I just quit today after two weeks. I thought I was lucky enough to land a job at a SNF/subacute place nearby. After the first week, I was in for a rude awakening.
I had only 5 days of orientation in a 98 bed facility and was labeled charge nurse. Half the place is LTC, the other half subacute. 1st and 2nd shift have 3 nurses--usually 1RN and 3 LVN; 3rd shift usually has 2LVNs. Once I was on my own, passing meds to about 35 pts (in the LTC side) pretty much took me my entire shift. It was overwhelming and frustrating. On top of that, since I was an RN, I was responsible to hang IVs for all IV pts, no matter what side. I barely had time to document, and little to no time to assess the pts. As a friend had said, it felt like an assembly line--and that's how I felt I was treating the pts. There was no time to chat, no time to care, no time to critically think. Many of the staff members actually work on their OWN time (i.e. Not getting paid!) to chart, since many of them are afraid to get too much overtime since Administration will question them about it and may affect their performance review.
Many of my co workers were trying to convince me to stay, saying that it'll get better, that everything will become routine. But why is it that they are still taking more than their shift to do their work? It's simple: it's understaffed.
I brought all my issues up to the DON. All she said to me was, "I told you it's a lot of work and that it's a lot of patients. It wasn't going to be easy." Of course I didn't expect the work to be "easy", but I explained to her that there was no amount of training that could help me provide quality patient care if there is no time given to do that. She said she would like to hire more nurses, but Administration apparently doesn't want to hire anymore for any one shift. She just didn't seem to care too much.
I just had to vent and bring this up to all you new grads. I know I'm not the only that experienced this since I spoke and heard about a few people that experienced the same thing. I just want to give you some advice if you're looking into LTC or SNF. Some things I wish I had done before hand:
You may not see everything that goes on behind the scenes with this, but at least it's a good overview of the place. It's better than making any judgements based on how nice the building looks upfront or the nice painting and furniture in the reception area.
3) Ask the DON a lot of questions.
How many beds? As a new grad RN what are the job responsibilities? The job description? Expectations? Number of patients in your care? What is used for documentation/charting?
4)If you do commit, remember to buy some malpractice insurance (I guess that goes for any place you work at, but especially at a high liability job)
I hope this will be of some help to someone out there considering a job in a nursing home. I understand that many of us are still looking for a hospital job, but the pickings are few and far between. I haven't given up hope in finding that job, or even finding a job at another, better LTC facility in the mean time, but these are just some things to consider... Hopefully it'll save you from being burnt out or at least some tears.
BTW, I've never seen orientations longer than a week-2 max in skilled. Those long lovely new grad preceptorships & orientations are pretty much only in acute care...& not all of them any more.
I'm a 46 y/o male nursing student. Will graduate in Spring of 2011 from a community college in New York.
I've read through all the posts with great dismay. This is going to be my second career. My first career of 25 years will be laying me off at the end of the month. I thought nursing was a good choice but after reading all of the posts I'm not so sure. I'm also not sure what be job prospects will be upon completion.
The first thing that comes to mind is that all Ive heard have been horror stories except for one DON who sounds like she does the right thing for her staff and patients. Where are the other good stories? Is the system that broken? Why isn't the working popualtion in these facilities shouting out at the top of their lungs? What are the whistleblower protections, if any? Where are the unions in all of this? Aren't unions supposed to protect the worker from these very issues that are being described? When JCAHO comes through are they blind to the understaffing? Are they acting just like the Fed not seeing Madoff right under their noses? Why do you jepordize your license? Why do you jepordize the patient by not doing required V/S before passing meds. Work off the clock to finish your work *boggle* don't call me naive but that is wrong in so many ways. You are ENABLING the institution to get away with it.
If you are being abused and don't stand up to it you are allowing the abuser to do it to someone else.
Thats wrong!
Who is standing up for your rights as workers? Where is the nursing loby in Washigton? Who's calling JCAHO to tell them about the deplorable conditions? Does anyone from JCAHO subscribe to this website?
JCAHO (monitors hospitals) regulates very few nursing homes. Most are regulated by DHS. The staffing requirements are set by CMS and are decades old, some states do have some stricter requirements. What was ok for staffing back in the 70's and 80's is not adequate now, since acquity levels are higher. The reimbursement rates for medicaid and medicare are also dwindling and it is becoming a losing game. Facilities need to pay a decent rate for staff but, need to make some cuts somewhere along the way.
I believe all facilities need to be staffed according to the acquity levels of the residents. We have a union in place for our CNA's, housekeepers and dietray aides... it is a joke, the only thing they do is take their share of the worker's pay check.
Welcome to LTC world. Unfortunately, that's how it is in the long term care field in general. A lot of politics involved. But there few skilled nursing facilities that are not so bad. I'm fortunate to be in one of them. I've been working here for
The hardest part in working in a long term care facility is getting to know the residents. It usually takes about 3-4 months to get to know them. Once you get past that, it's not that bad. As a matter of fact, if you get assigned to a permanent section, you would know your resident meds by heart. During med pass, you look at the MAR for any changes, and pretty much the rest stays the same. They emphasize documentation in LTC's because LTC facilities are one of the highly regulated industries here in the US. The only way you can save your "butt" is by documentation. It would be nice to have more nurses in the LTC setting, to lessen the load (of documentation), and more time at bedside. Acute changes/illnesses (in a resident) will throw you off your schedule, you just have to learn how to manage your time. Prioritize...
Unfortunately, because of heavy patient load (30:1 normally) this scare nurses away from LTCs. But if you want job security, LTC is the way to go. "For-Profit" facilities are usually understaffed (I had worked in one of them). Try looking into "Non-For-Profit" facilities. They may not pay as much as "For-Profit" but you won't be overworked and understaffed. I work in a "Non-for-Profit" facility, and here's the scenario: In our skilled floor, in 7-3 shift, 63-bed capacity, 7 CNAs (9:1 ratio), 3 nurses (the 3rd nurse is the "Sheltered Care" nurse doing treatments).
Just like any other industry, when there is an abundance of workers, if you leave there's always someone to take your place. In my area, when there aren't enough "home grown" nurses, or the "home grown" nurses won't work under the conditions present--the facilities import from other countries (does great things for our working conditions [sic])
Not all facilities are run this way, but it tends to be the rule rather than the exception for skilled facilities. There are some places that are nice to work.
The first thing that comes to mind is that all Ive heard have been horror stories except for one DON who sounds like she does the right thing for her staff and patients. Where are the other good stories? Is the system that broken? Why isn't the working popualtion in these facilities shouting out at the top of their lungs? What are the whistleblower protections, if any? Where are the unions in all of this? Aren't unions supposed to protect the worker from these very issues that are being described? When JCAHO comes through are they blind to the understaffing? Are they acting just like the Fed not seeing Madoff right under their noses? Why do you jepordize your license? Why do you jepordize the patient by not doing required V/S before passing meds. Work off the clock to finish your work *boggle* don't call me naive but that is wrong in so many ways. You are ENABLING the institution to get away with it.
If you are being abused and don't stand up to it you are allowing the abuser to do it to someone else.
Thats wrong!
Who is standing up for your rights as workers? Where is the nursing loby in Washigton? Who's calling JCAHO to tell them about the deplorable conditions? Does anyone from JCAHO subscribe to this website?
You know, there are some who might read your comments and call you naive. I don't. I like and admire your passion and I hope you never lose it.
Sometimes the system can break even the best of us. Many people do blow the whistle only to find that nothing gets done. They feel broken and that their efforts to change things are futile. Others are intimidated and become so afraid of retaliation that they say nothing, even putting their licenses in jeopardy because, by their inactions, they are colluding with the abuse. Some find that they, too, have to cut corners at times and feel guilty because they know they aren't delivering the best care they can. Being chronically understaffed---or improperly staffed due to acuity---can wear a nurse down. Not delivering good care can make nurses distrust themselves or their gut instincts. They begin to think they're bad nurses and not worthy of working in a better facility. They become burned out and part of the problem.
Sometimes, when you take a stand, you run the risk of losing your job. You can even run the risk of becoming unemployable if you're thought of as a "troublemaker". I have seen people who will shut up and put up with workplace abuse---like the practice of making nurses work off the clock---or the whole CYA mentality of covering up mistakes so the department of health won't find out. All because they've been sufficiently threatened and are worried about losing their jobs. Whistle-blower protection should be a given but often it is not, partly because the state agencies are also underfunded and understaffed---or they have to wade through so much bureaucracy that nothing gets done.
Then again, I have asked myself, what kind of person would I rather be? Would I rather stick to my principles and risk unemployment or would I rather put up, shut up and work in an environment that causes me tremendous moral conflict? Having no money is no fun, but I'd rather be poor and principled than be part of a system that perpetuates workplace abuse and cuts corners on the delivery of safe, adequate nursing care.
If you continue to stick to your principles and try to make a difference, you may often feel like Don Quixote, chasing windmills and pursuing an impossible dream. Then again, you could end up becoming a nurse leader someday, in a position in which you can make positive change. You can be like the good ones here on AN. Noc4senuf is one; CapeCodMermaid is another. I'd work for either of these effective, conscientious nurse leaders in a heartbeat.
Trying to be an agent of change is hard work---it's especially hard when one is trying to deal with the stresses and rigors of being a nurse in any setting, not just LTC. I think many nurses don't bother to join their state nursing associations or the ANA, not only because of cost but because they don't have the time. And then they become frustrated because ANA does not represent their interests. It's a self-perpetuating cycle and the only way I see to make change is to become active in nursing organizations. If you don't like their politics, try to be a voice for the opposition. At least you will have made yourself heard, even if you don't change things right away. You can also look at legislation that affects nurses, particularly those that affect nurse:patient ratios. If you agree with it, write to your legislators. If you don't, write to your legislators. Know what's going on so you can be part of the solution rather than the problem.
Now, the current job market is tight, particularly for new grads, and it seems to be worse for many AD grads and LPNs. Many ADNs and LPNs find themselves working in LTC, even if that wasn't their first choice, simply because they're having trouble getting hired by hospitals. That can put you in a bind; unfortunately you will find more abusive practices in LTC than in acute care settings, though crap happens in the hospital as well. Should you find that you need to work LTC as a new grad, make sure to check the previous state surveys of the institution at which you are considering applying for a job. The state surveys will tell you a LOT. What kind of deficiencies did the institution get? Have any resulted in actual harm to residents? If there are repeated deficiencies related to bedsores, for example, you might steer clear because that might indicate poor staffing; same for repeated falls. If there are deficiencies related to dignity issues, again steer clear. If a facility is not respecting resident rights, you do not want to work there. Talk to people who are employed at a facility---not just the nurses, the CNAs and other staff as well. If they consistently report feeling burdened or give you a strange look when you ask if the facility is a good place to work----it isn't. Run. If a facility has had such serious deficiencies that it has lost its ability to admit Medicare patients---even temporarily---run. If you are told upon interviewing that, as a new graduate, you will be in charge, doing staff development, management or MDS, run. You will not have time to just become used to being a nurse before being expected to take on a role that really does require more expertise.
Spartacvs, some folks who read your post and my answer are going to write us both off as idealistic. I don't think being idealistic is necessarily a bad thing and I hope to remain idealistic until the day I die. Continue to stand up for yourself. Ask questions. Be involved. You are doing the right thing and I'd be thrilled to have you as a co-worker, a student or my nurse.
Just like any other industry, when there is an abundance of workers, if you leave there's always someone to take your place. In my area, when there aren't enough "home grown" nurses, or the "home grown" nurses won't work under the conditions present--the facilities import from other countries (does great things for our working conditions [sic])
Not all facilities are run this way, but it tends to be the rule rather than the exception for skilled facilities. There are some places that are nice to work.
of note: JCAHO visits are not without warning
Curious, just wondering which part of the country are you in that are still importing nurses from other countries nowadays? Maybe Texas or Okaloma? Most places used to import foreign nurses 4, 5 years ago, but not any more. The bills that are trying to give foreign RNs more visa numbers have failed a couple of times. I guess had there been a real shortage of nurses, that bill would had been passed already.
Where I'm, lots of LTC are not hiring new RNS either, they want experiences.
You know, there are some who might read your comments and call you naive. I don't. I like and admire your passion and I hope you never lose it.
Sometimes the system can break even the best of us. Many people do blow the whistle only to find that nothing gets done. They feel broken and that their efforts to change things are futile. Others are intimidated and become so afraid of retaliation that they say nothing, even putting their licenses in jeopardy because, by their inactions, they are colluding with the abuse. Some find that they, too, have to cut corners at times and feel guilty because they know they aren't delivering the best care they can. Being chronically understaffed---or improperly staffed due to acuity---can wear a nurse down. Not delivering good care can make nurses distrust themselves or their gut instincts. They begin to think they're bad nurses and not worthy of working in a better facility. They become burned out and part of the problem.
Sometimes, when you take a stand, you run the risk of losing your job. You can even run the risk of becoming unemployable if you're thought of as a "troublemaker". I have seen people who will shut up and put up with workplace abuse---like the practice of making nurses work off the clock---or the whole CYA mentality of covering up mistakes so the department of health won't find out. All because they've been sufficiently threatened and are worried about losing their jobs. Whistle-blower protection should be a given but often it is not, partly because the state agencies are also underfunded and understaffed---or they have to wade through so much bureaucracy that nothing gets done.
Then again, I have asked myself, what kind of person would I rather be? Would I rather stick to my principles and risk unemployment or would I rather put up, shut up and work in an environment that causes me tremendous moral conflict? Having no money is no fun, but I'd rather be poor and principled than be part of a system that perpetuates workplace abuse and cuts corners on the delivery of safe, adequate nursing care.
If you continue to stick to your principles and try to make a difference, you may often feel like Don Quixote, chasing windmills and pursuing an impossible dream. Then again, you could end up becoming a nurse leader someday, in a position in which you can make positive change. You can be like the good ones here on AN. Noc4senuf is one; CapeCodMermaid is another. I'd work for either of these effective, conscientious nurse leaders in a heartbeat.
Trying to be an agent of change is hard work---it's especially hard when one is trying to deal with the stresses and rigors of being a nurse in any setting, not just LTC. I think many nurses don't bother to join their state nursing associations or the ANA, not only because of cost but because they don't have the time. And then they become frustrated because ANA does not represent their interests. It's a self-perpetuating cycle and the only way I see to make change is to become active in nursing organizations. If you don't like their politics, try to be a voice for the opposition. At least you will have made yourself heard, even if you don't change things right away. You can also look at legislation that affects nurses, particularly those that affect nurse:patient ratios. If you agree with it, write to your legislators. If you don't, write to your legislators. Know what's going on so you can be part of the solution rather than the problem.
Now, the current job market is tight, particularly for new grads, and it seems to be worse for many AD grads and LPNs. Many ADNs and LPNs find themselves working in LTC, even if that wasn't their first choice, simply because they're having trouble getting hired by hospitals. That can put you in a bind; unfortunately you will find more abusive practices in LTC than in acute care settings, though crap happens in the hospital as well. Should you find that you need to work LTC as a new grad, make sure to check the previous state surveys of the institution at which you are considering applying for a job. The state surveys will tell you a LOT. What kind of deficiencies did the institution get? Have any resulted in actual harm to residents? If there are repeated deficiencies related to bedsores, for example, you might steer clear because that might indicate poor staffing; same for repeated falls. If there are deficiencies related to dignity issues, again steer clear. If a facility is not respecting resident rights, you do not want to work there. Talk to people who are employed at a facility---not just the nurses, the CNAs and other staff as well. If they consistently report feeling burdened or give you a strange look when you ask if the facility is a good place to work----it isn't. Run. If a facility has had such serious deficiencies that it has lost its ability to admit Medicare patients---even temporarily---run. If you are told upon interviewing that, as a new graduate, you will be in charge, doing staff development, management or MDS, run. You will not have time to just become used to being a nurse before being expected to take on a role that really does require more expertise.
Spartacvs, some folks who read your post and my answer are going to write us both off as idealistic. I don't think being idealistic is necessarily a bad thing and I hope to remain idealistic until the day I die. Continue to stand up for yourself. Ask questions. Be involved. You are doing the right thing and I'd be thrilled to have you as a co-worker, a student or my nurse.
Amen. You wrote exactly how I was/have been feeling. Since I quit my job at SNF, I've been looking for other places to work with no leads so far. I've also been feeling like maybe it was a bad idea that I quit, but as you said here:
Would I rather stick to my principles and risk unemployment or would I rather put up, shut up and work in an environment that causes me tremendous moral conflict? Having no money is no fun, but I'd rather be poor and principled than be part of a system that perpetuates workplace abuse and cuts corners on the delivery of safe, adequate nursing care.
That pretty much summed up everything for me. And that's why I left. Before I did so, I informed the DON of all the issues and concerns I had during my experience, but as she said, the blame is on Administration...
It's hard trying to keep your head up when right now it just feels hopeless...
Amen. You wrote exactly how I was/have been feeling. Since I quit my job at SNF, I've been looking for other places to work with no leads so far. I've also been feeling like maybe it was a bad idea that I quit, but as you said here: That pretty much summed up everything for me. And that's why I left. Before I did so, I informed the DON of all the issues and concerns I had during my experience, but as she said, the blame is on Administration...
It's hard trying to keep your head up when right now it just feels hopeless...
You are not alone. Remember that. I have found so much support here and it's truly helped. :icon_hug:
I think I would have given up on nursing had it not been for AllNurses.
All of the poor conditions described on this thread happen to "seasoned" nurses, too- not just new grads.
That's the way nursing is. Now you know the real reasons for what was formely known as "the nursing shortage"- poor working condtions and not enough time to properly care for human beings- and nurses getting out.
zebsmom2002
91 Posts
BTW, I've never seen orientations longer than a week-2 max in skilled. Those long lovely new grad preceptorships & orientations are pretty much only in acute care...& not all of them any more.
It's not only frustrating, but can be dangerous.