I am starting this blog to share what a nursing home is really about. I have been a nurse for over 31 years and have worked in long term care nursing homes)and acute care (hospital) settings. I have worked in many roles in nursing homes from a nursing assistant to a licensed practical nurse, registered nurse, nursing director, administrator and regional vice president. I have worked for individually owned homes and large corporations. The whole reason for this blog is to change the publics view about nursing homes. I feel that I have a lot of experience and would like to share it with the public.
First of all I want everyone to know that not only have I worked in nursing homes but I have had to place loved ones in nursing homes as well.I want this blog to help those that are in the decision making step to placement in a nursing home as well as those that already have a loved one in a nursing home. I also want to help other health care providers as well.
It is my plan to discuss actual scenarios and issues that I have to or have dealt with. I hope this will help people understand the importance of a nursing home.
The first thing I would like to talk about is the reputation nursing homes have that needs to be over come. First, a nursing home is not a place that someone goes to die. Nursing homes are a place for people to go to recover and or live. I want to discuss the long term patient. Patients in nursing homes are from all age groups, sex, size and nationality and financial background. For an example the nursing home I currently work at has patients from 29 years to 102 years. There are more females than males (mostly due to life expectancy for females being higher). The patients are not from 1 specific area. Many people think that the persons in their local nursing home are all local. Unfortunately this is not true. Many bordering states do not accept patients with expensive health care needs or behaviors. That leaves our state to accept these patients to fill our beds.For example if a patient in a West Virginia hospital has a wound vac, tube feeding or intravenous infusions the nursing homes in that state will not take them. They are farmed to other states such as Ohio where the Ohio Medicaid system must pick up the bill.I will discuss this later. Nursing home patients are all treated the same weather they pay privately or Medicaid pays for their stay. All nursing homes are held to the same federal regulations plus their individual state regulations. I am rambling a bit so I will talk about 1 area tonight.
Staffing in a nursing home.
I don't care where I have worked or who I have worked for all nursing homes have the same problem. Hiring and keeping good staff. First of all the hiring process is very expensive for nursing homes. They are required to do several things before they can even hire anyone. They are required to complete finger print checks, drug screens, employee physicals and reference checks. All of these cost the facility money they can never recoup. The cost for the facility I work for is about 150.00 per employee just for thoses 4 items. This doesn't include the time for interviewing, paperwork and then the orientation proces. The cost is usually between $5000.00 and $10,000.00. After all that most employees particularly the line staff don't make it past 90 days.
The staff at a nursing home has special requirements for training, education, certification and licensure. All nursing assistants must be state tested. The training for a nursing assistant is about 3 weeks. After that they can work for 120 days before testing which costs over $100.00. If a facility hires someone that is not state tested the nursing home must pay for the test. After that all nursing assistants must have 12 hpours of in-services per year to keep their certification. Nursing assistants are at the forefront of providing care. They are responsible to perform all of the residents direct care. Therefore this training and education is very improtant. As I mentioned before nursing homes must get 2 reference checks for all staff hired. The only problem with that is that nursing homes do not share any information other than hire dates and seperations dates due to the fear of legal issues. This makes the process of getting a reference check very ineffective. Staff jump from facility to facility with no ramifications for leaving a previous employer. As a manager I feel that this is not in our best interests. I feel that all facilities shoud share the reason that the employee left. This would stop the job hopping that is being done. As an example I had the following happen. I rehired a nursing assistant that had worked at the facility before. The staff said the person had been a good worker but had some attendance issues. I discussed this with the person and decided to give it a chance. The employee was a good worker got along well with the residents and staff but started having some attendance issues. I followed our attendance policy and the persone was never at termination. The employee called off one day for personal reasons and then just did not show up for 2 days. I tried to call this person for several days and shared that I was worried with the staff. They obviously told her and she called me. I decided to let her come back on a different shift to help her out. Things went along well and later she did the same thing called off for personal reasons and then was a no call no show. I did not persue her anyfurther. I was told that she went back to work at another local facility where she had worked before. This person need to be stopped and or held accountable. Again per our policy if the other facility had asked for a reference I would have only given date of hire and seperation. I feel that facilities with the help of the governing board for Nursing Assistants needs to do something to stop this.
An additional frustration is staff quiting without notice. It used to be that you never heard of a licensed nurse doing this. There has always been this problem with non licensed lower paid staff but nurses never did this. I know of 3 director of nurses that quit without notice in a 1 year period. Other nurses do this as well. I think professionalism is gone for nurses. People say it is their age, the work, pay whatever. This is very unprofessional and I feel that nurses should be held accountable for this. Maybe if the board of nursing looked at this as something that is placed against someones license maybe this would stop. Being a nurse is a profession not a job and someone with that license should show professionalism in how they approach begining or ending a job. All nursing jobs are not alike and not for everyone.
My last thoughts on staffing for nursing homes is this. I don't care what facility you go to you will hear someone say "we're short staffed again". Well I am here to tell you this is completely false. No facility is ever short staffed. What happens is that when their are call offs and or emergencies other staff step in and do the duties of that person. For example a nurse may do the duties of a nursing assistant, other staff are certified as nursing assistants for example the activity staff. No facility just lets a shift go by with out additional help. I have personally worked as a nursing assistant in every facility I have worked at. Of course a nursing assistant cannot do a nurses job but there are always additional nurses working in other roles that can help out for nurse call offs or emergencies. Remember if you hear someone in a nursing home say we are short staffed ask them why they feel like that and make them explain who is helping out or ask the charge nurse to tell you. Nursing homes do not work short staffed.
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