In my short experience of being a nurse (2 years) and only having my RN I have been limited to where I can work, in Pennsylvania if you don’t have a BSN it’s very hard to obtain employment. Even in light of our current nurse shortage crisis most hospitals will not hire RN’s. I’ve been in skilled nursing rehab (SNF) & Long-term care (LTC) since I passed the NCLEX. I look forward to graduating at the end of this course, many doors will open, it’s going to be lifechanging for my family.
I have to admit that nursing is not what I imagined. It can be very unrewarding and disheartening. I can see how one can develop burnout or compassion fatigue, or even put a patient’s life in danger. This may just be my experience in a SNF setting, however there was a definite depravity in one facility that I was employed, both ethically and legally. I still feel compelled to report them but I’m not sure what is acceptable and what is not, my gut said none of it. The nurse-to-patient ratio is supposed to be 1:10 in SNF and 1:20 in LTC. LTC are much more stable and are documented at “Residents” whereas the rehab patients are sub-acute arriving on stretchers, these “patients” are discharged from hospitals not sick enough for the hospital and not well enough to return home, yet they’re often put in LTC and labelled “Residents” to ensure that all beds have a warm body. To have over 20 patients all with serious illness or injury, such as new fractures, stroke, cancer, etc. and to try to assess and treat in a timely manner is impossible. Ethically these people are without care for an inhumane amount of time. Their trust, dignity and autonomy goes out the window, sitting in their own feces and urine for hours, medications and parameter checks such a glucose and blood pressure, or heart rate not being assessed. One gentleman had a severe CVA and was sent to LTC where he should not have been only because our rehab beds were full; he was a paratrooper in World War II sitting there in a painful position for hours, hungry unable to feed himself and trying to find his words, I wound up crying with him. He was one of 22 patients that day on my schedule, I had just injected another patient with Glucagon who was seizing when I walked into his room (call bell on the floor) his BG was 23, every day was a mad house. The toll on the elderly losing autonomy and respect directly affects the quality outcome, not to mention the delay of medical care. (Devik, et al., 2020) Legally it was so unsafe call bells not being answered, falls not properly assessed or reported. The lack of respect for these geriatrics was nauseating, treating them like bad little toddlers. I’m sad to leave SNF because they need good care but it’s very unhealthy for me emotionally as the nurse, it’s also legally unsafe for nurses as it’s easy to have a med error.
LTC/SNF are governed by state regulations, inspectors come through and check patient records, inspect distribution of publicly available information on the policies and procedures, and they have limited time observing the patients. the problem stems from the considerable variation within states in the way government oversight transpires. (Miller & Mor 2008) Federal guidelines are subject to interpretation from the inspector’s judgment, I have witnessed the state board inspector pass many things that shouldn’t have passed, simple like blocking a fire extinguisher with a crash cart or worse improper medication administration. I believe there is a lack of inspectors, kind of like with the Food & Drug Administration there are not enough agents to properly inspect our food as well as it should be. Not sure if it’s a cost cutting problem or the explosion of LTC facilities and people living longer with comorbidities.
Miller, E. A., & Mor, V. (2008). Balancing Regulatory Controls and Incentives: Toward Smarter and More Transparent Oversight in Long-Term Care. Journal of Health Politics, Policy & Law, 33(2), 249–279. https://doi.org/10.1215/03616878-2007-055
Devik, S. A., Munkeby, H., Finnanger, M., & Moe, A. (2020). Nurse managers’ perspectives on working with everyday ethics in long-term care. Nursing Ethics, 27(8), 1669–1680. https://doi.org/10.1177/0969733020935958