I'm about to crack...read this and help!!!!

[SaharaOnyxRN]

Hello, my fellow nurses. It's so good to be here. I need your opinions on this situation.

Okay, I currently work in LTC on a rehabilitation unit/skilled nursing facility. Before I came on, they used to do 12 hours shifts. Now they are doing 8 hour shifts. Anyone who has ever worked on a rehab unit in LTC knows that it is near impossible to get anything done in 8 hours. Well, when they went to 8 hours, no one made adjustments to the work load. I work 1st shift. So, therefore, all of the treatments are scheduled on 1st shift. In addition to the normal duties; 2 med pass, treatments, charting, dealing with various issues, we sometimes get 7 and 8 admissions on 1st shfit. I have 25 patients that mostly are post-surgical and need pain medication on a regular basis. And it seems that recently, we have been having to send a lot of them back to the hospital as soon as they get there. These people have been butchered and develop so many problems.

So take 25 patients, plus discharges and admits, plus treatments, 2 med passes that seem endless because you have constant interruptions, plus family member's concerns, and you barely have time to look up before the end of the shift has come. I often stay over to finish up what I couldn't on my shift. Well, as you know, I am getting the blues from management for staying over because I am going into overtime. I told my manager that I just cannot, with a clear conscience, leave without doing my treatments and my charting. It is not the patients' fault that we are inadequately staffed and overloaded. They came there for good and care and by George, they are going to get it from me. So, she said, cool, do that. But she is telling me that if I stay, i must clock out and work off of the clock. I don't think that's right, but I guess i have no choice. But it's really taking a toll on me, physically and mentally. And I have only been there for 3 weeks. I'm already burned out.

This is where I need your advice. What should I do?

My manager says that it's understood that I won't be able to do everything on my shift. But if I don't do it guys, it won't get done. The 2nd shfit nurses won't finish anyting because they feel, "Well, that's 1st shift's responsibility". And I don't want to always leave them something to do. They don't deserve that. Also, I fear for my license. If I never do my treatments and leave them everyday, I'm afraid somebody's foot may rot off. And you know that in a court of law, they aren't trying to hear that I couldn't get it done. All they will hear is that I didn't do it. So, I am sometimes leaving an hour or two past getting off time and that is without being paid. I don't know about anyone else, but my time is valuable. I have a child that needs me. If I am going to be there, I feel that I should at least be paid, right?

By the way, we have a treatment/wound care nurse, but she won't touch a patient. She never does any treatments, except when the corporation comes in or state comes for a survey. Even then, she lied about doing the treatments. And get this, management knows about her, but they want to jump on me for staying on doing my job. And the CNAs cannot be counte on. They are nowhere to be found when you need them. They all go on break at the same time They run the floor and will tell the nurse what they are and are not going to do. And they even will sometimes tell the nurse what to do. The situation seems hopeless. Besides leaving, what options do I have? What's a girl to do? I just started this job 3 weeks ago and with all humbleness, I can honestly say, i am a pretty good "floor" nurse. I have worked in the hospital setting and left acute care to "get away." But I can honestly say, I don't think the hospital is as bad as this. I am at my wit's end. I am so tired, physically and mentally. I feel like crying everyday when I finish. And they schedule you to work 6 out of 7 days sometimes 4 days in a row before you get an off day. Somebody help me before I leave the profession for good. I need some inspiration and some advice. And it will all be much appreciated. I'll be waiting to hear from you all.

Good day!!!

[Daytonite, BSN, RN]

I'm glad to hear you're getting a new job. On your way out the door of this place you should place a call to your state department of health which is probably the agency that licenses and inspects the place. Tell them about the situation with the treatments and why you quit. They'll be interested and might pull a surprise inspection on them.

[HotmaleSPN]

Dont Crack, that is what they want you to do, I would stay at that job, because the next place you go to will be even worse. I work in LTC and I experience high pt loads, staying late every day, ect... A little trick I do is Flag all the priority treatments, and take the Treatment cart and the Med cart with you on your med pass. THis may seem like it takes longer, but once your done the pass your done, then all you have left is charting, and if they request prns ect.. Also Nursing is supposed to be a team effort, so dont feel bad for rolling anything over to the next shift, thats why they are there right?

[P_RN, ADN, RN]

Tell me why you are staying? And not that you love patients etc. What makes you want to stay?

I suspect that your answer is because you want a good job reference or a good evaluation. Do you honestly believe that anyone would accept what these people consider a day's work? Facilities' reputations get around.

Do not ever work, medicate, chart, pick up off the floor or anything else if you are off the clock. You can fight it in worker's comp hearings, but it's better to be either off and gone or on and getting paid.

I'm with the screen door theory. Vote with your feet and don't let the screen door hit you in the rear. Right now you are so stressed it's making you ill isn't it?

[SaharaOnyxRN]

Sahara - best of luck to YOU, my dear. Hopefully it will all work out for the best!:balloons:

Thank you very much. If God willing, all will go as I hope.

[SaharaOnyxRN]

I worked in long term care for 5 yrs but as a nurse for about 6mo. I went from doing medical records-CNA-LPN. As an LPN I was responsible for all the same duties although I was like you and felt overwhelmed. My husband had to listen to me complain about my job and my staff each day after work and I did not look forward to going back each day. I eventually had enough and quit. I have been so much happier with my new job and my husband can tell a great deal. There are better options out there maybe not better pay but happiness means alot!!

Oh, you have said something that is priceless. Happiness is everything. I used to think that more money meant I would be happier. I thought that if I had more money, i wouldn't have as many worries, ya know, bills, cost-of-living, etc. But i would rather take happiness and my health over a higher wage anyday. Besides, i think no wage could compensate us nurses for all that we are responsible for. You just can't put a value on it. But, don't get me wrong, we sometimes aren't paid enough. Especially LPNs/LVNs, they really get the shaft in some states.

[SaharaOnyxRN]

I also work in LTC. The CNA that said she wasn't going to make sure the pt was dry when the ambulance got there..well..then it's time to put pen and paper to her. Don't keep letting the CNAs walk over you like that. You are their supervisor, and that was not a request that she had the option to say no to. But all in all, if I were in your situation, I would pick myself up and head for the door and not let the door hit me in the you know what. It's hard work to become a nurse, and the work is hard, very hard. It takes a team working together. For myself, I'd definitely give my notice and when that time was up, it would be "adios" (spelling?). Even if it meant I didn't have another job lined up. Good luck, and keep us posted as to how things go.

You know, lately, I have been considering writing up a couple of CNAs. I guess, I have been reluctant up to now because I don't want them to see me as the type that always has to speak with the pen. But, you know, as much as I respect them and help them when they need me, I didn't think I would get that type of disrespect in return. I often have stopped what I was doing to help them take patients to the bathroom when they couldn't find anyone else But, oh no, these same ones are starting to bite me in the butt everytime.

You know, i usually don't stick around in environments that are toxic to both me and my patients. This environment is a very toxic one. But, since Christmas is coming, I was waiting until another position came open. And due to the Lord's blessings, one has come open. I wish this place on ill will, but I hope that they one day see the light and make things better. Because unhappy, overworked nurses always = unhappy, shafted patients.

[SaharaOnyxRN]

God bless you, is all I have to say. I am merely a student, and it discourages me, but also encourages me, to fight to make some changes in this profession. In my mind you are a saint!

Oh, my, I'm sorry if I am discouraging you by all this. But don't be, we need more activist nurses that will stand up and not take this sitting down. If we all protest, things will have to change. I get tempted to just quit nursing alltogether. I said earlier that I was going to change my career. But, I'm just venting and it makes me feel better. I really would like to stay in nursing because as the population ages, we will need nurses to take care of these people. We just need to stop taking this and speak up. If we can get some unity in the workplace and nurses stop backbiting one another, then this can happen.

Oh, thank you for calling me a saint. But I'm really not. I'm just one of the few. There are so many nurses that do stay in these environments and lose their health and sanity in the process. We just have to pray and ask God to bless up and help us improve healthcare. First thing, the business aspect of healthcare is going to have to go. You can't have good nurses and big business in the same arena. With that, you have patient care that gets put on the backburner and the bottom line becomes the almighty dollar. If these for-profit places really cared about the patients, they would make sure we were adequately staffed and not overloaded with work. But they work with as few nurses as they legally can and overwork them. It's not right. We've got to form a strong united front to combat this all.

Best wishes to you as you pursue nursing. I'm sorry if I discouraged you at first. But, you seem to have the potential to be a very excellent nurse that will be a fighter. Together we can change things. Thank you for everything. :balloons:

[SaharaOnyxRN]

Reading this - and all the other posts here - plus my own experience in the past few months has shown me a whole lot - the guy that invented nursing homes should be run over by a truck!

I remember a supervisor that I had at the hospital saying one time that she couldn't wait to retire and have some nice little low-stress job in a nursing home. That's what gave me the idea to go to work in one. Never DID like her.

LOL!!! She just didn't know, did she? I have heard nurses that thought nursing home nurses didn't have as much responsibility as acute care nurses. Well, I've worked in both, and I think that nursing homes can sometimes be worser that acute care. You have way more patients. And although the acuity isn't as high in a nursing home, on a rehab unit in a LTCF, these patients are often post-op and are coming to us sooner and sooner after surgery. This is no place to be when you are understaffed and overworked. Your license and the patients are not very secure.

[SaharaOnyxRN]

i know what you mean about the DON (i love her dearly). we had a med-aide call in one day so she had to pass the meds and the ADON and the MDS coordinator !!! All three of them and still the pass was out of compliance because of time. sorry just had to say it. After that for at least a week or so they appreciated all of us just a little more.

LOL!!! Sometimes it takes reality to bring them back to reality, doesn't it?

[SaharaOnyxRN]

Give a good report and leave!

I try, but most times, when I come in the next day, things are still not as they should be.

[SaharaOnyxRN]

i can relate to your situation.i work in critical care & tried LTAC to break my routine thinking that it will be less stress, i was wrong.two weeks on the job, i quit.

you seem like you are a very good nurse & i guess the best way for you is to talk to your DON/Management & if they don't do something about it, get out of there.there are lots of hospitals who are willing to hire good nurses like you.

GOODLUCK!!!

Well thank you for those very encouraging and sweet words. I know that I try to best I know to be. Oh, so LTAC is just as bad? I figured it had to be, the local LTACH has a high turnover.

[SaharaOnyxRN]

start by getting organized. you know that you can't complete all that work in eight hours. if i were you i would make a sheet organizing what treatments were an absolute priority - maybe about half of them. i would give my report to the evening shift and pass whatever was not done along reminding them that nursing is a 24-hour profession and you are expected to complete your shift in eight hours per your manager (by the way she sounds like a slave driver). we all try not to leave things for the next shift but you are being taken advantage of. when you do this it will force the manager to deal with the complaints and do her job. consult with the labor board on the issue. do not clock out on time and continue to work. if you are clocking out after your shift ends and they are not paying you for time worked i believe this is a violation. you should remind your manager of this. learn to stand up for yourself in this situation. the job doesn't sound as if it is worth keeping anyway. document everything and be professional in case you need it in the future. you must chart that you have passed on such and such treatment (dressing change, etc.) to the evening shift. make sure you chart your assessment, the patient's condition, and indicate that there are no complications. make sure to write something like "dressing change endorsed to n. nurse rn) - and report complete to n. nurse rn)". this will cover your license. be prepared for resistance and even being ostracized. the other option is letting them beat you to a pulp. you are saying that the situation was manageable when the shifts were 12 hours. this says to me that the eight-hour shifts can work if the manager does her job. you have to think about yourself and your children first. just be careful to do everything in a civilized and professional way. if they argue with you during report do not go on a guilt trip. simply state what needs to be done and do not defend yourself or argue. this will be very good practice in assertiveness. you state that the second shift doesn't "deserve" to have work passed on to them? no. what about what you deserve? you have to realize that you are not the only one working there. try to realize that you are a part of a team - you are not the entire team. if you document as i described and the patient suffers an adverse reaction your license is covered. i'm not saying i like the idea that the next shift will not do the work and harm the patient. but you are not their manager. let her discipline them. you may need to write this up because they are uncooperative and lazy. you can also write that dressing change on the mar and include a time (such as 2200). it sounds as if this will be hard to fight or change but there is always a possibility. they know you are new, insecure, and are preying on that. do not be threatened by being written up. respond in writing to any counseling and have it included in your file. keep copies of everything. you state that you are concerned about losing your license if everything isn't done. the workplace is unsafe so you need to protect yourself by properly documenting as i have described. in the meantime you should look around for another job that is less abusive. :trout:

thank you very much for your much needed response. the manager is worthless. i believe she may be wanting my job anyway. that may be the reason she is letting this continue to go on. i've told her about it and she knows because she's worked the cart herself when i was off. she even said that it was horrible, but did she try to change it? well of course she didn't. she even disclosed to me the other day that she wanted my position and had put in her notice so she could go to the floor and work the cart i'm now on. she told me that she was sick of being supervisor. but she said that when she put her notice in, they denied it and begged her to stay supervisor. well, i'm very analytical, so i put two and two together and i figure that she is wanting a job, and that would be mine. i see some other behaviors indicative of that. well, i wonder, when and if i leave, will all the work still remain on first shift? i bet, then, that things will change. because right now, they don't seem to change. and she is well aware of of everything. do you think that she may have contempt for me?

i thank you for the advice on assertiveness. i really need to learn to be that way. i believe that i need to be assertive more often. i have always been the one that would not speak up because i wanted everything to stay calm. but, in the process, it wears me down. i will try to be more assertive. i am not superwoman. i cannot do it all. now i've got to train myself to say that i will not do it all. once i get past that, i can gain the respect that i so cherish.