Yikes! Another bad observation at an LTC facility

Specialties Geriatric

Published

YIKES!!!!! That's about the only word I can express about this one.

Got off a weekend night shift (through my agency) at a nursing home I have never been to previously. I prefer to stick to hospital work when I can just because of what I am about to say.

Came on to the shift at 2200. As seems the usual, I had to sit and wait for report until 2245, already putting me behind for the night. I had to scramble to get caught up, but that's nothing new. Since we were running short 2 CNA's I was also putting in double duty answering lights and doing other aide work. No biggie as I always do this anyway, just usually as a helping hand not out of complete need. Still no suprise (been there done that). However, about 0200 I floated over to the other unit to cover a nurse who went home due to "female problems". She told me that she was having a "heavy flow", and so I left it at that. Now, I am covering my original unit as well as this lady's as well. No biggie, except I knew everything wasn't going to get done. A call light came up on this new unit as I was passing by, and I didn't see a CNA on the entire unit, so I went to help out. I got to the residents room and asked what I could help with. The gentleman promptly said, "my back is itch'in". I told him I get that all the time myself with a smile, and I asked him if it was okay to help him sit up. He pleasantly agreed that it would be fine. He also said "you sure are nice compared to most of the folks here." When he sat up I discovered the most terrible DC I've seen in a long long long time. It was so deep a 3 1/2 inch swab could be inserted all the way in and barely touch tissue. But that's not really the issue. It was full, and I mean FULL of the biggest maggots I have ever seen. When he sat up, they fell out all over his bed. I was shocked (not in a "gross! look at that!" way, but a "how the h*ll could this go unnoticed!?!" way). I cleaned the wound and got all the maggots (I think). Then, took another look inside. What I believe I saw was the back of his right lung. I quickly took a look at his chart (which took me about 30 minutes to even find as it was tucked away at the unit nursing station under an old notebook, NOT where it is supposed to be). This man was on a rotation to prevent bed sores!!!!! I called the DON, who said she would "call it in" with a yawn of disconcern. I also asked if she was aware that the LPN from the other unit left. She said that she was aware, and I would have to cover. I told her I would do my best, but we were pretty short all around. I asked her if she considered calling the agency for a nurse. She said NO WAY! We're not paying for a full eight hour shift if the person is only going to be there for 5 or so hours! Inside, all I could think was how rediculous she just sounded not caring an ounce for her residents care and well-being. I then charted what I discovered and the Doc arrived shortly after, VERY angry. He said (QUOTE), "They oughta shut this d*mn place down. Too cheap to pay for staff, and too cheap to use a d*mn agency." I replied with "I'm actually agency through ********." He then said, "That suprises the h*ll out of me! I have been on them for months now to get some help in here. In fact, I told them I would quit as the primary here if they didn't. Looks like they are trying to do just enough to get by. humph! Typical!"

Shortly after this conversation and about a 30 second exam of the resident, the Doc called for a transport. He said, "don't worry about messing with this. I'll take care of it. You have 40 other people to worry about. That's when I realized I actually DID have 40 other people to worry about!

I knew only the MOST BASIC requirements were going to be taken care of for these poor people tonight, but I hunkered down and started to try to accomplish the impossible. Meds got passed, the Doc stayed and did a couple foley's then did dressings on about a dozen residents!!!! Wow, what a cool guy!!! But of course, just about nothing else was done. I also discovered two other residents that were on scheduled turns were NOT being turned. Jeeeez!!!! And where in the world are the aides?!? I had only seen one aide (on my original unit) since I had been there (the aide issue is another story in itself).

Needless to say, when the DON came in an hour late (grrrrr!) I gave a report from h*ll to her. I told her that she needed to get some more CNA's in here and a nurse that cares more about patient care than a mild discomfort. She said something like, let's not talk about THAT and talk about all the things that you left undone. I was about to explode!!! I told her that unless I would have been able to split into 6 people last night, there was NO WAY that these people were going to be cared for properly. I also expressed to her the lack of attentive care the residents were getting. They were lucky to get a water refill in a 12 hour span, some clearly hadn't been bathed for weeks, and on and on and on. She rebuttled with something to the effect of, we aren't made of money and walked off! Seriously, she walked off!!!

I have never done this before, but for the first time ever I reported a facility to the state. God help those poor folks at that h*ll whole.

I know that agency won't cure the shortage of qualified nurses and nurse aides in this country, but in my opinion, if you need help and people are suffering as a result of such short staffing, it's time to call them in and in droves!

Sorry for the book... I had to get this off my chest.

Specializes in peds, office nurse and long term care fa.

What an interesting web site to check out nursing homes!

Eddy, way to go for reporting this nursing facility, (it sure isn't a "home"!) They deserve everything that they get!

Originally posted by casperbjs

What an interesting web site to check out nursing homes!

Eddy, way to go for reporting this nursing facility, (it sure isn't a "home"!) They deserve everything that they get!

. . . and more. This, IMHO, is criminal neglect. No one will be charged, and no one will spend one minute in jail (which is where they belong!)

This, IMHO, is criminal neglect. No one will be charged, and no one will spend one minute in jail (which is where they belong!)

Administrator and DON of a facility in Tennessee were arrested and charged with wreckless homicide for lack of care that caused a death. Where I work, the vulnerable adult act would come into play in this situation.

While I have mixed feelings on this particular family (assuming there is such) finding out, I wouldn't ever be the one to tell them.

Thank goodness you didn't. A co-worker has to testify in front of the SBON the results of a complaint investigation that resulted in a disgruntal former employee violating a resident's right to confidentiality. (The resident was alert and oriented.)

As a state surveyor, and having investigated a few complaints, I can assure you if we find something that warrants referal to the attorney general, medicare/medicaid fraud unit, the nurse aide registry, state board of nursing, and what ever other licensing boards we feel need to be notified of such actions we do it.

There are a few administrators out there who are upset with us for citing F225 for hiring someone with a criminal background for criminal domestic violence. One tried to say the person was just defending themself. I understand but what happens when that person is defending themself against an alzhiemer's resident who doesn't understand what is going on?

Eddy, just out of curiosity, did you get a chance to document in the chart what you found? Do you keep a journal of things that happen on your assignments? Did you know personal journals are admisable in court of law and formal hearings? When I use to work on the provider side and staffing was bad, I would copy the staffing sheet and the 24 hour report sheet as well as making an entry in my journal.

I admire your guts to report this facility to the powers that be. Keep up the good work.

And for all those out there, God Bless you for all your hard work and dilligence to protect our vulnerable elderly.

Catsrule16 - I chart like a crazed madman. In fact, some nurses call me the "chart nazi" at a rural hospital I go to frequently (not exactly politically correct but what can ya do... hehe). I make it a practice to record in a notebook anything that could someday come back to haunt me, or worse tried to be turned INTO something that could haunt me. Unfortunately, there are people out there who would just as soon "screw the agency dude" than tell the truth. As a result I keep a LOT of things in my little notebook. However, it is a fine line with that too. Since there is always a possibility that my journal of sorts could get into the wrong hands regardless of how I protect it, there are things that could be misconstrued as a violation of patient confidentiality. As a result, I am still quite careful as to what I write in it. It has to be specific enough to make sense but vague enough not to go over the line. I feel somewhat uncomfortable with the thought of people I work with and around knowing I keep this. I think with some it can create a sense of mistrust, so I do all my writing when away from others.

I would never have told the family regardless of how much I wanted to. Like I said in a previous post... not legal or ethical for many reasons.

I have a few rules that I live by as an agency nurse:

1. NEVER tell anyone I am insured to the gills. It'll bite you in the butt when someone else screws up and they go after mr. moneybags instead.

2. ALWAYS keep a log of important issues that could hurt me or in this case help others down the road.

3. NEVER go back to a place you feel endagers you in any way.

4. ALWAYS chart like a crazed lunatic to ensure proper things are communicated to the other staff AND to cover yourself against OTHERS mistakes.

5. ALWAYS make sure the narc count is correct before starting a med pass following someone elses shift, and count in front of someone else if and when possible. Note any errors in the count and present to a staff nurse or the nurse mgr prior to taking any other action. Charting a bad count is NOT enough!!!

6. ALWAYS do things the right way even when some staff members do them the "easy" way. For instance, sterile techniques.... what a joke these days....

7. ALWAYS remember the golden rule.... you know that one... (cheesy but it seems far too many know it but have forgotten it's practice).

I know everyone is saying they are happy/proud/etc. that I reported this. However, I was only doing my job, and something I hope all of you would have chosen to do in my shoes.

Take Care folks and hang in there!!!! :)

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
Originally posted by Vsummer1

They came up with the fact (don't know if it is true) that a flies entire life cycle is 3 days. Also, the maggots will only feed on necrotic flesh, not viable tissue (it is used sometimes to clean wounds...).

Yes, but they are sterilized maggots in a controlled environment.

Either way, I'm glad that you reported and facilities like this are shut down.

Our elderly deserve alot better than they get.....

That dear sweet man, my knees get wobbly and my eyes tear up when I think of him. I hope the state acts on this soon but I am hearing stories of them dragging their feet. God bless you, you are one of those heroic persons who never get their picture on tv but a hero nevertheless. That DON should lose her license, she is putting the welfare of the institution over those of the patients.

Oh yes....... been there! I was hired as DON...

Tried to improve conditions by increasing staff:patient ratio. Was told by administrator that "THE STATE" requires only THIS many staff per number of patients. When I said that was not enough staff to adequately care for the patients, considering their acuity, I was told that's too bad!!

I was having a problem with call-ins. Found out that when people had M.D. appts, or dental appts, they were calling in, instead of letting me know ahead of time so I could plan a replacement. I told them I would give them a sick day to use for these medical things, if they would let me know in advance. Again...administration said, "You can't do that. We don't allow staff to plan sick days. The only way they can be paid sick time is if they are sick."

The disagreements I had with administration are too numerous to list...

I lasted only 6 months, when I was asked to leave, which I gladly did!

My prayer is to die before my children decide to put my a** in one of these God-forsaken h*ll-holes!

:crying2:

WOW!!! I too am glad to hear you reported this. Yes there are a lot of bad apples out there but I have always said that one person can make a difference and I believe you have made the differance at this place.

I have had patients and their family members tell me that it takes a special person to do the job that nurses do and eddy I would like to say that you are one of those special ppl to not just overlook this situation like so many others obviously have.

Holy Cow!

The LTC facillity I work at may not be perfect, but after reading your story Eddy,it's very close to being perfect. You are right. We as nurses need to take a stand. You are to be commended for taking the action that you did. I certainly hope that justice is done to this LTC you worked at that night. Those greedy owners need to be dealt with severely. I believe what goes around comes around. Those who are responsible for treating the residents so terribly can only pray that they do not get me for a nurse some day. I would make nurse Cratchet look lke Mother Goose!!

Keep up the great work.

In the UK we have a body called The National Care Standards Commission who set and monitor the standards, both Clinical and environmental, for nursing and residential care providers. Does the same apply in US or do individual States set their own criteria.

not all nursng homes are bad. and not all nursing home nurses are idiots. let's here some good things that are going on in LTC. we that are in LTC are the ones that will make the difference, one little step at a time if necessary

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