Introduction
Long-term care facilities support individuals who require continuous care and assistance due to chronic illnesses or disabilities. Nurses are pivotal in ensuring residents’ well-being and quality of life in these settings. However, the demands and challenges of working in such an environment can lead to significant stress levels among nurses. This blog post will explore five common mistakes long-term care nurses make that amplify workload stress and give recommendations to help ease their stressors.
#1 Suboptimal Shift Reporting.
Starting a working shift with inadequate information sets the stage for stress. It is common to hear, “Mary in room 201 is OK, Sam in 203B is OK, Grace is OK, her finger stick is 110” Well, after receiving such a report, one would anticipate having an effortless day until halfway through a med pass, we realize we had to hang an IV drug at 10 am for Mary that was missed in report. To make this worse, the medication is refrigerated, and we must wait at least 30 minutes to 1 hour to administer it. Such occurrences are too common, causing undue anxiety, stress, and potential medication error.
#2 Lack of Shift Planning
Long-term care nurses generally love to jump in right away and take action. This is partly because we understand we have a heavy workload and must start immediately to complete our assigned tasks. As a result, we hardly take time to plan and map out our day. Instead, we come in, take a report from the outgoing nurse, take a count of the narcotic meds, and almost immediately get in to start our medication pass. Because we do not take time to plan out our tasks, we end up getting stressed very quickly. Picture this scenario, Nurse “A” starts their medication pass, only to realize halfway through the pass that Mr. Doe (a resident) has run out of his Neurontin. They take another 5 minutes combing through a disorganized med cart, looking for his “overflow” medications. Many times, they do not find it because it was never reordered. Now the nurse must stop, return to the nurse’s station, and call the pharmacy. In the meantime, Mr. Doe misses his morning Neurontin dose, and the physician must now be notified, or worse still, they borrow another resident’s meds, which is also a violation. In the meantime, Resident B is upset that her medications are delayed, so she calls her daughter, and you can only imagine what happens next.
#3 Ineffective Time Management.
We often overlook that situations in a long-term care unit can be highly fluid, and things can quickly worsen. All a long-term care nurse needs is for one of her 20 residents to get acutely ill, and her shift gets stressful. Long-term care nurses hardly get an easy day, so when the census is low on the unit, we get a false sense of relief from our workload. We often are laid back, and rightly so, but before you know it, an admission comes through or a resident falls, only to realize you are halfway through your med pass, and then you begin to stress and have anxiety.
#4 Practice Implications
We often forget that the Board of Nursing enforces practice laws and does not give reprieve for practice errors that originate from heavy workloads. The average long-term care nurse does not pay much attention to the regulatory aspects of their care delivery. As a result, we are less mindful of the implications of our practices until we get into trouble. We do not take time to participate in continuing education programs to improve our skillsets and competencies.
As a director of nursing, two of my nurses were under investigation for negligent practice. In that case, the nurses failed to initiate a neurological assessment when a resident was hit in the head by another resident who died unexpectedly 24 hours later. In that same case, their CPR response was also being questioned. Their problems stemmed from how they documented their interventions. Though they succeeded in their litigation, the amount of stress and money spent could have been avoided if they had documented well.
#5 Lack of Collaboration and Teamwork
We agree that the Long-term care nurses’ workload is untenable. Dealing with a heavy workload in itself can be stressful. Work environments such as those described need an all-hands-on-deck approach. We need a supportive and collaborative environment to ease some of the daily stressors at work. Instead, we seem to work against each other. For example, the 7-3 shift blames the 11-7 shift, the 3-11 shift blames the 7-3 shift, or better still, we blame leadership. This behavior only builds animosity over time, and we avoid helping each other. We lose trust in each other, making our workloads more stressful. Also, using agency staff has further brought divisions among teams and a challenge for teamwork.
Recommendations
Working as a nurse in a long-term care facility is challenging, with heavy workloads and numerous responsibilities. However, it is crucial to recognize the mistakes that nurses sometimes make, which only amplify their stress levels. Nurses can proactively reduce stress and enhance their well-being by addressing these mistakes head-on.
Suboptimal shift reporting is a common mistake that can lead to anxiety and potential medication errors. Nurses must prioritize effective communication during handover, ensuring that all necessary information is shared accurately and comprehensively. This helps to establish a solid foundation for the shift and enables nurses to provide optimal care.
Lack of shift planning is another mistake that adds unnecessary stress. Taking a few moments to map out the day’s tasks can make a significant difference. By identifying priorities and potential challenges, nurses can effectively allocate their time and resources, minimizing stress-inducing surprises and delays.
Effective time management is essential, especially in the fluid long-term care environment. Recognizing that unexpected events can occur at any moment, nurses should maintain a proactive approach and remain adaptable. By balancing their workload and staying vigilant, they can respond efficiently to changing circumstances and minimize stress.
Understanding the practice implications of their actions is vital for nurses. They must stay informed about regulatory requirements, engage in continuing education, and document their interventions accurately. This ensures adherence to best practices, mitigates legal risks and reduces unnecessary stress associated with potential practice errors.
Finally, fostering collaboration and teamwork within the long-term care setting is crucial. Nurses should embrace a supportive work environment where colleagues help one another and build trust. By working together and sharing the workload, nurses can alleviate stress and enhance the overall quality of care provided.
While reducing workloads and improving staffing ratios are essential long-term solutions, addressing these common mistakes can bring immediate relief to stressed nurses. Comprehensive workflow management training, time management strategies, team-building activities, mindfulness training, and effective communication systems are practical steps facilities can take to support their nurses and create a healthier work environment.
Conclusion
In conclusion, acknowledging and rectifying these mistakes is essential for long-term care facilities to reduce stress levels among nurses. By implementing practical solutions and fostering a supportive culture, we can create an environment that prioritizes the well-being of nurses and ultimately enhances the care provided to residents. Let us work together to support and empower our dedicated long-term care nurses in their vital roles.
Sylvia Abbeyquaye Ph.D. MPA. RN
Further Reading
Smith, S. A., Kokoczka, L., & Cottrell, C. (2023). Utility of a “Lavender Lounge” to Reduce Stress Among Critical Care Registered Nurses: A Cross-Sectional Study. American Journal of Critical Care, 32(3), 198–204.
Stiller, C. (2022). Stress Management Tools to Place in Your Nursing Toolbox. MEDSURG Nursing, 31(3), 165–168.
Lagrosen, S., & Lagrosen, Y. (2022). Workplace stress and health – the connection to quality management. Total Quality Management & Business Excellence, 33(1/2), 113–126.
