So, I have been working in long-term care facilities since I was 14, first as a candy striper, then as an activities assistant, at 16, I became a CNA.  I know that nearly every long-term care facility has the same problems, lack of adequate staffing, overburdened staff, lazy staff, the naysayers, etc.  As for me, I love working in long-term care.  I think it is our duty to provide the best possible care for our elderly and I am privelaged to have met so many wonderful residents thus far in my career.   Last year in May I passed my PN-NCLEX exam and began my career as an LPN at a long-term care facility where I worked as a CNA.  I am a new nurse, I know, but I have recently seen things that have disheartened me terribly to being a nurse.  When I first began as an LPN at the LTC I currently work at (August, 07), I noticed at times that the med count was off on a few residents.  At first, I didn't figure it as such a big deal, it was only a few times on a few residents.  I thought there had to be a reasonable explanation and also, being new, they stuck me wherever they needed a fill-in, so I was never on one "side" consistently.  Last year in November, a nurse quit and they moved me into her position.  Since then, I have been on the same "side" consistently, enough to take notice of a LOT of discrepancies in the med count.  One particular nurse leaves her shift with numerous holes on the MARs, making it look as if she didn't give any meds that day.  I can see where she gave some of her meds, but I can't honestly say that she gave them all.  In fact, I brought the discrepancies to my charge nurse's attention.  All they did was counsel that nurse on making sure she signed out her MARs before she left her shift.  She continued to leave holes even after being counseled.  In December, I noticed that there were missing entries in the narcotic sign out sheet.  At that time, we had one resident receiving Ativan twice daily scheduled at 8am and 5pm and another resident receiving Vicodin twice daily scheduled at 8am and 5pm.  For 5 days the 5pm dose was the only one signed off on the narcotic sign out sheet, yet on the MAR it was signed off that it had been given at 8am.  There was no way that could have happened, because the count of the pill cartridges matched the narcotic sign out sheet and we count the narcotic box at the end/beginning of each new shift. (Our shifts are: 6am-2pm, 2pm-10pm and 10pm-6am with the RNs on for 12-hour shifts 6a-6p/6p-6a).  Again, I brought this up to my charge nurse and also my DON.  Supposedly corrective action was taken.  Next thing I know, the days the nurse signed off the meds, but didn't give them had circles around her initials and on the back of the MAR she had explained that the resident refused the medication.  How can that be if she never even offered it to them?  So, I thought well, maybe she asked them before she pulled the med, but being that one of the residents has dementia and can not fully participate in her care, I highly doubt that.  The other resident would never have refused his pain pill, he is on the call light at 8am every morning asking for it, if I have not already given it to him.  But neverless, I gave her the benefit of the doubt.  But then, I noticed several residents on antibiotics with missed doses.  We mark the pill cartridges with the date and time they are to be given so no doses will be missed, however, lets say there are 14 pills in a cartridge, its scheduled twice daily x 7 days, pill #14 eve dose is popped out, 13 day is not, 12 eve is, 11 day is not, 10 eve is, and then the rest of the week I work and all the rest of the pills are popped out.  You know that the AM dose has not been given.  So I made out a med error sheet and filled out an incident report.  Instead of this nurse getting written up or fired, they wrote ME up, saying that I was causing trouble for this nurse.  I never knew her prior to working there, HAD no grudge against her, however I do now, due to her neglect of the residents.  In March, they hired a new DON, I went straight to her to let her know where I stood as far as this issue.  She said she would look into it.  This particular nurse still works there, so for the past two months, I have been secretly conducting my own investigation into the issue.  I have marked the pill cartridges in a way that no one could tell they were being marked and have kept a journal of the times meds were not given.  I have 9 notebook pages of meds that were not given on her shifts.  My question is:  Should I go to the DON with this information or should I go over her head and take it all the way to state?  Or do I sound as if I am being petty and trying to get that nurse in trouble, as my previous DON stated?  I feel as if I am not being taken seriously by my supervisors and I think this is a VERY serious problem.  I was on the verge of quitting, but decided to stay on because I love my residents and feel like at least when I am there, they are being given the best care I can give them, so they are being cared for half the time.  The other half, I have no confidence in whatsoever.  Oh, and it's not just the meds that are being missed.  We also are responsible for our own wound care, and some treatments are not being done on her shifts either.  The other nurses I work with notice it too, but won't say anything.  I am at my wit's end here...

I worked at an LTC facility as a CNA and as an LPN. The capacity there was over 100 residents, and if a hall was full, one CMA passed medications to about 37 residents. If a CNA called in sick, the facility would often request that the CMA would work as a CNA, and a nurse would pass pills, and another nurse would cover two halls. Everytime they requested me to do that, I would ask the CMA if they would prefer to pass pills. I knew that with 30+ residents needing medications, I was bound to mess up somewhere, especially when I first became a nurse. I knew and trusted the CMAs on my shift, and I was lucky for that. I knew that I was much less likely to cause harm to a resident by transferring them than I was by administering medication to too many people. I know as well as anyone else working in a facility like this that there is no way to prevent every single error in the amount of time given, but I know I always tried as hard as I could to be sure every medication ordered was given. Unfortunately, residents suffer when facilities are over-crowded and under-staffed.

I loved working LTC and I still miss the residents I worked with. However, knowing the risk I was taking working there everyday, and knowing that I was capable of so much more made me decide to change to working in a hospital when I became an RN.