Yikes! Another bad observation at an LTC facility

[eddy]

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.

[RN2B2005]

Wow, I checked out my state (WA) on that Member of the Family link, and it seems like every single nursing home I've ever heard of is on the complaint list. Even Bailey-Boushay House, a nationally recognised hospice for HIV patients, is on the list.

So, is neglect or outright abuse endemic in nursing homes? Or is it something about the reporting process that skews the figures? I sincerely hope it's the latter.

Anyhow, kudos to Eddy for reporting that facility. If something like that happened to a relative of mine, I'd be kicking a*s and taking names (and licenses!).

[Catsrule16, RN]

Unless you know the specific "F" tags cited at a facility, I would not be too quick to judge a facility based just on what you see on websites. While the websites give you an idea of a facility's past performance, the actual details in the deficiency statements of the survey results give specifics. I have seen F 309 Quality of Care and Services cited because a Nurse forgot to pre-medicate for pain prior to performing pressure sore treatment. The resident flinched and grimaced in pain during the treatment. Because the staff member inflicted pain..... this was cited at the "G" (HARM) level. One observation. One human mistake. There are specific tags that speak to Abuse and Neglect. They fall under Resident Behavior and Facility Practices F 221 - F 226. Just because something is cited at a Harm level, doesn't mean the facility is abusing and/or neglecting a resident.

Many of the complaints I have investigated, have been unsubstantiated. I have only been able to substantiate 2 cases; one neglect (a Nurse) and one verbal/mental abuse (a CNA). I haven't made it to the State Board of Nursing yet to testify and verify my findings. The CNA is apealling her case. All our reports are reviewed by the state's attorney's office for possible legal proceedings and criminal charges.

I commend Eaddy for having the guts to report his/her findings. We all need to be more pro-active and remember we got in to nursing because we care!

[Hellllllo Nurse, BSN, RN]

I tried speaking up against poor conditions at nursing homes for years.

I worked in LTC for years, but I will never do it again.

The deck is stacked against the pts and the nurses. You just can't win.

God help us all.

[realmean1]

I work at a LTC fac as a supervisor and also cover 12hr shifts in an LPN slot: meds, tx, etc. I sympathize with those who work in h#llholes. I certainly agree that the steps Eddy took were excellent. I guess I am a troublemaker at my fac., when I see something wrong, I usually bit#h about it, until something is done. My current targets are unnec. drugs and figersticks. Have yet for an RN to justify sticking someone's finger every day for months with no change in routine insulin or oral meds. Routine tylenol every 6hrs for yrs. Megace for yrs, even when the pt is eating well. My all time fav. Ventolin treatments, 3 bronch dilators, nasalnex, give Tussex for cough. These are all v.o. by the nurses. The MD has no clue what all His pts are taking. 6am med pass takes as long as 9am. Can someone tell me why a geri pt needs lo-dose synthroid at 6 am????? with no hx of thyroid problems??????

[night owl]

We usually tell the doc who comes in every morning if we think he/she needs the nebulizer tx or not and the doc will review the order, examine the resident then draw his own conclusions from there, but at least we make the doc aware of it...Now if we could clear up the unnecessary FSBS. What would you consider unnecessary?

[CapeCodMermaid, RN]

I used to think we were short staffed here. Compared to all y'all we are OK. We give excellent care despite being short. What really makes me angry is sending our patients to the hospital with intact skin and having them come back with horrid stage 3's on their heels or huge stage 2's on their coccyx with a little note from the hospital nurse. Bad care is bad care no matter what facility it occurs in.

[CseMgr1, ASN, RN]

Originally posted by BrianWhitfield

While your story is horrible, it really doesn't surprise me. Not putting down the honorable profession of nursing, but there are some bad apples out there and the state agencies and NH administrators don't pay enough attention. My mother was killed in a NH about a year ago by a RN who had a long history of medication errors, paitent assaults, etc. All the state people did was write up violations against the NH. The state attorney general brought homicide charges to a grand jury but they didn't prosecute. The RN told the grand jury she was having a "bad stress" day and they took sympathy on her.

The bottom line is that NH administrators and owners treat these elderly people like farm animals. When reported to state agencies, all they get is a simple slap on the wrist. I could have done better by having my mother boarded at a animal hospital. It's a lot cheaper, she would have gotten walked twice-a-day, bathed once-a-week, and fed twice daily......

I know the feeling, Brian. My father died last year at the hands of a nursing facility, too. He was medically stable when he was transferred there from an inpatient facility, and three weeks later, he was dead. I'm not going to to go into the details, for my family and I have litigation pending against this place. I will tell you, however, that he was IGNORED to death.

[rnnurse2be]

Please keep us updated as to what is happening. Even though we would HOPE most nures would turn them into the state, there are some that dont.

No matter what happens, you should feel PROUD of what you've done! We all are! :)

[2bPhD]

Eddy,

This is the worst experience that I think I have ever heard. You did the right thing to report the facility, and I wouldn't worry about the DON's complaint to the BON. While this facility was terrible and nursing home residents often do not receive the quality of care that they deserve, there are many reputable facilities out there and many dedicated long-term care nurses. Long-term care needs more nurses who are just as dedicated as you are. I have worked in long-term care for the majority of my nursing career, even though I could have worked in many other environments with my BSN. I work in long-term care because that is where I am needed the most. I hope that your story doesn't discourage other nurses from working in long-term care. Although this was probably the most challenging 12 hours of your life, you made a major impact in the lives of many people. Your shift may have been the catalyst for change. It sounds like the doctor was at the breaking point and ready to see some heads roll. No doubt he confronted the DON and this is why she filed the complaint. Also, don't forget, you also have a case to file a complaint about her to the BON. She is ultimately responsible for the facility and she failed to repond promptly when you notified her that there was insufficient staffing.

[dwoodruff, RN]

eddy,

I want to thank you for doing the best you could do in that tough situation and for reporting that nursing home. I was always taught to consider: If it were my father in that home...

Though your actions were tough, and may get tougher. You will be able to sleep at night knowing you did what was right.

Keep up the good work. We need more nurses like you in the profession!

Best wishes,

David Woodruff, MSN, RN, CNS, CCRN

Ed4Nurses, Inc.

Nursing Continuing Education

[wif411]

I work in LTC to. I broke my foot four weeks or so. Worked on this foot, (I thought it was a bad sprain, bruise), for three of those weeks. I work nights. The good doc put me on my bottom for two weeks. I spent 1 wek doing paperwork, but no light duty for non-workman com issues, so I can't work for a week.

To the point---the ADON called me yesterday wanted to know Can you come in and work, if I get yu a CNAII to do tube feedings and accuchecks in am??? You should be able to give what meds there are....I said Duh---I am on crutches and haven't put full weight on this foot for two weeks---like the doc said. I haven't even washed a load of clothes..I could just imagine a code. With just me and three aides to 50 pts I do not think so.

Am I crazy???????

[wif411]

I work in LTC to. I broke my foot four weeks or so. Worked on this foot, (I thought it was a bad sprain, bruise), for three of those weeks. I work nights. The good doc put me on my bottom for two weeks. I spent 1 wek doing paperwork, but no light duty for non-workman com issues, so I can't work for a week.

To the point---the ADON called me yesterday wanted to know Can you come in and work, if I get yu a CNAII to do tube feedings and accuchecks in am??? You should be able to give what meds there are....I said Duh---I am on crutches and haven't put full weight on this foot for two weeks---like the doc said. I haven't even washed a load of clothes..I could just imagine a code. With just me and three aides to 50 pts I do not think so.

Am I crazy???????