Working in a "toxic" workplace

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So I'm working my first job almost ending my training period at a LTC facility, and hit one of the long term floors. Working there really depresses me and angers me. Some patients are addicts they seem to be always early asking for narcotics conveniently early the same time each time, super paranoid patients that write down everything you do and even sometimes daring to say you never did it (via reporting to the higher ups) even though its documented, and patients that don't pay a dime to stay at the facility with attitudes like they own the place and call you stupid just because you don't give him his PRN vicodin just because they didn't ask to quote the patient "Are you stupid? They always give me the vicodin every morning!".

The doctors don't seem to care and they just keep prescribing the very same drugs the patients are seeking. And the workload just drives the staff crazy (Nurses get 30-50 patients on the night shift and we still have med passes that usually involves fingersticks and GERD meds). There was one patient with a spinal injury that needed to go to the bathroom and the aide just said no and walked away. I walked by and she was calling for someone, I walked to her the bathroom and back, sure it took 10 minutes but she appreciated it. Apparently, her daughter works for "the State", so I'm not sure what that exactly means. She also tells me to keep my love because apparently the staff has none of it as well.

My preceptor did does not feel satisfied in her work since the patients just get worse and not better. My supervisor tells me to bear it out and use the place as a stepping stone to better things, but the long term floors there just make me sick in the sense its almost a warehousing of the elderly, homeless, and disabled. Am I supposed to turn a blind eye to this? I'd leave the job if I could but this was the only place that would take new grads for almost 50 miles.

How do you guys bear it?

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I'm sorry Catch, for what you are going through. You are stronger than I.

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Specializes in Mental health, substance abuse, geriatrics, PCU.

Yikes, that place sounds like an utter nightmare! I've been there, done that and got the t-shirt.

I think no matter what, that it's important for nurses to set boundaries with our patients, for example:

"What are you stupid?"

"Sir, do NOT call me names, I am here to take care of you not for you to belittle. Now, you said you want your Vicodin?"

In every situation will this work? No. However, most of the time it will.

As far as the patients writing everything down, that probably comes from behaviors such as that as the aide you described. That's something you may just have to live with. Typically, it makes it easier if you actually encourage instead of acting as though it's a bother, this will help facilitate trust between the patient/family and yourself. After all, you know that you're doing your job correctly so if they want to write it down, then so be it. As far as false accusations just be sure to document your butt off so that such accusations will be seen as false.

Sometimes it can help if you accept that no, you can't change their circumstances, no you can't change their behavior but you can change the way you react to their behavior. Go in, do your job which is to maintain their present course and help them to get through the day. That may sound cold and I don't intend for it to, but it will definitely help you cope with your job until you can find something better suited for you.

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Specializes in MDS/Office.

That's why I work in the MDS Dept.

Welcome to Long Term Care..... :cool:

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I'm sorry :( This sounds like that classic nursing home horror story...

I think the idea of using it as a stepping stone is best for your personal interests. Become confident in dealing with things here, use your experience to find a better job, and move on.

I agree with TheMoonismyLantern in that you can help yourself with the issue of patient suspicion by accepting it and even making it easier for them. Show that you have nothing to hide, and even though it might be hard, do your best to give them the care they need.

Finally, even when you finally leave this crummy facility, you don't ever have to stop advocating for this population. You can pursue this cause for a lifetime. Walking away from this one situation does not mean walking away from the whole problem.

The "warehousing" of the elderly, homeless, disabled, mentally ill, and otherwise "unwell" has been a major issue for a long time. It calls to mind facilities like Willowbrook (a notorious "state school" for mentally challenged children where young people were isolated, warehoused, and sometimes ultimately allowed to die from neglect).

If you know what happened there, you know that it catalyzed new legislation to keep things from getting that bad again...but you also know that some situations are way too eerily similar to make us comfortable, and that we have a long way to go. In addition, it is a bit of a different issue because the group in question was mostly young people, not mostly the elderly. The elderly face other unique types of prejudice.

Society's treatment of the elderly involves practical issues that won't be solved just by telling nursing homes to "make it better now because it's just not fair," because even they can't snap their fingers and fix everything. But there are innovative people to come up with creative ideas, and there are passionate people to advocate politically for the elderly and anyone else who needs to be cared for over a long period of time.

You can educate yourself on the issues today that will affect your population the most. Things that immediately come to mind include Medicare/Medicaid, national health care, funding for scientific research, and other public policies. When you know the issues and where your candidates stand on them, vote for the one you judge most likely to support laws that will be the best. Your vote alone is a good way to advocate.

You can always donate to nonprofits, too, maybe even on an ongoing basis. You could find a national one or a local nonprofit that helps seniors in your community. Some, like AARP, are generalized. Many of them address a specific issue, like the "right to die." These are more controversial and it's up to you to figure out which ones you like.

You can also raise awareness personally. This would probably take the most time, effort, and creativity on your part, but you can write about your concerns to post online, answer other people's senior-related questions, and try to involve yourself directly in your community such as writing a letter to the editor of your local paper the next time you get a chance to discuss this issue. There is so much creative volunteer work to be done.

It really stinks working in a place that is unsupportive of your efforts to be a good caregiver. If you decide that advocating for these people is your passion, you can move to a place that will support your beliefs more strongly. You will be able to work better and feel more satisfied.

I don't mean to push you towards all this stuff, of course...it's up to you...you just asked whether you had to just turn a blind eye or not, and I'm saying you don't really, you just need to look at "helping" a bit differently.

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Specializes in Long-term Care.

LTC is care is a different kind of monster. Coming from a primarliy LTC background I feel your pain. Sadly you will always have those residents,family members, and staff that will make you job just that more difficult. I can not stress the impotance of documentation of enough for residents that have behaviors such as the ones you mentioned. It will help you in the long run trust me. LTC facilities typically are understaffed and overworked and I have left many a day feeling completly defeated. Continue to be the good nurse that you are and take care of your residents to the best of your ability. If you can leave at the end of the day and tell yourself that you did everything with in your power to help your residents thru the day even if it just taking someone to the bathroom then you have done your job.

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LTC a special kind of hell. Find the small good momments and try to leave the rest behind when u leave for the day. Believe it or not, you are learning valuble organizational skills, and learning to deal with some of the hardest problem behaviors. (patient's, MD's, and other staff) You are learning supervision and follow-through.

Go home and write down at least one thing you learned every day.

Look up one thing (disease or something that interests you every day

When u get really depressed, apply for a new job, u don't have to take it!

Getting called for an interview would be something wouldn't it!

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I think you will find diffucult residents/ patients no matter where you go? Trust is a big issue for the residents. How often do you work there? They might keep asking for prns (them constantly asking vs you anticipating is a entire other thread that was debated here) because they don't trust that you will be back or ask them at the prn time or when they do call for the med, it might take a while to get it.

As far as the name calling...Tell them you won't tolerate it, walk away and come back when they are civil. (if they don't have dementia)

Try to get to know the families/ residents. If they know that you are there do do your job and care, they might not be paranoid note keepers.

The CNA that was rude and walked away from the resident needs a written or verbal write up. Are you a nurse that can do this? Do you report it?

30-50 residents to one nurse on a LTC units 11-7 shift is the norm. 30 is more along a 7-3 or 3-11 staffing ratio.

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You do what you have to do to pay the rent and put food on the table, and to get experience. Your supervisor was right, follow her advice.

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I've been in LTC for most of my career. At 15, I lied about my age to get my first job as an aide. At 26, I got my LPN license and at 37 my RN degree. I've done other jobs, home health, private duty, and hospital (ER, oncology, same day surgery, and labor and delivery), but I always come back to long-term care. There is no middle ground. You either love it or hate it.

My first day as an LPN I walked into the facility for my 6p to 6a shift and the nurse I was relieving threw me the keys, pointed, and said you have this hall and that hall and walked out. Today she wouldn't get away with that but then I was too green to do anything about it. The two halls I was responsible for consisted of 60 patients and I had 6 CNAs. That number dropped to 4 at 11p.

That facility was not my first, I had after all been a nurse's aide for nearly 11 years. But it was the first where I knew that the well-being of the patients was my responsibility. And it's where I encountered hundreds of my "firsts". My first code, my first death, my first patient to choke, my first time being hit, and spit on, and having food thrown on me. It was also my first time to save a life, to befriend someone completely alone in the world, and face an irate family member. It was also where I learned to love the all together unlovely. There I learned how to deal with egotistical doctors, an undertaker with less than perfect respect for the dead, and a sadistic administrator.

Looking back I am amazed at the things I learned.

Working in other forums I've found the world of nurses outside long-term care consider LTC to be the place where poor quality nurses go. I beg to differ, it's where the best nurses go... and stay. The ones who leave probably never should have been there in the first place.

Take my advice... If you genuinely feel your workplace is toxic because of mean patients and drug seeking behaviors and rude CNAs and demanding family members, then definitely go somewhere else. And give me a shout when you find the job that doesn't have any of the above. I know a lot of nurses that want a job like that. :)

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My orientation got extended a week so I'm happy. I'm going to try to stick it out with this place, if it weren't for the fact my supervisor, and several of my preceptors have been looking out for me I'd have quit already. I hope what I learn working nights translates well into the hospital eventually.

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