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.
one of the reasons these things happen is because staff and facilities hide behind those stupid pt. confidentiality rules. now with hippa and the threat of fines even fewer people are going to report any abuse. many times unless you can cite a specific example of an abuse then it does not exist. because of confidentialty rules you cannot take a patient's name home. if there was a way to anomously (sp) report abuse there would be more self policing. as it is now when nurses see problems they run the other way and don't look back. can't blame them. would you give up your livelihood to report neglect? in the eyes of the law you also neglected the residents if you were not able to adequately care for the 80 patients assigned to you. that is how the don intimidates the nurses for so long.
you wonder how facilities look like gems during inspections? when i worked in ltc the way the facility looked so good in front of those inspectors is because when they showed up the admin. miraculously overstaffed the floors and gave double portions at meal time. you would have thought they were in a fancy hotel. as soon as the inspectors left they went back to the usual understaffing and half portions of food. very sad.
i have seen pts. die at the hands of healthcare workers and the only thing the family is told is they died peacefully or it was their time. in other words many deaths are covered up.
forgot to say this about staffing. there is no excuse for understaffing when there are agency nurses willing to work. the facilities excuse is always we can't find anyone to work. bs. they just don't want to pay.
I applaud you for your courage,and strength,yes inner strength,for reporting the NH,and phyicaly strength,
I have neevr heard of such a horrible thing,and i have been a nurse for a long time,I have seen bad things,,but this,,never !
I hope the place shuts down,and also,how about the Ombudsman,did they get involved.?
,how about an update,is the place still open,?
I hope not
,what you did that night is nonthing short of a miracle!
I myself work agency,,and for 50 residents,i have to be charge nurse,treatment nurse,and anything else nurse.
all the while with residents families wanting everything 10 minutes ago,,residents families threatening to sue,because as they say,,their words,not mine''piss poor nursing''
I do the best i can,with the 2 legs and 2 hands i have.
I take no breaks,or lunch,
Just a quick 2 minutes for a smoke break,thats it.
It seems to me,every place I go to,its the same problem,not enough nurses or cna's.
nurse to resident ratio is about ,from what i see every day is 40 residents to 1 nurse!
thats so dangerous,its not funny.
I swear,,,i keep saying im going to quit nursing,and go work at Burger King,less stress.
In closing Eddy,,I'm very proud of you for the wonderful job you have done,and for the good nurse that you are:)
I have worked in LTC facility in management for over 15 years and have seen good and bad. No facility is perfect, there are some really poor facilities just like there are some really poor acute care settings. There are many good nurses in long term care who work hard at making things right for their residents and work on making changes to benefit their residents. Please do not let this experience sour you on long term care.
Eddy, you should feel some satisfaction knowing that this facility will hopefully be shut down by the state, Medicare, or by the press as family members who are still available will hopefully have enough sense to take their relatives out. I know you posted some time ago so I have not looked back at your last posting.
I worked in a hospital med/surg. Many times, far too many to count we would get patients from LTCs. Most had decubiti at least throgh the initial layers of skin and in time began to heal. I am only afraid the new skin wasn't going to last long as they were going back into the same situation. We have also had a few come in that were so deep you could see each individual vertebrae of the sacrum. They would be almost as large as a football. Many did not complain of pain as I think at that point too much neuro damage had been done to the skin.
We did have a patient come in from home who had a leg wound and it did have maggots in it. The doctors took him directly to surgery for debridement but we had to remove the maggots as they were not aloud in the OR. Wish they were. The doctor said that the maggots were the only thing that saved the guys leg as they had removed most of the infection and in some areas new tissue was beginning.
Another sad issue I have found is patients that come in from these facilities who have been obstipated for days. We end up getting them and have to do a manual disimpaction along with x-rays as we go along. I had to have had pounds out of a little old woman who didn't complain and the films still showed her completely filled. I had worked on her for more than an hour at that point. Regular laxatives or even enemas were going to help at that point. I think these are definite cases of abuse. The nurses are responsible for patients as to whether or not they are having bowel movements or constipated or worse. I have seen hospital patients charts not marked for days when a patient has been in only to ask the patient about the situation and find they did have a BM and had told someone but was never documented. We have serveral docs who are adamant about this documentation and if not noted they patients are subjected to unnecessary laxatives and such.
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??????
realmean1 thank you also for your advocacy as much as you can. As someone mentioned these unnecessary treatments,etc will continue to go on. What is the physician saying about any of these things or does he/she know or even care. That person is recieving a stipend if not charging the individual patients. Maybe getting a geriatric nurse practitioner in the facility may be a start who will have a physician or the current physician contract with them. My girlfriend and I were joking the other day about when we get to 65 we have already rented a hotel room, with a microwave and small fridge, room and maid service. That would still be far cheaper than going to a LTC when necessary. We could even hire someone to help us with ADLs. I have always treated my patients as if they were my family members or if it were me in that bed as some day it could be. I think HIPPA is going to make reporting more difficult as patient's confidentiality could become an issue.
With the nursing shortage why are facilities not hiring on flexible scheduling such as using a mom with young children. When significant other is home she could work just a day or two and when gets home takes the children to school and goes home to bed. We need to do this also in hospitals by offering shortened shifts for parents with small children.
Stat minimums for staffing in LTC have not been updated in 15 years. what do you expect? Our LTC facility stays above the minimum and still does not have enough staff and of course, company won't pay for more. They recently decreased a few of the "extra" employee positions. Nurses should demand Nursing Boards update the stafing ratios for nurses and CNAs. Of course this would close some facilities but what is the alternative? Dead or injured pts.
Not too long ago the regulations changed for LTC facilities as ratios were established. There has to be one PCT to every 10 patients and no less. They also have to be insured with a certain type and amount. However, as you probably already know most of the LTC are not meeting this requirement. It is truly frightening and I don't want to even think about were it could go in the next decade or so
I just have to say that it's great that you were there to bring this all into the light. It is wonderful that you took such pride in your work to care for those people as best you could. You are a wonderful nurse for taking charge of the situation and helping those that you could. The profession needs people like you.
:) Oh, its unbelievable what you saw and experienced. Bless you a thousand fold, you must've wanted to just cry. I'm so grateful for the dedication it took for you to just start your duties that shift, you just don't know how proud and honored I am to just know that for such a time as this, you witnessed this place they so much have their nerve to call a "home" for those who can't even advocate or vouch for themselves. How can this so called DON even live with herself.!!!!???? How sad and pathetic and cold heart she must have to allow this place to continue, someone special like you, had to come and take a stand for such a pathetic nursing facility who take tax dollars and private dollars to throw down the drain in the name of 'CARING FOR THE ELDERLY". It just makes me cry for who else is out there without no one to speak up for them and help these human beings who need help the most. Oh, my heart just cries and cries. Help us to care and give with love and dedication as you did and continue to do. Thank you and may someone help us to stand and advocate for those who can't help themselves. A fellow lpn in an upstate nursing home who also continually gives until I can't give anymore.!!!!
I do realize that there are many nursing homes in the nation where residents receive poor care & it IS almost always due to poor staffing, for many different reasons. And for this reason, the state does have to survey & follow up on complaints. But let me tell you, I've had many residents return from the hospital in worse shape then when we sent them. So, remember that poor care is a result of incompetence, not the environment. It can happen anywhere.
After having been a DNS for 9 years, in facilities that are absolutely wonderful, it saddens me, no I am horrified, to think that a nurse would ever have to deal with what you did, much less what that poor resident(s) went through. I agree, that this facility should be turned in to the state, & the administrator should be hung out to dry, for not providing ample staff to care for the residents. This is definitely fraud, abuse & neglect.
However, please understand that not all nursing homes are like this. I work for a nationally known chain, where residents come first. And I'd have it no other way.
I have never, in 16 yrs. of nursing seen anything like this. And I have never, in 9 yrs. of being a DNS, ever had a resident in this condition. I realize that I am lucky to have always had wonderful nurses & CNA's & although I have had many situations that were scary, we have managed to do what was in the best interest of the resident & family members. No it wasnt' easy, & I have had to stay on my toes to keep up with all the changes & in turn communicate those changes. And skilled nursing homes, like mine, have much more going on than the traditional nursing home, but we take little credit for it. We are the mini-hospitals of yesterday.
And please understand that it's this kind of information about LTC nursing that gives all of us a bad name. There are many geriatric nurses out there who do care, & who are proud of their accomplishments. We all deserve a hand for dealing with day to day crisis. We are never bored. And although it is highly stressful, we are nurses first.
In the nursing home environment, you are not only the nurse, you are often the only family some residents have. You are also a mother-figure for many of your staff, who, perhaps, the best part of their day, is coming to work. I've raised many CNA's, & some have become responsible career-CNA's who love their residents.
Too often, we've been treated like outcasts, who couldn't succeed in the 'hospital' world, but in reality, we do more than hospital nurses on a day to day basis. Especially in skilled care homes. We don't have lab & x-ray staff 'downstairs' to identify conditions, but we're expected to know what's going on at all times. It's our specialized assessment skills that help us prevent complications, & it's those assessment skills & interventions that allow residents to rehabilitate & go home.
We have many success stories, whether someone is discharged to home or not. Helping a resident maintain a quality of life for several years in an institutional environment is not easy. We have to be creative. We have to work as a team, & we generally have to do it for less pay than other nurses. But we do it because we love nursing & we love long term care nursing. We know our residents well & we care for their every need day after day. Helping someone die with dignity in itself can be a success story, if you realize the dynamics of families in crisis. And when your staff have cared for a resident for 5 years, losing them is like losing their own grandparents. You also have to be the on-site counselor when staff are grieving.
We don't have ward clerks to help answer the phones & we don't have security guards to make sure the building is safe, we don't have doctors making rounds on a daily basis, or pharmacists on staff to review our orders, & most of our staff are non-professionals, but we manage to provide a life of dignity for those we are responsible for.
So please, nursing students & new nurses out there, please don't think that what Eddy went through is a typical day in a nursing home. We have stress, but we have fun. We love what we do & we welcome anyone with integrity to join the world of geriatric nursing. Because that is what it takes.
Thanks for the opportunity to remind others that geriatric nursing is the best of both worlds.
Thanks for your post DNS! I too am a DNS. I work in Minnesota. I'm less than a year as DNS, but have worked in management for several years.
I was planning to post much what you said myself, and I'm glad you did it for me. There ARE good people working in LTC. And, there ARE good nursing homes out there.
What Eddy experienced was horrid, and I hope they get their just rewards so to speak.
The LTC industry needs good people, nurses and nursing assistants. The residents need them too!
itsme
266 Posts
Tina, you arent crazy, that ADON is!! I had to check what state you are from cuz she sounds like my ADON!!