Turnover

Mabel 29 · Mar 11, 2008

I turned in my resignation yesterday. I gave them 2 - 1/2 weeks notice. I've been at a LTC facility for 18 months, my first job as a new LPN grad. Yes, turnover is high. At this time, they can't even buy new CNA's!! No one applies. And the quality of the new nurses that they have been hiring has been questionable. I can't stand the backtalk from the CNA's and the talking about everyone behind their backs. Management has been staffing a unit that NEEDS 7 aides with only 5. I was called today (my day off) and asked if I would come in the 3 - 11 shift. (My normal shift is 7 - 3). I felt bad for them and said yes, I'd come in for a few hours. The administrator said thank you very much, and by the way, you'll be working the floor as a aide. Good Bye! I feel tricked and don't even want to show up. I can't wait until my time is up. I am soooo outta there!!!

TheCommuter, BSN, RN · Mar 11, 2008

Commuter, I am particularly interested in your responses.

I am not saying that all LTCFs have high turnover rates, but many of the ones in my metropolitan area do for a myriad of reasons.

1. Staffing - I have been the only nurse for nearly 70 patients, and I only had 2 aides helping with the patient load. These were not your traditional, stable LTC patients. I dealt with nightly seizures, chest pains, projectile vomiting, tracheostomies that needed suctioning regularly, about 10 feeding tubes that needed flushing and bolus feeds, 3 patients who needed to be sent out to dialysis in the morning, and about 20 diabetics. This was in addition to the ridiculous paperwork and charting that I could never seem to do.

2. Lack of support - This can be manifested in a number of ways. A power-hungry nurse manager suddenly decides she wants to rid herself of the current staff, so she looks for petty things that could result in write-ups or suspensions, up to and including termination. A house supervisor permits lazy CNAs to sleep while on the clock, take excessively long breaks, and disrespect nurses, but the same supervisor will not back up the nurse who attempts to get this same CNA to actually answer a call light.

3. Lack of supplies - I have worked at facilities that had no crash carts. If a patient coded, you basically had to conduct a third world rescuscitation effort. There's never enough gauze on hand to do dressing changes. There's never enough lancets or chem strips to do blood glucose monitoring. I need to fax something to the physician or pharmacy, but the fax machine has not been working properly in 6 weeks. There is often not enough linens to go around, so residents must use the same ones.

4. Family members - They rule the nursing homes. Management loves to coddle to families and kiss their butts. In LTCFs, "The family member is always right." They pressure the doctors into ordering unnecessary labs, xrays, and medications. They like to scream at the nursing staff and complain, frequently without looking at the big picture. Family members can often be abusive, threatening, and way out of line. Thank goodness I now work at a facility where many of the family members don't visit often.

Rexie68 · Mar 11, 2008

i didn't read the post you're talking about, but i agree that ltc has a huge turnover rate. i'm very lucky in that my facility has adequate supplies and a wonderful management staff, but it's still tough to keep good nurses and aides. i truly think that if you want to give quality care, you're going to have to pay better than the other nursing homes so that you can have your pick of the best. if we did that, staff wouldn't want to leave, and it couldn't cost much more than constantly training new cna's!!!! of course, the cfo doesn't want to hear that. it's tough to orient someone properly when you're short staffed...and it often scare them away.

as far as firing people, sometimes i think they'd have to catch someone "holding the smoking gun" before they'd fire an employee. we're all about giving people second chances...and third, fourth, fifth, etc.

pepperann35 · Mar 11, 2008

I work as a night shift supervisor in LTC. We usually have plenty of staff and the nurses are pretty good. We still have some turn-over with both the cna's and the nurses for various reasons, some personal, some work-related. Management could be more supportive and take less smoke breaks during the day. Complaints from patients and family members are sometimes can be very stressful when we are all doing our best. Paying more money helps but is not usually why we lose staff.

ShifraPuah · Mar 12, 2008

I am not saying that all LTCFs have high turnover rates, but many of the ones in my metropolitan area do for a myriad of reasons.
1. Staffing - I have been the only nurse for nearly 70 patients, and I only had 2 aides helping with the patient load. These were not your traditional, stable LTC patients. I dealt with nightly seizures, chest pains, projectile vomiting, tracheostomies that needed suctioning regularly, about 10 feeding tubes that needed flushing and bolus feeds, 3 patients who needed to be sent out to dialysis in the morning, and about 20 diabetics. This was in addition to the ridiculous paperwork and charting that I could never seem to do.
2. Lack of support - This can be manifested in a number of ways. A power-hungry nurse manager suddenly decides she wants to rid herself of the current staff, so she looks for petty things that could result in write-ups or suspensions, up to and including termination. A house supervisor permits lazy CNAs to sleep while on the clock, take excessively long breaks, and disrespect nurses, but the same supervisor will not back up the nurse who attempts to get this same CNA to actually answer a call light.
3. Lack of supplies - I have worked at facilities that had no crash carts. If a patient coded, you basically had to conduct a third world rescuscitation effort. There's never enough gauze on hand to do dressing changes. There's never enough lancets or chem strips to do blood glucose monitoring. I need to fax something to the physician or pharmacy, but the fax machine has not been working properly in 6 weeks. There is often not enough linens to go around, so residents must use the same ones.
4. Family members - They rule the nursing homes. Management loves to coddle to families and kiss their butts. In LTCFs, "The family member is always right." They pressure the doctors into ordering unnecessary labs, xrays, and medications. They like to scream at the nursing staff and complain, frequently without looking at the big picture. Family members can often be abusive, threatening, and way out of line. Thank goodness I now work at a facility where many of the family members don't visit often.

:bow: to all LTC staff. My God, the crap you all put up with!!! :madface:

tatgirl · Mar 15, 2008

Nurse hanson: do we work at the same facility? lol. I am so tired of having to scrape up supplies to do my treatments. My patients pay alot of money to be there, and by golly they deserve all the supplies that they need!!! Last week we ran out of iv tubing. Our policy is change tubing q48 hrs for just iv fluids, but change it qd for iv abt only. I had a man receiving iv Zosyn q6 hrs. We had to reuse the iv tubing for 2 days! We had no other choice. I love my residents but stuff like this is making me seriously considering leaving ltc nursing for other options. Add to the mix family members who are allowed to verbally abuse nursing staff (no mgt back up there), lazy nurses who never do their treatments, and manage to finish up their med-pass in less then an hour!!!! Alert and verbal pts telling another nurse on another unit that they hadnt gotten their am meds or insulin. LTC seems to be a no win situation for nurses and aides who truly care.....

Wendy LPN

squeakykitty · Mar 20, 2008

2. Lack of support - This can be manifested in a number of ways. A power-hungry nurse manager suddenly decides she wants to rid herself of the current staff, so she looks for petty things that could result in write-ups or suspensions, up to and including termination. A house supervisor permits lazy CNAs to sleep while on the clock, take excessively long breaks, and disrespect nurses, but the same supervisor will not back up the nurse who attempts to get this same CNA to actually answer a call light.
3. Lack of supplies - I have worked at facilities that had no crash carts. If a patient coded, you basically had to conduct a third world rescuscitation effort. There's never enough gauze on hand to do dressing changes. There's never enough lancets or chem strips to do blood glucose monitoring. I need to fax something to the physician or pharmacy, but the fax machine has not been working properly in 6 weeks. There is often not enough linens to go around, so residents must use the same ones.

:spbox:

I bet the state would love to hear about the place. Any CNA who is lazy is neglecting residents somewhere. And having no crash cart? The owner probably couldn't afford one because he had to make payments on his new Mercedes. :madface: :angryfire:barf01:

TheCommuter, BSN, RN · Mar 20, 2008

:spbox:
I bet the state would love to hear about the place. Any CNA who is lazy is neglecting residents somewhere. And having no crash cart? The owner probably couldn't afford one because he had to make payments on his new Mercedes.:angryfire:barf01:

Many bad LTC facilities miraculously get their acts together when the state is in the building. Hence, these places remain in operation year after year, with only a handful of minor state tags.

squeakykitty · Mar 20, 2008

Many bad LTC facilities miraculously get their acts together when the state is in the building. Hence, these places remain in operation year after year, with only a handful of minor state tags.

That isn't right at all. I wonder how they find out the state is coming? I don't think they should know the state is coming until they see the surveyor come through the front door. At the place I worked, they knew the state was coming a day in advance. The place was a decent place, though.

Lovely_RN, MSN · Mar 21, 2008

2. Lack of support - This can be manifested in a number of ways. A power-hungry nurse manager suddenly decides she wants to rid herself of the current staff, so she looks for petty things that could result in write-ups or suspensions, up to and including termination. A house supervisor permits lazy CNAs to sleep while on the clock, take excessively long breaks, and disrespect nurses, but the same supervisor will not back up the nurse who attempts to get this same CNA to actually answer a call light.
3. Lack of supplies - I have worked at facilities that had no crash carts. If a patient coded, you basically had to conduct a third world rescuscitation effort. There's never enough gauze on hand to do dressing changes. There's never enough lancets or chem strips to do blood glucose monitoring. I need to fax something to the physician or pharmacy, but the fax machine has not been working properly in 6 weeks. There is often not enough linens to go around, so residents must use the same ones.

This is the story of my life right now! I have a ruthless NM who is out to get me and I spend way too much time out of my shift looking for stuff! The other night I wasted almost half an hour trying to find a wound culture bottle. The (new) night supervisor is a BS artist who weasels her way out of doing her job and I am fed up to "here" with this place already. I have been there a whooping 7 weeks and I am actively searching because I will not have a license if I keep working at this place.

I want to add that I know that other LTCs are basically the same but I just need a floor where the NM isn't out for my blood because with the conditions that I am forced to work under there is always going to be something that doesn't get done the right way.

bethin · Mar 21, 2008

3. Lack of supplies - I have worked at facilities that had no crash carts. If a patient coded, you basically had to conduct a third world rescuscitation effort. There's never enough gauze on hand to do dressing changes. There's never enough lancets or chem strips to do blood glucose monitoring. I need to fax something to the physician or pharmacy, but the fax machine has not been working properly in 6 weeks. There is often not enough linens to go around, so residents must use the same ones.

What is it with LTCF not having crash carts? I did my training in a facility that had no crash cart with residents who were full codes and we were urged not to obtain CPR certification.

I sometimes work in the LTCF that is attached to our hospital. We have residents who are full codes and we have to get our crash cart from another floor. How the heck am I supposed to carry a crash cart up the stairs when you can't use the elevators in an emergency? And what if the floor that I take the cart from has a code? It's a bit like stealing from Peter to pay Paul (or however that saying goes).

Personally, I would never place a loved one in a place that couldn't provide the most basic necessities. I fear though that when the time comes that my db and I have to think about taking care of our parents that there will be no even halfway decent facilities around.

Think our insurance system needs an overhaul? Try LTCF needing a big overhaul.