View Full Version : nursing home LPN's


Maremma
01-24-2012, 01:18 PM
I am a new LPN that went back to school "later in life". I am 44 and have only been working as an LPN for 6 months. I worked as a CNA in this facility while I was in school. I have only ever worked in the same nursing home so may or may not have enough information in general to base my decisions.

I have run into so many different issues that strongly concern me while working here. I am guessing that they are all common to every nursing home but want to be sure before I give up on the desire to continue to work with the elderly in a nursing home setting.

Money, money and money are the only bottom line concerns with corporate when any issues are taken to them.Thus why I am assuming that it is the same no matter what nursing home I would apply at.

One of my BIGGEST concerns is how we deal with dementia patients.They seem to be just another "bed fill" to corporate and their condition does not seem to make any difference.
They used to have a dementia unit that was staffed with a higher ratio. They decided to close that unit and turn it into a rehab unit. Now dementia patients are simply placed wherever there is an open bed and no extra staff is provided (at least not on second and third shifts when sun-downers would warrant the extra care.
of course problems came up right quick and so they created the "CSR" room. (constant supervision room) where ONE CNA would be in that room and ALL "fall risk" (Acting out patients) would be put in there to be "kept safe". Well of course you know they are not going to take turns trying to get up and so the CNA could only prevent one fall at a time and someone else would either wind up on the floor or provoking another resident while the CNA was already tending someone else. The solution? Just close CSR room and put all the acting up patients out at the nurse's desk so "everyone" could "watch" them!

Really? How can we protect them while we are in a patient room unable to leave because THEY are in a mechanical lift or being washed or being given treatments or meds?

HIPPA concerns of course came up because of the "crowd" of people sitting and standing around the nurse's desks with this "new plan".

So NOW I have to literally drag between 3-7 sun-downing dementia patients down the hall with me as I am trying to pass meds. They are trying to constantly get up so I must stop what I am doing repeatedly to prevent them from falling.I am physically attacked by a sun downing patient frequently when trying to convince them to sit down so they won't fall, again all the while in the middle of med passes. I have been kicked with a needle in my hand that stuck me right to bone. I am out of compliance for time almost every single evening because I am forced to spend far to much time trying to protect these people and give meds at the same time.Med error just waiting to happen here. of course it will be ALL MY fault when someone winds up over or under dosed or given the wrong med etc. It won't have anything to do with me getting a beating or not being allowed to focus on what I am doing during med pass.CONSTANTLY repeating of one or two phrases for hours on end right next to you while you are trying to concentrate. "I have to go to the bathroom" (just came out of there literally ten seconds ago) 100-200 times in a row, or "Help me I don't know what I am doing" like a broken record and nothing you say or do to try to help them changes the behavioral repeating of single phrases. Two or three of them all saying their particular behavioral phrase at the same time hours on end.

CNA's cannot take them with them of course because they must provide direct patient care to other people in their rooms and it would violate privacy issues.

The other patients are constantly complaining and becoming angry because there room mates have so many different behaviors and they are subjected to them 24/7. How would we feel if we never got an sleep because someone in the next bed over was screaming and swearing at us all night long? How would we feel if someone in the next bed over would wheel themselves over to us and stick their hands in our food trays while we are trying to eat? How would we feel if we were afraid constantly that the person in the next bed over was going to hit us or kick us or try to strangle us with the call bed for no apparent reason at any given moment? These are things the patients keep telling us they fear.

Then we add staff hours being cut even further, people being called and told not to come in for their shift or being sent home early leaving even less of us to try to deal with all if this. The CNA's are of course getting burn out and becoming less and less efficient taking all kinds of short cuts and suing equipment alone that requires two people then getting fired of course because a patient winds up hurt that way.

I truly have a heart for these people and giving up on this environment is not an easy decision to make. I have to currently float from one hall to the next every time I show up for work. I do not have a permanent hall of my own yet. (making it even harder) All the patients love me and want me to stay as their permanent nurse down there halls. I have made a lot of progress with several of the patients that used to be nasty to others and behaviors in general (not dementia caused)so I feel I have done some good here. I am attached to a lot of these people but on the same note if I would make an error that would harm any of them I can't see me being able to forgive myself either, nor do I want to lose the license that I had to work so hard to get.

IS it the same in every nursing home? If I would try to go somewhere else and start over with a new set of residents would I still be in the exact same "disaster waiting to happen" situation?
If so what other options does someone have that only has their LPN license?