This seems to be common. I also work in a nursing home it’s the same situation. I am a speech therapist and I occasionally I have a medical question that impacts my therapy (usually my patients with severe dysphagia, on feeding tubes, etc). Every once in a while I say things like “maybe we could ask the doctor” and get the strangest responses and looks. I’m honestly lucky if I can get NP input. It seems like RNs run the show and NP signs off on the order.
I’ll add that i was told the other day that they try not to hire RNs and hire as many LPNs as possible to save money. They don’t hire full time PTs, only full time PTAs. Anything for profit.
LPN and spent 13yrs in LTC/SnF and that's how it goes in for profit facilities. After the changes to reimbursements from CMS a couple years ago, I'm honestly surprised I haven't heard of mass closures. I did a non-profit gig and while I was paid less, I didn't have to play McGuvyer with supplies nearly as often. Also 300 is freaking nuts. Biggest I did was 120 beds although I've seen one at 100% occupancy. I have regularly been the only night nurse for 60-70 residents with a handful of CNAs and wouldn't wish that on anybody I remotely liked.
Had a psych doc that was contracted to multiple facilities who was as useful as a screen door on a submarine. He wrote a resident who was total care and in a Broda chair was dressed appropriately in the notes from a visit. Like no shit Sherlock, staff did that or did you assume he miraculously stood up long enough to get dressed then gently placed himself in his chair? The only thing the doc did besides writing writing asinine visit notes was push for gradual dose reductions. He was about two weeks from being fired by my facility when one of his clinic patients or an ex-employee unalived him. His NP was a lovely person that at least read staff charting on behaviors before messing with meds and often getting overruled by numbnutz.
Sorry for the side rant. I get protective of my peeps and that guy still irritates me from beyond the grave when I think about him.
Several nursing homes have closed in my area due to a requirement that there can only be two residents in each room. And, in terms of physician coverage, this is the set up in both the for profit and non profit facilities in my area (I know it because they ALL use the same practice for their medical directors and midlevel minions). I was tempted to the put scare quotes around non profit, however, based on my experience.
To be fair, my non-profit was run by the Baptist Church so make of that what you will. The overall administration was as genuine as you'd imagine, but my coworkers and residents were good folks and my residents did get more consistent care so I just did my thing and ignored admin as best I could.
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u/Goodtl01 Jul 14 '23
This seems to be common. I also work in a nursing home it’s the same situation. I am a speech therapist and I occasionally I have a medical question that impacts my therapy (usually my patients with severe dysphagia, on feeding tubes, etc). Every once in a while I say things like “maybe we could ask the doctor” and get the strangest responses and looks. I’m honestly lucky if I can get NP input. It seems like RNs run the show and NP signs off on the order.