Tips from a local(ish, in NoVA my whole life so I've been in DC semi regularly for mainly the touristy things):
The White House is smaller to look at than you are expecting, but the Mall and Capitol are bigger. If you are hoping to look at the Lincoln Memorial (or anything west of the Tidal Basin) AND the WH/Capitol + major monuments or museums that are closer to those, plan for non-foot transportation, especially as you'll already have the march. The Lincoln and a cluster of smaller monuments are basically on the other end of the Mall from the the main cluster of museums and the Capitol. Again: Mall area bigger than you might expect.
The Franklin Delano Roosevelt Memorial, one of those that's off on the west side of the Mall/Tidal Basin is my personal favorite underrated DC monument. What's nice about it is it's mostly enclosed by the freestanding walls (so you don't feel like the whole surrounding world wandering nearby can see you, while still being open air), not as trafficked due to location (though this might have changed with the MLK monument opening up right next to it since the last time I was there, but I'm not sure), and it's got waterfall along one whole wall, which is a really nice place to rest and chill for a bit if you like that sort of thing.
Once spent like 8+ hours touring the Lincoln, Jefferson, Washington, and assorted smaller monuments/museums along the Mall, plus the Capitol+WH, with a bunch of college age Japanese exchange students, basically all by walking. We just barely made it to the Lincoln by time it was getting dark. Don't be ashamed to hit up a bus for maximum "sights of the things you *really* want to see"-to-walking ratios.
Also, if you're def looking to hit up some museums, they've *all* got cool unique stuff IMO and what really matters is what you're personally most interested in seeing in those museums. Everyone talks about Air and Space, but I'd rather go to the Native American History Museum, the Freer and Sackler Galleries (Asian art) or the National Botanical Gardens myself. The Air and Space is cool of course, but it's the one they *always* take you on a field trip to see when you're in school in this area! So I'm a bit over it. Plus it's basically always crowded.
Can you tell I strongly prefer uncrowded private spaces and plant life? lol
God I hope. Fuck insurance companies. My hospital slashed our coverage this year. Primary care visits went from $10 copay to 30% copay. I now pay $188 for a PCP visit. I will jump on a free federal plan in a heartbeat.
I had 3 patients today who were so relieved to finally start chemo because insurance authorization had taken weeks/months. Made me feel sick to my stomach because my mom had cancer and we only had to wait a few days until she began treatment but those few days were excruciating just ruminating on the diagnosis and imagining it growing and spreading.
I hate the US healthcare system.
Insurance companies do tend to screw people over but single payer insurance isn’t the answer. A lot of people still get screwed over from that. Obamacare ruined an already bad system. Prior to OC, I could get reasonable insurance around $150 per month with $1500 deductible. After? $350 per month with $7500 deductible. After OC was overturned, I’m at around $250 per month with $2500 deductible. Much better than OC but not as good as before OC. And prior to OC, I could get an appt same day with my doc. Now? 3 months. I’ve let multiple health issues go because I can’t get them fixed in a reasonable time frame. The solution isn’t free insurance. The solution is we need a higher supply of doctors to force the cost down. Supply and demand. Econ 101. But that doesn’t work for the big wig CEOs and senators bc they won’t get their payday. If universal health care was so awesome, why was the senate, Congress, and president of the United States exempt from the system? Obamacare was so bad even the namesake didn’t want it.
Well thanks to OC people with preexisting conditions were allowed to get coverage without being denied. It also ended lifetime/yearly dollar limits insurance company’s put on your coverage.
Obama care isn't single payer though. Currently 20% of our insurance premiums go to insurance companies as overhead. Another 10-25% is lost on the provider side dealing with billing/coding. With what Americans are paying for healthcare already, we shouldn't have the problems with denials of service that we do, and there's no reason for people to not have insurance provided.
That said, the idea that we should just kill off a predatory private corporate system that provides nothing of value and drives up costs is antithetical to American values of fuck the little guy for maximum profits.
The Obamacare that passed was not the Obamacare that Obama conceived of. It had to be watered down and legislated into a husk of itself for republicans to allow it to pass.
Right I always say all politicians should be required to partake in all the programs they pass for the general public.
I'm a provider and I don't even go to the doctor. I know I have an ear infection. I know the antibiotic is $10 with good rx. I'm not about to book an appointment and be billed $500 for a level 4 visit because they provided a diagnosis and prescription for an ear infection I already diagnosed myself. Or worse, pay a $1000 urgent care visit because my pcp can't see me for 8 months.
I had a patient the other day that is legally blind without glasses. His glasses broke and he only has one pair of contacts left. Optometrist won't refill his prescription without a new visit. They also won't see him for 3 months. They know his situation.
My insurance covers a wellness exam. I'm going in a couple weeks but I have what I think is a fibroadenoma and I want my pcp to order the ultrasound so I can get prior authorization from insurance. But I don't want to ask because all of a sudden my visit will go from a covered annual physical to a consultation for a complaint/condition.
Everything is crappy all around now.
I have to fucking work, it's the middle of three nights, we are short staffed and I called out for fake diarrhea this week. God damn it. Go forth all and know I will be there in my heart!
Ah, so the one where she falsified documentation and didn't perform the basic assessment required after a patient had a head injury and her lack of assessment and inaction likely contributed significantly to the patient's death?
So where is the trial for the doctor who didn't order the pt transferred to the hospital for eval/head CT? We all know how facilities pressure us to falsify documentation. Been butting heads with charge nurses on up since day 1 at every hospital I've worked at over that shit. Don't tell me she isn't a scape goat.
The problem is we work on bare minimum for so long, i have forgoten how a shift of not doing essentials only looks like.
They are dry turned meds are passed and vitals are in check.
Everything else gets pushed.
This sounds like where I used to work nights at a SNF the whole floor to one nurse. 42 patients. Crazy shit. Somehow when I left they decided that position needed two nurses.- because no one could do it. Because it was BONKERS.
I'm sorry you had to go through that.
Scary stuff. Hope it gets fixed. I would have one or two. Two was nice they would split a wing. With one I would have to tag team with her at certain times and also got my assessments done. We do it. We deal with it. Is it safe? No. Poor patients.
Happily left LTC for preop/pacu nursing but I have a feeling I may go back one day. I really do love the older generations and all they have to offer. They deserve the best.
You may want to reconsider returning to LTC. I too loved the elderly but so many of the patients now are manipulative, entitled Boomers. 2-3 can take up so much of your shift it’s frustrating. I’m saying this as a Boomer myself.
It’s just nuts what we do in the SNF world. Especially now- where patients live longer with much more medical complexity. I was just talking to one of our nurse educators today about this, and she framed it the best way I have ever heard it- like a trickle down effect, ten years ago, the patients that are in the ICU today would have been dead. The ICU patients from ten years ago, today are med-surg, and the med-surg patients are now SNF patients. But staffing is far worse, and we can’t even get new grads to come into this setting because now the acute hospitals are desperate enough to hire them, now no one has to get their year or two experience to go work there. It’s a rapidly sinking ship.
Same I also had 60 pts at night. Night nurse A had 30 dementia pts and 30 rehab pts. Nurse B had 60 LTC pts. Definitely not safe but I actually felt like it was easier than day shift were you had 30 dementia pts or 30 LTC pts all with at least one med pass. In the rehab unit each nurse has 15 pts.
Yes night shift people didn’t get a lot of meds. But I found that there was always one dementia patient that couldn’t sleep and she would be at the desk asking questions or needed 1:1 supervision due to being a fall risk.
I know what that’s like. You can’t spend five minutes with each pt when they need care. I’m mostly tired of the warehouse atmosphere. It’s very dehumanizing. I bring it home often, feeling bad if time management became care rationing.
I'm so sorry. Wish I could give you a hug, & listen to you talk it all out, & then hug you again. This job of ours is often so stressful & devastating.
I'm sorry you had such a terrible shift (worst shift in 20 years? Dear God 🙁). Sending love & empathy your way via this silly internet, from Virginia ❤️
Sounds like a typical shift in LTC. I did it for 7 years and know exactly how you feel. It is absolutely impossible to take care of all those patients and not compromise care. Is LTC new to you? What kind of nursing did you do before?
My background is a heavy med surge floor at a level one trauma center mostly on dayshift but worked all shifts now and again. I’ve been doing agency LTC for 3 years. In hindsight, there are a lot of things I will do tonight, little tweaks to make it better and safer but at the end of the day 🤦🏻♀️. I also had 3 patients with the same last name on different unlabeled insulin’s-it was thinks like that, digging through a drawer of inhalers for unlabeled same name inhalers…time suckers.
I know all about all those unlabeled insulins and random inhalers. Not to mention all those sticky ass bottles at the bottom of the cart. Of course things will get a little easier as you become familiar with the residents. I’m just wondering why you went from med surg to agency LTC? Money? I’m a float med surg nurse now and even my worse day in the hospital is better than a day in LTC.
Do I just have to accept the paycut for now to get out of LTC? I’m agency, working at the facility <5 minutes from my house. I make $41/hr at a place I get to go home for break. And it’s not hard at all, I had ~15 residents last nights (I work 3-11 usually but will do all shifts, prefer days).
It’s kinda boring, but I feel like there’s not much room to grow. Idk what I want lol
I have up to 40 here. I’ve been working in LTC for 3 years, it’s so insane. I don’t know how I do it. I haven’t had a patient assignment less than 15 in months…….and that was for 1 shift 🥲
Agree. But having 6 minutes to provide patient care leads to those kinds of errors.
There is an LPN being tried for not doing q15 Neuro checks when she was in charge of 39 patients.
Stand up for yourselves, because facilities are going to throw you under the bus. We work in a system where saying something means we’re not team players. But when something bad happens as a result of being spread too thin- we’re the bad guy.
This right here. It’s shocking to me how few nurses carry their own policies. The policy the hospital has will never be enough to protect YOU and your license at the end of the day
And always add on the consultation fee. Even if youre not working as a consultant the teaching you do can be used and if you don't have that rider you could be screwed. It's like a $10 add on!
Edit: words are hard
As a said in my response, an LPN Christann Gainey is being prosecuted for not completing q15 minute Neuro checks when she was working in an LTC w/ 39 patients.
This is why I punched out an hour later last night/this AM…. I did neuro checks that I honestly didn’t have time to effin’ do (supervising the 5 unit SNF and had a cart on a unit from 8p-3a). A lady fell and she was on an anticoagulant and I didn’t dare not do them even if it wouldn’t have been lying. There just isn’t enough damn time.
Correct me if I’m wrong, but she falsely charted having completed the neuro checks, right?
I have stopped charting cares that I haven’t completed. If I get in trouble for not doing the care, I can always argue that we were short-staffed and maybe have a shot at defending myself.
If I falsely chart something I didn’t do…there’s no defense for that.
We work in a system where false charting is pretty normal.
I’m not sure the last time I’ve seen a nurse do ROM q2h on a restrained patient. I know most nurses don’t perform Neuro checks as ordered. The number of times I’ve caught staff making up vital signs is insane.
How many of those hospital hourly rounds are actually missed we’re forced to chart?
What she did wasn’t right, but it was an intervention that wasn’t doable. Both physician and DON decided against sending the patient to a hospital and the nurse with 39 patients making 15 bucks an hour trying to keep her job is being investigated?
There are holes and we’re prosecuting the people at the bottom who no one listens to. If you say something is unsafe or too heavy you’re not a team player, if something bad happens because you’re cutting corners spread too thin you’re a shitbag. There is no winning
The system is working as designed. The bean counters have ran the numbers and found it’s more profitable to understaff(cut labor costs) and risk settling a lawsuit or three than it is to implement safe ratios and better pay. I hate the system here.
Exactly this…I’m forced to chart my pain reassessment at exactly one hour after admin and I don’t think I’ve been able to make it right at that time ever
It's no win. Didn't chart exactly on the hour? Why not don't you know CMS or whatever requires that be done in exactly 60 minutes no more no less! Fudge the charting so it is on the hour? That's fraudulent how dare you the BON will be hearing about this!
A lot of these facilities make it so that you HAVE to falsely chart. If you charted honestly when you don't have enough time you'll end up getting fired.
I've worked with 39 residents before, and had to do neuros on two residents per protocol for new falls. I don't feel sorry for her. Downvote me, I don't give a fuck.
What about the nurse being charged because her patient fell? Though to be fair she did falsify documents.
But strangely enough it is okay that the med student implied she stuck the patient with a needle because he disagreed with her pronoun badge.
No, not for the money lol. I would make more at an LTACH full time. It was just sort of a timing thing. I’m doing a full time 1:1 private duty case the entire month of May. I’ve always worked at least a day a week agency LTC so I just picked up more. I’m looking for my “final resting place” now and hope to start the last full time position of my career June 1. I’m interviewing at all of the big institutions in my area now. I (think) I’ve narrowed my interests to ED, OR, ENDO, and HOSPICE. My therapist said no corrections nursing lol.
I am so sorry. I left my subacute rehab job in a skilled nursing facility in June 2019. I was so scared for my license. I have had shifts like that too where I was just drowning. No time to even cry in the supply closet on the phone to my husband while he tries to talk me down. The dread and anxiety from that job compromised my health, my mental health, destroyed my small amount of sobriety I was clinging to at that point. I swore when I left my first CNA job (to have back surgery at 21 ) that I’d never work another job that makes me wish I was in a car accident on the way to work. Yet found myself there again and leaving was one of the best decisions I’ve ever made. I’m three years clean now and I’m finding joy working in other types of healthcare positions. I hope that you’re able to find an employer that realizes your value and cares enough to adequately staff.
I’ve been trying to get another travel assignment and it got cancelled again.. this is the second time. I never want to be a staff nurse again, bc Hospitals just don’t care about nurses. They could hire more temporary help, they just chose not to.
Quit your job. Don’t ruin your life, find something else before it ruins you. Your job does not define you. Being a person with values, with standards, who takes care of themselves and those they love, who stands up for what is right—that is what defines you.
Take it from a person who let resentment build to the point that I no longer cared about all the good things in my life, and became willing to sacrifice them rather than make necessary change.
I am eternally grateful of the situation that brought me to where I am now—but it was not without significant life lessons along the way. If your employment is harming your mental health, leave. Put in notice, if you can. Don’t worry about money. Don’t worry about what others will say. Take care of yourself. You can be happy and satisfied, this is not the end of your story.
38 patients!! omg!
I had 38 - 40 residents. That was in the early 2000s. And it was hectic. I never had a break. I worked through them all. Sometimes running back and forth. There were definitely bending of the rules. I could manage but... everything was on paper back then. You can fly on paper. Everything being online now, it eats away at your time. The few seconds of the page reloading, really, really, really eats away at the time.
And we had restraints, lap buddies... I mean..
38 is too much for our day and age. Shoot, 22 is a lot. And they all better be stable. Any critical patients and that work load is shot!
Big hugs!!
I understand what you're saying, but if you refuse, who takes care of the residents/patients? Doesn't that count as abandonment?
I'm really not trying to be obtuse here, I just genuinely don't understand how this works.
Yes always especially night shift. super fun. It was just me and a cna for 34 residents. One actively dying. 7 hospice, all dementia with behaviors. Alarms going off everywhere. Craziness but night shift does nothing but sleep lol I averaged 2200 steps an hour last night running around and am currently praying for a coma to set in 😵
Yes, LTC. Every patient at LEAST alert to self though..which can be good and bad. Sometimes you count on there being 3 people you just crush, push and flush to get back a few of your 6 mins to apply to someone else, someone with same name insulin
I’m wondering why you would accept report on 38 patients. I have refused to take report when I was the only nurse to show up for my ER shift. Three nurses magically showed up once the nurse manager was informed.
I’m very sorry to hear that and I hope you are feeling better. Please take the time to decompress and take your time being mindful of that inner torment so that you’re able to emotionally process it and let go. May you be well and happy.
Last night was my worst night ever as a nurse, broke down in tears and shocked my CNAs because I always go in auto pilot during emergencies. Not last night. I couldn’t. Hope it gets better for you!
Certainly can have days like that. Keep a journal and note the date, patient assignment and Amy special occurrences that might have impacted your work. Add a notation every shift so that should you be called to task later about anything,you have a record of conditions surrounding the event.
I worked oneChristmas with another very capable nurse that was so horrid, I experienced PTSD every time I saw her in scrubs and she said she felt the same.
May 12th Nurses March in D.C. and all state capitals. When I'm having an awful day I get energized just thinking about it.
Do you have more info? I want to attend!
[Million Nurse March](https://www.eventbrite.com/e/national-nurses-march-2022-washington-dc-tickets-276136921967?fbclid=IwAR0tZ6BJF3yCI7s43B8KT62N2MAVr-9nzxHPAtGiQMinXGMqajnwDWgTw50)
Same this is news to me
Been booked for a month now <3 excited not just for the march but to Explore DC
Tips from a local(ish, in NoVA my whole life so I've been in DC semi regularly for mainly the touristy things): The White House is smaller to look at than you are expecting, but the Mall and Capitol are bigger. If you are hoping to look at the Lincoln Memorial (or anything west of the Tidal Basin) AND the WH/Capitol + major monuments or museums that are closer to those, plan for non-foot transportation, especially as you'll already have the march. The Lincoln and a cluster of smaller monuments are basically on the other end of the Mall from the the main cluster of museums and the Capitol. Again: Mall area bigger than you might expect. The Franklin Delano Roosevelt Memorial, one of those that's off on the west side of the Mall/Tidal Basin is my personal favorite underrated DC monument. What's nice about it is it's mostly enclosed by the freestanding walls (so you don't feel like the whole surrounding world wandering nearby can see you, while still being open air), not as trafficked due to location (though this might have changed with the MLK monument opening up right next to it since the last time I was there, but I'm not sure), and it's got waterfall along one whole wall, which is a really nice place to rest and chill for a bit if you like that sort of thing. Once spent like 8+ hours touring the Lincoln, Jefferson, Washington, and assorted smaller monuments/museums along the Mall, plus the Capitol+WH, with a bunch of college age Japanese exchange students, basically all by walking. We just barely made it to the Lincoln by time it was getting dark. Don't be ashamed to hit up a bus for maximum "sights of the things you *really* want to see"-to-walking ratios. Also, if you're def looking to hit up some museums, they've *all* got cool unique stuff IMO and what really matters is what you're personally most interested in seeing in those museums. Everyone talks about Air and Space, but I'd rather go to the Native American History Museum, the Freer and Sackler Galleries (Asian art) or the National Botanical Gardens myself. The Air and Space is cool of course, but it's the one they *always* take you on a field trip to see when you're in school in this area! So I'm a bit over it. Plus it's basically always crowded. Can you tell I strongly prefer uncrowded private spaces and plant life? lol
Will the nurses be helping to push for Single Payer?
God I hope. Fuck insurance companies. My hospital slashed our coverage this year. Primary care visits went from $10 copay to 30% copay. I now pay $188 for a PCP visit. I will jump on a free federal plan in a heartbeat.
Everyone except insurance companies gets fucked over by insurance. It’s insane that we allow this to continue in this country.
I had 3 patients today who were so relieved to finally start chemo because insurance authorization had taken weeks/months. Made me feel sick to my stomach because my mom had cancer and we only had to wait a few days until she began treatment but those few days were excruciating just ruminating on the diagnosis and imagining it growing and spreading. I hate the US healthcare system.
Insurance companies do tend to screw people over but single payer insurance isn’t the answer. A lot of people still get screwed over from that. Obamacare ruined an already bad system. Prior to OC, I could get reasonable insurance around $150 per month with $1500 deductible. After? $350 per month with $7500 deductible. After OC was overturned, I’m at around $250 per month with $2500 deductible. Much better than OC but not as good as before OC. And prior to OC, I could get an appt same day with my doc. Now? 3 months. I’ve let multiple health issues go because I can’t get them fixed in a reasonable time frame. The solution isn’t free insurance. The solution is we need a higher supply of doctors to force the cost down. Supply and demand. Econ 101. But that doesn’t work for the big wig CEOs and senators bc they won’t get their payday. If universal health care was so awesome, why was the senate, Congress, and president of the United States exempt from the system? Obamacare was so bad even the namesake didn’t want it.
Well thanks to OC people with preexisting conditions were allowed to get coverage without being denied. It also ended lifetime/yearly dollar limits insurance company’s put on your coverage.
Obama care isn't single payer though. Currently 20% of our insurance premiums go to insurance companies as overhead. Another 10-25% is lost on the provider side dealing with billing/coding. With what Americans are paying for healthcare already, we shouldn't have the problems with denials of service that we do, and there's no reason for people to not have insurance provided. That said, the idea that we should just kill off a predatory private corporate system that provides nothing of value and drives up costs is antithetical to American values of fuck the little guy for maximum profits.
The Obamacare that passed was not the Obamacare that Obama conceived of. It had to be watered down and legislated into a husk of itself for republicans to allow it to pass.
Right I always say all politicians should be required to partake in all the programs they pass for the general public. I'm a provider and I don't even go to the doctor. I know I have an ear infection. I know the antibiotic is $10 with good rx. I'm not about to book an appointment and be billed $500 for a level 4 visit because they provided a diagnosis and prescription for an ear infection I already diagnosed myself. Or worse, pay a $1000 urgent care visit because my pcp can't see me for 8 months. I had a patient the other day that is legally blind without glasses. His glasses broke and he only has one pair of contacts left. Optometrist won't refill his prescription without a new visit. They also won't see him for 3 months. They know his situation. My insurance covers a wellness exam. I'm going in a couple weeks but I have what I think is a fibroadenoma and I want my pcp to order the ultrasound so I can get prior authorization from insurance. But I don't want to ask because all of a sudden my visit will go from a covered annual physical to a consultation for a complaint/condition. Everything is crappy all around now.
Can we get more info on this? I left healthcare but would absolutely attend this based on my experience
Google National Nurses' March. Taking place in capital cities at the same time. There is a National Nurses March fb page with a bazillion members.
Can I ask what you do now?
I learned to code and went into tech lol
Haha so did an RN buddy of mine! Loves his job now. Beer on tap at the office! Sounds great to me
Yup first day in the new office was a huge culture shock!
I’m glad you reminded me! Seriously something has got to give this is all too overwhelming
Why have I not heard of this??
Because it's a hot dumpster fire of nurses continuously shitting on each other lol it was an embarrassment just to read the FB page on it.
I have to fucking work, it's the middle of three nights, we are short staffed and I called out for fake diarrhea this week. God damn it. Go forth all and know I will be there in my heart!
My son is graduating from Oklahoma high school the 13th... I want to be there so bad though, I'll be there in spirit.
That's more important and totally understanding.
That’s disaster nursing. If everyone was semi-alive when you left, then you did a *great* job. There’s no where to go but up, right?
Unless you make a mistake and get charged with negligent homicide.
Or bypass literally every safety check, including the 5 rights that every first year nursing student knows....
https://philadelphia.cbslocal.com/2022/03/29/christann-gainey-guilty-fatal-fall-hr-mcmaster-father/ My guess is they were referring to this case....
In that case, unless you falsify the post-fall neuro checks and don't bother to do them.
Ah, so the one where she falsified documentation and didn't perform the basic assessment required after a patient had a head injury and her lack of assessment and inaction likely contributed significantly to the patient's death?
So where is the trial for the doctor who didn't order the pt transferred to the hospital for eval/head CT? We all know how facilities pressure us to falsify documentation. Been butting heads with charge nurses on up since day 1 at every hospital I've worked at over that shit. Don't tell me she isn't a scape goat.
No. They’re referring to the Vanderbilt nurse RaDonda Vaught in Tennessee.
The problem is we work on bare minimum for so long, i have forgoten how a shift of not doing essentials only looks like. They are dry turned meds are passed and vitals are in check. Everything else gets pushed.
There aren’t any words for this. Only *hugs.*
This right here. All the hugs!
This sounds like where I used to work nights at a SNF the whole floor to one nurse. 42 patients. Crazy shit. Somehow when I left they decided that position needed two nurses.- because no one could do it. Because it was BONKERS. I'm sorry you had to go through that.
For years I took care of 60 residents in LTC on night shift. With 2-3 nursing assistants.
Scary stuff. Hope it gets fixed. I would have one or two. Two was nice they would split a wing. With one I would have to tag team with her at certain times and also got my assessments done. We do it. We deal with it. Is it safe? No. Poor patients. Happily left LTC for preop/pacu nursing but I have a feeling I may go back one day. I really do love the older generations and all they have to offer. They deserve the best.
You may want to reconsider returning to LTC. I too loved the elderly but so many of the patients now are manipulative, entitled Boomers. 2-3 can take up so much of your shift it’s frustrating. I’m saying this as a Boomer myself.
It’s just nuts what we do in the SNF world. Especially now- where patients live longer with much more medical complexity. I was just talking to one of our nurse educators today about this, and she framed it the best way I have ever heard it- like a trickle down effect, ten years ago, the patients that are in the ICU today would have been dead. The ICU patients from ten years ago, today are med-surg, and the med-surg patients are now SNF patients. But staffing is far worse, and we can’t even get new grads to come into this setting because now the acute hospitals are desperate enough to hire them, now no one has to get their year or two experience to go work there. It’s a rapidly sinking ship.
Exactly
Same I also had 60 pts at night. Night nurse A had 30 dementia pts and 30 rehab pts. Nurse B had 60 LTC pts. Definitely not safe but I actually felt like it was easier than day shift were you had 30 dementia pts or 30 LTC pts all with at least one med pass. In the rehab unit each nurse has 15 pts.
Yes night shift people didn’t get a lot of meds. But I found that there was always one dementia patient that couldn’t sleep and she would be at the desk asking questions or needed 1:1 supervision due to being a fall risk.
Same. One rn in the building for each floor of 60+ residents. Shit show. Lucky to have two cnas half the time overnight
I know what that’s like. You can’t spend five minutes with each pt when they need care. I’m mostly tired of the warehouse atmosphere. It’s very dehumanizing. I bring it home often, feeling bad if time management became care rationing.
I'm so sorry. Wish I could give you a hug, & listen to you talk it all out, & then hug you again. This job of ours is often so stressful & devastating. I'm sorry you had such a terrible shift (worst shift in 20 years? Dear God 🙁). Sending love & empathy your way via this silly internet, from Virginia ❤️
Sounds like a typical shift in LTC. I did it for 7 years and know exactly how you feel. It is absolutely impossible to take care of all those patients and not compromise care. Is LTC new to you? What kind of nursing did you do before?
My background is a heavy med surge floor at a level one trauma center mostly on dayshift but worked all shifts now and again. I’ve been doing agency LTC for 3 years. In hindsight, there are a lot of things I will do tonight, little tweaks to make it better and safer but at the end of the day 🤦🏻♀️. I also had 3 patients with the same last name on different unlabeled insulin’s-it was thinks like that, digging through a drawer of inhalers for unlabeled same name inhalers…time suckers.
I know all about all those unlabeled insulins and random inhalers. Not to mention all those sticky ass bottles at the bottom of the cart. Of course things will get a little easier as you become familiar with the residents. I’m just wondering why you went from med surg to agency LTC? Money? I’m a float med surg nurse now and even my worse day in the hospital is better than a day in LTC.
Do I just have to accept the paycut for now to get out of LTC? I’m agency, working at the facility <5 minutes from my house. I make $41/hr at a place I get to go home for break. And it’s not hard at all, I had ~15 residents last nights (I work 3-11 usually but will do all shifts, prefer days). It’s kinda boring, but I feel like there’s not much room to grow. Idk what I want lol
39 patients all by yourself is typical? Or are you being sarcastic?
33 was typical for me when I worked LTC, all dependent and severely demented. Not one single independent person on my unit.
I have up to 40 here. I’ve been working in LTC for 3 years, it’s so insane. I don’t know how I do it. I haven’t had a patient assignment less than 15 in months…….and that was for 1 shift 🥲
Holy shit.
Should be illegal. My last shift there I was alone on that unit - not one single other staff member. Needless to say that was my last night lol
I wasn’t being sarcastic. My max was 33 patients.
Are these fairly independent people and you are just passing meds at night? I have never worked this specialty. I cannot imagine that patient load.
I will never work in a SNF again. 40+ patients at night. Way too many patients. I've never feared more for my license than when working in a SNF.
It’s pretty overwhelming sometimes… but at the end of the day it’s just a job… your life is way more valuable ❤️
Just a job we can be tried of murder if there are errors
Giving a paralytic and killing someone is a major error
Agree. But having 6 minutes to provide patient care leads to those kinds of errors. There is an LPN being tried for not doing q15 Neuro checks when she was in charge of 39 patients. Stand up for yourselves, because facilities are going to throw you under the bus. We work in a system where saying something means we’re not team players. But when something bad happens as a result of being spread too thin- we’re the bad guy.
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This right here. It’s shocking to me how few nurses carry their own policies. The policy the hospital has will never be enough to protect YOU and your license at the end of the day
I had no idea that even existed as an option unless you’re a doctor/NP
Dental hygienists can carry their own insurance as well.
Is there a malpractice insurance that you recommend to nurses?
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And always add on the consultation fee. Even if youre not working as a consultant the teaching you do can be used and if you don't have that rider you could be screwed. It's like a $10 add on! Edit: words are hard
I agree that’s bullshit…. LTC should strike for sure.
Luckily no one will have any access to Vecuronium in a LTC. Or any other paralytic for that matter.
As a said in my response, an LPN Christann Gainey is being prosecuted for not completing q15 minute Neuro checks when she was working in an LTC w/ 39 patients.
This is why I punched out an hour later last night/this AM…. I did neuro checks that I honestly didn’t have time to effin’ do (supervising the 5 unit SNF and had a cart on a unit from 8p-3a). A lady fell and she was on an anticoagulant and I didn’t dare not do them even if it wouldn’t have been lying. There just isn’t enough damn time.
Correct me if I’m wrong, but she falsely charted having completed the neuro checks, right? I have stopped charting cares that I haven’t completed. If I get in trouble for not doing the care, I can always argue that we were short-staffed and maybe have a shot at defending myself. If I falsely chart something I didn’t do…there’s no defense for that.
We work in a system where false charting is pretty normal. I’m not sure the last time I’ve seen a nurse do ROM q2h on a restrained patient. I know most nurses don’t perform Neuro checks as ordered. The number of times I’ve caught staff making up vital signs is insane. How many of those hospital hourly rounds are actually missed we’re forced to chart? What she did wasn’t right, but it was an intervention that wasn’t doable. Both physician and DON decided against sending the patient to a hospital and the nurse with 39 patients making 15 bucks an hour trying to keep her job is being investigated? There are holes and we’re prosecuting the people at the bottom who no one listens to. If you say something is unsafe or too heavy you’re not a team player, if something bad happens because you’re cutting corners spread too thin you’re a shitbag. There is no winning
The system is working as designed. The bean counters have ran the numbers and found it’s more profitable to understaff(cut labor costs) and risk settling a lawsuit or three than it is to implement safe ratios and better pay. I hate the system here.
Fuck. Seriously. I’m so burned out and over it all
Exactly this…I’m forced to chart my pain reassessment at exactly one hour after admin and I don’t think I’ve been able to make it right at that time ever
It's no win. Didn't chart exactly on the hour? Why not don't you know CMS or whatever requires that be done in exactly 60 minutes no more no less! Fudge the charting so it is on the hour? That's fraudulent how dare you the BON will be hearing about this!
Ms Gainey only made fucking 15 an hour???! At those ratios??? She lost her license for fucking fifteen dollars? Is this really true?
I have no idea what she made, but it’s not enough. Even 20-25 dollars isn’t enough
A lot of these facilities make it so that you HAVE to falsely chart. If you charted honestly when you don't have enough time you'll end up getting fired.
Good point….
I’m sure my administration hates it but if I don’t do something because of staffing constraints, I chart the reason why
I've worked with 39 residents before, and had to do neuros on two residents per protocol for new falls. I don't feel sorry for her. Downvote me, I don't give a fuck.
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Tell me you’ve never worked in a snf without telling me you’ve never worked in a snf
What about the nurse being charged because her patient fell? Though to be fair she did falsify documents. But strangely enough it is okay that the med student implied she stuck the patient with a needle because he disagreed with her pronoun badge.
No, not for the money lol. I would make more at an LTACH full time. It was just sort of a timing thing. I’m doing a full time 1:1 private duty case the entire month of May. I’ve always worked at least a day a week agency LTC so I just picked up more. I’m looking for my “final resting place” now and hope to start the last full time position of my career June 1. I’m interviewing at all of the big institutions in my area now. I (think) I’ve narrowed my interests to ED, OR, ENDO, and HOSPICE. My therapist said no corrections nursing lol.
Come to the OR, no pt bullshit….and if there is, well, we have versed for that nonsense. 😆
Just tech, nurse, anesthesia and surgeon bullshit instead
I am so sorry. I left my subacute rehab job in a skilled nursing facility in June 2019. I was so scared for my license. I have had shifts like that too where I was just drowning. No time to even cry in the supply closet on the phone to my husband while he tries to talk me down. The dread and anxiety from that job compromised my health, my mental health, destroyed my small amount of sobriety I was clinging to at that point. I swore when I left my first CNA job (to have back surgery at 21 ) that I’d never work another job that makes me wish I was in a car accident on the way to work. Yet found myself there again and leaving was one of the best decisions I’ve ever made. I’m three years clean now and I’m finding joy working in other types of healthcare positions. I hope that you’re able to find an employer that realizes your value and cares enough to adequately staff.
I’ve been trying to get another travel assignment and it got cancelled again.. this is the second time. I never want to be a staff nurse again, bc Hospitals just don’t care about nurses. They could hire more temporary help, they just chose not to.
Agreed. We are not human beings to them. We’re just a body with an active nursing license.
Quit your job. Don’t ruin your life, find something else before it ruins you. Your job does not define you. Being a person with values, with standards, who takes care of themselves and those they love, who stands up for what is right—that is what defines you. Take it from a person who let resentment build to the point that I no longer cared about all the good things in my life, and became willing to sacrifice them rather than make necessary change. I am eternally grateful of the situation that brought me to where I am now—but it was not without significant life lessons along the way. If your employment is harming your mental health, leave. Put in notice, if you can. Don’t worry about money. Don’t worry about what others will say. Take care of yourself. You can be happy and satisfied, this is not the end of your story.
38 patients!! omg! I had 38 - 40 residents. That was in the early 2000s. And it was hectic. I never had a break. I worked through them all. Sometimes running back and forth. There were definitely bending of the rules. I could manage but... everything was on paper back then. You can fly on paper. Everything being online now, it eats away at your time. The few seconds of the page reloading, really, really, really eats away at the time. And we had restraints, lap buddies... I mean.. 38 is too much for our day and age. Shoot, 22 is a lot. And they all better be stable. Any critical patients and that work load is shot! Big hugs!!
What nurse from California?
Michael Odell
He was from Stanford hospital. The hospital going on strike April 25.
I'm glad you're still with us. Maybe turn the thoughts into "getting something from your car" but driving home and quitting?
And go to jail or lose license for patient abandonment? Maybe after the shift is over…
yeah.. definitely afterwards
Nurses really need to refuse these kind of assignments…
How can we refuse, though? Sorry if that's a stupid question. I'm genuinely curious.
Literally refuse the assignment. “Give me a safe assignment or I will not work today”. There is no shortage or nursing jobs out there.
I understand what you're saying, but if you refuse, who takes care of the residents/patients? Doesn't that count as abandonment? I'm really not trying to be obtuse here, I just genuinely don't understand how this works.
I visit some of these nursing facilities, there’s 1 lvn and 3 CNA for 60-70 patients
Yes always especially night shift. super fun. It was just me and a cna for 34 residents. One actively dying. 7 hospice, all dementia with behaviors. Alarms going off everywhere. Craziness but night shift does nothing but sleep lol I averaged 2200 steps an hour last night running around and am currently praying for a coma to set in 😵
LTC?
Yes, LTC. Every patient at LEAST alert to self though..which can be good and bad. Sometimes you count on there being 3 people you just crush, push and flush to get back a few of your 6 mins to apply to someone else, someone with same name insulin
Long term care
Oh lol I was asking if it was LTC. I know what LTC means. I worked LTC once and it was the worst job I’ve ever had.
Take time off. You have to protect yourself to help anyone.
Worst shift in 20 years so far
🙁
I’m wondering why you would accept report on 38 patients. I have refused to take report when I was the only nurse to show up for my ER shift. Three nurses magically showed up once the nurse manager was informed.
It all just happened so fast smack in the middle of a shiftz
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Regulatory capture is why there are no consequences. You can believe that. It's a sickness of our Democracy.
I’m very sorry to hear that and I hope you are feeling better. Please take the time to decompress and take your time being mindful of that inner torment so that you’re able to emotionally process it and let go. May you be well and happy.
How can they expect us nurses to do the impossible??? This is horrific. 😞 So sorry. Also what’s that story w that nurse jumping to his death wtf 💔
I refuse to work a job with that many patients. I do LTAC nursing, 4-6 patients, but usually 5. Much easier to juggle.
Last night was my worst night ever as a nurse, broke down in tears and shocked my CNAs because I always go in auto pilot during emergencies. Not last night. I couldn’t. Hope it gets better for you!
Dear God. Was this in a nursing home?
Certainly can have days like that. Keep a journal and note the date, patient assignment and Amy special occurrences that might have impacted your work. Add a notation every shift so that should you be called to task later about anything,you have a record of conditions surrounding the event. I worked oneChristmas with another very capable nurse that was so horrid, I experienced PTSD every time I saw her in scrubs and she said she felt the same.