[Malt123]

what happened to the work ethics, respect for each other and doing your job? Why are CNA's allowed to refuse to do work? Why are the DON's always blaming the nurse? There isn't any one that doesn't know how hard LTC is, so why are we not more understanding of each other? I once did some calculations and proved to management that it was litterally impossible to do what they wanted in the specific time frame. Management can stay as long as they want but the staff has to leave in a certain amount of time. You can't put aside some ones tray or taking them to the bathroom or put off taking care of a crises. Every one has to do their jobs for it to work. If CNA's are refusing to do something or the DON is putting too much on the nurses or families are being too unreasonable than things fall apart. It starts from the top and works it's way down. If management has an attitude that only they matter then the staff starts to lose morale. Good people are needed in every aspect of LTC. Not just management. The nurses do not do the hiring and firing we have to work with what is given to us even if that means a whole unit full of CNA's that other floors don't want.

[nurse educate]

I think the problem (at least in my facility) is that it is not as Long Term, or Sub-Acute as it once was. The peds LTC that I work at is classified by the DOH as a Nursing Home, and gets funding as such. Because of this the pay is low, and the nurse to pt ratios are high (but not nearly as high as an adult NH). We have chronic kids, yes. But we also have trached kids on O2, CPAP, Central IV's with TPN or antibiotic therapy. The kids are NOT stable. The acute care facilities (which we transport the kids to when they get 'sick') think we are a joke. We don't have the staff to support the clientele, nor can we attract the staff because the salary is not competitive with acute care. Therefore, morale among nurses who stay is low. I'm not saying the staff is incompetent, but their not adequately trained. Many of them do not have Acute Care experience, and many are LPNs, who cannot get jobs anywhere else (they are hard to come by where I am).

For those who are not lazy and useless, i think recognition goes a long way. So does $$ of course, but that's not always possible. Little things- a 'thank you', or 'good job guys', or even a free meal ticket may help boost morale. If that doesn't work, start giving out the pink slips

To the OP- what is your previous experience? I find that many NMs and DONs waltz in and out of our facility, and try to change everything. Much of our staff have been there for many years, and it's like they don't believe that the next one coming in is actually going to stay, much less make things better. They're kind of like orphaned children bouncing from one foster home to the next.

[RE Agent]

Originally Posted by nursemid02

Hi I am im great need of information regarding DON's how to deal with staff that wont listen and people who wont work as a team is there anything i can do to help improve our quality of patient care?? I have been working my hardest but have been pretty much doing it myself!!! Im pretty much tired of doing and am to the point i could just walk away with a different job!!! If anyone can help please let me know!!! THANKS SO MUCH

This happened in a PACU before I was hired. The management got together, and hired new staff. The interview for the position was geared to hire only nurses who were interested in working together. It was a tough, but very good interview. In 4 months time the PACU staff was replaced, and it was a wonderful place to work.

[nursemid02]

Originally Posted by Malt123

Welcome to the world of LTC. Have you ever worked a unit before? What are you refering to when you say you are doing it alone? Is there no one else working there?
Are you passing all the meds, doing all the treatments, assessing all of the pts.,ansewring all the lights, calling the doctors,labs and pharmacy,pt. teaching,dealing with families and staff that refuse to work, feeding pts., bathing pts,admitting pts, discharging pts., dealing with state, starting IV's and monitoring them, doing the MDS, vital signs, charting etc........

Yes as a matter a fact i was because there was no MDS coordinator your talking to her yes i was calling the doctors making sure everyone was taking care of and yes I was dealing with family and staff that refused to work and dealing with call lights pharmacies and STATE along with taking care of IV starts being the RN 7 days a week so whats with the attitude It wasnt always like that there used to be a time where people worked And yes i did do alll the treatments I wasnt asking for your sympathy all i was asking for was a suggestion from you So thanks but no thanks i dont need your attitude i get enough of that at work

[Malt123]

Yep you were the only one there 24/7. sorry you took what I said the wrong way. Maybe a whip would work

[Malt123]

by the way I worked PM's and there was no DON there at that time. It sounds like you want to be recognized as the only nurse. I have heard that before, I am an RN and because I worked the floor that made me what? a CNA? I also worked with supervisors that went and hid when things got hairy, the people on the floor don't have that priviledge. and if we took an extra 5 minutes to regroup the DON was down our butts. I have seen both sides. if you don't want attitude than stop giving it.

[nurse educate]

Originally Posted by nursemid02

Yes as a matter a fact i was because there was no MDS coordinator your talking to her yes i was calling the doctors making sure everyone was taking care of and yes I was dealing with family and staff that refused to work and dealing with call lights pharmacies and STATE along with taking care of IV starts being the RN 7 days a week so whats with the attitude It wasnt always like that there used to be a time where people worked And yes i did do alll the treatments I wasnt asking for your sympathy all i was asking for was a suggestion from you So thanks but no thanks i dont need your attitude i get enough of that at work

I, personally, didn't see an attitude in her post. If your just venting, fine, just say your venting. If your looking for advice (as evidenced by the title of your thread), you should be prepared to explain and clarify what your situation is, and not get so offended. It is easy for readers to misinterpret what others are trying to say, especially when grammer and sentence structure are used incorrectly (some may be rushing to write, others may be trying to make a point by 'rambling'). I've posted many a time asking for specific questions, and people reply with things that have nothing to do with what I'm talking about. I think it's just human nature to add more to what is asked, to share their own experiences, and maybe giving some food for thought (as I did in my earlier reply). Maybe it was helpful, maybe not. Do what you want with the info.
Some (like the previous poster who 'interrogated (sp) you), actually have similar situations and experiences in the same field, and want to know more. So lay off, man. No doubt you are stressed over this. But as fellow nurses, we all share that stress (in whatever it is we do). We are not your co-workers (who are obviously stressing you out). We're just trying to help you, as you asked.

Also, I noticed that this was your first post here. You might want to check out the other forums (in your case, the Nurse Manager, LPN, or CNA [if they have one]) to get a feel of the 'culture' of the website. Maybe some other NMs can give you the advice you are looking for. Many have asked your level of experience, because yes IT IS RELEVANT. Personally, I have never known anyone to move their way up the ladder so quickly, with a Diploma no less (I know every geographic area is different). If you did indeed graduate in '02, and you've worked your way up, more power to you. For all we know, you could have been working in this facility since you were 18 yrs old. Or you could have been working as a school nurse (until now), and maybe you are in over your head. Not too many people are 'out to get' total strangers on this bb. It is really like a support group. Support we cannot get (or choose not to seek) from our co-workers. Again, just trying to help you.

[kesneysmom]

Originally Posted by nursemid02

Yes as a matter a fact i was because there was no MDS coordinator your talking to her yes i was calling the doctors making sure everyone was taking care of and yes I was dealing with family and staff that refused to work and dealing with call lights pharmacies and STATE along with taking care of IV starts being the RN 7 days a week so whats with the attitude It wasnt always like that there used to be a time where people worked And yes i did do alll the treatments I wasnt asking for your sympathy all i was asking for was a suggestion from you So thanks but no thanks i dont need your attitude i get enough of that at work

I don't know if you have a good administrator but at the facility I worked at they made some simple general rules that helped everyone.
1) If a call light went off everyone was responsible to respond meaning if the administrator or the sectretary whoever was walking down the hall and there was a call light going off you could not walk past it or you were subject for a write up. That helped alot.

2) The staff voted for employee of the month.

3) We had an LPN do scheduling, if there was a problem she went to the ADON then on up the ladder if needed, also management had a float schedule for weekend house supervisory so you might do a weekend every 2 months. Also the RN'S had a schedule so they took turns during the week being house supervisor.

I really believe as long as you stick with it, show the staff you really do care and that you are willing to work just as hard or harder then them then slowly it will get better. It just takes time.

[Malt123]

I would like to know what the size of the facility was. Some of the smaller ones just don't have the finances for an MDS cord. or ADON and yes you would be responsable for everything. I did case management along with the floor nursing. did the MDS,care plannig, aimes test ect. was given an extra dollar an hour for this. If you want to change things you first need to know where your staff is coming from. Maybe reading some of this will give you insight into what your staff is going through. I know my DON did not utilize me properly and ended up raking me over the coals because she didn't see what I had to offer, instead she wasted me. Try looking at everybody as if you were watching a movie, we are all movie critics then identify the problems and tackle one at a time. I wrote up an aide one time and I know she probably had adult ADD, she improved but retaliated doing all kinds of things to make me look bad. I am not a mental health nurse yet i am expected to know how to deal with this person and their were probably more. I guess I am rambling sorry. In nursing too long hehehe

[bucksandra]

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Originally Posted by nursemid02

Hi I am im great need of information regarding DON's how to deal with staff that wont listen and people who wont work as a team is there anything i can do to help improve our quality of patient care?? I have been working my hardest but have been pretty much doing it myself!!! Im pretty much tired of doing and am to the point i could just walk away with a different job!!! If anyone can help please let me know!!! THANKS SO MUCH

Hi Nurse Mid.. I was a DON for 6 years. It sounds like you are putting out small fires and can't yet see what is causing the blaze. First things first..hold a mandatory staff meeting and let the staff know what is expected, what will and will not be tolerated. Be very clear in your expectations. Next, evaluate the results. You will know rather quickly who wants to be on the team and who doesn't. What was the last DON like? Perhaps she/he was very lax and didn't expect very much. It is also very important for the staff to see that you are buying into your own program. I have seen many DON's with the attitude of "do as I say, not as I do". Being an effective DON takes a lot of time and hard work. To be an effective (and respected) DON, you will spend very little time in your office and alot of time on the floor. How large is your facility? There are many things to think about, priortize what is most important and don't try to fix everything at once. I wish you all the best.