NH nursing

[chanab]

Haven't been on in a while... it's great to see how much this group has expanded.
Wanted to throw something out there to a group I know has similar background in adhering to halacha.
I recently started a part time job in a NH. I have never worked in a NH before, most of my experience is in a busy clinic setting with 3.5 short weeks experience in ER (was not for me). I do not know how NH nurses do it! I find that working in a NH is challenging my beliefs about how healthcare should be practiced and putting my license in jeopardy. It took me over 3 hrs to do a med pass the other night and I am dreading going back tonight for more of the same. I am WAY out of state regulation on when meds can be given and I refused to pull my meds early (also a no-no) and I'm not sure how to actually stay in state regs and get everything done. And from talking to the other nurses they are also pulling their meds early or starting med passes at 3:30-4 AM. Apparently this is NH everywhere. I feel like I'm a pill pusher and paperwork does and that I have no time to do propr assessments. How can I reconcile my belief that I should be practicing within state guidelines and my own personal belief sx of how nursing care should be provided when I just don't have the time in an 8 hr shift? I know I can speeed up some of that process with more experience but I was told by my orientating nurse that I was actually going quickly for not having pulled my meds in advance. Input please, especially from other people who have done the NH route. Thank you.

[medic09]

All I can offer is sympathy. It seems to me that most LTC (long term care) work is critically important and impossible to reconcile with our values, at the same time. Patients quickly get reduced to 'a task that needs to be done' when they are the patients most in need of being personalized and treated with extra dignity. I admire those nurses and others who can do the job well; while at the same time I resent those who reduce the job to a list of tasks and the patients to obstacles in getting those tasks done. In the ER we often receive LTC patients who we are convinced were sent to us just because the LTC facility staff didn't have time to deal with their problems properly. The poor patient to staff ratios, the general environment often don't allow for the staff doing a good and kind job. If you succeed in being one of those good LTC nurses (rare in my limited experience), you will be a heroine!

I got confused by your use of NH. Didn't know if it was New Hampshire, or National Health (British).

Good luck. Hashem should bless you with success and strength in taking care of these most vulnerable patients.

[achot]

Hi Chana, I have worked Nsg Homes for quite a while. and Baruch Hashem did not have ur experience. Since your orienting nurse says you did well, I have to wonder if she was not concerned about the amount of time it took you. You might want to make an appointment with the DON and bring your concerns to her. If other nurses are starting at 3:30 then maybe they are the problem. As long as management sees that the nurses are "managing" nothing will improve. If all the nurses were working according to the ethical and legal definitions that we are bound to, then management might see that they have to improve staffing (always a battle) . The problem is that the DON gets a bonus if she keeps the budget tight and she will be not so willing to improve things as long as others are willing to sacrifice their standards (and license) by providing care as you described. Please know that there are good nsg homes out there which staff the units appropriately, provide med technicians to help the RNs so they can concentrate on their assessments etc. Paperwork is always an albatross around our necks but the bottom line it provides proper communication and accountability. I am a believer in proper and accurate documentation and justify the time needed to do it.
Good luck in whatever you do, but please, continue to provide professional care as you were taught and dont learn bad habits, sloppy care or short cuts from others!

[chanab]

Medic - totally Hew Hampshire

So I "managed" my med pass by.... starting at 4 AM And the only reason I finished on time was because the other nurse I was working with took 2 of my more complicated pts. I will continue to refuse to pull meds early because I think it's unsafe in so many ways. And I don't know that the DON will care but I will look into talking to her about it tomorrow AM. Hashem yirachaim! Why couldn't I have chosen an easier profession? My parents are nurses, one would think I would have learned better.

[medic09]

Jan 22, 2012 7:33:05 GMT -5 chanab said:

My parents are nurses, one would think I would have learned better.

Well, it may be a genetic flaw then; and you couldn't really help it.

Both of my parents (and older sister, aunts and uncles...) were teachers. I swore I would never go into education. Somehow I ended up in the classroom and informal education for nearly 20 years. So don't agonize over it. It is very hard to escape that nefarious submerged family influence...

[cganz1]

Hi Chana! I can totally relate to what you're talking about It is so sad and terrible! I began working in a nursing home/long term care facility last Decemeber and the beginning was completely awful. I can not believe that I made it to a year. I never thought i'd survive this long! I was desperately hoping to manage for 6 months and somehow I'm still working there. I've been battling the same dilemma and have unfortunatley heard that most LTC facilities in the US are the same. I very quickly learned that the way other nurses finish their work on time is by cutting corners and doing totally unsafe and illegal practices. I spent many shifts scared out of my wits that I was going to kill a patient or just crying because it was impossible to pass meds to 30+ pts who have tons of meds in such a short time frame. In addition, they cut corners with gtube meds and I've seen and heard first hand that they sign off on treatments that are never completed. It's really scary! There is no time to car about your patients. The staffing ratio is awful and unsafe and they have no qualms about pulling nurses and leaving you to work short staffed. I work on a vent unit and some days they leave us hanging with 2 nurse for 28 critical pts on vents with gtubes + lots of wounds. One nurse even told me that when they have an admission, she completely focuses on the admission and doesn't even pass meds - just does paperwork. Can you imagine a pt not getting their evening meds!!!

In additon, in my experience, unfortunately the administration (Administrator, DON, ADON...) are only focused on one thing - budget! I get in trouble often for staying late. Anything past 5 minutes after my shift is late and you need permission to stay late, but they told the supervisors not to sign any late papers. They cut staff and know that it's unsafe nursing practice but it's on our license not theirs.

Sorry for the ranting. I could go on and on, but I guess you get the idea. If you want to talk, you can contact me. I just realized that I never wrote any tips or suggestions for managing working in a nursing home, but I'm tired and have to be at work in less than 6 hrs. I'll try to post again soon.

[achot]

Wow, you are totally justified in ur post I can only encourage you to try focusing on the patients and what we can do for them and not just the work, forget the other nurses, they are not your problem, if they cut corners or whatever, its on their conscience, you can try reporting it but without proof it wont get you far. maybe try to find a better facility?
Please understand that the problem isnt with the nurses or the supervisors as much as its with a system that doesnt prioritize long term health care and doesnt budget for it properly. If you are understaffed because of the budget than what are you going to do? get volunteer nurses. There are better facilities that budget properly for nursing care and you would do well to find them so you can work the way you want to. Good luck, it sounds like you really care and we need more like you out there.

[chanab]

Wow cganz1! Your experience sounds worse than mine. At least my pts aren't nearly as acute. I've been at this nursing home for almost a year now. I see there are areas where I've learned bad habits and compromised my standards in order to focus on more important things. It makes me sad to know I've done that. I still start my med pass early though in order to not pull meds early. Oh, and the meds most definately get given! I can't believe there are nurses who put paperwork ahead of meds! I only work part time so if I'm late finishing up paperwork my employer hasn't complained yet... and I'm frequently late leaving because paperwork gets pushed to the side when I'm still in charge of my pts.
I wish you a lot of luck. I know at least partly where you're coming from. It's very scary and yet if we weren't there can you imagine the care these pts would (or would not be) receiving?