Unsafe situation? Need advice, please.

[BabyRN2Be]

Where to begin. I'd like to keep this short not only for HIPAA reasons, but because I'd possibly spend the entire night explaining this situation. I'm a relatively new CNA. I've worked in hospital situations so I'm not a totally green but I am new to geriatric LTC. I took a job recently and I'm wondering whether I should continue. I guess I'm wondering if this is the norm for LTC or if I should just change jobs. Part of the reason why I took this job is so I could gauge if nursing is right for me, I believe I have that answer but I'm wondering if this job situation is normal for CNA's or is this an unsafe atmosphere. I took this job working with Alzheimer's patients and I was under the impression that most of them were on the higher end of functioning and that I would be working with 3 patients. This was a home situation and not a facility. Although I knew that I would be doing the cooking and cleaning for them as well, with 3 people I thought that I could handle it. It would be a slight challenge, but doable. When I got there, I found out the situation was different. There were 6 patients, 3 of which were higher functioning, 2 not as well off as the others, and one was total care. To care for this group would be one CNA (me). No LPN/RN's, no other CNA's. Just me. On top of the normal CNA duties, I would also be expected to cook and clean up for part of breakfast, lunch and dinner while trying to keep an eye on the residents - a few of which are ambulatory and wont to explore the place. The one total care does not leave his room. I would be expected to come to his room in another part of the house and feed him, while the others are in the main room. This bothers me. I'm still in training with an aide but I will be expected to do all of this, alone. One day while in training, the other aide was feeding the total care resident and went to go get something for her and happened across the main room. One of our more unsteady residents was walking around. As I was guiding her back to her chair, she almost took a spill sideways onto her chair. It scares me to think what would have happened if I wasn't there. I told the other aide about this incident, and she told me, "Falls happen. You've got to expect it." But I'm thinking, "But this is a fall that was totally preventable if one had an eye on the residents and not having to be in another room tending to the basic needs of another resident." Am I wrong in this? This is one of many problems I have with working here. I believe that this job would be great for me, IF I had one other person to help me out. As it is, it's busy enough with two people but I'm terrified of doing this alone. But I'm wearing myself out with the physical needs of 6 residents, cooking full meals, feeding residents, toileting/changing, cleaning up after meals, doing pt laundry, being sure that no one tries to leave (there is an alarm system), keeping everyone safe, monitoring physical conditions, etc. At no time have I received a basic report when I come on, and as of yet, no one has sat down with me and explained the particular problems with the residents. I feel that this is not a good situation, but if I leave, I'd miss the residents. I've already become attached to them and I'd be concerned about them after I leave. There are other problems but I don't want this post to be too long. I'm just explaining the basics here. Bottom line: Is this normal for LTC and I need to "toughen up" and give it time or is this a situation which may spell disaster? Thanks for any insights you all have. BTW, my original question to myself was answered, that is, is nursing right for me? I believe with my heart that the answer is yes. It's just a matter of saving up money to pay for school (I don't want to take out any loans). I'm sorry if this is hard to read as I'm having trouble with formatting.

[BabyRN2Be]

I'm having such problems with formatting and I didn't want to make that post worse. I will also be expected to set up and pass meds after I get that certification. I also need to get a food handler's permit as I will be doing the cooking for a group of people. Again, thanks for any help. I know that this is just six people, but it seems like too much for one person. Maybe I just need to get used to it... ??

[beautifulb]

I have never heard of a place like that. It seems like a lot of responsibility. Is there a DON? Actually, is there even a nurse? Discuss with them your concerns.

"Are you right for nursing?" Nursing is something that you want to do. And people will argue this, but for me, nursing is in me. It is what I have wanted to do since I was 5 y/o. There are many nurses who do their job because they like to help people. And there are lots of ways of helping.

There are many places that you may not like and that is okay. Keep searching for the job that you do want. Have you worked as a CNA in a hospital? You will get lots of experience that way.

Good luck with what you choose to do.

[Midwest4me]

This facility sounds like a group home/assisted living home to me. You thought you'd only be responsible for 3--is that what you were TOLD or just assumed? If you were told this, the job was obviously misrepresented. Have you talked with your supervisor about your concerns? I would do that and ask about he residents' problems---are you also giving meds? How long has the home operated this way---months, years? What's the protocol if someone is injured--have they gone over this with you? Are you supposed to be receiving report(seems only appropriate) from the previous shift? And if so,and you are not getting report, talk to the supervisor about it.

I can see your concerns are very valid and yes, I think it's unsafe....(my daughter works in a similar setting) for you and the clients----I work in group homes too but we have 5 pts and 2-3 direct care staff to care for them.

[burn out]

If you believe that you are in an unsafe situation then it is time to leave. I have left jobs before when I believed that my license were on the line the same should hold for a certificate. You have worked hard and earned your certificate and it is your livlihood and you must protect yourself and I am not for sure if I would even give a two week notice..it is not worth it if you think your license is in jeopordy. I would write a letter of resignation and explain why I couldn't come back and when administration sees that it leaves them in a bad light they might change their policy but for right now the only thing that you can change is yourself. Good luck I don't think there is anything you can do but leave.

[BabyRN2Be]

I have never heard of a place like that. It seems like a lot of responsibility. Is there a DON? Actually, is there even a nurse? Discuss with them your concerns.

As Drifternurse said, this is a group home and I feel that the level of care of above assisted living. There is no nurse with me, other than hospice visits and I know that they are there to see their patients, and not help me. As far as I know, none of the owners have their LPN/RN's either.

"Are you right for nursing?" Nursing is something that you want to do. And people will argue this, but for me, nursing is in me. It is what I have wanted to do since I was 5 y/o. There are many nurses who do their job because they like to help people. And there are lots of ways of helping.

Actually, I've always wanted to be a nurse, but I wanted to actually have a taste of what nursing is like before I spend all the money on school and find out that it's not right for me. My mom is an RN and she always said that she wouldn't support me if I became an RN. However, I believe that she is wrong (sorry, mom!).

There are many places that you may not like and that is okay. Keep searching for the job that you do want. Have you worked as a CNA in a hospital? You will get lots of experience that way.

I have worked as a doula (professional childbirth assistant) in a hospital, but not as a CNA. This is something that I would like to explore (hospital work, that is). I know that I'd gain a lot of experience that way.

[BabyRN2Be]

This facility sounds like a group home/assisted living home to me. You thought you'd only be responsible for 3--is that what you were TOLD or just assumed?

When I originally inquired about the job, I was told that it was 3 people. We were going on vacation and he told me to call back. I called back a few weeks later and was hired. I was not informed that in the interim they consolidated houses and brought 3 more people in and I discovered this when I walked in that day.

Have you talked with your supervisor about your concerns? I would do that and ask about he residents' problems---are you also giving meds? How long has the home operated this way---months, years? What's the protocol if someone is injured--have they gone over this with you? Are you supposed to be receiving report(seems only appropriate) from the previous shift? And if so,and you are not getting report, talk to the supervisor about it.

I will be talking with my supervisor this week. I just wanted to ask to see if this was the norm for a long term care group home situation. I will tell him that I thought that the level of acuity was lower than it actually is and that I'm concerned about what could happen if I'm in another room and there's an incident in the other room.

Also, in answer to your question, I will be expected to set up and pass my own meds. The only problem (and this might be a way to make a graceful exit) is that I'm not certified and the next available class is not until fall. I can't see how I can go 12 hours w/o someone needing some type of med. No one has taken the time to explain protocols to me. With the exception of one, the aides do not want to take the time to explain procedures with me. It's not that we don't have some down time in the afternoons, it's just that they want to be on the phone with other people. The CNA who wanted to explain procedures, show me charting, etc is no longer employed at this home.

This is only within the last week or so that they've moved 3 people over. I just don't see how anyone one CNA can do this. I know that I could do the job if I had someone with me, another CNA but the owner said they couldn't afford having 2 CNA's at the same time.

Thank you for your insights and I see that 5 people with 2-3 direct care people might be more towards the norm. I just can't see how one CNA can do all this within 12 hours.

I want to give more than just the basic care to the residents. I want to take the time to show them I care for them, beyond the basic feeding, changing briefs, etc. This is what they deserve but I feel so bad that I don't have the time to just sit and talk for just a moment. I've grown to love these people in just a short period of time. I'm going to miss them if I leave.

[BabyRN2Be]

Just an update, I have left this job. I have decided that this is too much for me to deal with at this time.

Incidently, my husband's grandmother was at that home. Not anymore. My MIL found out the conditions of this place NOT FROM ME, but from someone else. She's being moved to an Alzheimer's unit in a nursing home which happens to be right behind our house. I'm interested in employment at this home; however, they really take care of their employees and many CNA's are clamoring to work there. I've been told I need a little more experienced in order to be considered.

Last time I heard, they are still running this home with 6 (now 5 with my dh grandmother leaving) patients and one CNA. I'm still sad because these patients are not getting the care they need and deserve.

Just wanted to update you all and thank you for your replies.

[azhiker96, BSN, RN]

If the place you live starts with an A and ends with a Zona, you might want to check out Banner. They have a lot of facilities and pay fairly well. You can check their job listings online. They also have programs to help their CNAs get their education to become RNs.

Good luck!

[chadash]

Six patients, as you describe, would be considered a very light load in LTC, but the problem in your situation is that there is no consistent supervision for the patients while you are, for instance, caring for the total care pt in his room, and making meals. In LTC you might have 15 patients, but you are not alone on the floor, and there should always be a nurse. Assisted living can be a bit hairy, I worked in one place where...never mind, you wouldn't believe it .

This sounds a bit risky to me. What are the regulations for this type of home, and are you certain they are meeting these?

Also, if you are there alone, how are they getting their medications at this time?

As far as whether you will like nursing, you sound like a sure thing to me! :)

[gr8rnpjt, RN]

BabyRN2B,

You did the right thing leaving. Do not worry about the residents. They have families that should be worrying about them and you cannot save the world.

I am concerned that you will not realize your dreams if you try save up the money for school. I know how it is trying to save up the money and it never seems to work. Have you looked into hospital-affiliated schools that offer loan forgiveness if you give them 2 or 3 years after you graduate? You seem to be a very loving and compassionate person and you should be able to realize your dreams without having to save up the full tuition.

[penguinCNA]

I am so sorry to hear about this situation. Listen...I have been a home health aide/private duty for over a year. I have also LTC nursing home care expirience. Never in my career have I ever been in a situation like this so I know that you must protect yourself by leaving this case. You have been given too many people to care for who have needs that are extensive. By this I mean that they are Alzheimers patients. I have "specialized" in the alzheimers unit at a nursing home enviroment as well as private duty. Many patients need "one on one" care because of their state of mind. It doesn't matter if they are functional or ambulatory, as sad as it is to say, most are like taking care of a child or toddler. Taking on 3 cares I think is crazy for one person but 6 is out of control and you are putting yourself in a situation where you can be held liable for anything and everything. Then to train a new aide on the case while you are fully expected to fulfill your daily duties with 6 cares. I'm sorry darling....please save yourself! I commend you on your soft heart and willingness to serve the community and care for those who cannot care for themselves, but you must learn to protect yourself too. This situation, I feel, is not "kosher". In my opinion you can only be a good nurse if you are given the proper environment and tools to do so. This is not one of those places. How helpful will you be if you are blackmarked on the registry for unsafe practices?! How will your spirit feel if you could have prevented a bad situation if there was enough people for the amount of care needed? Don't put such a huge burden upon your shoulders. As hard as it is to walk away, it is better that you don't have regret and problems from this situation. Being in the nursing profession can be tough. It is equally rewarding as well but a lot of times nurses get the short end of the stick and this is one of them! Please....at least consider what I'm telling you. Feel free to speak to me about this more. I have stories and maybe some helpful things to say. I do hope that I'm not offending you. I feel that you were greatly and grossly misled by whomever or whatever and I wish to see you free yourself from it. Contact me anytime!