The Christann Gainey, LPN case has a lot of people talking, like all the sad and scary charges against nurses right now. I am hearing a lot of nurses placing the sole blame on the nurse for falsifying records. And I agree- that is not something nurses should do. But what they don’t understand, is the impossible situation that working in a long term care facility puts you in as a nurse or CNA. Hospitals are understaffed and in crisis, but long term care has been that way for a long, long time.

A quick lesson in terminology.

CNA= Certified Nursing Assistant LPN= License Practical Nurse LTC= Long Term Care SNF= Skilled Nursing Facility

My Experience

I worked in a SNF (skilled nursing facility aka nursing home) on their Transitional Care Unit as a fresh out of school, just turned 22 year old LPN. They gave me four days of orientation. Yes, you read that right. Four. Then, left me alone with one CNA on a unit of 22 patients. I took care of people who were coming out of the hospital post stroke, hip/knee repair, anyone needed inpatient physical/occupational/speech therapy. I also had patient that needed things like long term antibiotics. I worked for a short time on the long term unit when I was burn out on TCU and had a difference of opinion on some management issues. When I was in school, I worked PRN day shift on all the units. I also would work as a admission/discharge nurse. I completed all the admissions and discharges and also processed all the orders for the day. The TCU was so busy this was a full, 12 hour job on Fridays (and could have been every day).

A Night on the Unit

I worked 7p-7a for most of my time in LTC. The shifts were busy. Med pass to 22 patients is something I never want to have to do again. And you do it all- blood sugar checks, medication administration, and breathing treatments. Trach care, PICC dressing, wound care- also done by you. I spent a lot of my time answering call lights and helping change people, turn people, take people to the bathroom, etc. I obviously am always happy to help my CNA do these things- they also had 20-24 patients. We both were barely getting by to keep everyone safe. Add in charting on every patient on TCU (paper charting at that), chart checks, admissions, faxing orders and medications to pharmacy, having to send people to the hospital if they were sick or in distress. It was just to much at times.

Admission are always a lot of work, but in LTC you have to do it all. You settle the patient, assess/evaluate, and tons of paperwork. At night, you also have to call the on-call provider to verify medications, write out the order for the medications, fax it to pharmacy, fill out the lab sheet, and enter medications on the MAR. This is usually happening while you’re also suppose to be passing medications to 22 patients. And everyone wants to go to the bathroom and go to bed.

Belittled as an LPN

I have had people say such mean things to me about being an LPN. Talking down to me, telling me I’m “not a real nurse,” saying I’m “just an LPN.” And I HATE this type of language about LPNs and feel passionate no one should say these things. I would defend other LPNs, but I just got tired of defending myself. So once I became an RN, I stopped talking about it. I even hesitated to answer with my LPN years counted when asked how long I have been a nurse. Which is so sad, and not okay. As people and nurses- we need to do better. LPNs are amazing and have taught me so much throughout my career.

There was Good, Too

I want to say- I worked with some truly amazing people at this job. I learned SO much from the LPNs, RNs, and CNAs I worked with. We had some really good times together. I went from being a baby nurse, to being a seasoned nurse. I started to learn my love of helping new nurses and teaching. I got invaluable experience that helped me in my transition to being an RN and working in the hospital. I had trach experience, PICC dressing changes, medication administration, admission & discharges, communicating with physicians, and more. I am so thankful for that time. I still think of some of the patients and residents I cared for. They made a profound impact on me as a nurse and person. I still think of some of my favorite coworkers. I do miss them. I just don’t miss the unrealistic ratios.

Advocate for Change

It is no surprise Nurse Gainey couldn’t complete neurological checks with 39 other residents. It’s absolutely ridiculous. That number is not even reasonable for a floor nurse with 1:5, yet alone 1:39. The system set her up for failure. And while people say don’t document it if you can’t do it, that’s usually not accepted in LTC by management. And right or wrong, people need jobs. And many LPNs, many who are BIPOC, don’t have many other opportunities. They have children to take care of and need the income being a nurse brings. The system is truly broken and it is never the system that is punished. Anything that goes wrong- staff is “reeducated.” Unrealistic policies are set in place for staff to follow. But actual problems aren’t addressed- like lack of staff and resources. I hope to see it change someday. I am working on a followup post with more thoughts on Nurse Gainey and the poor management of long term care.

Thank you if you made it this far. And thank you to the amazing staff- from dietary to activities to therapy to nurses/CNAs/providers and everyone in between- who care for our geriatric long term residents and patients. You all are so amazing and doing such important work. I truly appreciate you. THANK YOU.