Our Nurses Can Veto an Admission. Last Month, One of Them Did.

In most places you have worked, nobody asked you whether a new patient should be admitted. The decision was made somewhere above you, by someone who had never met the person, and it arrived on your shift as a fact. You found out when the bed filled.

We do it the other way around, and last month it cost us an admission. I think that is worth explaining, because it is the clearest thing I can tell you about what working here is actually like.

What happened

At our September staff meeting, our administrator brought the team a prospective resident. The needs were a real step up from anyone currently in the house: a tracheostomy, and ventilator support overnight. We had been told this was the right first one to start with. The home has the backup power for it. On paper, it worked.

She got about two minutes in before one of our night nurses shook her head.

To her credit, our administrator stopped and asked. And what came out was not a feelings answer. It was a nursing answer, and it was correct.

One of our current residents is a two-person assist for everything. When that resident needs care, both people on shift are at the back of the house, at the same time, with their hands full. Nobody is within earshot of an alarm in another room. Add a resident on a ventilator overnight and the math does not work. Two people cannot be in two places.

Then a second nurse narrowed it further. Days would be fine. There are more bodies moving through the house, more eyes, more coverage. Nights are the problem.

Our administrator said the quiet part out loud: nobody had ever raised this. Not in a survey, not in a one on one, not once. It surfaced because she happened to catch a face across the room.

Nothing got signed that night. What she told the room was that staff have always had veto rights here, and if the collective answer is that we are not ready, we do not do it.

What happened next

Here is the part I care about more, because a veto by itself is just a no.

Most of our clinical team is now training at Children's First alongside their LPN team. Not a video module. Hands on, with nurses who do this every day. One of our most experienced nurses volunteered on the spot to lead trach transition training inside our own house, for everyone, without being asked.

We are also hiring a night shift leader, which was already our priority before any of this came up. And the admission itself is not on a clock we control, so we have the time to do this properly instead of fast.

The answer was not no. The answer was not yet, and here is what we need. That is a completely different thing, and it only happens in a building where people believe saying it will not cost them anything.

Why this should matter to you

If you are an LPN reading job posts right now, you are mostly reading claims. Everyone says team. Everyone says family. You cannot tell the difference from the outside, which is why we would rather just tell you what we actually do.

Reading this because you are trying to work something out for someone you love? You can tell us about them at the bottom of this page. A real person reads every inquiry.

Six residents. One LPN Shift Leader and one caregiver on every shift, around the clock. You will know all six by name, and you will know what a good night looks like for each of them, because you will see the same six people every time you come in.

And when we are considering someone new, we ask you first. Your answer counts. That is not a perk we invented for a job post. It is a thing that has already cost us money.

The other details

LPN Shift Leaders earn $58,240 to $70,720 a year based on experience, plus a dollar an hour on nights and another dollar on weekends, starting with your first shift, not after a probationary period. Full time night nurses earn a $1,500 retention bonus: $500 at 60 days and $1,000 at six months. Health insurance, and a 401(k) with profit sharing.

We are a medical home, not a behavioral one. Our primary care doctor makes house calls. Our caregivers are cross trained on medications and tube feedings, so you have a real partner and not just a second set of hands. An RN nurse manager backs you up. Some of our first hires are still here three years later.

Trach and vent experience is a plus and not a requirement, and as you have just read, we will train you.

If you want to see the house before you decide anything, apply and ask for a visit. Come meet the six people. That is usually what makes up people's minds, one way or the other, and we would rather you decide with your own eyes.

About Audubon Gardens Group

Audubon Gardens Group operates two licensed 24-hour nursing residential care homes in Orlando, Florida: The Garden at Bennett and The Garden at Ibis. We serve medically acute and complex adults with intellectual and developmental disabilities under Florida's APD iBudget Waiver and Florida Community Care (ICMC) programs.

Joshua Wilson is a co-owner of Audubon Gardens Group and writes on residential care, APD services, and the practical realities of navigating Florida's IDD service system.

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