We've also been in the shoes of a busy, experienced nurse trying to do our best to take care of a patient despite a complaining, nit-picking family member and you clearly have NO idea what that is like.
Please try to see ALL sides of an issue before you go blasting away at the seasoned nurses whom you are going to be expecting to "train you." The only malicious comments I've seen on this board are your own "I'm NEVER going to be like YOU" comments.
I have been through what you are going through - my own mother going through this journey three facilities - almost being overdosed on Ativan because of her behavior and knowing in my heart that she is not going to get better and will never see the outside of a facility again. While we have had a contentious relationship it's still heartbreaking and I feel for you and your dad. If he is on his 3rd round of C-diff I suspect he never got rid of it in the first place - as the successful cures I have seen are people treated with 3 different broad spectrum ATBs for 6 months. 7 to 14 days on Vanco is not going to get rid of it and if the doc is not doing post treatment culture and sensitivity you are not going to know if it was successful.
I think the hardest thing for me to watch is a family come to grips with the fact that mom or dad is not going to recover fully or maybe not at all. That this admission to LTC is the beginning of the end of their journey. I have patients who are A nd O times 4 who know they are dying beg me to tell their families to just stop and let them go! Still because the POA will not face facts I keep passing the pills and the G-tube feedings going and providing pain medication on schedule even though the family doesn't want "Dad" who is 89 and suffering too knocked out or "Getting addicted."
If the Charge nurse treated you the way you describe then you have every right to take your complaint up the food chain. I truly believe that nursing is a service industry in many ways and we as nurses must always compose ourselves and deal gently but realistically with families. Still ordering her/him from the room was probably not the best way to handle the situation. Usually if a family member wants to see me - I am prepared that they have a complaint and take a moment to compose myself before walking into the room.
Rest assured I do care about your dad and actually do know the names and basics of every patient on my unit, But I have come into a room where the staff has done everything right only to have a family member angrily instructing them that this is not how they did it at home and that they (my staff) are total idiots who should never be allowed near a patient again.
Again I am sorry and apologize for all of us in LTC to work really hard to do it right. I'll admit that there are some less than stellar personalities out there but all we can do is continue to do our best.
I understand that people wanna jump all over her for being a new nurse and having lots of complaints but try to put yourself in her shoes? Her dad is very sick and that's a big life change and can really mess with ones emotions. I've personally never encountered bad care for family.. But if a nurse talked to me the way you described OP id be really upset too. Even the most annoying families of my patients still dont get treated that way by me.. I take their concerns seriously and am polite but stern if they are being over the top. The way she talked to you was unprofessional.
I am not there to see exactly the care he is getting but honestly, it's never gonna be as good as you want. Sometimes you have to put yourself in their shoes too. No facility is ever adequately staffed to care for your dad as you would. BUT they should not be letting a dressing be soaked in green drainage and say "oh but he doesn't have a fever."
In the time she took to insult you, she could have changed the dressing and elevated his feet.
Just my take on it.
That being said you might wanna try to smooth things over with staff before reporting her.. Just be very stern but polite in how you would like them to address the issues. People tend to listen more when you are nice but to the point. just take a deep breath and try to keep your emotions in perspective when looking at what the staff does.
I'm sorry that you're in such a difficult situation. I can't imagine how heart-wrenching it must be to watch a parent go through what your Dad is going through.
That being said, there is a textbook level of care we are taught as nurses and there is the reality of care that is provided within our medical system. We have widespread, complex systemic issues that need to be addressed before this reality is ever going to change. Nurses are working within a system that leaves us extremely thinly stretched. When we prioritize care, acuity takes precedence. Things like a turn or a limb repositioning tend to wait. Not to say that failing to do these things can't eventually have dire consequences, it's just that immediate ramifications are not always apparent. It doesn't make it okay that these things sometimes aren't done as frequently as they should be. But there is a broader context to consider.
From what I gather, however, you are in a LTC facility. In terms of acuity, your Dad's complex pressure ulcers should be one of the priorities. I don't think that it's unreasonable for you to advocate for this. And I'm sorry that you were made to feel otherwise by the charge nurse. You have every right to enforce what is most likely already part of your Dad's care plan (well hopefully already part of your Dad's care plan!). Your Dad is lucky that he has you.
In answer to your question: I don't think you can separate yourself as a nurse and yourself as a loving/caring daughter. You are both of those things. As nurses, we are trained to be strong advocates for our patients, question orders, implement plans of care, etc. This mode of thinking isn't going to go away when a loved one is the patient. If anything, it will be heightened.
However, be mindful of the fact that while you are a nurse, you are not your Dad's nurse. In this scenario, you are his daughter. Push for him to get the best care possible. Be wary of your expectations, though. Are you pushing for care that IS actually possible or are you pushing for textbook care?
This is by far the best response to the OP! I can't get over all the unnecessary rude comments. I too have worked in rehab as an LPN while I was going to school for my RN and I would have anywhere from 15-30 patients. Needless to say I didn't stay after I upgraded my title! It is near impossible to provide the much needed care to every single patient. State would come in to follow-up on patient complaints and I would always ask when the patient-to-staff ratios were going to change. The last time I asked (about October) I was told "very soon" (WA state). I pray this holds true because every patient deserves quality nursing care.
OP: I pray for a speedy recovery for your dad and please continue to advocate for him. Whether the nurse was busy or not she had no excuse to speak to you that way. Good luck :)
I have experienced the same attitude. Most nurses dont give a ****. Especially if you are a nurse yourself and know what care should be. They take any criticism personnally. My dying daughter was not be assisted to the commode. They gave her a urine pan to have a BM. They documented she got an enema prior to discharge but i knew they didnt do it. I can write a book. I will never go to a hospital, rather die at home with no nurses around.
This is by far the best response to the OP! I can't get over all the unnecessary rude comments. I too have worked in rehab as an LPN while I was going to school for my RN and I would have anywhere from 15-30 patients. Needless to say I didn't stay after I upgraded my title! It is near impossible to provide the much needed care to every single patient. State would come in to follow-up on patient complaints and I would always ask when the patient-to-staff ratios were going to change. The last time I asked (about October) I was told "very soon" (WA state). I pray this holds true because every patient deserves quality nursing care.
OP: I pray for a speedy recovery for your dad and please continue to advocate for him. Whether the nurse was busy or not she had no excuse to speak to you that way. Good luck :)
Oh I feel the pain you felt as an LPN. I truly give my all to my patients but I have 50! I was told in June 2015 that I'd be passing meds, "for a few weeks" and that then I'd get a med tech. Now 8 months later im still the only nurse with no med tech
So hard to give the care you want to when you're spread so thin! Which is why I am also going to get my RN!
I'm sorry that you're going through this. As many others have said... LTAC nursing STINKS. It's not necessarily the nurses fault either. The ratios of nurses and techs to patient's are horrible and it is nearly impossible to provide adequate care to all patients. You cannot be in two places at once. That does not excuse the charge nurse from being rude, however. You couldn't pay me enough to work in LTAC or a SNF. If it were my father, and I could not be there 24/7, I would do my best to hire a sitter. Someone who IS comfortable turning him, changing him, feeding him, etc. I work in a med-surg floor and I have had patients come with their own private hired sitters. It's quite nice for most of them! Some of them are nothing but a pair of eyes and company in the room to keep them from getting out of bed. Others are more experienced and will change briefs, bathe the patient, feed them (encourage them to eat as well). It makes a HUGE difference in outcomes for older adults with decreased level of function who cannot do their ADL's by themselves. I've had other families that will do that around the clock for their loved ones at home and in the hospital. In fact... just had a patient with a family like that this week. It was kind of irritating on one hand, because everything was questioned and it took a LOT of time and patience dealing with the family and explaining the plan of care, why we are doing what we're doing and why we can't try X instead. LOTS of messages to the doctor. As frustrating and time consuming as it was, I really REALLY appreciate the fact that they were trying to do the best that they could for their father. Before his hospitalization, someone stayed with him at his home at all times. They took shifts around the clock. They bought a lift to get him up to chair during the day. They patiently cut up his food and fed him. It was a labor of love and was impressive to see. He is a blessed man to have family that cares for him so much. Where there is a will, there is a way. You cannot, unfortunately leave the care of older adults to an LTAC or SNF and expect the best outcomes though. It takes work from the family as well.
Hi all, I am a new RN and am curious about some experienced RN's perspective on this topic. My dad recently had a very debilitating stroke. We have been to 6 facilities in 5 months and I have seen the good, the bad, and the ugly of nursing staff. "
MY RESPONSE: That's a lot of facilities in 6 months. From a hospital discharge standpoint, insurance doesn't change quite that often, and having been in the "business" for over 25 years, this is quite revealing. It is more due to family/patient preference, not insurance-dictates.
OP QUOTE:Often I find myself having to remind the nurses to float his feet for pressure wounds and turn him every 2 hours. He has been left in soiled diapers for longer then is acceptable among other communication issues.
MY RESPONSE: This will never be ok in a profession that demands 100% compliance, however, nurses do not yet enjoy enough autonomy and power to enforce the required staffing patterns that support this lofty goal.
OP QUOTE I draw a line this past weekend when I went and asked to speak to the charge nurse just to get more info since his assigned nurse was an agency nurse and didn't know much about his history or long term care plan. She acted so unprofessionally. If you have a moment to read our dialogue it is below. (It is typed because I intend on sending a complaint to the company.) If you want to skip that part I totally understand.
MY RESPONSE: If the facility is using an agency nurse, then they don't have enough of their own staff to come in regularly to pull extra shifts. This is quite telling about how the Management runs the home. I would place this as a red flag for further review of how the facility operates.
OP QUOTE[[[Nurse entered his room and immediately had an attitude which was demonstrated in her tone of voice and dismissive body language. She stated You asked to see me, what can I do for you?â€
MY RESPONSE: In what manner did you request to be seen? Did You "set the tone" of this meeting? Did the Agency Nurse, who has probably never seen your father before that day, come at you unprovoked?
OP QUOTEand I responded by stating my observations of the treatment of the heal. I stated that there were 3 nurses sitting at the nurses station (one of which had their phone out) and she immediately interrupted me by saying I don't have 3 nurses so that's not true.â€
MY RESPONSE: Why would you even bring up the fact that there are people sitting around? That's a pretty rookie assumption on your part; that sedentary activity = idle time. Especially in such a massive paper-bureaucracy that is a skilled nursing facility.
OP QUOTEI responded by saying Well I saw 3 people at the desk none of which offered to assist with my concerns.â€
MY RESPONSE: Could you please clarify: did you go up to them and ask " would you please reposition and attend to my fathers soiled attends?" Or did you just go up to the nurses station and hope to be noticed?
OP QUOTEShe interrupted me by stating What is your point, get to your point.â€
MY RESPONSE: I would be put off by that attitude. That was uncalled for.
OP QUOTEI stated My point is I came in and his heal was flat on the bed with a soiled bandage and I want to make sure it is off the bed as prescribed. There is available staff that are capable to attend to this task.â€
MY RESPONSE: That's a pretty big assumption on your part. Again, the people whom you saw at the desk might be early for the next shift and aren't even on duty yet. They could have attended a meeting and aren't even scheduled to work the floor. They could be clocked out, but are forced to chart off-the clock, because that's what happens many times in care facilities like that. Especially ones that use agency nurses.......
OP QUOTEShe interrupted me by stating I know you're a Registered Nurse so you think you know but I know how to run my floor and we are doing everything we can to assist him.†I asked to then speak to her manager who was currently unavailable.
MY RESPONSE: That the manager was unavailable to listen to family complaints speaks volumes, and is another red flag that I would file away, mentally.
OP QUOTEI asked her to please stick to the concern which was the wound as it had a green drainage that could indicate infection.
MY RESPONSE: If I thought my father had an infection, I would know that merely changing a dressing is not going to fix that. I would ask if cultures had been taken, does the physician know? Does he have any mental changes? What were his vital signs? Did you ask those questions? Or did you just tell her to change the dressing then and there?
OP QUOTEShe stated If the patient had an infection he would have a fever.†I responded by saying A fever is not the only systemic change a patient will have with an infection.†She interrupted me and stated I am not going to play this game with you. What else do you need?â€
MY RESPONSE: I think this was uncalled for as well. At this point in time, if I was not getting anywhere with the nurse, and I could not reach anyone in management, I would call the Dr's office and follow up my suspicion of a possible infection. Get an appointment for him to be seen, or at the very least, get a culture taken of the wound.
OP QUOTE I was completely floored at this point and requested she leave the room and please remind her staff to keep his extremities elevated.]]]
None the less, how do you balance being a nurse and having knowledge on how things should be handled versus being a concerned family member and letting things slide because you know how the system works?
MY RESPONSE: I don't get the impression that you know how the system works. I think you are a frustrated family member who is loosely familiar with how things should go, and expect a broken system to magically become un-broken when dealing with your father.
OP QUOTEI am so disappointed in how some nurses have acted and feel sometimes (with any job) when you have been doing it for so long you really probably shouldn't do it anymore if you lost your passion.
MY RESPONSE: Your side of the interaction with the agency nurse certainly seems to support the impression that the agency nurse was dismissive, sloppy, careless, and rude.
Try to take several more steps back and see the bigger picture. In nursing homes across America right this very moment, this scene is being played out over, and over, and over again. The system is broken, and it takes away the profits from the share holders to staff up to the higher standards of care.
As long as some nurse, somewhere, is in a position to be held accountable for getting everything done perfectly on his/her shift, instead of the management being held accountable for providing an appropriate level of staffing to enable everything to get done perfectly on every shift, this abhorrent care will continue.
You're berating the staff , who are getting it from both sides. You and the management.
I've seen this so many times, it is like watching the second act of a play that I've sat through 100's of times.
You want to REALLY do something to help your father? Go sit in managements office and make THEM answer for their staffing patterns. Go to your local legislatures office and demand laws that force nursing homes to comply with safe staffing to promote standards of care.
That's the big picture.
In the meantime, hire a private duty HHA to be with your dad to ensure that his care is given as desired. That is the reality of skilled
I feel your frustration. I hope you can channel it into a direction that an not only help your dad, but other dad's as well.
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Libby1987
3,726 Posts
He may not be tolerating them. Is he restless? Does that need to be addressed?
Or is the staff just non compliant, (I mean non adherent
) in applying the boots?
And are they the good boots or just the cheap ones?