Want to hear your pet peeves in LTC nursing

fairyluv · Oct 28, 2013

Every CNA on the hall who has to tell you that so and so has a cough and you need to listen to her. Yes I'm sure I probably do, but I don't need every cna on the hall to tell me that in a matter of 5 min. then run and tell everyone i didn't do anything...ah yes I did, I got x ray order and got exray done.

doctors/apns who don't want to talk to families. family member wanted to know who authorized sending pt to hosp. and why. Told family member who made the decision and why. Family member said they would be in to talk to APN/DR. Tell APN?DR and get told that family member has to direct all questions to charge nurse (not unit super). Ah I am the charge nurse and I can't tell family member why doc made that decsion.

Mngmnt that wants to admit every tom dick and harry under the bridge and keep them in a bed til they are nearly dead before they let us send them out to hosp.

Hosp who send them back while they are still nearly dead. Just for us to send them right back.

Starting my shift off by sending someone out to the hosp. because they are nearly dead and previous shift says they weren't like that and hr ago. really ?? they are in ICU now.

And the nurses who say i am incompetent because I have poor time management. Really ?? i swear everyday I worked for a solid week I sent someone out to the hosp before I even started my first med pass. Because mangment was hoping they would improve and we wouldn't have to send them out. in other words don't call the doc yet, we have to give him something substantial rather than a change in mental status...IT'S A HUGE CHANGE IN MENTAL STATUS. When you go from being outgoing, alert, oriented to lethrgic, combative and uncooperative. One night I sent out 4 back to back. I was 2 hrs behind on my med pass and no one to help with the discharge orders because they were busy with there med pass. and my UM left after telling me to get the discharge orders started on the 3rd one and call about getting the other one sent out to.

Being told by UM you're a great nurse you can do it !!

I DON'T FEEL LIKE A GREAT NURSE !!

that annoys me.

CloudySue · Nov 4, 2013

I DON'T FEEL LIKE A GREAT NURSE !!
that annoys me.

Gee, that sounds familiar. I always left my facility knowing in my heart of hearts I did a craptastic job, although I gave it 110% every day. Unfortunately I needed to give 150% and most days that was logistically impossible. Now I'm in peds private duty. I give the best care and feel great about myself with no doubts or hidden shame. There's time to keep my kids in tip top shape AND write this post.

NutmeggeRN, BSN · Nov 4, 2013

Staffing based on census and not acuity.

oliveoil · Dec 10, 2014

I can't help but to agree with everything here that everybody posted. It's very nice to know that I'm not the only one feeling this type of way with the little and very big pet peeves that can affect work!

But I must say I'm surprised that there are some things in here that have not been mentioned. So here are some of my pet peeves that I've seen and experienced:

1) I don't care if you're not a CNA, if you answered that damn call light, you can easily get that resident their pitcher of water or empty the urinal. Don't chase the assigned CNA down for simple stuff, especially if they are in the middle of passing trays!

2) RN supervisors or DON who don't inform you of any admissions coming in on your shift until they come in.

3) Poor management. Enough said.

4) New inexperienced nurses who are in orientation and think they know everything but when it comes down to doing the real deal such as giving report to paramedics and what nots they turn to you because they don't know what to do. All in all, you are a front!

Take care all.

hnwbeachbum · Jan 28, 2015

-Coming in at 7 pm and spending the entire first hour of my shift receiving phone calls from family members wanting to know what happened in therapy that day, and how their family member is doing. Well nothing of concern was reported to me, so I'm going to assume that your family member is still alive. Perhaps you should call during the daytime when they actually receive therapy?

- Nurses who spend their whole shift picking apart charts and MARs for everything the previous shifts didn't do. Look, I've found meds you forgot to give too. I'm not saying it's okay, but if no one's dead, how about we cut each other some slack. The only thing that's going to come from turning each other in all the time is less staff because people are getting fired.

- Neb treatments scheduled for 12am and 4am. I understand they were in the hospital with pneumonia, but perhaps sleeping more than a couple hours at a time would also be beneficial to them, and we could do Q4 hour treatments when they're awake.

- 90 year olds on Vicodin. Was there no other solution for their arthritis? Really? Throwing a narcotic at a problem drives me insane.

- Our weekend supervisor who thinks that just because she's an RN and used to work on a stroke unit at a hospital, she isn't required to answer call lights.

- This is probably a nitpicking thing, but nurses who use bad grammar. I've seen nurses chart "admitt", "I seen so and so do this", "Nurse called a cold blue". Oh, and while we're on the subject: the nurse who called me from another floor the other night because she couldn't figure out what her order said. Apparently she didn't know what "CXR" and "PNA" stood for.

- PAPER MARS!!!!!!!!

bethann27 · Jan 29, 2015

LOVE this one: management by crisis! That's such an excellent way to describe the whole problem!

Every single frustration in LTC could be solved by setting policy, sticking to it, laying off the ones who really don't want a job and allowing the ones who do to fully utilize their abilities. Simple, professional environment is what's needed. Healthcare organizations could learn ALOT from Publix and Chick fil A on how to run a successful and profitable business.

Some times I'd rather be bagging groceries lol

amoLucia · Jan 29, 2015

I know this is an old thread, but with the terrible bad weather we just had --- don't you just love it when families call to ask you to tell their pt they couldn't make it in r/t weather. Then they ask you is there enough staff to do care.

Well, THERE WOULD BE if I wasn't having to answer the phone non-stop by them all!!!

CoffeeRTC, BSN, RN · Jan 29, 2015

Hows my mom?

running out of supplies

pistolchick · Jan 29, 2015

-Coming in at 7 pm and spending the entire first hour of my shift receiving phone calls from family members wanting to know what happened in therapy that day, and how their family member is doing. Well nothing of concern was reported to me, so I'm going to assume that your family member is still alive. Perhaps you should call during the daytime when they actually receive therapy?
- Nurses who spend their whole shift picking apart charts and MARs for everything the previous shifts didn't do. Look, I've found meds you forgot to give too. I'm not saying it's okay, but if no one's dead, how about we cut each other some slack. The only thing that's going to come from turning each other in all the time is less staff because people are getting fired.
- Neb treatments scheduled for 12am and 4am. I understand they were in the hospital with pneumonia, but perhaps sleeping more than a couple hours at a time would also be beneficial to them, and we could do Q4 hour treatments when they're awake.
- 90 year olds on Vicodin. Was there no other solution for their arthritis? Really? Throwing a narcotic at a problem drives me insane.
- Our weekend supervisor who thinks that just because she's an RN and used to work on a stroke unit at a hospital, she isn't required to answer call lights.
- This is probably a nitpicking thing, but nurses who use bad grammar. I've seen nurses chart "admitt", "I seen so and so do this", "Nurse called a cold blue". Oh, and while we're on the subject: the nurse who called me from another floor the other night because she couldn't figure out what her order said. Apparently she didn't know what "CXR" and "PNA" stood for.
- PAPER MARS!!!!!!!!

I don't know this for certain, but I've seen neb treatments ordered q4h while awake - so if they're ordered around the clock, if makes me wonder if this isn't a standard of care for the type/severity of pneumonia a person had.

Why is it a problem for 90 year olds to be on vicodin, so long as they are otherwise managed to combat the side effects? I'm sure by the time a 90 year old is prescribed vicodin for arthritic pain, they've been around the block when it comes to managing the pain. Arthritis can start young, and I'm sure one can build up quite a tolerance for many kinds of analgesia in the decades the preceded their 90s.

I'm actually horrified that you would be upset that another nurse would clarify an order with you - there really is no safe alternative. Clarifying an order that isn't understood is an absolutely essential part of prudent nursing. To now allow this creates a culture of nurses who would rather make a medication error, or some other mistake, than ask for help or clarification. That's hostile - and dangerous. And by the way, I've been a nurse for 8 years, in a variety of settings (inpatient, LTC, amb care) and had no idea what PNA stood for. I had to Google it - and THAT search brought me to other threads where nurses were asking each other what "PNA" stood for.

lumbarpain, ADN, RN · Jan 30, 2015

OMG...there is so many I can hardly THINK straight.....first of all..carts are not filled up...trash not taken away...Aides come in late..nurses call out, Report from days is not adequate enough and sometimes downright dangerous for LACK OF INFORMATION....dumping is the usual thing when the day nurses cant get their own work done....not being taught correctly on the computers for admissions and other things...housekeeping not doing their job.....nasty rude, complaining, terrifically needy patients and family members that want you to BE their SLAVe or maid/butler......this is what I think and feel nursing has turned into today..its not respected anymore and its just a job where people think of you as a GO get it for me and that's it.....

lumbarpain, ADN, RN · Jan 30, 2015

why do I have to delegate to Aides who have been on the floor for years before I got to work there and know the patients better than I do.? they shouldn't have to be told their SAME old job duties eVERY single day...and if there is a discrepancy....OMG....all heck breaks loose.....arguments....who did that , who didn't do their job during that shift...JUST DO IT....and report it to the nurse and let her handle it ....many many many complaints I have...too numerous to mention....from bad housekeeping in the facility..to nasty, violent patients that argue and fight with you...patients that are drug addicts and the doctor doesn't want to do a darn thing about it....family members who jumps down your throat at the drop of a hat.....family that go into treatment rooms on their own or other rooms they aren't supposed to.....Nurses that try to pry open the narcotic box on the med cart because the other nurse went home with the keys in her pocket......oh man...so many stories , so little time.

hnwbeachbum · Jan 30, 2015

I don't know this for certain, but I've seen neb treatments ordered q4h while awake - so if they're ordered around the clock, if makes me wonder if this isn't a standard of care for the type/severity of pneumonia a person had.
Why is it a problem for 90 year olds to be on vicodin, so long as they are otherwise managed to combat the side effects? I'm sure by the time a 90 year old is prescribed vicodin for arthritic pain, they've been around the block when it comes to managing the pain. Arthritis can start young, and I'm sure one can build up quite a tolerance for many kinds of analgesia in the decades the preceded their 90s.
I'm actually horrified that you would be upset that another nurse would clarify an order with you - there really is no safe alternative. Clarifying an order that isn't understood is an absolutely essential part of prudent nursing. To now allow this creates a culture of nurses who would rather make a medication error, or some other mistake, than ask for help or clarification. That's hostile - and dangerous. And by the way, I've been a nurse for 8 years, in a variety of settings (inpatient, LTC, amb care) and had no idea what PNA stood for. I had to Google it - and THAT search brought me to other threads where nurses were asking each other what "PNA" stood for.

I don't know if it's because I work in a skilled rehab unit in a LTC facility, but I've never seen an order for the neb treatments that reads "while awake". That would be nice. I understand that they need the treatment. Really, I do. I just think they need sleep more.

As for the Vicodin, that's more of a personal hang up, I guess. I know I'm there to give meds, but I hate feeling like I work in a pain clinic. I hate narcotic pain medication. I think doctors dispense it for anything and everything, and it's a huge problem. If a person truly cannot get their pain under control, okay. If they're lying in bed asleep and I'm waking them up to give it, that's unnecessary.

I'll take back what I said about the abbreviation if there's really that many nurses who also don't know what it means, but I've worked at this place two years and since I see it written all the time, by both the MD/NP and the other nurses on our "cheat sheets" of patient's diagnoses, I would have thought another nurse who works on the same skilled rehab unit, and has at least 2 or 3 years on me, would know this too.