Should I stay at this facility???!!

[wendyd]

Hi,

I am working on my pre-reqs for the RN program. In the meantime, I decided that I would start working in a nursing home as a hospitality aide and then take their CNA course. I thought that being a CNA would help me get some clinical experience and would help me in the long run.

I had my first shift at this facility last night, and am now re-evaluating my entire plan. I am so dis-illusioned and saddened at what I saw.

I have to work around my dh's schedule, so I have been scheduled for an odd houred shift. I started at 6pm and worked till 2am.

When I arrived at the station, the whole place was in a chaotic mess. The (agency) charge RN did not even know that I was coming by the way. There are 60 beds in the skilled unit. There was 1 hospitality aide assigned to all 60 beds! There was 3 CNA's on shift (20 pts each), 2 of which had just finished the CNA course and of those for one this was her first night working on her own. There were 2 LPN's, I think one was agency. Aren't these nurse-patient ratio/s dangerously low??

The residents had just finished dinner and the aides were bringing them back to the unit from the dining room. They were then parked in front of the big screen until a CNA could take them to thier room for the night. Many were crying that they wanted to go to bed. Begging, pleading with anyone who walked by to please help them, etc, etc. As a hospitality aide, I of course could not put anyone to bed, or even take any time to even try to comfort anyone as I was now helping the other hospitality aide that was assigned to 60 beds.

All of the CNA's were extremely rude to the patients. (They were all young, early 20's). I had a very hard time with this. I understand that they are totally overworked and that many of these pts have a habit of repeated nagging, etc...but they are human beings and I just couldn't deal with it.

I helped out the best that I could where I could. I think all of the pts were finally in bed by 9:30 pm. The CNA that I told you about that was working her first night on her own was reprimanded for not working fast enough. (I am not sure by who)

These CNA's were busting their ass. They never sat down the entire eve. Their faces were flushed and they were highly stressed. Not one had ANY break or lunch. I did not see anyone wash their hands or wear gloves in any of the rooms.

Around 11:00 things quieted down. Third shift was very quiet until I left at 2 am and for the last two hours there was nothing for me to even do.

I would like your advice. I do not have to work right now. I do not want to return to this place. It really looked like a nice place when I was interviewing. Very clean, many procedures in place, and seemed very well organized.

But these people are not being taken care of!! They are being fed and washed, and that is it. There are activities, yes, but the nurses have such bad attitudes because of their being so short staffed and overworked that they do not even talk nicely to these people or try to comfort them at all. The person that was the greatest with the pts was the hospitality aide...and she is quitting in 2 weeks!

I am wondering what you all think of this situation and what you would do if you were in my shoes?

What is the PA state regulations for nurse-pt ratios?

Thanks for your advice,

Wendy

[nightingale, RN]

Wendyd:

Follow your gut... it willl get your through a lot of situations that simply (uh oh) don't feel right......

If you do not have to work yourself through nursing school then don't.. Take the extra time to work on your clinical skills in the lab at school..... Often, we will simply pick up bad habits by working in bad facilities.... Ivory tower nursing is often what nursing school is about... Charm your insturctors socks off by carrying gloves around all the time in your pocket and first and formost know how to keep your patient safe....

There is enough time to deal with the reall world of nursing work when you have your degree in hand and do not have to work in facilities that provide inadequate and unsafe environments for patients.....

Good luck to you.....

[aimeee, BSN, RN]

Wendy, that sounds awful! I'm sure you can find somewhere else to work that will be better. I worked in a facility like that for a short time and I felt physically sick every time I had to walk in the door. Find a place where you can feel good about what you do.

[debbyed]

I'm sorry you have had such a bad experience and I agree with those above.

A situation like this could actually be harmful to your school work as you may get burnt out before you start.

You reason for wanting the experience is a good one, but since you don't need a job, leave this one behind. Talk to other students who work and find a place you can be confortable with.

[nur20]

THIS, SADLY, IS THE STATE OF AFFAIRS IN THESES FACILITIES. THIS IS SO HEARTBREAKING TO ME BECAUSE I LOVE THE ELDERLY, AND THERE NEVER SEEM TO BE ENOUGH STAFF TO TAKE CARE OF THEM PROPERLY. THIS NURSE TO PATIENT RATIO SEEMS A BIT HIGH, PREHAPS THIS FACILITY SHOULD BE REPORTED TO THE STATE. MY EXPERIENCE IS THAT THE ONLY TIME THAT THINGS ARE PUT IN ORDER IS JUST BEFORE INSPECTION TIME, WHICH LEADS ONE TO BELIEVE THAT THEY ARE 'TIPPED OFF' THAT THEY ARE COMING. YOU WOULD NOT BELIEVE TE HUSTLE AND BUSTLE THAT GOES ON AT INSPECTION TIME.HOWEVER DON'T LET THIS DETER YOU FROM YOUR CHOSEN CAREER.I WOULD NOT ADVISE STAYING THERE IF YOU ARE NOT HAPPY, YOU JUST HAVE TO FIND YOUR NICHE IN NURSING, YOU'LL BE FINE.GOOD LUCK, WE ARE HERE FOR YOU VISIT MY WEBSITE

[AGI]

We need you in nursing, keep going. There are alot of facilities out their that put the resident first! Yes, the ratio is way too high. I too wonder how to take care of each residents needs, and it seems as tho those needs are having to be met all at the same time. I have no magic answers, but as you go through school and become a nurse, never lose sight of the goal, never will you forget the experience and that will make you a resident advocate and a true nurse.

[jkw]

I agree, I think you need to go with your gut. If it were me, I would contact a local hospital that maybe your doing your clinicals -and see if they have an internship program or even some time in which you can just observe some time- a teaching hospital is very good about doing this. I think you would have a better learning experience. I wish I had done the internship like some of my collegues had done. Because sometimes when you get into longterm care, it is very difficult to get into a hospital.

Good luck. JKW

[CoachCathy]

Wow, sounds like you had one heckuva night! What you may want to first see, when looking at the staffing, is were there call-outs, etc. Once in a while working with less-than-minimal staffing can happen. You know - some one calls in, has a sick child, etc. If they had four (or even five) CNAs scheduled, it takes the ratio down to 1:12, 1:15, which is really good (at least for around here). North Carolina doesn't look at exact staffing ratios, it looks at personnel-hours-per-patient - meaning how many hours a day does an employee of the facility actually provide care for the resident. Amazingly enough, for NC the requirement is only 2.1 hours/day. There are chaotic nights whereever you may go - was this an exception, or the rule. A code blue, patient de-sat-ing, seizures, someone calling in at the last minute - all can make things pretty crazy. There is simply no reasoning for the rudeness to the residents. I wouldn't ignore that - it will only get worse. You should report it (annonymously if you are uncomfortable) to the DON/ Administrator. Both of these individuals have a personal interest in curtailing verbal abuse - they could both be held personally responsible for the actions of their employees if someone were to sue. (This has actually happened, where the Adm. was jailed for the actions of a CNA).

Side note to Nur20- At least in our state, we aren't 'tipped off', but we know when our window is open for inspection. Yes, we do try to tighten up during that window - focusing on the details, crossing the 't's and dotting the 'i's, but I don't think it is any more than hospitals do before JCAHO....

[betts]

Hello! The client/patient comes first. You were witness too clear violations of patient rights. The responsible thing too do is contact the State Board of Health and report your experiences.

The attitudes of these so-called nurses is unethical and irresponsible and could be life threatening as well. The State Board of Health will investigate and isn't allowed to disclose the source(s) of any complaints.

Please, DO-NOT judge nurses or nursing for the actions of a few; continue your education and make a difference, set an example thats positive.

What happened too you makes me LIVID! Even if they were over-worked and shorthanded, that's NO-EXCUSE for their indifference as to the care they took an OATH and promised too do.

[mtgirl63]

Sounds pretty wild and sad, but it also sounds like there was more staff available than what we usually have on the 3-11 shift in our 60 bed facility. Normally we have one LPN for the full 8 hours, and one that comes in from 6-9pm to help with meds and treatments. Then we usually have 4 CNA's and once in a while an additional aide that comes in from 4-8 to help in the dining room and help get people ready for bed. We don't have hospitality aides so I don't know what that job entails. The aides work hard but are very kind to the residents (our facility has a zero tolerance for abuse -- including verbal) and they DO get their breaks. I think, like everyone else has said, you need to go with your gut feeling. I don't think working in this facility (if this kind of night is a norm that is) would be beneficial to you in any way!! Good luck and hang in there!!!

[Catsrule16, RN]

Sorry you had such a day. In South Carolina, there are some minimum staffing requirements set by the State.

In SNF's for Nusres (RN/LPN) 1:44

1st shift CNA 1:9

2nd shift CNA 1:15

3rd shift CNA 1:22

These are the minimum. I worked in a facility that just met these standards. Didn't work there long... I was too worried about my license. One nurse there had no problem picking up the phone and calling state boardswhen the person responsible for staffing didn't have the minimum. I now work on the regulatory side of LTC.

Go with your gut feeling. If you stay may I suggest you keep a journal. It doesn't have to be detailed. I inspected one facility where a resident kept a calander of the staffing on her unit. When it was compared to the staffing schedule and staffing ratios required, the facility was cited.

[oldfolksnurse]

I agree, it sounds like you had a bad first night and it also sounds like there were some staffing problems. What I am going to say is off the norm from the rest of the group. You have seen the bad, now, what can you do to make it better? It sounds like this facility may need you and you can be a positive influence on the staff, if you choose to be, but that is your choice. You may be able to make a difference in the lives of many of those residents who were sitting in front of the TV waiting to be put to bed...and let me tell you...making the difference in one old person's life is worth all the bad feelings you have experienced. Good luck, I hope you make a wise choice - the one that is right for you.