As someone who's been a charge nurse in a nursing home for some time now (as first RN job) I must admit that I was wrong and many on here have been wrong as well.
The position is looked down upon but I can assure you there is a lot of critical thinking, decision making and responsibility in that position. As the lone RN in charge of 8-10 Aides, 3 LPN and 65-70 residents it is a huge task and responsibility. Not to mention when things go south for a resident, you might as well be a nurse in the rain forest or Kenya (as far as supplies are concerned). All you have is your critical thinking skills.
I refuse to work off the clock and I'll pass my extra in report bc I'm off the clock. My previous job if you went into overtime you got a write-up, they tried to give me one once and I straight told the DON "are you F'ing me? Have better patient loads or call in help but either way you can't write me up for having to stay over to finish my work bc of SEVEN CODES" most facilities around me the charge nurse is fine with overtime but nurses on the floor it's a huge no and a write up. Usually if I'm even called in about it I make it clear I don't work for free just like they don't and I can get another job somewhere else easily. Honestly I won't stay and I'll call the labor board.
Many facilities are starting to get shady with the hour calculations too. My old subacute used the nurse in medical records as well as the UR nurse's hours towards our subacute hours plus they also took some LVNs and put them as LVN/RT and use their hours as well when they only do RT work. So they knocked down number of RTs on the floor plus they upped the nurse/patient ratio to 16. They also had a CNA float between the SNF and our subacute to answer call lights and cover breaks but they weren't allowed to do any transfers or care so pretty much not an actual CNA "job" so all around completely UNSAFE! But soon as survey is coming around all of a sudden we were fully staffed. SNF/LTC is unsafe most of the times.
i love my patients and they are like family especially those who never have visitors even for the holidays or their birthdays. So heartbreaking. It's no wonder so many get burnout.
So, will freely admit that I am one of the judgmental ones.
When it warrants it.
SNF sends out a patient who is combative, fell, AMS...I don't care. I just hope that I get the correct paperwork from the SNF (because I've been there, I've seen the files, I get how it can be confused and I try to at least let them know that "hey, you sent me Mr. Kidney, but I have some stuff from Mr. Renal here...looks like his official DNR. What would you like me to do with it?")
I get a patient who has no history of dementia or other organic brain disease that had EMS called for a sudden onset of crushing chest pain, and tells me "no, I was just watching TV. I have a little cough, but I've had that for years...no, my chest never hurt." I tend to raise my eyebrows and start thinking about how they're going to get home.
I get a patient who has gone so far beyond septic that we're having trouble getting a central line placed because they are that hypotensive, the sacral pressure ulcer is unstageable with nothing in the paperwork or report about it, and they're about ten minutes away from being in irreversible shock after getting a report that "they were up and walking around just before all this happened?" I judge the hell out of that place and the people working there who sent along a chart that says that skin is clean, dry, and intact. (Same with foleys that are full of pus with a report saying that there isn't even one.)
Of course, every specialty out there will have people who judge it. It's the nature of being human.
I hate to say it but yes some of the nurses are scattered and overwhelmed but there's a few that don't belong in nursing just like any nursing field. I must say this though...
Sometimes you getting those patients its fully bc those patients complain of something then change their story come 911 or come the ER. I had a patient complain of chest pain with all vitals normal. 911 comes and he changes his story to something different, I can't back track what he claimed and he has to go get checked out bc hello it's chest pain! Now the ER nurse is calling me bc his story has changed again. Ended up the PITA wanted to go to the ER bc his hands can't stop shaking. Yeah the patient with PARKINSONS, hes fully oriented and no history of cognitive impairment. Just a lying PITA who wants what he wants even if it's wasting fifty different peoples time and Medicare $$$. I looked completely stupid but I even put in my charting that I copied and faxed what he reported to us and the change of story to 911. I seriously hate that patient with a passion and most patients I have such compassion for, not him. He's done stuff very similar multiple times. He did something similar complaining of chest pain and sent him out but ended up it was bc he had dysuria, that could've been handled in house. Like just be honest already!
Never work off the clock. If something happens to you or a patient, the company can wash their hands of you.
Exactly. When I'm not clocked in (just coming in or leaving) residents always ask me to toilet them. I tell them that I'm off the clock, so if something happens , I could be in big trouble. The residents don't like it, but I stick to my guns. What if there's a fall or injury?
"lone RN in charge of 8-10 Aides, 3 LPN and 65-70 residents"
I work as an RN in LTC. I would just like to ask where is this staffing? I am a charge nurse that is also working the floor with one other LPN, a CMA, and three CNA's on a sixty to seventy bed facility.
I agree, I've read many posts where people say ltc is lesser than. It's the only job that will take anyone. I agree their hiring is far less competitive but it's only because the workload is so much, most bow out.
I worked LTC for many years. I have worked with more skilled and dedicated nurses than any hospital can ever imagine. We would whip some booty compared to many acute care nurses. The only nurses I'll give a hand off to in acute care are icu, ccu, cardiac and cancers units. Other than that, we did it too!!! I am a LPN. I do NOT want to be a RN. My gift is here. Stop pushing us to be a RN. It's ridiculous! Sometimes, we know more because many RNs have no beside knowledge.
I am a nurse in LTC, I am an LPN in charge of a staff of usually 7-9 CNA's and caring for usually 90 residents at night. It takes great multitasking and organization to just maintain and that is barring any emergencies. Before you consider us the "bottom of the barrel" think of the skill it takes to make this work. Definitely not for the faint of heart!
chare
4,372 Posts
Federal wage and hour regulations require that you either receive an uninterrupted meal period, or you are paid for your time.
Regarding coverage, this is a question best posed to the Texas BON.