Another dilemma...please help us

P_RN, ADN, RN · Jul 18, 2002

When I worked in Public Health I felt this way. I started a time sheet of my tasks for every 30 minute stretch.

After a week I gave it to the NM. She divvied up the chores so the others took some of the weight.

Sleepyeyes · Jul 18, 2002

Originally posted by P_RN
When I worked in Public Health I felt this way. I started a time sheet of my tasks for every 30 minute stretch.

After a week I gave it to the NM. She divvied up the chores so the others took some of the weight.

This sounds like a very interesting idea with a lLOT of workplace applications. Could you please tell me exactly how you did it? (And when you were able to complete it??)

night owl · Jul 18, 2002

That is a very good concept. Maybe when they see how long it takes for us to do all of these tasks, hopefully they could revamp...

Jenny P · Jul 18, 2002

I'm sorry, but if the night crew is supposed to be doing treatments on the patients, when are the patients supposed to sleep?

Recently, my hubby's aunt was in a rehab center for a couple of months after breaking her hip. There were no treatments done on night shift, but they did make the patients take naps during the day, EVEN THOUGH some of them (including Hazel) did not usually take naps at home. Now, Hazel IS taking naps during the day since she is back in her own home. She doesn't sleep as well as she used to, either. Why do people want to disrupt the elders sleep schedules?

Enabled · Jul 18, 2002

When I graduated 19 years ago there were few jobs in Florida s that I ended up working my first job out of state. On nights we did the dressings and did the preps for OR. My first night I found a central line that would not flush. The doc was called as there was antibiotics due during the night. I could not believe what the doc said. He told me to 'advance' the line. One thing came to mind that if you can't flush leave it alone. The supervisor was notified and the line was dc'd so that no one else would have it happen. We would team up as all the rooms were private with carpeting. We also had 2 VIP rooms for staff, hospital board, and anyone who had a name in the town. We would load up the cart with all the supplies that we needed and if it was a good night we would finish in time but when a bilateral amputee 92 years young with the rails up jumps OOB there isn't too much to do. The room looked like a battlefield. There was blood everywhere as she pulled her line out. I got good at putting in 18 g for surgery patients. Why can't dressings that are relatively simple be done when the bath is done in the am? So you take a few extra things into the room. If you don't use them now there wiill be other times. I had a doc read me the riot act for waking his patient with a prep. He wanted to know why it wasn't done on evenings as the patient was having a very serious surgery and he wanted him to sleep through the night. What is the purpose of giving a sleeper if you are going to wake him/her up. I had it with the screaming. I had a patient with preops given and the patient refuses surgery yet they took him any way and had to bring him back without the procedure. The surgeon said it was my fault but I did my job in telling the patient what would happen after surgery so he/she would not be frightened.

We had two internist who would cover each other on the weekends and Doc 1 had the insulin levels on his patient and Doc 2 changed them by 2 units the first time he was in to cover. The doc would come back and change them back to the original

ktwlpn, LPN · Jul 18, 2002

Originally posted by night owl
How are all your Head nurses, assistant HNs, unit managers whatever when it comes to having difficulties with your shift, do they help you out at all? Do they try to make your job easier or more difficult? Here's our problem...
We have two nurses on nights scheduled for 60 residents and so many treatments to do that alot of times they don't all get done becaue we just don't have the time. We've asked them to please cut back on some and give some to the day shift since they have 4-5 nurses on most of the time. Instead, they keep adding more and more on us...I don't get it. Is this just for spite because they just don't like complainers? Or is it they don't want their "precious" day people to get burnt out? Or what? We've learned not to say anything to them anymore because what's the point? If the day shift complains about something it gets fixed right away. It's very discouraging to say the least and very disappointing to have such managers who make some workers happy (the ones they work with all day) and then turn around and make others so frustrated they want to resign, or retire early.
Why do they do this? Is it the authority thing...Because they can? It's just not a very fair way to run a unit in my book and our morale is flatlined. Their answers to us are, "You take care of it." Or, "There's nothing we can do." I'd like to also hear from the managers
on this one...please give my coworker and I some insight on how you would handle this or tips on how we can resolve this. The residents are neglected when things aren't done for them and they could really get us on that if they wanted to. We mention in report if so n so's tx wasn't done b/c we just couldn't get to it and I know they're angry, just by their looks! So why keep adding more for us to do when you know we have too many already???
I don't want to sound like an old crab, but how much is enough?

>>>>>>>Night owl,are you in LTC? We stopped doing most dressing changes q shift a few years ago-just is not necessary for most wounds.We do them BID-day shift or evening depending on which shift does the resident's bath(days does half of them and evenings does the other half) Most topicals are also BID-unless for a really severe rash or excoriation.Your residents should not be disturbed at night-med admin times should be adjusted where ever possible to limit night time disturbances also.We have a wound care specialist (a staff nurse whom has had some training-seminars,etc) and she is up to date with the new trends....Make a proposal at your facility-do you have a quality of life committee? Resident counsel? You can certainly show how your present routine is not beneficail to your resident's rest....

gkplatt · Jul 18, 2002

One more suggestion----Invite your manager to work a night shift with you. I did this when I took over as DON in a nursing home and it certainly opened my eyes---and those of the staff who like to knit and nap instead of taking care of residents.

Also LOL with shifts fighting each other

night owl · Jul 19, 2002

Yes I'm in LTC. Our BID times are supposed to be 9am-9pm. If the nurses on day shift c/o having too many tx's, they'll tell the Doc to change some of them to BID, @ 0600 and 2100 to suit their needs. Our meds are also scheduled at 5am,6,7,& 8am.

If tx's are scheduled @ 6a, on paper it looks like the Doc isn't

disturbing their sleep, and his a$$ is covered, but in reality you can't do tx's and meds @ 0600 b/c we have so many meds... you just can't stop and do tx's too! So in order to get them done, we have to do them during the night sometime. Now @ 0400, we have two fleet enemas because those residents get OOB for breakfast. The rest of them are scheduled @ 0600 and then again his a$$ is covered and it looks good on paper for him, but we can't do enemas and meds and tx's @ 0600 so again we HAVE to do the all the enemas and all of the tx's before 6a b/c we have all of those pills to give out at 6! Do I even sound like the Blessed Trinity? Never mind looking like the BT! So in reality , we're waking them up many times during the night just to do different proceedures in order to get them done before the big med pass to cut down on any errors. Today I had an extra proceedure to do at 0600...give a SSE as part of the prep for a colonoscopy, plus meds, plus tx's plus fleets, all ordered at 6. Looks very good on paper for the Doc...no sleep disturbance at all for the residents. Well...the SSE was given at 0400, the tx's were done at various times during the night, the fleet was held b/c resident didn't need it...thank God! (Had lg loose BM), but 15 min. prior to report time, he vomits sm amt of coffee grounds material...GREAT! Now I've got to get vitals turn off GTF, check his ABD which was very soft, check residual and clean him up....still not done passing out my pills. Still had to collect a urine spec. from someone else. I asked this other nurse who came in @ 6a (and is part of day shift)to PLEASE obtain it for me. She copped an attitude over it b/c I ***FORGOT*** to change the drainge bag and now she has to do it...in the middle of her med pass...GEE! Aren't I allowed to forget something? H*LL NO! They think you're doing nothing all night.{{{sheesh}}}...Next time I'll TELL her to do it, won't even ask. One day she had the nerve to tell me, "You could have at least do my finger sticks!" What else does the day shift want us to do for them??? Some kind of committee is going to find out and we have many to pick from! Since the HN and AHN don't even listen when nights asks them to give us a hand and have some of this stuff changed to the day shift who has ***MORE*** STAFF, The best committies to go to are the Director of the Nursing Home, the DON, and the Director of Administration. Plan #1...(HN and AHN) was tried with results being we were given more tx's to do, so now plan #2 will be implemented...have a meeting with the Director of the Nursing home. Can't say we're not going thru channels, but the HN and AHN will be suprised and livid to say the least that we took it further up the ladder. I'm sure our lives will be miserable from then on, but that's to be expected. It's sad b/c you work your A$$ off for your pt/res, not for them. You go above and beyond your call of duty, only to have your working life made miserable by the ***Heads***

They are both mandated to work one day a month on the off shifts, starting this past March or April I think it was. They come in unannounced say on they're day off and change their schedule accordingly. Since then, only one of them have worked nights one time, but they've both been on evenings every month. Wonder why they keep avoiding us??? They hate it when staff complains about anything and try to avoid it at all costs. When days complain about something, it's changed right away. When nights complain, nothing is changed. Why just yesterday days complained that the hallway with the heavier work load should have some of the heavy duty residents moved to the hallways with the lighter work loads to even up the work load. Well, before I left, it was said and done...just like that. We've been aking for the same thing for months with no results...Go figure...Why do they do this to us? It's not only frustrating, it really hurts too and they just keep on doing it. I'm trying to figure out when I'm supposed to get my monthly summaries done by the end of the month of which I was assigned an extra one. I just never seen it so bad...anywhere and to think I have 18 more years of this nonsense...I'll never make it. 20 years ago I remember saying it's getting worse. It's never gotten any better and 18 years from now, at the rate it's going, I should be DEAD! No joke.

Enabled · Jul 21, 2002

As someone suggested insist on someone in administration come one night and see what happens. I know you are just catching all those ZZZZZZZZZZZZZZZZs From the time you clock in make a flow sheet of what gets done when and any deviation that cause more time than expected. We have our techs do some of the simple dressings when they are changing a patient for the nth time. The patients I am convinced hold their outputs till night shift and every duoderm or tegaderm is undermined and has to be treated and new mateirials. See if the techs when they are changing a patient do a simple dressing. Sometimes that may only require a topical. We oversee the techs when they are learning how to do it, as if anyone could really do it if told what needed to be done. I have worked with terrific techs and I don't know how I was so blessed. It is probably because I work with them and not dump on them as many nurses do. Maybe get another tech on shift to do the simple ones. You need to check with your state's Nurse Practice Act before assigning the task or they can get you when they are changing someone so that it isn't keeping the patient awake and additional time. Also, if you are not a member of your state nurses association do join. They have lawyers, etc at your disposable as the facility is making it impossible for you to finish the work and that is setting you up for an error or worse. Otherwise if there is another facility such as a hospital I would say GOOD BYE as you need to COVER YOUR BUTT. Don't forget that if you don't do something it can be said to be an act of omission.

Just last week here in Florida an Alzheirmer's patient was seen near the exit with his baseball hat on. He usually got up very early in the am and would walk around the facility on the inside. The doors had activated alarms in working order. Well, the staff thought it was a patient call light on and it was actually the patient exiting the facility. Authorities were called and an employee walked to a pond nearby and his had was floating. He was pronounced dead at the scene from drowning. If your alarms sound anything like the call light insist that the tone be changed so that there isn't confusion. We have to be our patient's advocate and not a contributor to a tragedy.