I received a "write up" warning at my LTC - page 3

by Blackcat99

7,553 Views | 32 Comments

Apparently, I have committed the terrible sin of "working overtime." How dare I want to be a responsible person and do the " medicare charting" before I go home. What was I thinking?... Read More


  1. 1
    ybanurse- It's the nature of the job, take it or leave it I'm not saying that to be mean, but it is what it is. I've been in your situation, and you do your best. You have to re-assess at some point, however, how safe is the care you're providing, and if it's not safe, you need to bring that to management. Not your supervisor, they're just as overworked and underpaid, trust me. Take it to a unit manager or the ADON. If they don't provide you with some sort of ideas or information, go somewhere else. I'll tell you this though, it's practically impossible to prevent call-outs. It's out of control, people just don't take nursing as seriously as they used to. We need to work on that, but it's an inherent level of self-worth and work ethic that prevents call outs. No management team can give an employee that.
    Blackcat99 likes this.
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    Quote from ybanurse
    If you short of staff 3 CNA's on a floor with a bunch of fallers who wear alarms How you gonna do rounds and as a nurse do my work if all the alarms keep going off, Ive got a high risk faller sitting at the desk with me in w/c cause they can't keep their @&*% IN THE BED AND THE UNIT GOING HAYWIRE Nobody's coming to help cause most likely the supervisor has a cart ( somebody called out) and she tells you your on your own
    Hey, I think we must work at the same facility.. on the same unit too!
    NurseQT and Blackcat99 like this.
  3. 2
    Quote from NurseGuyBri
    I hate to hear all of the trouble with LTC. I feel for you, I do- but there are some things you have to short cut and some things you cant- an admission skin assessment is one that you cannot short cut. Before I get beat up, trust me- I know you are overworked and underpaid, you don't have to say it. I have been in LTC a while in many different hats, so I know. My facility has done the same yours has- with each thing missed, we have added a new step to cover it. We do that because LTC Regulation mandates that we self-audit and come up with a stable plan to prevent recurrence. WHen we identified a similar situation that you have with the patch, we reacted the same way because we can get in so much trouble with state over that AND it's substandard care. Now- please don't get mad, I'm only stating facts so far. I have learned that the above situation is NOT EFFECTIVE. Adding more paperwork does NOT fix the problem and makes it worse for you on the floor- but sometimes hands are tied and we have to try to find a solution that the survey agency will accept. I have started making deals with our nurses. When they make a mistake related to Admissions, orders, or skin, they get to make it once. If they make it twice, I have that nurse do the paper skin check (for example) with a sign off. Once they are consistently done right, I take them off again. I know I KNOW I KNOW it's too much work, but it just has to be done right. I dont think you should be beat up, either, for making a mistake, that's hostile. If your underlying environment is negative and lacking, you need to get out. There ARE GOOD LTC's out there! You sound like a conscientious nurse and deserve a break sometimes As for having meetings, we do that so that we can keep people on the same page- I don't like to go to people directly when a first issue is made, I make general statements to the group to be mindful and watchful. Then, if it continues, I go the personal 1:1 route. I feel the meetings are the most delicate and non-specific way to remind us what needs to be done. Not everyone agrees, that's fine. Also, Meetings should *not* be about telling you what you did wrong, it should ONLY be about what you need to do to make it right. I think you're in a detrimental place where you work I hope it gets better.
    Quote from Keep_Calm
    I agree 100% NurseGuyBri. Everyone has a job to do and (almost) everyone has someone over their head telling them how to do it better/different. Part of the anger in my first comment had a lot to do with my own feeling of inadequacy after the meeting. Something I am not used to feeling in my job and have NEVER felt in any job I've ever had. I AM a very conscientious nurse and I am not used to doing things half-assed. I have only worked there for about 5 months and it's my first LTC job in 9 years of being an LPN. After venting, and thinking a lot, I have come to realize that I will be a whole lot less stressed if I put my priorities in order. #1 being resident health, safety, and well being. This includes skin assessments (although, I still despise paperwork on bruises being perceived as more important than mental health, lung sounds, etc.). Clocking out on time vs doing my job well isn't going to stress me out anymore. I refuse to race against the clock. If they want me to sign out washcloths (still lol at that) then I will. I bow down to the management gods. I will do my job as fast as I can--BUT I will do it well, whether it takes 8 hours or 9 (or more--blah) If that isn't acceptable, then they can let me loose.
    Quote from NurseGuyBri
    BEAUTIFULLY put If you make patient safety first and then do your best with time management, then only result should be improvement. If your management doesn't get that, then they're missing something.
    Quote from ybanurse
    If you short of staff 3 CNA's on a floor with a bunch of fallers who wear alarms How you gonna do rounds and as a nurse do my work if all the alarms keep going off, Ive got a high risk faller sitting at the desk with me in w/c cause they can't keep their @&*% IN THE BED AND THE UNIT GOING HAYWIRE Nobody's coming to help cause most likely the supervisor has a cart ( somebody called out) and she tells you your on your own
    I feel your frustrations personally. Similar dilemmas here. They hired me for my high work ethics and my specialty in customer service. Residents are #1 was emphasized in orientation. Boy howdy right there with me (I thought). Each night (7p-7a) proved the opposite. 1 person (regardless of stamina) cant do it all. Jobs are few so I havent left yet. I am searching. I will do what I can for the res. but have accepted defeat and handed it over to my highest chain in command "God".
    LTCNS and Blackcat99 like this.
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    Quote from NurseGuyBri
    I'll tell you this though, it's practically impossible to prevent call-outs. It's out of control, people just don't take nursing as seriously as they used to. We need to work on that, but it's an inherent level of self-worth and work ethic that prevents call outs. No management team can give an employee that.
    I find these threads on LTC very scary and they've served to let me know to Never work there. But, I disagree with the statement above. Call-outs may be a result of poor work ethic in a small percentage of people, but the reality is that nurses are abused in the workplace by a healthcare system that does not value our input at all.

    Most times I call in sick is really a mental health day because I have such anxiety about going in and working in an environment where there is no support for me or my nursing judgement and where I have to spend the day making sure I document to cover myself instead of taking good care of my critically ill patients. I just can't face being there again.

    I take the time I need to provide care, but always running around. It sucks. There's no better way to say it.

    Sent from my iPhone using allnurses.com
    Nola009 and Blackcat99 like this.
  5. 0
    It seems that whenever I think I might leave on time something always comes up. A fall, sending a patient to the ER etc etc etc. And I can always depend on the pharmacy to bring in a huge supply of medications right before the next shift arrives. I've given up hope. That's for sure.
  6. 1
    Delegate as much as you can to the next shift when it's something that happens at change of shift. Make a note in the patients chart that you did so.

    LTC - love my patients, the rest of it, not so much..
    Mn nurse 22 likes this.
  7. 0
    Where I work you can stay as long as you want to finish your charting and won't be written up. The catch is, unless you write in the OT book a valid reason for staying (charting does not count) you will not be paid for the extra time past your normal shift. You don't even have to punch out on time. If they see you stayed late, they check the OT book and if you didn't write anything in there, they just pay you for the normal shift and leave it at that. Why can't every facility do this?
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    Quote from icemanof92
    Where I work you can stay as long as you want to finish your charting and won't be written up. The catch is, unless you write in the OT book a valid reason for staying (charting does not count) you will not be paid for the extra time past your normal shift. You don't even have to punch out on time. If they see you stayed late, they check the OT book and if you didn't write anything in there, they just pay you for the normal shift and leave it at that. Why can't every facility do this?
    Every facility can't do this because you can't force employees to work for free. If you are performing duties associated with your job, you need to be on the clock. At our facility, we are not expected to work for free, and if we need to stay late for whatever reason then we are paid for that time. I simply can't imagine how anything else could be legal?
    Here.I.Stand and noc4senuf like this.
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    We had a big problem with OT until our managers asked that we call them at home to get approval for any OT that wasn't an emergency. (They can read a fall report and understand if a patient fell at shift change)
    Our OT dropped by 67%. A lot of the problems could have been fixed by talking to one nurse who insisted on staying late every shift to build up comp time for personal reasons but it did help all of us to start delegating any items that we could to the next shift.
    Patient comes back from appointment with new orders? Hand them off to the next nurse.
    Since we are all in the same boat we have all learned to accept the list of items from prior shift vs the 1 or 2 nurses who never wanted to take on any extras at the start of the shift.
    noc4senuf likes this.
  10. 0
    Wow!! I thought the LTC I worked out was difficult! No signing out washcloths here, but LOTS of time consuming double charting paperwork. I feel your pain.


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