What are common problems at Nursing Homes

[Nursebabe2009]

I'm just went through orientation. I'm a new registered nurse with my very first job at a nursing home. What are the most common complications or problems that happen at a Nursing Home?

[Laurab14]

Unreliable workers, and corporate ownership.

[Fiona59]

Families with unrealistic expectations toward their aged and their outcomes. Unrealistic expectations of staff and their care.

Hidden hostility from all staff levels.

Management that just does not give a damn because they've been off the floor for years and want bodies working. Gawd forbid they come out of their office and help.

Now if you are talking about the patients--hostility aimed at staff because they are not visited by the families apart from holidays. Diabetics that go up and down frequently. Pressure sores because they refuse to be turned. Incontinence issues that you try to address but can't deal with properly due to lack of staff.

[linzz]

Behaviour issues of the residents, many are not very tolerant of each other. If you are in a dementia type of area, there can be assaults on staff and other residents. Another thing you will see alot of, is falls because there is just not enough staff to ensure that walkers etc. get used.

[Baloney Amputation, BSN, LPN, RN]

Staffing issues, shift wars, excessive smoke breaks, sundowner's in the residents for the evening shift, and the necessity of staff shortcuts in order to finish on time come to mind. Some residents will be combative, but the ones that really wail on the staff aren't considered a problem by management until another resident is wailed on. Staying over if your replacement doesn't show up is an issue more for CNAs, but that's there for nurses, too. If you're the only nurse on duty, you won't get to leave the facility for your "break."

Karen

(still proud to be an Iowan)

[pagandeva2000, LPN]

I find that high nurse-patient ratios are another issue. In my area, most floors are run by LPNs, who also take charge position and maybe another LPN that is the medication nurse. The med nurses are usually administering anywhere from 30-60 patients on one floor. Too many for me. Coupled with working on floors with no ID bracelets, no picture of the patient on the MAR (or it there is one, it is too old for you to recognize) and dementia patients who don't know who they are, this makes medication administration a nightmare. I never worked at one as a nurse (and hope not to), but did as a CNA.

Also, the above mentioned situations are also challenging...the falls, the wanderers, irate family members, and some of the CNAs are passive aggressive, so, for sure, there will be many incontinence and bedsore issues because the patients are not being turned the way they are supposed to. I can say in their defense, however, that not all CNAs are this way. Many are dedicated workers that do the best they can towards their assigned patients. Problem is that they do very physical work, making it hard on the body. Many of them are TIRED. Especially when they are picking up the slack of the CNAs that avoid assisting their patients.

[linzz]

Oh I forgot to mention the short stay patients. Often you get those who have some big sundowning issues or other behavioral issues, or ones that are health train wrecks, yet the family thinks they are just fine and just need a little assistance when they really need total care.

[fortune-teller]

So much work...so little time.

You finally realized that you only have two hands and just 10 fingers and it is not enough.

[MegRyanGirl]

LOL!! I am laughing cause your post describes my work place exactly!!! :thankya: Sad but true... I have to laugh to survive :lol_hitti

[texastaz]

I am a Agency CNA and only do nursing homes when in dire need for the money. - Supply shortages, too many patients, unreliable CNAs. I am seeing more and more nursing homes taking in short term care also - example hip/knee replacements. Many short term patients hound the nurses constantly and think they need to be served like they are in a 5 star hotel. I am also seeing more facilties where the CNAs are passing out the meds which adds to the work load-mind you no pay increase - and then the administrators have figured since the nurses don't have to do that - they give them twice the patient load. Administrators - Eeeehhhhhhhhhhh.

[Midwest4me]

families with unrealistic expectations toward their aged and their outcomes. unrealistic expectations of staff and their care.

hidden hostility from all staff levels.

management that just does not give a damn because they've been off the floor for years and want bodies working. gawd forbid they come out of their office and help.

now if you are talking about the patients--hostility aimed at staff because they are not visited by the families apart from holidays. diabetics that go up and down frequently. pressure sores because they refuse to be turned. incontinence issues that you try to address but can't deal with properly due to lack of staff.

i agree with all the above but want to add the following:

1) pressure sores are seen more often not only because pts will refuse to be turned but also because of the staff shortage or refusal/lack of time by the cnas to make sure that the patients get turned on a regular basis. the good cnas are worth their weight in gold who make it a priority that their pts are turned and kept clean so that skin breakdown doesn't occur.

2) the hostility from staff is not always hidden but outright demonstrated on a daily basis. i was once told by someone who'd overheard a cna say to another : " we cnas run this place; it's time the nurses realize that."

3) brittle diabetics, those with hip replacements, amputees, those mentally challenged, those with copd, chf, etc are also common problems seen in the nursing homes.

[texastaz]

Miwest4me is right about the hostility. The hostility and bad attitudes I see in about 80 % of the homes I have worked in. Many CNAs spend more time worrying about if they are doing more than the next person and feel the nurses don't do tooo tooo. Then of coorifice they blame the nurse for not supervisoring so and so, so nurses often don't get much support from the CNAs. The inmature attitudes-make things twice as difficult. The floor nurses also pretty much slammed by DON, Administrator, family members who question everything and constantly complain and threaten reporting. While I work agency and I am a CNA - that is number one reason I refuse most nursing homes even when I am in dire straights for money.