Working in a Nursing Home

[Tracoyana]

Hello,

I'm a relatively new LPN who works the evening shift in a nursing home in MO. I've been working here for going on five months and lately feel like nothing I do can make the admins happy.

Example:

This last week was change over. Nothing new about that, right? I worked Weds-Fri and planned to get change over done, but:

Weds:

I was told at the beginning of shift that I would have two (C?)NAs until 6PM when one would leave and then I would have an hour break between with one (C?)NA during the busiest time of the shift when everyone wants to be laid down. Most of those people being two assists or hoyers. So, I passed my dinner meds (I'm also CMT on my floor) quickly making sure that I was done it time to have a ten minute dinner break before I helped the remaining (C?)NA put her two assists and hoyers to bed. We finished in time to get most of them down before the new aide got there. I then resumed passing my remaining meds and doing my treatments. I ended up not being able to get change over started.

Thurs:

I had my first by myself admission. No change over done due to finishing all admission paperwork.

Fri:

I had two falls during my open times. (Which I completed all paperwork on AND did a dipstick on one of them) I ended up with one CNA after dinner due to one of them being pulled, without warning. No change over was accomplished.

Sat-Sun:

Off.

I came in on Monday and found that NO change over had been done over the weekend so the ADON was kindly doing it for me! I was happy and got to work on the floor, until I was called into the office and verbally reprimanded for "forcing" the ADON to do my change over because I had not even started it. I was slightly chagrined, I really hadn't started it and that was my fault, but then they wrote me up today for "not finishing change over" and "not controlling my CNAs."

Basically, it doesn't matter that the other nurses that work day shift and the nurses that worked the weekend didn't do change over, it's my fault because it wasn't finished. I've done change over every other month I've worked at this nursing home and always gotten it done, but this month was busier than usual due to the increased number of hoyers and two assists.

My question is: Is this fair? I'm so alone at this nursing home that I can't even tell if this is normal or not...

[kythe, LPN]

It takes time to develop the time management and organizational skills you need to fit everything into your day. Have you brought up what you said here to your manager, and asked for suggestions on what you should have done differently? Did you let them know at the time why you were too busy to do the change over, or wait until they discovered it on their own? Sometimes this can come across differently, they may see you as proactive in dealing with a problem you are encountering, or they may see you as skirting your duties and then making up excuses afterward. Are you the only person who didn't finish change-overs you were assigned to, or did others have the same problem (you mentioned it hadn't been done over the weekend)?

The other issue I have encountered in nursing homes is cutting corners wherever they can and trying to survive on minimal staffing. I've worked in facilities where you are constantly running, falls are frequent, it isn't possible to do a med pass in a reasonable length of time, and shortcuts are taken in all possible areas because there is no time to accomplish everything that needs to be done. Patient care suffers, nurses are stressed, there is generally a high turnover rate in these places, and nurses and CNA's are the ones who take the brunt of the issues when things aren't done according to how management says they "should" be. If you are in one of these facilities, it may be good to move on.

Not all nursing homes are like this. I currently work in a good one with appropriate staffing levels and management does seem to listen to concerns. If this is your first write-up, it may not mean you are being picked on.

[Tabi]

I work in long term care as well and it is hard due to the nurse to patient ratios. I am currently looking to work in a physicians office because I don,t feel in ltc that you have enough time to spend with the people you are assigned to care for, I wanted to be a nurse because I enjoy caring for my patients, not to bust my butt trying to take on too many patients at one time to save the facility money and put my license in jeopardy! I am a nurse because I choose to be, because I enjoy people and I enjoy helping others, not because I want to help the administraters save money. They need to find other ways to save money than over working nurses and under staffing these facilitys which only hurts quality of care. To me this is only a means to an end for these places that operate this way. I really don,t see how a business can be run like that. But it does seem to be becoming the norm in ltc and if so I don,t want to be a part of any place that puts the bottom line before patient care.