Skilled nursing facilities are not the best work environments for RNs. I am seeing more RN terminations, LPN terminations, State Nursing Board complaints, and other issues stemming from CNAs "double teaming" or "triple teaming" the RNs usually or sometimes the LPNs, reporting false information to the DON and Administrator which then causes licensure, workplace, or career issues for the nurses.
I will say it again, skilled nursing facilties are not the best work environments for RNs. I had to tell one of my clients from 2005 this just yesterday when she called me regarding "he say she say" issues at a nursing home in Columbus, Ohio.
Skilled nursing facilities are not the best work environments for RNs. Why?
1. The staffing at the a nursing home pits RNs against LPNs because the staffing and work assignments are not written with the State Nursing Practice Act and the principles of delegation in mind. This sets up a constant battle at some facilities between RNs and LPNs, LPNs and STNAs, and RNs and STNAs.
2. There is NEVER enough time to do what needs to be done and perform the assigned tasks in a shift for the residents. Oh but guess what the facility doesn't want its nurses to work any OT. So what do you do?
3. Nursing homes are highly regulated, for a reason I might add. Any incident needs to be reported to the "MAN" or "to the State." What this means for nurses is because we bear most of the accountability and responsibility for patient care, the buck stops with the LPN and/or the RN. The nursing home blames the nurse, fires or writes the nurse up, and reports the nurse to the State Nursing Board.
4. The turnover rates with nursing home administrators, DONs, and unit managers is comparable to the waitress/waiter turnover at your local Waffle House. There is turnover galore from the top to the bottom and from the bottom to the top in nursing homes. So as a RN you are working with different administrators, DONs, unit managers, CNA, LPNs, and other staff every couple of months. What's up with this?
5. I have drank 4 cups of coffee and I am going to say it bluntly here this morning. RNs you have alot of options for employment and unless you LOVE geriatrics you need to do a cost benefit analysis before you decide to work in a nursing home. When you interview for a position, you need to interview your employer and ask around before you jump in head first into the deep end of a concrete swimming pool with 5 inches of water.
6. Any nurse who works in a nursing home needs professional liability insurance with a license defense benefit. You need the max in coverage in baby. Working in a Skilled Nursing Facility as a LPN or RN=MAX in Professional Liability Insurance Coverage with a License Defense Protection Benefit. Go for and obtain the MAX! You may really need it.
7. If you are a RN and you just have to work in a nursing home, work part-time at the SNF and part-time elsewhere or per diem at the SNF and FT or PT elsewhere so that you are bogged down "day and night" with the drama.
8. If you are a RN and you just have to work in a nursing home, move up to management. Which may or may not be too much better because I have alot of legal consultations with nurse managers in SNFs in Ohio, Kentucky, and Indiana and you are starting to see more lawsuits where nurse managers in SNFs are being named as defendants in nursing home negligence cases.
9. If you work in a nursing home FT, develop a risk management plan for your nursing practice. Documentation is extremely important. I read in an article written by an attorney who represents nursing homes that staff in a SNF should provide care first and worry about documentation later. Excuse me? This attorney obviously does not represent nurses before the State Nursing Board.
Your license will not survive a patient care first and then documentation last attitude in a SNF and you will emerge from the State Nursing Board investigation and evidentiary hearing with scars and wounds because you "knew better." Its a do or die mentality in some of these SNFs. RNs and LPNs are being treated like fungible and at-will employed employees who can be tossed about, thrown in the air, and replaced at any time like a garbage bag on a large roll.
10. You know when its time to leave a facility. Trust your instincts. Don't let your pride get in the way or the fact that its "your hall" or "your cart." Its your license on the line and quite frankly that is the most important item on your agenda because with your license you can work ANYWHERE. You are not licensed by your SNF, thank God, you are licensed by the State and you can practice SOMEWHERE ELSE. There isn't any institutional licensure of RNs and LPNs and I think some SNF administrators need to be reminded of this.
Don't sweat the small stuff and allow the drama in a nursing home to consume you. Keep it moving because you have alot to offer. There is a reason why you see so many nurses working just a few years here, a few months there, and a couple years....