The Right Priorities

I also worked in a rehab/subacute/ltc facility-I was in rehab, but did have some patients that should have been either in assisted living or in ltc, as they had severe cognitive issues.  It was staffed with 1 RN, 1 LPN and about 2-3 CNA's, for around 40 patients.  Sufifce it to say that the RN and LPN were always tied up with physician orders, passing meds, wound care, etc--very little direct pt. care.  The CNA's usually without exception were there to do a "job" and pick up a paycheck.  This job was not a calling,or a passion, or whatever it is that we nurses have in our hearts to pursue this profession.

It sounds that in most of the cases discussed that case management is called for.  But that in itself is a difficult field to break in to.  It used to be in the not too distant past, that one could practice case management without certification so that the nurse could gain experience, hours, etc.  Now most employers require certification.  In order to obtain certification, one must work "X" amount of hours doing case management.  You can see the difficulty.  I have tried, believe me.  I am a RN with 28 years experience, cannot work the floors due to back issues, and can't find a job.  We are our own worst enemies at times; what has happened to the that we can not support our own profession, and especially those who want to work, but can't get in the door?  I would love feedback, suggestions, etc., as I am one frustrated nurse.  Can you tell?

I've worked in a few LTC/Rehab facilities "in my day".  I would always tell families to hire a private duty and they would balk because the facilities were private and costly, but there is NO WAY 1 CNA could take care of 8-12 residents!  While I was usually the only RN, I was usually too busy looking for baby gifts, and my "guys" got whatever they needed pretty much on time, or whenever they asked for it (ok, maybe 5 minutes later - I worked my tail off - 1 RN:48 residents).  I totally sympathize with your mom.  My mom died of cardiac complications in the Arizona Heart Institute, boy talk about dumb bunnies, especially relating to people who should be in hospice for cardiac.  I was there 24 hrs/day even after I got her into the hospice.  Now, I'm ready to get back into nursing.  I've taken my refresher course, and everywhere I apply and am granted an interview (sometimes two), they NEVER get back to me.  Aren't WE supposed to be PROFESSIONAL?  Why aren't the places we apply to?  Why isn't HR professional to us?  How can WE re-break into nursing?

My sympathy lies with your mom.  I have been an orthopaedic nurse practitioner for 8 years, the first 6 at a hospital in NYC and the last two at a New Jersey hospital.  I frequently send people to rehab hospitals after total hips and knees. I tell the patients that the information I receive about these places are from patients that I have sent there.  I frequently ask my patients to please let me know if the care or the physical theapy is good or bad in the place I've arranged for them to go.  I have been able to help patients decide where they might like to go based on these helpful hints.  We are trying to promote discharges to home for many of our total joint patients.  The only draw back with this is the lack of physical therapists and visiting nurses.  Patients actually do very well in their home enviornment.  I also tell patients that if they are unhappy with the care they are receiving in a rehab center, it is not a prison.  They need to tell the person in charge that the facility does not meet their expectations and they want arrangements made to send them somewhere else.  We, as nurses, need to take pride in what we do, and bring back the compassion that brought us into nursing in the first place.

This situation rings a too- familiar bell for me. My mom had orthopedic problems aggravated by MRSA, systemically, and was in a community hospital, then a teaching university hospital, then a convalescent facility. There are amazing differences in nursing care at all levels, and even in different units in the same hospital - but my mom is a nurse from the 40's,  I graduated in the 70's, and it seems that a lot of professionalism, compassion and skills are missing from hospital (and  other settings too) nursing. Its a pretty sad commentary when you can remember the name of the one or two nurses that made a difference in your loved-one's  6+ weeks of care. I'm sure there are all kinds of reasons, staffing being the main one, but it scared the ---- out of me thinking what it might be like when I need nursing care someday!!  As long as we are on this subject, I have a huge problem with home health agencies whose staff elect NOT to care for people with AIDS. Anyone had that experience?

I am very sorry your mother had such an unpleasant experience. I know I had many unpleasant experiences while my mother was a patient in a well known teaching hospital here in New York City. I always booked a private room and stayed with my mother and provided as much care as I possibly could and even with that we ran into problems. Unfortunately, there are good nurses and bad nurses out there. Some have feeing and really care and others erect emotional walls, lacking sensitivity. Just imagine the patients that do not have family advocates.

http://dianej.wordpress.com

I totally agree, and I comiserate with your mother.

I had a similar experience when I was in the hospital after having my son. I'd had a C-section and had trouble voiding, so I had a catheter in longer than expected.

I was changing my son while trying to manage the "water balloon" I was dragging around. My son, as baby boys often do, urinated all over himself and started screaming. Not knowing any better, I panicked and thought it would cause some harm. I yelled for help while trying to clean up my son the best I could. It was a while before someone, an aide, came in. She looked at me like I had two heads and her first words were "Why do you still have that catheter?"