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The cost & courage of caring - stories that spark resilience.
Welcome back to this week's
episode of the Caregivers Podcast.
I'm your host, Dr.
Mark
Ropaleski, and you can call me Dr.
Mark.
Many families are afraid of
long-term care before
they even walk through the doors.
They've heard the stories, they've
seen the warnings,
and then one day someone they love
is there.
You press the call bell, you wait,
you watch someone
you love need help, and part of
you starts to wonder why isn't
anyone coming.
Today we're
asking what is happening on the
other side of that moment.
Where is the nurse?
Who else needs
them at the same time?
What are they being forced to
choose between?
And when care feels rushed,
delayed, or inconsistent, how much
of that is the nurse in front of
you, and how much is being
shaped by staffing levels,
budgets, and management decisions
inside the facility?
This conversation
is about the space between
families and nurses, the fears
families bring, the anger that can
land on
the nurse on duty, the impossible
choices nurses are forced to make,
and what happens when good
people are asked to provide care
in conditions that often make good
care difficult to deliver.
Our guest today is Nurse Crystal
Moran.
Crystal is a long-term care nurse,
a mother, a patient
herself, and one of the most
outspoken public voices describing
what nurses are actually living
inside.
Crystal, welcome to The
Caregiver's Podcast.
Before we begin today, please take
a moment and
subscribe or follow The
Caregiver's Podcast wherever
you're listening or watching.
It's free,
and it helps support the show, and
it helps these conversations reach
more caregivers and families
who are trying to protect someone
they love.
Crystal Moran, welcome to The
Caregiver's Podcast.
We're so happy you're here with us
today.
Thank you so much.
I'm glad to be here.
So in the tradition of this
podcast, we like to jump in from
the start.
So tell us, Crystal,
when a family is in a long-term
care facility watching someone
they love wait for help, what are
they
usually not seeing about where the
nurse actually is, who else needs
them, and what choice the nurses
need to make for being forced to
make in that moment?
Well, I think that there, you
know, obviously there
are seen and unseen sides of any
situation.
In the nursing home specifically,
what families don't
usually see, sorry, my cat is
creeping in, what families don't
usually see is the schedule.
The other human beings who have
similar problems, maybe more
extensive problems, maybe
something
trivial.
You know, I might spend an extra
10 minutes in the room with
someone, and it sounds like
trivial
conversation, but it's really just
to make them feel more comfortable
or more at ease.
They're having a lot
of anxiety.
There are different, you know,
tasks that we are charged with,
but ultimately the schedule
is just so full.
Everything nowadays is
budget-centered care, and I don't
mean that across the board.
There
are still a few rare facilities
where this doesn't happen, but by
and large, we are overworked, we
are
understaffed, and everything needs
to be done right now.
So how do you prioritize, you
know, human beings
and human needs, basically, is
what happened.
So the family member doesn't see
that the reason the
nurse sounds like she's kind of
shooting the bull with Mr.
So-and-so next door is really that
she's
trying to make him feel more
comfortable.
He had a rough night.
Maybe he's going through something
in
his personal life with a family
member or something like that.
And then on the other side of
that, the
nurses are trying desperately to
manage their time.
The CNAs are swamped.
There is absolutely no way to get
all the work done.
So you're basically just trying to
get through a round, basically, is
the entire
shift.
And so I feel like we do our best
to prioritize, but ultimately it's
a broken system,
and we're doing our best with what
we have.
And those 10-minute conversations
are so important
for building patient and, I think,
family-centered connection as a
professional caregiver, right?
You're absolutely right.
I think that for you to trust me
with your life or with your
mother's life,
you need to know, basically, how
I'm going to respond to her needs,
whether they be a critical,
you know, moment of care where
we've got to respond kind of
quickly and know what's going on,
or whether you're more concerned
with the day-to-day.
How are you going to be with her
on each
interaction?
How does she respond to you?
You know, that kind of thing.
So, and if it were you
yourself, you would want to find
some kind of a connection, like,
okay, she's a good one.
She remembers what I said
yesterday, or she knows that this
is my preference about such and
such.
She communicates with the other
staff things that I've said I want
or I need, things like that.
I
think that's very, very important
whenever you're trying to care for
human beings.
It's not, you know,
you didn't pull your vehicle in
here for something as impersonal
as maybe a tire change.
You're living
here.
This is your home.
So, it's very important that you
know who is coming in your door,
who is
taking care of you, who is going
to care for your loved one.
Absolutely.
Certainly, in the setting of
longitudinal care, such an
important additional step, but
definitely one
which can make one person in need
have to wait a little bit longer
for the person to finish with
someone else.
When families are scared and angry
in that moment, Crystal, are they
wrong to feel that
way, or are they just kind of
missing the larger, bigger
picture?
Well, I think that communication
ultimately will decide which side
of that we kind of fall on.
If
the family member has been given,
or the resident has been given
zero information,
they are only right to assume
whatever it is that they see.
So, if they experience no
communication
and the nurse just evaporated into
thin air, they're not wrong to
assume she got lost or she
prioritized somebody else or for
whatever reason, she's not in
front of you.
He or she is not in front
of you.
And I don't think that they're
wrong to feel that way, but I
think that we can do a better job
as healthcare professionals of
saying, hey, you know, I hate to
tell a staff member, excuse me,
I hate to tell a resident that we
are short-staffed, but I like to
communicate with them realistic
time
goals.
If you're looking for your noon
medication, for example, I try to
be as routine as possible,
but sometimes deviations happen,
real life occurs.
And as long as I communicate that
with you,
your expectations can match what,
you know, I'm realistically going
to provide.
So, I think as
care providers, we have to be
realistic and communicate.
Use your words.
You know that you're
swamped today, so don't promise
Mr.
Smith that you're going to be back
in five minutes or that
you're going to have his noon
medication promptly at 12 o'clock.
I think that we have to kind of
bridge
that gap with communication.
Is all communication safe or is it
sometimes unsafe for the
professional
caregiver to say we're
short-staffed?
I wouldn't necessarily say that
we're short-staffed,
but if someone draws that
conclusion accurately from the
things that I have said, then, you
know,
they're not wrong to feel that
way.
It's an accurate depiction of
what's going on.
I think
that the responsibility is on
these facilities to do a better
job of staffing and managing
expectations.
they sell them the world on
admission.
I feel like they, you know,
promise them quick response times
and,
you know, all these different
preferences just to get them in
the building.
And again, this is not all
facilities, but so many times I've
seen this, they will oversell.
And then we as care providers are
under-delivering based on those
promises.
And it, you know, I think that the
facilities can do a better job
to make that happen.
But no, I traditionally try not to
tell someone just blatantly,
we are short-staffed.
They would be able to read context
clues like the look on my face and
the sweat
on my brow and, and my scarcity,
you know, the fact that I'm all
over the place.
If they draw that
conclusion, they're not wrong.
You know, a lot of families are
already afraid of long-term care
even
before they walk through the front
doors and they've heard the horror
stories.
And I'm sure some of those
fears are not irrational.
What are they right to be worried
about today?
Today, I would be concerned with a
lack of supervision.
So if you are putting a loved one
in a facility where you will not
be able to visit routinely or you
don't have family close by in the
area, you need to get a friend, an
advocate involved, someone that
can lay eyes on your loved one and
listen to them if they're able to
verbalize, you know, kind of their
experiences and things like that.
Believe them, obviously, if they
tell you that something is wrong.
But I think that
ultimately, you're right to be
afraid of a situation that you
have zero control over.
You can use your
voice as much as the next person,
but ultimately, the care is going
to be provided by someone other
than yourself.
And you have to believe that the
facility is going to do that for
you.
I have seen,
again, multiple times where it's
just not the case.
And you advocate as care
providers, we advocate on
our side for the things that we
see that we feel like are
deficient or that we don't feel
like are,
you know, justified to these
residents.
And obviously, we're mandated
reporters of things that fall well
below the standard.
But I think that, you know, to be
afraid to put your resident in
long-term care,
I wouldn't say that so much as
because there are so many of us
that do care and that do show up
to
work and do our absolute best to
make those people feel welcome and
comfortable and, you know, and
top to your care.
I think that there are a lot of
clinicians out here doing that.
But I also think
that your fears are valid.
You're out of control.
You can't be everywhere all the
time, you know.
And then
whenever things happen, you kind
of question, well, what was the
root cause of this?
If something is not
sitting right with you, though, I
would say question it.
Absolutely.
If something just does not seem
right,
completely, full force, yes,
please question it.
So looking from 35,000 feet, where
do you see the biggest disconnect
between, let's say,
what families expect and what most
facilities can actually deliver?
I feel like the expectations that
are set forth, like I said, in the
admissions process,
I feel like that's probably the
biggest disconnect because they
need the census.
They need the head in
the bed.
They need the body.
You know, they need these people
to be admitted so that they can
continue to provide care.
But I think that the largest
disconnect for me is in
admissions.
We,
you know, as a facility, we will
tell them whatever it is that they
want to hear to get that,
you know, process done because
it's so salesy.
It's like buying a vehicle, except
this is where you're
going to live.
So I strongly encourage to conquer
that.
I strongly encourage families to
show up at odd
times, to show up unannounced,
just to get a full picture of kind
of how things go.
Show up at a
mealtime.
See how chaotic that is.
Or if it's a rare building, it's
not chaotic.
But that's going to be the
smaller portion.
Most of these facilities are owned
by large corporations and budget
is the key component
in how we can care for these
patients.
I would love to say that it's all
patient-centered care
per CMS guidelines, but it's just
not the case.
It's more budget-centered in these
facilities today.
It reminds me of a conversation we
had a while back with Janice
Martin,
who equally said, when you're
touring, don't under-represent the
needs of your loved one
and only to see them mount
afterwards because there too,
there may be a disconnect between
what
is offered or what can be provided
as opposed to what's truly needed.
Do you see that happening often
where, you know, the report you
get on the individual coming in is
so-and-so and then when you
realize what
the care needs are at the bedside,
there's a complete disconnect?
Oh, absolutely.
That's a great point.
A lot of what comes to mind most
often is psychiatric
needs.
So for our residents who come in
who are on some, maybe some mental
health medications,
who have had some behaviors in the
past, maybe this is a new norm for
them.
Maybe they went through an
event like a stroke or some kind
of hospital stay and this is the
new person.
Either those behaviors
were not witnessed prior to, or
those behaviors had to be buried
to get that person approved for
a stay in a facility full of
defenseless people.
So sometimes we have residents who
come in who
have no psych history.
Maybe they were unhoused,
experiencing homelessness, and
they have no real
history.
And then suddenly they come in and
we are finding out that they do
have physical, you know,
behaviors.
They have some mental needs that
we were ill-equipped to deal with
until we experience
those firsthand.
And sometimes that takes a little
while to kind of unravel, whether
it's because
there was a change in medications
whenever they admitted to the
facility or whether that drug was
not quite in therapeutic range.
You know, maybe they started a new
med in the hospital and just
hadn't quite
hit yet.
And so, and also a change in your
environment if you're experiencing
mental health
difficulties can be very
triggering.
I think that moving from place to
place and it's still not home
is very triggering.
So definitely psychiatric cases
definitely come to mind there
where we have no idea
really, either, either, like I
said, they weren't witnessed to do
these things at the hospital or
have
these needs at the hospital.
And then traditionally they'll
come into the facility and we have
to
really work through those, those
things.
And long-term care, as much as it,
you know, the reputation in
the 80s would be, you know, that
we would chemically restrain
people.
If you were acting out and things
like that, we gave a lot of
sedatives, we used restraints.
We don't use those things anymore.
And the laws have now changed with
psychiatric medications.
So we're, we're doing our best to
let people just be who they are
without, uh, medications.
And then, you know, you have to
show
that you've been through all the
interventions, that you've done
everything you can before you get
to
that point.
So sometimes it's just a mixed
bag.
You have no idea who that person
is until they show
you who they are.
Boy, when you stretch thin, if you
think about the amount of time it
takes just to
build trust with those individual
patients as a nurse and an allied
health team.
Um,
I'm not sure if that extra time to
build trust in the therapeutics
and the plan are really factored
into, uh, assignments and, uh,
shift detail and ratios.
No, I don't think they are.
I, again, I think that ultimately
it just boils down to how many
people
can we take and the schedule up is
divided by number, not by need or
acuity, which is something
that I have harped on for years.
I think that there are no, there
being no federal guidelines based
on
acuity.
That's, that's a huge problem for
me because I might have 10 total
care people and you,
you know, have the other side of
the building and you have people
who are able to walk independently
or who need your care less.
Um, and so, yeah, I absolutely
wish that it had been mandated.
If,
if these facilities are not
required to do it, that will never
happen.
So, Crystal, what does it do to a
long-term care nurse to walk into
a shift knowing they
may have to delay tending to
someone or worry a family or leave
a need unmet, even if they work
as hard as they possibly can?
Let me tell you, that is,
that is a mental marathon.
And I don't think enough is said
about the fight or flight response
in your body.
You know, when I'm still a human
being, I'm going to clock out at
some point and
go home to my family and, and, and
live a life.
Um, but I am constantly in fight
or flight because of
the nature of long-term care.
You, you feel guilty.
You ride this rollercoaster of
emotions,
guilt, um, inadequacy.
You feel like coulda, woulda,
shoulda.
Maybe I, if I had done this
differently and, you know, you're
constantly like reevaluating your
shift, you're, and, you know,
God forbid you should have
something going on in your
personal life.
You know, like you've got a
concern or something that's kind
of eaten away at you.
You better leave all that behind
because this,
this job will eat you alive.
And it did that to me.
And now I work on, you know, the
other side of
that in the courtroom and I
advocate for patients that way.
And that has really helped my
mental
health because I, like I said,
the, the constant battle of, can
you get everything done?
I am
extremely neurotic because of my
work in nursing.
I know that sounds crazy, but you
become OCD, you
become COVID, COVID, uh,
definitely enhanced my OCD, uh,
cleanliness and infection control
procedures and,
and trying desperately to keep
these people from, you know,
getting in contact with these
microorganisms and things like
that.
I, I feel like not enough is said
about the person that you become,
the traits that you have to
acquire for your survival in
long-term care.
You have to be able to
turn it off at the end of the day.
Um, there's, there's no way to
meet every need.
I have woke, I've,
I've, uh, had nightmares about
forgetting to do X, Y, Z.
It might be anything from bring a
glass of water
to putting a call light back in
reach thinking, well, how long was
it before so-and-so got their
call light back?
Or, you know, did I put that call
light back?
Just different things.
It will eat you
alive.
Honestly, it is brutal.
As a long-term care, as a
long-term care nurse, when you
walk out at the end of a shift, do
you
remember the people you were able
to help?
Or is it a rumination and
perseveration about the people
you just couldn't get to fast
enough?
I think the empath in me is more
concerned with the unmet need than
reveling in the accomplishment
of completing these things.
Yes, it does feel good whenever
someone pats you on the back and
says,
thank you, or job well done.
Um, or whenever you're able to,
you know, solve a problem, work
with a
provider that you've never worked
with before, you know, there,
there are little successes, but
they
are heavily outweighed in my mind,
at least by the things that I was
unable to do or the things that
I felt were unfair that happened
in the shift, you know, to another
resident or another employee,
things like that.
And you're not often the
determinant of the fairness,
right?
You're just
sort of the mediator of the
process.
Right.
I mean, you're, you're the face of
a broken system
at this point where, where the
spokes in the wheel, you know, so.
So in long-term care then, when
more than one resident needs you
at the same time,
how do you make the decision no
family wants to imagine?
Who gets care first and who has to
wait?
I think resourcefulness is a big
thing.
So if for some reason, depending
on what it is,
you know, depending on why these
two individuals need a nurse at
one time, uh, you just have to
prioritize, like, what is the most
critical?
If I don't see this person in the
next five minutes,
are they going to die?
I would then be resourceful enough
to get a colleague, you know,
someone to,
hey, sit with this person or do
this, you know, delegate, uh, as
best you can.
Sometimes there's no
one available and you really do
just have to make someone wait.
I've gone back and forth multiple
times
with two patients that were not
doing well at the same time.
Uh, that, unfortunately, that
happens a lot
on night shift whenever we are at
the lowest staffing levels, uh,
for the day.
Uh, but yeah,
just delegating and, and being as
resourceful as possible, get
someone, you know, on a breathing
treatment while you run over here
and, and help this person to the
restroom or what have you.
So
certainly it's, it's doing the
best with what you have, but it's,
it's an imperfect system and it,
ultimately the, the care provider
is the person who really just
feels distraught.
It's like, well,
how do you decide?
But I try to treat everyone as if
they were my family, uh, probably
better than I
would treat my family because I'm
probably not as harsh about bad
decisions and things like that.
Uh, not as critical as I would be
if it were my own family, but, uh,
certainly try to treat everyone
with the respect that they, they
truly deserve.
Can you share with us, Crystal,
what's the highest
patient to nurse ratio you've ever
experienced on a night shift?
54 to one.
54 patients to one nurse.
How do you rationalize that in
2026?
I can't.
It is becoming, I, you know, with
the community that I have on
social media, they,
they tell me things and some
things I'm allowed to talk about
and some things are just letting
them
vent, uh, privately, but I have
heard 60 to one.
I have heard just over 60, uh, to
one patient and
that is criminal.
You are setting me up as there's,
there's no way to succeed like
that.
One person gets
sick and another person has a
fall.
What, what do you do?
You know, there's absolutely no
way to manage
all of that.
And then to add to that, we rush
people through orientation.
Uh, traditionally these
facilities will rush you through
an orientation.
If you get one, you're just, they
just assume that,
you know, long-term care and it's
926 page manual because you
graduated with a nursing degree
and then,
or, you know, a CNA certification.
And then you get to night shift
and all of these things are going,
it's, it's, it's the most damned
system.
Like there, there's no winning.
And, and I, I scream at
the top of my lungs, Mark, because
I know I can see the train that
we're on.
So many providers know
exactly how this is going to go.
And we accept it because we know
that to stop the system the way
that
it is, we have to stop.
And we know that that would cause
harm to people.
We know that, you know,
needs would go unmet.
And, you know, if, if every nurse
everywhere decided, Hey, we've all
had enough,
uh, of this, it, it would destroy
the system that is barely
functioning.
So we take barely
functioning and just keep going.
And ultimately I think it's going
to take a complete shutdown of
long-term care the way it
currently exists.
I just don't think that it, it,
it's one of those
things you can just see, you just
know.
So how are new nurses then taught
to deal with multiple competing
interests?
Is there
a mentorship agreement?
They are not.
Um, and they are taking their own
license into their hands whenever
they take
these assignments.
Whenever you take these keys,
whenever you take that report, you
are quite
literally in a balancing act now
with your career because it takes
one allegation.
It could be a false
allegation.
It takes one accident.
You know, you get an immediate
jeopardy.
They are questioning
every single thing that you did.
They are, you know, witness
statements for every single thing
that went on that shift.
And then if you are found to have,
you know, been in deficient
practice,
that that's your license.
Uh, these new nurses, I was
working in a facility in Indiana
Indiana that would hire in, they
would hire in RNs because of the
24-hour rule.
And these RNs were fresh
graduates.
And it's not that they didn't know
anything.
They knew how to do nursing
things.
They were not,
however, familiar with long-term
care.
There is so much.
What's the 24-hour rule?
Sorry.
I'm sorry?
With the 24-hour rule, can you
just explain that?
So, the Office of Long-Term Care,
Centers for Medicare Services,
CMS, mandated, and that has since
been repealed, but they mandated
that we had to have 24-hour RN
coverage.
And that would help,
I believe it would help with a
certain level of reimbursement.
If you, if you could say,
government, Medicare, we have 24
hours of RN coverage, not just
LPNs.
They've since pulled
that back to where it's no longer
required.
But at that time, they were hiring
in people with that
certification, the RN level
licensure, so that they could meet
that rule.
Those people were not equipped.
A lot of those people were brought
straight from nursing school.
And, you know, that has its own
advantages.
You can teach someone everything
that you need them to know versus
having to unlearn acute
care or something like that.
But ultimately, you need time to
be able to understand how
long-term
care works.
There are so many nuances to
long-term care.
And it's a complete shift from
everything you
learned in the med-surg floors,
the OB work, all the different
clinicals that you do, the
rotations that
you do in nursing school, those do
not prepare you for long-term care
whatsoever.
So I think that it's,
it's terrifying.
It's terrifying that your mother
is with someone who knows very
little about what's
going on, is also very spread
thin.
And then to the people that, you
know, find themselves in these
situations, they are unaware of
how much responsibility they are
taking on whenever they do this.
It's,
it's unlike any other animal
really.
So when a family's angry because
someone they love has been left
waiting, has had a basic need,
go unmet, or sat with an
unanswered call bell, the nurse on
duty often becomes the person held
responsible.
But how can families actually tell
whether the problem is the nurse
standing in front of them
or the staffing levels, the
budgets and the management
decisions at that long-term care
facility?
I mean, families and nurses should
be on the same side, right?
Absolutely.
And we're, we both are working
hard to, you know, provide the
care that that patient needs,
that resident needs.
The problem is, like I said
before, I can't really say, hey,
Mark, you know,
I would love to be there, but I,
we're short-staffed and I've got
to go give three showers.
I can't really
say that without violating
probably some kind of policy.
And then ultimately, if people
hear short-staffed,
they attribute everything to
short-staffing and then the
building gets, you know, the
administrative staff
gets upset.
Why would you tell them that?
Don't tell them that.
You know, then they, you know,
are looking for a problem.
And I, and I understand why they
do it.
And I try my best to avoid that
conversation.
However, I think that when a
family has a problem, number one,
approach with dignity
because you have no idea if the
person that you're speaking to is
the person that is responsible for
whatever it is that you, you know,
feel like failed the, the system
that failed or the, you know,
policy that was broken, what have
you.
Sometimes it's not that person's
fault and they have absolutely,
you know, they just picked up a
shift because, you know, someone
needed to take over.
But I would also
say to the staff, communicate
like, hey, we're, I'm doing my
best.
And she said that she had to use
the
bathroom first.
You know, why is she late for this
appointment?
Well, she had to go, we had to
leave
to go back to the bathroom before
we could take her or whatever the
case is.
Communication is key.
And people get so buried in their
work that they forget.
Just talk, just explain like, you
know,
like you would to anybody else
what's going on.
And that goes a long way.
And ultimately, if we get to
talking, you're going to also tell
me some other things that maybe
make you uncomfortable.
And maybe I
can head off some things, you
know, maybe we can make a better
plan so that we don't get to this
particular moment every time, you
know, the call button is pushed.
Or every time you come in for
a visit, you're handling things
that you don't think were handled
appropriately or what have you.
You're trying to put out fires all
the time.
And it's a very reactive approach
when sometimes we can
just talk and make a plan.
The problem there for the family
is going to be consistency and
caregivers.
You may see my face once every two
weeks.
You know, I may be on this
assignment once every couple of
weeks.
I may not have your resident that
day.
So it's very important, again,
that we communicate
shift to shift and that we update
care plans.
Because I really do look at care
plans.
I want to
know why this lady cries if the
window, you know, shade is up.
I want to know why this person,
you
know what I'm saying?
Like it explains a lot about how
these people are.
So providing the continuity
of care starts with updating that
care plan.
Let's keep those as up to date as
possible so that we
understand exactly how best to
care for these people.
Well, you answered my follow-up
question to the T is that, you
know, so much of the connection
that's required for optimal
patient care at the bedside and
long-term care does depend on that
extra level of communication
between provider and family.
And it translates into basic
tenets like
trust and others.
But if you don't have, you know,
consistency in the duty
assignment, I can't imagine how
the
efforts actually pay off
longitudinally as opposed to just
sort of being in the moment.
But then
they're not really banked in any
way in terms of continuity.
But hopefully those care plans
capture
it.
Is there enough time at the end of
the day to make sure the care
plan's up to date?
Probably not for the nurse who's
working that assignment.
There is so much charting and
there are so many,
you know, assessments that have to
be done to be able to bill for
Medicare and Medicaid, what have
you.
But I think that if I were in a
position that I was unable to
complete an update on a care plan,
and a lot of nurses are just not
familiar with how to do that based
on, you know, the fact that
someone
else usually manages the care
plan, if it's social services, if
it's, you know, the DON, whoever
it is in
your building, I think that a
quick email, a quick phone call to
that person, hey, this person
really
doesn't like this.
Can we update the care plan?
Sometimes it's, a lot of times
it's dietary, you
know, a lot of times, you know,
mealtime, it's kind of chaotic.
I may not have time at mealtime to
update
that care plan.
But if I call the person who
usually manages those things,
usually you can get those things
added.
I think it's just being consistent
and writing it down if you can't
do it right now,
you know, so that you don't
forget.
But that way the family doesn't
have to repeat themselves
and grow more and more frustrated
with every time that this happens,
because they've tried to explain
it to you and then you disappeared
for two weeks, you know.
So I claw at any opportunity to
finish
something so that it doesn't just
continue on.
You know, you talk very openly
about staffing and
budgets and ownership and money
and long-term care, but when
families are trying to understand
why care
feels rushed, why it's delayed or,
you know, inconsistent, what do
you want them to know about
the business decisions between and
behind bedside care?
Remember that just like we are
trying to hustle
through care.
You may see us feel a bit rushed.
Remember that there are X number
of people, two or
three other people behind you that
are waiting for us.
And so we're not skipping care.
We're trying to
provide the best possible care we
can in a circular formation.
So we just start around and then
just keep
going until everybody is seen.
And we only have so many hours of
the day to do that.
It is absolutely
impossible.
And do I wish that there was more
time?
Absolutely.
Do I wish that we had more time
per
person to be able to truly learn
their preferences and take care of
them?
Absolutely.
But I want families
to know that if we're rushing,
it's because we're trying to get
to the other people.
You know, there's
always somebody that needs
something.
And so if it feels rushed, it is
not because we don't care about
your person quite the opposite.
It's because we care about
everyone so much that we are
trying to manage an
impossible assignment.
I mean, truly, on my best day in
the nursing home, I still had
probably double what I
should have to be able to
adequately care for these people.
So where and how then do families
actually feel those financial
decisions and management decisions
at the bedside?
I feel like the, you know, quick
response is delayed quite often.
You may press the call button.
And if
I'm walking right by, I'll pop my
head in and, you know, see what's
going on.
But sometimes you wait for
20 or 30 minutes for a need.
And sometimes if you're not able
to get out of the bed and come to
the nurse's
station to ask about whatever it
is, you know, you're at a
disadvantage.
I think that families being able
to
advocate is their given right.
And I encourage families to use
like resident council meetings and
grievance
forms to air out their concerns so
that it's documented.
But I also want you to understand
that we're, you know,
we're not rushing because we don't
care quite the opposite.
So, I mean, I would say to answer
your
question, more than likely, you're
going to feel like we're rushed or
that it took us a long time to
get to you.
And sometimes, you know, if you're
waiting to go to the bathroom, for
example, you know,
it's really just, it's so broken.
It is the most, it's the hill that
I'm going to die on.
It is my
legacy to raise hell until
somebody hears us, until somebody
says, you know what, they've got a
point,
like, that this can't continue.
And eventually, my dad will get
old enough to need care.
And,
you know, my kids will put me in a
facility and all that.
What will health care be like?
And I don't
just mean long-term care, but in
general, what will health care be
then?
If it's profits over patients
now, imagine, you know.
Well, families may see a nurse who
seems tired, rushed, or
emotionally
guarded.
And, I mean, in those instances,
is burnout even the right word for
nurses who still
care deeply, but are working in
conditions where they can't
provide the care they truly
believe
people deserve?
Or is it moral injury?
I think there's a difference.
I think occasionally you
get to a point where you are
exhausted.
You experience what I would call
compassion fatigue.
And so it's hard for me to care
about the level of ice in your cup
over the fact that, you know,
someone who was burned out ripped
the sleeves off of this lady the
other day and, you know,
and degloved her entire arm.
Yes, that really happened.
It's hard for me to care as much
about
the level of ice in your cup as I
care about someone who was abused
or neglected in some way.
Those
things, I think, you know, in the
grand scheme of things, I
experience compassion fatigue with
the
little things versus, which, you
know, everybody's entitled to
their little preferences and
little
quirks and I have my own.
But I think that ultimately the
distinction between burnout and
compassion fatigue are, and I
would say compassion fatigue,
moral injury, is aggravation.
Whenever
you are so aggravated that you
have to do your job, you are
aggravated at the staffing, when
you just feel
like your entire personality could
be captured by saying the word
aggravated, that's when you need
to step away.
And that's when there's a shift
and you are more prone to make
mistakes.
You're more prone
to be verbally abusive.
You're more prone to...
Be cynical.
Absolutely.
I mean, jaded, you know, it's a
hard job.
And I think recognizing when
you're at your
personal limitations, just because
I've been doing this for 16 years
doesn't mean that you're not going
to be burned out in six months.
That doesn't mean that I've done
it consistently for 16 years or
whatever the case is.
And so I think that the fact that
there's...
It's driven by the staff member to
know whenever, you know, to
self-reflect and know, like, hey,
I'm reaching that point.
But I also have
to earn an income.
Like, how do I just say, you know
what, job?
I can't do you for, like, I don't
know,
six weeks.
I have a girlfriend who
recently...
She and I have worked together for
over a decade.
Like,
we've known each other for a
really long time.
She's been a nurse for
30-something years.
And she was
recently in long-term care.
And she had to step away.
She took family medical leave.
And she stepped
away because her mental health was
just toast.
And I think that if she had not
stayed, she would have
fallen into that bucket of
burnout.
She just couldn't take it anymore.
And I think aggravation was
probably
her top trait.
Like, she was already irritated
before she walked in the building.
And obviously, we all have
those shifts.
We all have those days.
But whenever you feel like that's
not a fleeting thing, it's time
to step away.
And families will notice.
Residents will notice.
People will take notice whenever
your
demeanor is not compassionate.
There's that transition from
aggravation, which I think
everyone in healthcare has felt at
times.
But
once the situation or the
decisions you need to make start
conflicting with your own deep
moral values
as a provider, as a care provider,
that's where moral injury rests.
Have you ever felt morally
injured yourself?
Not necessarily.
I do my best to separate how I
feel about a certain situation
versus how a resident
feels.
Yes, I try to put myself in their
shoes to some extent.
But I do my best to try to just
separate from that.
And so I have experienced what I
would call burnout several times.
And I do see
moral injury.
I see that.
I think it's more discussed now
than it traditionally would have
been years ago.
Thankfully,
social media has really helped
that, where people are able to
kind of express where they are and
how
they got there.
But I would say
I've not experienced that
necessarily in those words.
I would say that I've reached the
burnout
point several times.
And for those reasons, I'm not
practicing as a nurse right now.
I just
just need some time.
And I've gone to different
specialties and done different
things.
But
geriatrics is the love of my life.
So actually, yesterday,
true story, I went to the store
and just bought a whole bunch of
stuff and just showed up for the
staff.
Like, I just dropped it off.
I didn't put a note on it to say
my name.
I didn't say anything
about social media.
Like, I genuinely just wanted them
to know that, like, someone
sees you, knows what you're doing.
And part of the gift that I left
was things that were things that
would help do your job or things
that would make you make your job
easier, things like that.
So
I think that not enough people.
I won't say that.
I think that showing our support
and solidifying as a group is the
only way that we can change
this about long-term care.
you've stood in the face of
burnout on several occasions, you
just told me.
Is the hardest part
really the workload itself?
Or is it knowing that the
conditions
inside the facilities are just
keeping you from being the kind of
nurse
you came there to be?
I think the most frustrating part
for me is feeling like these
people just deserve better.
You know?
I feel at the end of the day, when
you clock out, you're like, well,
are they going to be cared for?
What's the assignment going to
look like tonight?
How long is that person
going to scream?
Are they going to close the fire
doors so that they don't have to
listen to that
person scream?
You worry constantly because it's
like an extension of your family
in some way.
You know, like for at least eight
or 12 hours or whatever, you're
treating these people like
family.
And so you worry about all the
things that are going on when
you're not there.
I was a nurse
manager for a building and I
showed up at like 1.30 in the
morning just to do a round and see
what
was going on because I had a
sneaking suspicion that, you know,
that things were not well in the
middle of the night.
I was hearing tales of people, you
know, sleeping in their vehicle
and
not showing up.
And, you know, I was coming in the
morning and things just didn't
seem to be
done.
And, and the assignments at that
time were reasonable, uh, for, you
know, 2026 long-term care.
And, uh, I, I just did that out of
caution that, you know, if I'm not
here and, and I hear things
and I, I should probably check.
And, uh, those types of the, it
was a snowstorm whenever I did it,
the last time.
And you're quite literally risking
your own life to go out and check
because you feel
like these people deserve better.
It's so frustrating that you have
to go to these links to, to make
sure
that these people are cared for.
Not everyone views long-term care
the same way.
I would say there are
some generational differences, uh,
amongst the staff that you see in
these facilities and maybe in the
workplace in general, you know, in
this country, maybe generational
gaps, uh, you know, all operate
a little bit differently or, or
experience things in different
ways.
But, uh, yeah, it's terribly
frustrating for me that I have to
leave and I have no idea what's
going to happen.
I, I've had more than
one crash out on the internet
about things that I found because
it just pissed me off.
It, how do you
work in a, in a profession that
requires you to care for human
beings, to value human life?
You know,
it, I don't know.
I think several things can be true
at the same time.
And for me, the burnout came
from constantly worrying about
what was happening when I wasn't
there.
It's guided by that type of
empathy and commitment.
It's pretty hard to leave work at
work
and come home to your family,
isn't it?
Absolutely.
There's always something to keep
your mind occupied at work, even
when you're not there, you know,
so.
You know, families often judge
care by what they see and, you
know, that's best shown by whether
someone came quickly, whether
medication arrived on time or
whether a need was met.
But what parts of nursing and
long-term care
are families really not seeing it
at all?
That's a really good question.
Obviously, the families don't see
the worry that we have outside of
those walls.
They don't,
they don't know that we go home
and think about.
I know, you know, nurses that are
praying for
their residents and, and the
things that those families might
be going through.
I would say more often than not,
they don't see the empathy that we
have, that we,
we truly do suffer along with
them.
We truly do worry about probably
as much or more so because
we're kind of on the inside.
We know the things to worry about
more so than the family member.
Like
I don't think that families would
believe it if we explained exactly
how much of our time,
our, our thoughts are consumed by
what's going on at work with that
resident.
That's an important message to
spread for sure.
You know, if someone followed you
on an ordinary shift, what do you
think would surprise them
most about how little of the task
they were waiting for is just a
fraction of what nursing entails?
Trying to think of a good example
for that.
Uh, let's say
mealtime.
I mean,
things are so highly regulated
that when we follow all of the
steps to complete a task,
we have spent excessively more
time, exceptionally more time
preparing for, explaining, you
know,
then carrying out whatever it was,
the orders, the doctor's orders or
whatever the thing was,
and then the cleanup or the, um,
you know, whatever we do to close
that down, whatever we do to, um,
in that task, it sometimes is a
lot.
I'm trying to, besides mealtimes,
I don't know.
I guess it's just so highly
regulated because if, if you're
doing something in the nursing
home, there is a hundred percent,
a rule or 50 about it.
It could be anything from, you
know,
I go in to refill your ice water.
Okay.
I have to knock on your door.
I have to announce my name.
I have to request permission to
come into your room.
I have to wash my hands.
I have to, uh, you know,
remove the cup and, and bring in a
new one with a fresh date and a
time and a, and I say all that
just to say there's, there's so
many rules to what we're doing
that it's not ever just, oh, let
me run
in and go do this or it's not
supposed to be.
I mean, there, there's rules about
that kind of stuff.
You have to explain what you're
doing.
You have to, sorry, I'm turning my
fan off.
You have to explain
what you're doing.
You have to ask for permission to
do it.
You have to make sure that the
person is
comfortable.
You have to assess, you have to,
um, follow up and, and whatever
the outcome was of the
situation.
You have to document everything.
There's just a lot that goes on
from A to C,
you know, it's unseen, but there's
a lot that goes on.
You could see how not being aware
of those details and that process
that's involved in so many of the
steps that are involved in
delivering care that, uh, it could
lead to tension and impatience
even.
I mean, in long-term care,
families are there to, when they
can be, to try and protect and
advocate for someone they love,
especially when that person's
vulnerable and can't advocate for
themselves.
But from the nurse's side, at what
point does a family become like so
intense, angry,
suspicious, or hard to approach
that staff actually start avoiding
them or defending themselves or
just
kind of shutting down?
Well, I think that we get to a
point where it, I question whether
or not
I as a care provider or we as a
nursing facility can meet your
needs, can meet your expectations.
And it, it's not that your
expectations are wrong or
excessive or that, that really
doesn't even
matter.
What matters is whether or not we
can meet your expectations in
delivering the appropriate
amount of care.
And if the, the answer to that
question is no, you're not.
Okay.
Are we capable?
Are we equipped?
Do we have the ability to meet
your expectations to your
standards, provide the care
to, you know, your liking and your
preference?
And if the answer is no, then we
need to, we need to find
somewhere else.
And sometimes I think that that
conversation provides a little bit
of perspective
with families.
Can they expect that they will
find a facility that will manage
their expectations,
that will, you know, meet their
expectations.
Whenever they start looking, they
get a pretty
good perspective as to whether or
not that's going to happen, you
know, depending on what it is.
Sometimes it's like, yeah, yeah,
absolutely.
Come on over.
You know, you, you transfer over
here
because we prioritize those types
of things.
And sometimes it's just, I find
that I've had, you know,
experiences where the family has a
laundry list of expectations that
I would consider trivial,
but it's the bigger picture is
they're controlling what they can.
And whenever they are out of
control
of a situation, they're not able
to manage that person at home.
They're not equipped with the
knowledge
or the resources to be able to
care for someone outside of, you
know, an institutional setting,
it becomes a control thing.
Like, well, I want to make sure
that when I'm here, he gets, you
know,
X, Y, Z, whatever it is, you know,
a nice fresh glass of water.
Well, why isn't his water fresh
when I come
in?
We'll set that expectation and
determine whether or not it's
realistic that someone will meet
that
expectation or if we're just not
capable because we're, you know,
too busy or too nonchalant or
whatever
the case is.
And then go and find a facility
that will meet those needs.
If that facility exists in
your area, a little bit of
research, you know, now that you
know what your expectations are,
a little bit of research into, you
know, the surrounding area or
maybe a more convenient city
or what have you would definitely
help.
But sometimes it's just not
realistic.
Sometimes
all of the facilities in that area
are going to be this way.
There are just, you know, call
light wait times.
You're going to wait on a call
light at some point,
if not every time, at least a few
times a week.
You're going to wait an
exceptionally long time
because of human life happening in
the doors around you or behind the
doors around you, you know.
So should those expectation
conversations happen when you sign
on the dotted line and
enter that community?
I think they should, but they are
not because we're trying to,
again, admit the most people that
we
possibly can.
But I do think that there are
opportunities for, you know, for
that conversation
to be ongoing.
I think that care plan meetings
and like I said, resident council
meetings and then,
you know, whenever you're in the
building with your loved one, just
having a quick conversation with a
nurse or the
nurse manager or somebody that,
you know, would be able to relay
your preferences or your
expectations
to the care team.
I think that those conversations
need to happen.
I don't think that they do.
Realistically, real world, they
don't talk about that stuff on
admission.
Or if they do, it goes in
one ear and out the other.
You know, I think that people tend
to get labeled as needy or
wanting too much or whatever the
case is.
And ultimately, we just need to
know if we're going
to be able to meet those
expectations or not.
You mentioned something earlier
about being very
forthcoming with the level of care
and with your expectations for the
care that's going to be
provided with your loved one.
Don't hold back.
You're not doing yourself a favor.
You're not
doing the resident any favors by
kind of obstructing that
conversation.
That conversation needs to happen
on admission and then frequently.
And if it's not changing, if it's
not improving, if it's not
meeting your expectations, then
you need to reevaluate and
possibly move on.
So, as a nurse invested and, you
know, empathetically connected to
the care of that resident,
are you the one who gets the
privilege to have that
conversation to reestablish
expectations?
Or
does management swoop in in a very
disconnected way and just try and
sort of smooth things out?
But
in the end, not much happens.
It depends.
If I know that the person who, a
lot of facilities will say that
it's a nurse management,
you know, function.
It's something that the unit
manager or maybe the director or
somebody would
normally handle.
Maybe even social services would
get involved here.
But I also have worked in
facilities where I know that this
person will be very dismissive.
This person may not have the time.
This person may not get along with
the family quite like I think I
would.
And so, sometimes I will have
that conversation just knowing
that it's probably easier to go
ahead and just take care of it
right
now, discuss it right now, and
then I can kind of report back to
the team.
But generally speaking,
it would be your unit manager,
your social services director,
even like with the nurse
practitioner and the doctors that
make rounds, you know, whenever
you
are visiting and you see one of
them and you need to discuss
something with them, absolutely on
the
spot would be ideal versus a
meeting situation that you have to
wait for and possibly have that
situation, you know, unresolved
until that meeting.
So, it just depends, I guess.
So, those kinds of conflicts that
I alluded to, there is a scenario
where they can improve the
care of the resident if the right
communication choices are made.
But at the same time, it could
also make it harder for the family
and the care team to actually work
together.
It can.
What I'm hearing is...
Feelings get hurt.
Feelings get hurt and egos get
bruised.
And, you know, I feel like
I may have anxiety to go into this
room because I know that they
don't like me or that they accused
me of something or that they, you
know, whatever negative situation
has occurred.
But I also feel like
the lines of communication always
have to be open.
It baffles me that people don't
realize,
but like, we're caring for human
beings.
Like, these are humans.
These are mom, dad, grandma,
grandpa, aunt, uncle of somebody.
And I think that everybody grew up
differently.
Everybody raised their
children differently.
Everybody has their own
preferences and things like that.
I feel like it
takes a little while to be able to
understand exactly what you like,
exactly what you don't like.
And it may
take experiencing something before
you realize, hey, I have a
preference about that.
I really don't like
that.
You know, I didn't know that I
wasn't going to like having a
roommate because I didn't like
someone
else having the TV on or whatever
the case is.
And so, I encourage you to handle
those things quickly,
but also respectfully.
I've seen, I don't know if I can
even talk about this.
One of my colleagues
was recently attacked at work by a
family member.
And when I say attacked, I mean
physically assaulted
and terribly, terribly.
It was pretty devastating.
And so, you're also like, okay,
well, I see that this
person's angry.
Are they going to, are they going
to really lose it?
And, and sometimes that, that
happens
too.
So, it's so bad.
It's so bad because it could be so
good.
It could be so much better.
And there, the problem is that
it's not a one size or one fix,
you know, would solve the whole
thing.
It's such a multi-layered
convoluted problem because you
have the families and the staff
and
something, you know, you've,
you've met people that you, let's
say you go to Walmart, you get a
cashew
that you don't like, you know, for
every one that you do, you might
get three that you don't and no,
you know, obviously nothing
against Walmart, but, um, I feel
like care providers are the same
way
and families, you know, they, they
have preferences.
Families bring a different dynamic
also to the bedside and the
relationships among different
tiers within family and siblings
that it
is complex.
Um, you know, we're very sensitive
to, uh, nursing violence.
We've had several episodes
on the podcast addressing that
detail.
And I can only hope that your
friend and colleague, uh,
felt that somebody had their back
going through that harrowing
experience.
Yes.
So you've warned nurses to protect
their license.
What are the real stakes for a
long-term care nurse when staffing
levels, workload, management
decisions,
just create unsafe conditions, but
yet the individual nurse can still
be blamed, disciplined,
gaslit, reported, or fired if
something goes wrong?
Well, I think that not enough
people view it through the lens
of,
I think not enough nurses have
perspective on this specifically.
A lot of people think,
myself included, whenever I first
started, I thought that a bad
situation would be easily
identified.
And the truth is a routine day,
six months from now, under review
by strangers,
could have been a bad day.
You may not realize what occurred,
you know, for some time.
It could be
days or weeks or years, you know,
before you realize the gravity of
that situation.
If your documentation
was lacking, you know, well, what
really happened that day?
And, and I think that not enough
people
realize how quickly that can
change.
Whenever you're working for people
who tend to prioritize
the company, people, you know, a
company that tends to prioritize
budget, when you're working for a
company that will look for a
scapegoat in a situation, you are
dispensable.
And I, and as much as I like to
say,
like, you know, I'm, I'm pretty
smart and I, you know, I'm a good
worker and I have all these great
qualities.
Why would anybody hate me that
much?
Because if it comes down to you or
them, they choose
them.
And that's not just with nursing
homes.
That's, you know, any line of work
that you get into,
generally speaking, that's, that's
how that goes.
Well, now that I work in the
courtroom, I see
innocent documentation mistakes,
uh, innocent, you know, things
that turn into a neglect, a
lawsuit
about neglect, you know, uh, you
know, negligence.
People don't realize how quickly
that happens.
And
it's just, you signed your name in
that chart that day, you gave that
medication that day, something
super routine that you normally
do.
Whenever you are involved with
people who do not have your back
and say, you know, people that'll
say, Hey, you know what, that
Mark, Mark would never do that.
That's a good dude.
He would never, you know, people
that will stand up for you in your
absence.
A lot of these facilities are not
like that.
They're like, Hey, cut her loose,
you know, whatever.
And
people end up in handcuffs.
People end up with criminal
charges.
People end up spending their
life savings on attorneys for the
next several years to fight
something.
People end up losing their
entire career, uh, over just a, an
innocent moment.
Sometimes it's, you know,
malicious, but
more often than not, it's
something routine that was
incident, you know, innocent and
it just got into
the wrong hands and spiraled out
of control.
And you have no proof that it
wasn't your fault kind of
thing.
So I don't think that not enough
nurses know that the situation is
not easily identified as a,
Oh, okay.
This is when I should be worried
about protecting my license.
Those things don't reveal
themselves until later.
And so sometimes what was a
routine day turns into a
nightmare.
Yeah.
Just a thought that comes to mind
with, you know, technological aids
exploding everywhere.
Um, would an AI, portable AI
scribe to document these
encounters actually save time and
capture
things efficiently to protect
nurses?
I think it would.
I've often considered, you know,
body cameras and things like that,
but how do you do
that and protect to preserve the
dignity of, you know, human
beings, uh, but something that
could,
you know, just transcribe the
interactions and, and, you know,
maybe even just an audio recording
device in the room.
Um, I often feel most welcome in a
room that has a nanny cam or, you
know what I'm
saying?
Like I've done home health and
every single peds case that I
worked, we had, you know, cameras
in the
room and that always made me feel
better because I knew that there
would be a visual, uh, to go along
with the interaction.
There would be, you know, if
anything ever went wrong, someone
could replay that
and see exactly what happened.
But I, I think that in, unless
it's a regulation, I don't, I
don't foresee
that ever being commonplace
because, uh, it's, it would cost
quite a bit of money, you know,
that,
that we don't have kind of thing.
So I think it would be fabulous
though.
We do see the evolution of tools
that can, uh, and are improving
and maintaining a confidentiality
and that are being adopted in a
healthcare system.
So fingers crossed.
So, you know, in light of all
these risks, how does that change
the decision a nurse makes during
a shift when they're trying to
protect the resident, protect
their license and get to everybody
who needs them?
My best advice is to bring a
witness.
Any situation that you feel like
may need someone else's opinion
or may resurface later in a
different context, I would always
grab somebody.
Hey, do you mind coming
in here with me?
And then, you know, I make a phone
call.
Hey, can we update the care plan
to be two
people or what have you?
Sometimes you work with people
who, I have worked with residents
who were
very manipulative in nature, um,
and not necessarily to be
destructive to that person's
career, but to
maybe get what they wanted.
They wanted a reaction or, or
whatever the case is.
And sometimes people do
that.
I'm just being honest.
Sometimes, sometimes that happens
and I take more than one person in
with
me.
Um, that also protects the
resident.
So, abuse is less likely to occur.
Negligence is less likely to
occur if there is another person
in the room.
And, and I'm a huge advocate of
that.
Anytime I feel like
it's needed, I request it.
Is it feasible?
Not always.
Uh, but you can schedule things,
juggle things to be
able to, um, you know, get
somebody else in the room.
We're going to take a little break
folks and get a chance to hear a
question or two from our
illustrious production team, which
is a tradition we keep here on the
podcast.
We'll be back in a bit.
So Crystal, I've been listening to
the conversation and you mentioned
earlier that eventually you're
going to have to probably put your
dad in a facility.
Um, the comments that we got
whenever we talk about
this subject on the podcast are
really split between a group of
people that tell the horror
stories and say, they would never
again do this, or like they had to
pull their loved one out and take
them back home.
But for the families out there
that are completely burnt out and
can no longer provide
safe care and really don't no
longer have a choice about whether
or not to put their loved one in
long-term care.
If you could sort of imagine
yourself, um, going to a facility
and sitting
down with the sales team, because
I think a lot of issues sort of
start there, how would you
approach
that meeting if it was for your
dad?
So if it were for my family, uh,
I, I think I've made a video or
two about this just to try to give
people some kind of, you know,
structure to work with, but I
would number one, show up at an
unannounced
time, uh, so that I knew that what
I was seeing was organic, um, and
not a presentation because I, I
can
schedule a presentation anytime I
want to.
So I would say go at an off time,
um, you know, or a time that
you have not previously scheduled,
maybe be a little early.
Um, I would also request things in
writing.
So if you have very specific
needs, um, or if you have very
specific preferences about maybe
dietary
requirements or your, you know,
worship schedule for church, um,
things like that that are
important
to you, I would say make sure that
you get in writing, uh, the, the
acceptance of those needs or those
requirements and that they, you
know, the facility does intend to
provide those, uh, for you.
I would also
say to review the state, uh,
survey manual.
Usually in long-term care
facilities, it's located, you can
get it online, but a lot of us are
pen and paper, myself included.
So whenever I go into a building,
I look at the survey manual so
that I can see exactly what they
were cited for.
Was it super
malicious or was it something that
could probably happen anywhere?
And, you know, kind of think to
yourself.
So just because they were cited
for something doesn't make it an
immediately a bad
facility.
Just look at what their plan of
correction was.
And if you, you know, can look
around and see
that they, reasonably, it looks
like they're trying to follow
that, then I would say, you know,
you would
look past it.
But if they, you know, racked up
these deficiencies in areas that
are crucial to the care of
your loved one, then, you know,
that, that should probably be your
sign to move on and, and look for
somewhere else.
So also you can kind of observe
whenever you walk in, like, what
does it sound like?
Do I hear
a bunch of people yelling or do I
see chaos?
Do I feel, how do I feel when I'm
here?
How you feel
when you're there, you know, is
probably, you know, a
representation of how your loved
one is going to
feel on a daily basis.
If it feels rushed and chaotic
and, you know, kind of forgotten,
or if it feels
interactive and fun and, you know,
upbeat, you can, you can get a
pretty accurate vibe from just
your
initial interaction in a building.
Okay.
The other thing I was interested
in is you mentioned that
there's sort of a different
approach professionally to
long-term care by generation.
Could you, so what
have you noticed around that?
And can you sort of give us like
where it cuts off?
I recently had a
medical procedure and I had this
Polish nurse that had been nursing
for like 35 years and she made me
feel immediately, like she felt
like my mom or something.
And then there was a younger
person
in the room that also was doing a
good job, but was less engaged.
You know, the concern didn't seem
to be as much about like calming
my fear or making me feel
comfortable, but the other nurse,
the older
nurse really seemed to understand
that and connect on a different
level.
That's just something that I
noticed.
Could you sort of break down where
the generational shifts occur and
what's sort of the
difference between the older
generation and some of the younger
generations coming into nursing?
Well, I think that the newer
generations of nursing, I won't
necessarily classify them as
younger
just because I was older whenever
I went back to nursing school, but
I would say the newer generation
of nurses has been rushed from day
one.
Whenever they enter their nursing
program, it is crunch time.
They are trying to, you know,
manufacture answers for a test all
the time, you know, test taking,
test taking, test taking.
And so they don't learn
necessarily the things that the
veteran nurses have learned
through a program where they had
to wear stockings and a white hat.
Those were very rigorous programs
where you were dismissed for
absolutely any reason.
Not saying that nursing school
isn't hard these days
because it's very tough, but I
think that it started in nursing
school and the experiences that
you had
in nursing school, my particular
program was very...
They did things to prepare us
like, you know, fake scenarios
that still have PTSD from those.
But
anyway, so I think that the people
that have been in nursing from the
white cap era that, you know,
that wore the white stockings in
their graduation photo, those type
of people, I think that they
they understand more of this
generation that is currently in
the facility.
I also think that the newer
generation
probably tends to do a better job
with mental health crises, with
accepting people who are from
different
backgrounds or different sexual
orientations and things like that.
I think that the newer generation
of nurses
probably is a little bit more
aware and respectful of that as
opposed to people, you know, who,
like I say,
are from just a different time.
But I also think that the needs of
the patient probably play a factor
in that too.
Sometimes we see like a younger
population in nursing homes and
maybe you connect with a newer
generation nurse
because you guys are more close in
chronological age than, you know.
But I think that the older
generation
of nurses and the people who are
up to probably their 50s, 40s,
50s, or as low as 40s, 50s, I
think those
people are more of a mother figure
if it's a woman, you know, a
caretaker figure.
And then the newer generation
nurses, I feel like are probably
more systematic about survival and
just getting through the shift
and making sure that you're okay,
obviously.
And this is in no way a diss.
I just mean that the cultures
are different and you can, that it
becomes very obvious whenever you
work on shift together.
So.
Thanks for answering my questions.
Thank you.
So we're back from some really
interesting perspectives shared by
Crystal in response to
our producer's questions.
Crystal, getting back to
how families and nurses can
survive in the same broken system.
When someone you love enters
long-term care, the nurse is often
the person you see first
when something goes wrong.
But what should families
understand about
what the nurse can actually fix
and what has to be taken to
management or the facility itself?
Well, obviously, if you, if you
feel like it needs to be
escalated, please have, you know,
don't even hesitate to go straight
to the top of the chain.
However, I think that if it's
something
that is preferential, something
that your person, your loved one
prefers, let's discuss that on a
one-to-one level.
But remember that nurses are there
to carry out physician orders.
They are an entire person outside
of their medical conditions.
And I would caution anyone who,
who, I guess, puts too much weight
behind just the medical conditions
and not enough focus on the
person.
I think it's easy to do when we
get into the nursing home because
you on paper are your diagnoses.
You on paper are your, you know,
care plan and your doctor's
orders.
But you're more than that.
So if it's something preferential,
minor, what have you, I would say
just get one-on-one with the
nurse.
But if it's something that you
feel like is a systemic issue,
requires a policy update, maybe an
explanation of sorts, or needs to
be reported, you know,
something that you think should be
maybe sent up to, you know, a
higher agency, thing like that,
I would say definitely get with
management.
And sometimes that's whoever's
door is open.
Sometimes
that's whoever you can schedule an
appointment with, just depending
on your facility and, you know,
how available those people are.
I mean, in its purest sense,
that's an avenue towards
continuous quality improvement,
just like
any citations, maybe.
Not all citations are actually
meant to sort of harm morale, but
they're
actually agents of improvement.
If someone actually told me, we've
never been cited for anything, I
think
that would actually be a red flag
to me.
Absolutely.
So, what belongs in a conversation
with a nurse?
And if we can be a bit more
granular, let's say the
director of care or the
administrator or levels up, is it,
what are those systemic issues
that are
present today in 2026 that need to
be taken to higher levels?
Well, for starters, you know me,
and I'm going to tell you
staffing.
If you feel like the problem is
attributed to short staffing,
inadequate staffing, incompetent
staffing, a problem with the
staff,
I think that that needs to go
directly to the boss of those
staff members.
If you think that
there's a systemic issue with
maybe the culture, like you notice
that all the staff, and I don't
think that this is necessarily the
case, but just for example, all
the staff are just sitting on
their
phones at the desk and your call
light's been going off for two
hours.
Or whatever the case, you know,
mom doesn't get a shower like
she's supposed to, but the staff
are, you know, eating at the desk
or
whatever.
If you feel like it's a staffing
issue, then I would say, you know,
or a systemic issue with
the staff, I would say certainly
move forward with the supervisors
in that building.
But I also think that
if you want something different on
the meal tray, if you think that,
you know, Mr.
Joe needs a little
extra time at the dinner table or
whatever the case is, then I think
those smaller things, those now
things could be handled with the
nurse.
Because the nurse's reach is these
people, these rooms and
these people right now.
If it's something that I would
have to leave the unit for, you
probably need
to speak to management.
But outside of that, if it's
something that we're doing, if
it's something that
you've noticed that I'm not doing,
certainly let's have a
conversation, a respectful
conversation.
Absolutely.
You know, and just trying to bring
value to everyone listening,
before a family will
actually trust a long-term care
facility with someone they love,
can you tell us what the top three
questions might be that they
should ask that might reveal what
kind of care
is there and what care looks like
day-to-day in that facility?
I would ask what their ratios are.
I would ask about their care
provider ratios.
How many people does the
medical director see?
You know, if I have a concern and
I need to see my doctor, like how
long is it going to
take me to get in?
How many CNAs, you know, or how
many residents per CNA?
How many nurses, or, you know,
how many residents per nurse?
I would ask about, make sure that
you are seeing the actual room
that they
are going to be in.
Because sometimes those things,
I'm not pointing any fingers, but
sometimes those
things are a little switched
around.
Just be realistic about your, you
know, the person's environment,
where they're actually going to be
living, who their roommate is,
things like that.
And then I
would also ask for advocacy.
Phone numbers point me in the
direction of, you know, where
these phone
numbers are.
How do I get in contact with the
state?
How do I get in contact with the
ombudsman?
Make
sure that you have that
information so that in the event
that something, I'm not speaking
it into
existence, but if something does
happen, an adverse event has
occurred, you don't want to have
to go into
the building and go try to find a
phone number with people who are
trying to, you know, who are in
the
same situation.
I would rather not do that then.
So I would say, ask for relevant
contact information
then.
Those would probably be my top
three questions to ask.
You know, I think those are
important questions that don't
establish a level of
confrontation, but
they read, they rather establish
that this is a family that's
observant, that wants to
communicate,
that doesn't have blinders on,
that loves the person they're
entrusting to the care of the
facility.
And it would also indicate that
they either have a healthcare
provider in the family or they
have
spoken with another healthcare
provider.
It indicates to someone who works
in this industry that they kind
of know, you know, they know
things, whether that's because
they have a, you know, a
healthcare provider in the
family or because they've spoken
to someone, they know what's going
on.
So on the flip side then, when
families are trying to decide
whether a long-term care facility
is safe for
someone they love, what answers
from management should really make
a family pause?
I don't know that they would ever
necessarily disclose anything that
would cause you to
necessarily be alarmed.
Maybe in their responses, if you
were to ask about the things that
this facility has been cited for,
again, there's a binder at the,
you know, in the lobby usually in
these facilities when you're going
through that, if you have
purposeful questions to ask and
you feel like maybe the facility
blamed
blamed the resident or blamed a
family member or blamed the state
surveyor, which I have heard
also, and kind of escaping
accountability, if their response
seems evasive or like it lacks,
you know, accountability of sorts,
then that would certainly be a red
flag.
But I, again,
I'm not sure that even if the
facility were capable of those
things, they would disclose
something that
would give you that impression
initially.
Sometimes they're just putting
their best foot
forward and, and may not kind of
trigger that in your mind right
away.
Crystal, you've been a nurse and
you've also been a patient.
And when you were the one in the
care
bed, what did you understand
differently about vulnerability,
waiting and needing care?
That was the hardest period of my
life.
I'm going to be honest with you.
For starters, I was jealous.
I did not expect that I would feel
jealous of the people that were
providing my care.
I remember telling, I was crying
one day after a procedure and I
told the nurse,
I said, you know, I was just like
you, like last week.
Last week, I was working as a
nurse,
taking care of other people, you
know, before all this happened.
And,
and I felt like I was at their
mercy.
I'm at the mercy of your schedule.
I'm at the mercy of
your attitude in this particular
moment.
I'm at the mercy of what you tell
the doctor.
If you tell
the doctor, oh, her pain is not
managed or she's not responding,
you know, and, and I'm not part of
that conversation.
These, these are conversations
that, that go on outside of
necessarily the bedside,
maybe at the desk or they're
calling the doctor or what have
you, just making sure that
if I asked for something, they
knew that it was coming from a
genuine place because I don't
typically try to bother people.
I'm really, you know, meek and
quiet.
And that was very hard for
me.
But I will tell you, I went to,
um, most of my care was done at
Indiana University and the staff,
the doctors.
I even had a nurse just, just wrap
her arms around me one day.
Her name was Ms.
Flo.
I remember this because I got, she
had on periwinkle blue scrubs and
I got my makeup on her, um, the
collar of her shirt.
She hugged me so tight and I
needed it.
She, without even prompting, she
just
wrapped me up in her arms.
They were fabulous.
So while they could have exposed
that vulnerability
more than one time, because I was,
you know, uh, there was, there
were times that I couldn't do
anything for myself.
They were fabulous.
I had a very good experience and
I'm sure for every great
one, there's, you know, somebody
who struggles and whatnot, but
they were, they were wonderful.
They really made me feel at ease
and heard, I think was probably
the biggest thing that,
that I felt like they were
listening and they did.
So did being a patient make you
feel more compassionate towards
nurses or more angry
about how much waiting fear and
uncertainty patients are expected
to endure?
I think it was a realization of
sorts where I wouldn't necessarily
say an epiphany, but it,
but I felt like, I felt like I
could sympathize with more than
one specialty.
I have been so
isolated in, you know, the nursing
home and long-term care, you know,
maybe even dabbling in like the
home health space, but, and so I
know the problems of these areas.
And I think by being a patient in
the other areas, you realize how
at mercy these, like the hospital
staff, they're at the mercy of
your
insurance or, you know, whatever
the doctor says to do.
So it's not always, um,
even if you change the specialty,
the problems are pretty relatively
the same.
And so I kind of,
uh, empathized with the nurses
about the struggles that they face
because I, I wouldn't have known
that unless I were a patient in
that setting.
Um, but, but seeing people show up
every day with a
positive attitude and, and, and
compassion in their eyes and I,
they must do a really good job at
burnout, you know, um, uh,
training and things like that.
I didn't come across a single
person that I felt
like I would classify as burned
out or needed to take a break.
Everybody just seemed fresh and
eager to,
uh, to work every day.
Um,
Is that what distinguishes acute
care settings from long-term care
settings?
Not necessarily.
I think that there's a huge,
there's a huge rift between
long-term care and acute care.
And not that all nurses of each
specialty hate
each other.
That's not what I mean.
But a lot of times we'll send a
patient because it's a regulatory
compliance.
Okay.
We have so many regulations that
we're complying with.
We'll send a patient to the
hospital and the hospital's like,
Hey, why didn't you send them
sooner?
Why didn't you take their battle
signs?
Why didn't you do this, this, and
this?
And a lot of times we don't meet
those people.
So they don't
know if we're one of, you know, if
we're incompetent or if I've heard
us classified as
incompetent multiple times,
whenever really we're just
following regulations or we're
doing what our boss said
we had to do.
Uh, not every situation that ends
up in the emergency room was the
fault of the nurse or a
poor assessment, things like that.
So there's always been kind of
this back and forth between
acute care and geriatrics.
I think that both, both
specialties are doing the best
with what they have.
And that's what it boils down to.
So, Crystal, after everything
you've seen, what do you wish
families and nurses understood
about each
other before fear turns into
blame?
That's a good question.
I think that it's important that
you realize as a family member
that the nurses
are doing their absolute best.
Meanwhile, the families, generally
speaking, are doing their absolute
best too.
Um, it's been, it's very
disruptive to have a nursing home
admission, whether it's a
temporary
stay, whether it's a new long-term
care patient, whether it's, you
know, like I say, a more acute
situation, it's stressful for a
family.
You know, we, we, now we have
bills that we have to manage and,
and schedules and appointments
and, you know, whether or not
things were done following up.
And then the
nursing staff, we, I can't give
people bonuses to make them show
up to work.
I can't make everybody
happy in one fell swoop.
I can't hire enough staff or,
excuse me, I can't staff the floor
with enough
people so that your call light is
answered in an appropriate amount
of time.
I know that those are
deficient things and I do my best
to advocate when you don't see me.
Uh, but ultimately there's only so
much in the
control of a nurse or a CNA or,
uh, insert another, uh, division
of the nursing home here.
There's only so
much that we can do because we're,
we're bound to comply with
policies and, and ultimately I've
got to
do the most amount of work with
the least amount of help, you
know?
So I think that just understanding
what both sides are going through
so that you understand that
ultimately you're on the same
side, you know?
Just seems like in that moment, we
need to mutually acknowledge each
other's humanity
in the caregiving moment.
Absolutely.
If there's one thing a family
caregiver could do differently
the next time they feel angry at
the bedside, what would you want
them to remember?
Yeah.
I think it depends.
I would say, you know, give it the
five minute rule.
Is this gonna, or the, the rule of
five
is, is this gonna matter in five
minutes, five hours, five days,
five weeks, whatever.
Is this gonna be a huge
issue?
Is this a symptom of a bigger
problem or is this an isolated
thing?
But also just
understanding that there's only so
much control that any given person
on the floor really has.
So, um, I would say
remember that nurses are human
beings and how you say things
matter, uh, providing context and
adequate
communication, clear communication
of the situation.
Try to remove as much emotion from
it as you can,
not saying that if something
causes you to be emotional, you
know, um, you're not wrong for
that,
but try to be, you know, as clear
and to the point when you
communicate and, and be
respectful,
you know, and if you feel
disrespected or if you feel that
you cannot have a clear
conversation
with a staff member, then by all
means go to their supervisor or,
or to, uh, the next person
above them that will listen to
you.
So, um, yeah, I guess that's,
that's where I'll stop that.
Yeah.
I wanted to thank you for sharing
your empathy for the patient, for
your colleagues and for the
profession and bringing this
conversation to light at a very
challenging time for families,
for patients and for caregivers,
both professional and family
caregivers.
As many acknowledge, we probably
need to witness some sort of
transformation of the deliverables
and the system where patients
will be put first and people will
be put first once again.
I agree.
That wraps up another episode of
the Caregivers Podcast.
Thank you, Crystal, for being here
and thank you everyone for
listening
and we'll see you again next time.
Crystal, thank you for helping us
look honestly at something many
families experience but rarely get
to
understand from the other side.
I think one of the clearest
reminders from this conversation
today is
that fear can make people look for
someone to blame.
And in long-term care, when
someone you love
is waiting, when a need has gone
unmet, or when the call bell has
not been answered, the person
standing
closest is often the nurse.
But the nurse on duty is not
always the person who created the
conditions
you are seeing.
It does not mean families should
stay quiet, does not mean they
should accept poor care,
ignore their instincts, or stop
pushing for someone they love.
It means the anger has to be aimed
at the right
level.
Because staffing levels, budgets,
management decisions, ownership,
and facility policies all show up
at the bedside.
Families and nurses should not
have to fight with each other for
care that the facility
should otherwise already be making
possible.
For anyone listening who is
someone they love in long-term
care
and who's facing that decision, I
hope this conversation helps you
feel more prepared, more grounded,
and more able to ask the right
questions.
I hope this helps you protect the
person you love without losing
sight of the people trying to take
care of them.
Before you go, please subscribe or
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Thanks for listening and we'll see
you next time.
Before we wrap up, I wanted to
remind you of something important.
The conversations you hear
on this podcast are here to
inform, to support, to spark
reflection.
We're not a substitute for
professional medical advice, care,
therapy, or crisis services.
Listening to this podcast does not
create a doctor-patient or
caregiver-client relationship
between us.
If you're facing a medical
concern, health challenge, a
mental health challenge, or a
caregiving situation that needs
guidance,
I encourage you to reach out to a
qualified professional who knows
your story.
If you're
ever in crisis, please don't wait.
Call your local emergency number
or recognize crisis hotline right
away.
You deserve real-time help and
support.
The views you hear on this show,
whether from me or my
guests, are our own.
They don't necessarily reflect any
organizations we work with, are
part of,
or have worked with, or been part
of in the past.
This podcast is an independent
production.
It's
not tied to any hospital,
university, or healthcare system.
Thank you for being here,
for listening, and most of all for
taking the time to care for
yourself while you continue to
care for
others.
I look forward to hearing from
you.