Turnover

[michael79]

I read a reply in an earlier thread about employee birthdays and the reply from the Commuter talked about turnover in LTC being almost 100% or employees were fired. It got me to thinking, why is that? What causes most nurses to leave LTC and why are most employees fired? Commuter, I am particularly interested in your responses. You and I think a lot alike! PM me if you'd like!:nuke:

[handyrn]

Ok, at the risk of stepping on toes, which I DO NOT mean to do, I will offer my 2 cents worth and give you one reason why I have seen staff turnover on the nursing part.

First of all, I would encourage anyone who has not done so, to read my article entitled "Tips for Geriatric Nursing" in the articles section. In there, I state that, despite popular belief, it is NOT EASY to be a LTC nurse!

That being said, we all know that there is a "so called" nursing shortage. Therefore, there are a lot of people (in my area at least), being encouraged and given incentives to go to nursing school. They are told about how great the money is (ha ha) and how rewarding it is to help others. The problem is this: the counselors at the colleges are not nurses and know nothing about nursing. Hence, we are turning out nurses that maybe have no business being nurses. And where do they end up? At a nursing home because someone along the way has told them that if you can't do anything else, nursing homes are always desperate.

Face it, not everyone is cut out to be a nurse, just as I was not cut out to be an accountant. But why, oh why, do nursing homes have to hire every new grad that comes in the door that was never meant to be a nurse?

Again, there are many competent nurses in the world, but I think we all have been exposed to one incompetent one in our life, right? So I am not stepping on YOUR toes here, I am stepping on theirs. Whoever they may be.

[Rexie68]

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.

i'm not quite even sure where to begin.....

ltcf's don't have crash carts because we're not staffed or equipped to run a code. we don't have a doctor in the facility 24/7....he makes rounds twice a week. we can't intubate or shock someone....we can push iv meds, but don't have standing orders to treat arrhythmia's, etc. that's the difference between an acf and a snf. if a pt who is a full code goes bad, we ship them out to the er. if the pt is already coding, we perform basic life support-cpr, oxygen, maintain an airway, iv fluids if we can get access, though not every facility will attempt a start, and call 911.

there are decent ltc/snf facilities out there...but it takes a lot of dedicated staff and management.

i do agree that ltc needs an overhaul...but more government regulations is not the answer. we already have more regs than a nuclear power plant and spend a lot of time and resources keeping the state happy, as opposed to focusing on our residents quality of life.

but...it's what we have to work with right now, and many of us are competent nurses who know how to assess a pt quickly and act independently. i can pass meds to 50 pts, admit someone new, take doctor orders, change 11 dressings, do all my charting, help feed, answer call bells, hold somone's hand, educate familes and start an iv.....all in one shift. we definitely know how to multi-task and organize.

as with anything, there are good and bad, pros and cons. some of us just keep doing it because we love working with the elderly and having a bit more autonomy than you do in a hospital setting.

[Hospice Nurse LPN, BSN, RN]

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.

:typing

Ditto to most of what the commuter said, but especially the lack of supplies. Last weekend I ran out of test strips, linens, and GLOVES! When our shift started, I went to the supply room to get gloves for the CNA's (I had a box on my cart) and there was ONE BOX! Of course, the DON stated she wasn't on call and not to bother her. We made due with what we had.

I tried to fax the med. director and found out he now turns his fax machine off on weekends because the nurses fax too many things to him. Hello....your the doctor!

We don't have a problem with families at our facility. Most of our folks don't have any family and the ones that do, never see them. Many are wards of the state.

Oh well, just wanting to finish school so I can leave LTC. I love my residents (and some of the staff!) but it is such a thankless job.