What "bad habits" are LTC nurses known for??

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A brand-new DON who previously worked in an acute care setting interviewed me and said that she would rather hire a new grad so that she can "train them how I want them" and that LTC nurses usually "have a lot of bad habits".

WHY did she generalize like that and WHAT bad habits might she have been talking about?! (Sorry, I was afraid to actually ask HER. She seemed like a really tough lady and I was kind of taken off guard).

Is there a general list of bad LTC habits people know about? Should I be worried to work in LTC due to any prejudices against people who have worked in this area of nursing?

Specializes in HH, Peds, Rehab, Clinical.

Complete =)

I had a resident tell me last week that I was "late" with her HS meds. It was about 2045. I said actually I'm not, I have an hour window on either side of 8pm. She went on to say that HER meds were scheduled for 8pm and that's when she wanted them. My CNA explained to her that EVERYONE had meds scheduled at 8pm and if she could come up with a way that I could be in all those places AT 8pm, that would be awesome. I wanted to kiss him!

slacker
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Specializes in ER, Med/Surg, LTC, Nursing Informatics.

That's a great CNA!

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Specializes in Home Health.

I think it was very unprofessional for a DON to make this comment to a new hire. She is already setting an atmosphere for a hostile environment. If she were really upset by so called 'bad" habits, she would initiate a retraining/refresher program or in-service on best practices,etc for her nursing staff. She should also look at the policies and procedures that might need updating/revision. Why not meet with Mds or NPs who write med orders and educate them on why 9 Pm meds for example might not work for all residents. If this does not work then maybe there are staff that should be asked to seek employment elsewhere(putting it gently) .:yes:

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Specializes in ER, Med/Surg, LTC, Nursing Informatics.

It sounds like you are running into the Catch 22 of nursing early in your career. That is, there is not enough time to do EVERYTHING exactly how you learned it in school. When you are at ANY job it takes longer at first, but in nursing it feels like you are agonizingly slow the first few months, because sick people are depending on you! Unfortunately, sick people only think of themselves a lot of the time. :crying2:

I think some nurses keep trying to get better and faster at their jobs and some just kind of give up and say "I'll get done what I can, then I'm done....this is a 24 hour facility". This is like taking teamwork to the extreme negative. Still, it is not all their fault for becoming that way, per se. An environment that has good team work, makes things much, much better.

You learn from other nurses how to do things faster, but without jeopardizing the patients. One advantage with LTC is you get to know the patients (e.g. residents, sorry I work in acute care now). As all of us do, they have habits and want to maintain their patterns as much as possible. When you can, you can accommodate them and to your advantage. I had two or three that wanted their meds early, because they went to bed early. I let them know that I was not suppose to give meds early, but if they insisted (they usually didn't, I was just making a point) my job was also to do what I could to make them comfortable. None of the meds would jeopardize their health having it a little early. I told them that today, I could give the meds a bit early, and most likely tomorrow, if they insisted, but I take care of a lot of people, so I can't guarantee that every time. Also, I don't work everyday and they should not expect other nurses to do the same. So we would take it on a day by day basis. Of course, they agreed. Those 2 or 3 I would give meds first and there were others that wanted their meds later. So this helped a little with getting things done. And it helped them keep some of their dignity and independence.

I found out later that another nurse was not doing all of his med passes. He was combining two different med passes. This is wrong for so many reasons :no:, I'm not going to begin to list the reasons. This is a good example of how some nurses "will take a mile, when you give them an inch". It was unsafe for many of the residents to have that done. He was skipping cardiac meds, etc. So you need to use good nursing judgement when making decisions that will make things simpler and faster to get your job done. And more importantly, not abuse the trust that has been given to you.

The answer to the Catch 22 is to work in an environment that is truly a team environment. You are always going to have "slackers", but they should be the minority. If they are not, then you should look elsewhere. It sounds like the job you are looking at has a high probability of being such a place. And, again, that is not ALL the nurses fault. It is management that molds the environment. Is the DON on the floor helping out or are they in the office all the time? Do they at least walk the floor to see how nurses are doing? Do they look for slackers? Or are they just upset all the time to everyone? This is where you could have asked a less direct question in the interview to find out what the DON/Manager was like as a leader.

At the end of every interview you have an option to ask questions. ALWAYS ASK QUESTIONS! Example: "Can you tell me what your management style is like?" If they are the type of person that walks the floor or jumps in when needed, they will tell you, because they are proud of it! Still, you could follow up. This is my best question..."At work, what are your pet peeves?" You can learn a lot about a person and their attitude toward things with this question. For example, if a manager says, "It annoys me when nurses don't come to me with their problems or questions." I would want to work for that person! They will be supportive. Or "The only thing that annoys me is when state comes around." They are just focusing on the bare minimum. I DON'T want to work for them.

Sorry for the long response, but I hop it is helpful. Best of luck!

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It sounds like you are running into the Catch 22 of nursing early in your career. That is, there is not enough time to do EVERYTHING exactly how you learned it in school. When you are at ANY job it takes longer at first, but in nursing it feels like you are agonizingly slow the first few months, because sick people are depending on you! Unfortunately, sick people only think of themselves a lot of the time. :crying2:

I think some nurses keep trying to get better and faster at their jobs and some just kind of give up and say "I'll get done what I can, then I'm done....this is a 24 hour facility". This is like taking teamwork to the extreme negative. Still, it is not all their fault for becoming that way, per se. An environment that has good team work, makes things much, much better.

You learn from other nurses how to do things faster, but without jeopardizing the patients. One advantage with LTC is you get to know the patients (e.g. residents, sorry I work in acute care now). As all of us do, they have habits and want to maintain their patterns as much as possible. When you can, you can accommodate them and to your advantage. I had two or three that wanted their meds early, because they went to bed early. I let them know that I was not suppose to give meds early, but if they insisted (they usually didn't, I was just making a point) my job was also to do what I could to make them comfortable. None of the meds would jeopardize their health having it a little early. I told them that today, I could give the meds a bit early, and most likely tomorrow, if they insisted, but I take care of a lot of people, so I can't guarantee that every time. Also, I don't work everyday and they should not expect other nurses to do the same. So we would take it on a day by day basis. Of course, they agreed. Those 2 or 3 I would give meds first and there were others that wanted their meds later. So this helped a little with getting things done. And it helped them keep some of their dignity and independence.

I found out later that another nurse was not doing all of his med passes. He was combining two different med passes. This is wrong for so many reasons :no:, I'm not going to begin to list the reasons. This is a good example of how some nurses "will take a mile, when you give them an inch". It was unsafe for many of the residents to have that done. He was skipping cardiac meds, etc. So you need to use good nursing judgement when making decisions that will make things simpler and faster to get your job done. And more importantly, not abuse the trust that has been given to you.

The answer to the Catch 22 is to work in an environment that is truly a team environment. You are always going to have "slackers", but they should be the minority. If they are not, then you should look elsewhere. It sounds like the job you are looking at has a high probability of being such a place. And, again, that is not ALL the nurses fault. It is management that molds the environment. Is the DON on the floor helping out or are they in the office all the time? Do they at least walk the floor to see how nurses are doing? Do they look for slackers? Or are they just upset all the time to everyone? This is where you could have asked a less direct question in the interview to find out what the DON/Manager was like as a leader.

At the end of every interview you have an option to ask questions. ALWAYS ASK QUESTIONS! Example: "Can you tell me what your management style is like?" If they are the type of person that walks the floor or jumps in when needed, they will tell you, because they are proud of it! Still, you could follow up. This is my best question..."At work, what are your pet peeves?" You can learn a lot about a person and their attitude toward things with this question. For example, if a manager says, "It annoys me when nurses don't come to me with their problems or questions." I would want to work for that person! They will be supportive. Or "The only thing that annoys me is when state comes around." They are just focusing on the bare minimum. I DON'T want to work for them.

Sorry for the long response, but I hop it is helpful. Best of luck!

This is an awesome response, and yes it was helpful! I decided to take another job with more established management ( less $$ though). That particular DONs comment kind of haunted me . I was wondering WHY she said LTC workers are so bad.

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Specializes in ICU, CM, Geriatrics, Management.
slacker

Hahahahaha!

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Specializes in Home Health.

Love what you had to say.:yes: I oved my clinical rotation in the nursing home and told my class mates I would be returning there to work and to say I was ridiculed is putting it mildly. My first job out of school was for a very prestigious medical center in NYC,which had been a dream for me. I got my start in neurology. I really liked my job but at that time rotating shifts was mandatory and I could not handle it due to having two small children. I applied at that nursing home and after six months was promoted to what we called Head Nurse at that time. I loved it just as I suspected. I stayed five years and left due to relocating. I returned to NYC five months later and went right back into LTC. Without going on and on, most of my career has been varied but somehow tied into geriatrics,which is what I actually have a BA in as well as AD in Nursing. I have been a director,home health aid instructor and settled into home care which I have done for most of the remainder of my career.Again,the majority of my patients have been the elderly and I have found it very rewarding. The most important thing is to keep your own focus and standards,try and make changes for the positive. Lead by example,don't gripe and if change is not possible go where your experience and standards will be appreciated. PS. I have also been exposed to supervisors and directors that were less than exemplary.

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"unfamiliarity with BON guidelines and nurse practice act especially in reference to iv therapy"

Unfortunately, LTC management encourages and expects LPN's to act outside their scope of practice when it comes to IVT and admit assessments. They have been known to discipline nurses who refuse to do it.

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Faxing the doctor without first checking that it`s already been done... three times.

Giving meds that haven`t been ordered (Volteran, tylenol, etc. mostly harmless stuff).

Giving meds that have fallen on the floor.

Not signing the MAR appropriately.

Not reading the MAR properly and following the checks.

Not questioning orders that should be questioned.

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Specializes in Geriatrics, Dialysis.

Bad habits...I have a few. Many have been mentioned already. I have no problem giving meds outside the time parameters, working NOCs I will give the meds when the CNA is checking them and waking them anyway, so its not unusual for a 2300 med to be given at 0100. Our computer assigns standard med times during order entry, but those times can be changed. This means that med times can be different based strictly on the whims of the nurse that entered the order. So there can be meds assigned to 0400, 0500, 0530 and 0600 that aren't contraindicated to give together, so I give them together. I am lousy at signing off prns when I give them. Signing it out of the machine is time coded anyway, so if I don't get back to the computer right away to sign it out on the EMAR the times won't match. I know it's crappy justification for not signing it out both places, but it is what it is.

Gosh, now that I keep thinking about my bad habits...yep! More than a few!

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Specializes in Hospice.

I would ask the DON what she meant:)

I work for DON who has a similar philosophy and for us, it's a good thing. Our DON is tough, but I couldn't imagine working for anyone else. Her expectations are that the regulations will be followed so that our residents get the best possible care. Some seasoned LTC employees that we've hired have felt like they must take shortcuts in order to get all their tasks done.

The other benefit of hiring new grads is that it gives us an opportunity to develop critical thinking skills and shift the focus away from an LTC nurse simply "passing meds all shift". Not that the med pass isn't an important part of LTC nursing, but it is just one part and there are many more equally important aspects.

Having said that though, it is so important to ensure that there are experienced nurses available to serve as resources/mentors for new nurses (all units, all shifts). The best case senario is an equal mix.

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The bad habit I saw most when I worked in ltc was nurses pre pulling patients meds. They would go ahead and pull out the meds at the beginning of the shift to make the med pass go faster. We had a few nurses that would give meds early too. One nurse gave her 6am meds at midnight and then had to go home sick so, she had to confess what she did. She was fired.

Some nurses conveniently "forgot" to do things. Oh, was I supposed to change Mr. So and so's catheter?? I must've forgot... The same people always forgot.

Some nurses hated to write out DR's orders so, they never would. We'd come in and all the previous shifts orders would still be in the fax machine. Sometimes I'd refill the fax paper in the morning and then when I came in I'd have to refill it again. When I'd put the paper in all the days faxes would come thru. I refilled the paper at 7am and it had mysteriously disappeared before 8am.

Sometimes the nurses wouldn't change out the feeding bags, tubing, o2 tubing etc if it still looked okay.

Pretty much most of the bad habits were short cuts etc. Some bad habits I had were forgetting to write in if a prn med was effective on the mar, I'd usually start my med pass early to get done on time, every time we used supplies for someone we had to put a sticker from that supply into a billing book, I always went home with stickers stuck on me that I forgot about, I never clocked out for lunch.

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