- 1Jun 12, '11 by studentRobI have a quick question…
First, for a little background information. I currently work at a ICF/MR facility where the unit that I work in is primarily a Skilled Nursing Unit Over half of our residents have G-tube, Seizure disorders and many other complex issues. Staffing for our unit normally consists of two nurses and 8 DCS (Direct Care Staff). The DCS have a supervisor (who is also a DCS who just have received a promotion and NO further additional training). The DCS supervisor is supervised by a QMRP. I have been told on many occasions that I am not the DCS supervisor even though they do provide basic Nursing Care such as Bathing, Appling Ted/ Jobst hose and etc. I have on many occasions given the DCS directives on how to do certain tasks, positioning and things that need to be done for our residents and am always met with resistance because “I am not their supervisor”. So I take the information on tasks that need to be completed to the DCS Supervisor for her to instruct staff. Most of the time these directives are not followed through and resident care suffers. I have addressed these issues with the QMRP over this unit and yet again no assistance is ever received. I have spoken to Our ADON and DON about this and yet again nothing is done about this situation. I think they have become compliant over the years as our DON has worked here for over 30 years and our ADON for 15 years. Our ADON used to work the floor in the building that I work in so she says that she is familiar with what goes on. She has not worked in this building for at least 3 years and it has definitely changed.
I am totally frustrated right now, I am at a complete lose of what to do. I do love my job and really do not want to look for a new one but I fear that it is coming to this.
Have any of you ever faced a situation such as this and what did you do??
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- 0Jun 12, '11 by virgo,student nurseI know what you are going through, I myself have seem to have the same issues. It becomes very frustrating when you care about the quality of work you do, and others don't. I am quite sure that the DON, and futher up know what is going on, they may care or may not care as long as it does not directly effect them, and what they have going on. I see it everyday. I don't know if leaving the job, is going to do anything. Maybe you need to look to transfer, or apply at a different ICF. Sometimes you luck out and get a good manager, who will support you. I hope all is well.
- 1Jul 8, '11 by alienRNwannabeStudentrob,
You facility seem very similar to mine. In my facility many of the direct care staffers (dcs) have been working there for a very long time and they are very resistant to change. Just be respectful to each other when ever you are delegating a task. It is hard to draw boundaries esp. when you are working with interdisciplinary teams. Before jumping on anything, I always take a step back and analyze the situation. I ask myself "How does their action effect the resident medically". If the resident is positioned improperly, I would show them how to do it properly and try to fix it. Now if the dcs is being uncooperative or talks back at you, I would talk to their direct supervisor and "write them up" is what we call it. Remember the chain of command in nursing school. I would email my statement of the incident to their direct supervisor, and cc it to my Unit Director, DON, H.R. Once you have it in writing it is official. Luckily, in my facility my complaints never went beyond the Unit Director (an RN too) who took care of the problem right away. Our UD knows that the nurses run the show, and never forget that the direct care staffs are working under your license. Without you, they won't be allowed to practice independently, and don't allow unsafe practices that will come back to bite you.
One difference is that in my facility the DCS supervisor reports to the RN on duty or the UD not the the QMRP. I know of another unit at my facility where the UD isn't an RN and boy it makes a lot of difference. Good luck
- 2Jul 15, '11 by juzmeSounds like where I use to work! It was a constant struggle and you had to pick your battles or else the staff would turn nurses in for every little thing. I didnt have a problem b/c I tried to motivate the staff by asking them to please make sure the clients got the best care and that meant changing them when needed, reporting bruises, cuts, anything that seemed off to us nurses. Most were ok to good, but the some of the ones on night shift never wanted to change the clients and hated to see a nurse do rounds, but I just said I am making sure they are ok because it is my license, nothing against them, I said I was just nervous;-) and when the a client was wet AND I MEAN SOAKING WET;-( I would kindly say, aww so and so is wet, I will help change them. yeah they would get peeved, but oh well...I wasn't going to let my clients lay there in that condition. Good luck to you but tread lightly and know how to handle things very diplomatically;-)
- 1Sep 14, '11 by stella2blueWhen you mentioned the Direct Care Staff work under your license - if something happens to an individual, for example they develop pressure ulcers because they are not turned/they have unreported skin abrasions and an infection develops - who is liable?
Is the RN liable for UAP's?
I work at an institution and am currently looking for other employment because I am not confident in the care the patients receive by UAP's - I worry about my license, my safety - no one else is watching my back. ..
- 0Apr 25, '12 by rdnkmom01every single day. I am not only a nurse at a icf facility i am also one of the house managers. Been only about a month in the HM position. Needless to say part of my nursing has suffered which i brought to our area supervisors attention yesterday. As of today I have logged 97 hours at 130 p.m. with 3 days left to go in the work period. I am overtime exempt. I was told I could take the rest of the week off since I felt overworked, tired, and my nursing judgement was obviously suffering because of this. We have a camp that is OPTIONAL for our clients, the ones that can talk anyway...lol, and I was told today that I HAD TO GO TO PASS MEDS. I am not the only HM that can give meds. Also, our QMRP doesn't want to go because she doesn't like outdoors. The way i see it, if she doesn't have to go, and i didn't volunteer to go, they shouldn't be able to make me. the thing with the staff happens all of the time. I am currently treating someone at another home with staph because the DSA's will not do as we keep telling them too when cleaning him. It's totally mindblowing. Wondering if I can claim safe harbor since i am mentally and physically drained. I have worked over 100 hours a pay period since taking this job and that is with me comping my time. I think I'm going back to LTC. I really love the clients though. In the end, management in ICF facilities (some of them)_ are not medically knowledgeable and our client suffer when staff leave because they have become attached. Sorry to keep rambling on, just frustrated about the whole thing I guess. Pt. care and management