I'm about to crack...read this and help!!!! - page 6

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,... Read More

  1. by   SaharaOnyxRN
    Quote from Nursonegreat
    i traveled after working on a nursing unit for 1 yr. was a great experience...saw many different sites and how things can be good and bad....

    i think that we do make a difference in many peoples lives in many different ways that NOONE except us and our patients will know. GL with your decisions.
    Thank you. I hope I'm making a wise decision.
  2. by   SaharaOnyxRN
    Quote from brendamyheart
    You would be surprised at what state does and does not do. Our LTC has had many complaints on staffing. Do you not know that the Admin staff also counts in the mix. When state investigated staffing complaints, we were not sited. Until there is a mandatory nurse patient ratio we will always face the same problems.
    You know, i wonder why there are no mandated staffing ratios for nursing homes? You would think that with all the state regulations, surveys and the fear that the state puts in the hearts of nursing homes, that if they really cared, they would make staffing ratios a must. But they don't. I wonder why?
  3. by   SaharaOnyxRN
    Quote from BoomerRN
    Not only is it against the labor laws to work off the clock but the facilities insurance policies do not allow this.
    I have worked in LTC for 25+ yrs. and there has only been one facility that that I counted it a joy to work for and it had a union for housekeeping, kitchen, laundry. Whatever raises they received, the nurses also received. They (union) also made it easy to get rid of those who called in often or who were not doing their work. The staffing ratio was ideal and you were never running around like a chicken with her head cut off because someone was always willing to help. It was privately owned and I worked there for four yrs. I have since worked for many other long term facilities (we moved to another state) and as I said I have never found another one that even comes close. It seems today that (at least around here) you're expected to carry pagers/phones, and be on call 24/7. I was touring another ltc facility last year, after an interview with the don and as we approached a nurse sitting at the desk. The d.o.n asked here where she was yesterday because he had tried to call her to come in to work. She said she was off and had thought that she didn't have to answer the phone if she was supposed to be off. He (d.o.n) chastised her and went on down the hall showing me the rest of the facility. I later learned that this nurse was leaving. Wonder why? We are human beings and we do have lives! Of course, I didn't take the job.
    All I can tell you is to find another job and leave this one. I found that most of the time the smaller ltc's were better to work for than the larger ones. Clinical research is better than floor nursing. You can still deal with patients in some instances and not be responsible for more than several pts. at a time. It depends on what type of research you get into.
    Good luck.
    Thank you for the advice. By God's grace, i have found another job. I thank him for it and will still be a voice in nursing rights. How can we be good nurses when we're not allowed the opportunity?
  4. by   allantiques4me
    Quote from 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!!!
    Oh my God.I was in a situation like this.I have the same mentality .the poor person in the bed could be your mother.If only every nurse and aid thought that way.Patients would be treated great.I remember staying after for 2 xtra hours to get that dressing done,I know wasnt done for a couple of days,while I was off.Or the trache ties that werent changed since the last time I changed them (at least 3 days before)I always signed my work.I personally almost threw in the towel.I found a new position which I feel am making a difference.Sometimes thats what you have to do.I started having panic attacks causeI thought i was suppossed to do all these tasks on a time limit and by myself,which looking back in retrospect was totally impossible from any nurse.also I hated hearing from family members what horrible care there family member was recieving,when I ran fron7a till7p without more than 15 minute break(breaksand lunch)without much help from the n/as or other nursesI had enough.my coworkers and supervisors kept calling me to come back,but i had enough of that environment.Remember theres a nursing shortage you could go anywhere for a job. shop aroundAs far as that treatment nurse,shame on her!!I used to be a tx nurse till they did away with the position.I loved that job.Id love to be a treatment nurse again!!!Look for another position. you sound invaluable!!!
  5. by   Simplepleasures
    The California Nurses Association has a plan to try to unionize the whole nation! Anybody who is truly interested in improving conditions in LTC really should go to thier website and take a look.
  6. by   Brad_RN_Student_PA
    Quote from 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!!!
    This is exactly why we need LTC reform...and exactly why I (as a new nurse) will never ever work in LTC. And actually, why I won't send my grandma to a LTC facility, and why I will be pursuing advanced nurse practitioner status asap.
  7. by   dream'n
    Never, never, never let management bully you into working off of the clock! I have heard managers, in my current and past jobs, threaten staff with write-ups for overtime. Where I work now there are a couple of nurses that have been scared and will clock out and continue working EVERY DAY for an hour or two. Then there are others, that work just as long, but on the clock. Guess what? The frightened ones work 10-20 hours a pay period unpaid, while there co-workers get paid for their time. I have NEVER seen anyone written up for over-time. As long as you are justified in your over-time, I don't see that they will ever write someone up, they couldn't defend it with the labor board. Just my two-cents.
  8. by   TrudyRN
    Do not work off the clock. It is pure BS that your boss wants you to do that and you are a fool if you let her talk you into it.

    Be prepared to find a new job and then start the battle. Make it clear that you are going to do your work and that you are going to get paid for doing it. Go to officials if need be. I wish you luck, I do not envy you, but you have to stand up for yourself. No one is going to do it for you.

    How certain are you that the Treatment Nurse is not ever doing the treatments? Is she really falsifying records and not carrying out legitimate doctors' orders? Sounds like the Board needs to know and the owners of your facility. Your boss is complicit in these illegal practices, I'll bet, although she will, of course, deny that.

    What a mess the moneyed have made of American health care. I wonder if George Bush knows about this.

    Oh, and start writing up the CNA's if they do not respond positively to the coaching talks you need to have with them. Let them know that you need their help. Find a way to get them on your side. Let them know what you need from them and see what they need from you. Take some bagels to work or donuts for them and try to start befriending them.

    Keep a copy of everything you write, a log of everything you notify officials about - topic, dates, to whom, response from them, if any.
    Last edit by TrudyRN on Nov 24, '06
  9. by   twotrees2
    Quote from 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!!!
    just the opposite of our facility - they tend on days to put everything onto PMS - even the dang admissions are coming later and later after the unit clerk leaves so not only do we have to do the usual admission stuff but do the complete chart from writing all the orders out an not just checking they are right , cause god forbid the y lat the unit clerk have different hours so she could do the job she usually does ie - putting the charts together.

    on the clocking out - i used to do that - not no more- not only is it illegal and if you are doing something of the clock you could get in deep doodoo from state for not being on the clock its unfair to you - i would tell them that i will not punch out. i am in the office all the time getting talked to over this and i dont even get ot as i am casual call and rarely have enough hours to get ot. dont let them intimidate you into being of the clock - tell them it is illegal for them to do so and it is illegal for you to not get your stuff done so unless they are gonna come help to be sure its done - well then you will be late.

    as for the aides - tough call - is there any aides yo do get well with that you could request them to be with you - i am blessed that most of the aides though as frustrated as we are they are pretty good.

    do not feel alone- i think many many of us go home crying before and after work knowing we have to give substandard cares due to management not staffing us the way they should.

    for me - it helps to every night i pick one good thing ( like a family member or resident who smiles and doesnt usually cause they know i am there and they feel good that i do my best...... it keeps me going the few pats on the backs with those smiles from especially the residents. )

    are you in a position to cut back your hours? its risky going per diem like i work - ( always a chance they will hire a bunch of nurses and you end up with no hours) - i wasn't but took the chance with this job cause I as sick of being shoved around - honestly in 1 1/2 yrs there has maybe been 2 paychecks i was short and worried id not catch up - but it has worked well for me. they cant keep nurses this place is so bad - but it helps me cause i look at the schedule and tell THEM when i will work not vis versa. its still risky and dont know what i will do when i do finally get the ax cause they find enough nurses who dont give a rats tush and will follow their rules and kiss butt - but for now i try not to think of that and enjoy the little bit of control i have over them ( which they of course hate) - also if you scale back from say 40 hrs to 32 - staying over an hour a night you no longer will be in ot and they cant complain and if they ask you to wok extra you remind them it gives you ot and when they say ok its on thier shoulders not your fault as they try to make it out to be. perhaps doing that would make them realize just what an asset you are - i know several at my work who have done just that for this reason and it has worked for them. they still end up with ot but management cant complain cause they only wanted 32 so that extra shift is them being nice.

    hang in there is all i can say. someday things have to get better. i would certainly hope it never gets worse- and dont see how it could sigh.
  10. by   twotrees2
    Quote from UKRNinUSA
    I don't believe you have any other option but to leave. It seems that you are the only one working and apparently doing the work of at least 3 people. Your manager is not doing her job, the treatment nurse is not doing her job, the CNA's are not doing their jobs - and they are getting away with it and using you as a doormat in the process.
    Go do some registry work for a while so you can really check out a place before you commit to work there full-time. And give the State an anonymous tip-off on your way out - these patients shouldn't be subjected to such mistreatment.
    dont know that id recommend anonymous tip offs - state in USA anyhow - in Wisconsin anyhow- doesnt seem to care- they give notice when they are coming so the prepare like crazy staffing nd whatnot appropriately - then they finagle thier numbers from other days to look as if they were rightly staffed - and they get away with it- its a waste of time and effort and ofetn the facility will find out who did the call and make life hell until they finally fire them. or they find out and blacklist ya by calling all the area places and telling even though that is illegal ( they all know each other and have the private lunches to tell who to hire and not hire ) been there done that - just what i now of Wisconsin - maybe other states are better.
  11. by   twotrees2
    Quote from michelle126
    I like a good battle, but it doesn't sound like this one will ever be won, esp if the adm and DON isn't willing to bend or make changes. Heck, we have about 20 pages on our admits and if you get a person with tons of skin issues...forget about it. You would be around forever.
    Bottom line, now that there is 3 shifts instead of 2, duties need to be split up.

    BTW, if you don't get to the dressings etc, make sure you are not signing them off. What we do is circle it and I put a not on report that they still need done, that way, I'm informing the next shift and not just ignoring it. Thankfully, we don't have to do it that often.
    we do this too - my only concern is this - and i dont know the answer so anyone input would be great -

    we circle we did not do it - we leave note in 24 hour book , where do we stand legally - we get called in they say why didnt yo do this ( day after day usually) what shall we say then. who shall we blame then as they will STILL blame US as it was our job to do. i dont think any court of law is gonna take we just couldn't get to it as an excuse especially cause we havent charted that we couldn't get to it - circling it means we just didnt do it for whatever reason - yet if we put in the charts ( which i did once and got nailed big time by bosses that that is a state nono ?? umm you mean THEY would get the grief from state and not me making it a state nono?) not done as unable to get to it due to other emergent cares that took priority over the dressing yada yada - then we face getting fired. hell - i nearly got fired cause i charted another dementia resident hit another and that is a "red flag" to state so i was hinted and pressured to never chart that stuff again.

    any ideas where we legally stand or what we should be charting besides circling we just did not do it.
  12. by   Simplepleasures
    Quote from twotrees2
    dont know that id recommend anonymous tip offs - state in USA anyhow - in Wisconsin anyhow- doesnt seem to care- they give notice when they are coming so the prepare like crazy staffing nd whatnot appropriately - then they finagle thier numbers from other days to look as if they were rightly staffed - and they get away with it- its a waste of time and effort and often the facility will find out who did the call and make life hell until they finally fire them. or they find out and blacklist ya by calling all the area places and telling even though that is illegal ( they all know each other and have the private lunches to tell who to hire and not hire ) been there done that - just what i now of Wisconsin - maybe other states are better.
    Yup, you got it completely right, I too am a nurse in Wisconsin and agree that the nursing homes Ive worked in always knew when state was coming.Also I know first hand the way in which a nurse who reports to "state" gets fired in retaliation, I am in the Wisconsin Court System now in an appeal of a lawsuit I brought forth against my former employer filed under the Wisconsin Health Care Worker Retaliation Protection Act. Also it is illegal for your employer to try to hide things from the "state" by forcing you to rewrite documents or use words that are not a "red flag"!!! So for all you Wisconsin nurses, you DO have some protection under the law. PM me if you want more details. Really what gives here in Wisconsin, or are all the states the same way?
    Last edit by Simplepleasures on Nov 25, '06
  13. by   twotrees2
    Quote from SaharaOnyxRN
    You're right. Nursing is a 24 hour job, and they know this, but they won't accept it. And I guess the DON and Administrator are afraid of losing them because it's so hard to replace nurses on 2nd shift. And the patients tell me all the time that they can never get anyone to come see about them on 2nd shift. You know, I wonder what are they doing? I know that they have 2 med passes, but so do I. But they don't have treatments, and don't have to deal with as many meals, etc. What could they be doing? I worked part of 2nd Friday, and it was so quiet in contrast to the day shift. On top of that, excuse my language, there is this cow in PT that thinks she knows more than the nurses and is always coming around tellling us nurses what we need to do for our patients. I am so sick of everybody being so disrpectful toward the nurses. Do we ever get a break?
    well i for one would jump to work 2nd shift there lol. our place has most of the treatments on 2nd - days doesnt think they should have to do any cause the pass a few more pills. by the way i have 2 med passes as well ans they aren't small on most units. add in the fact that admits now come on second ( i found out why - if hospitals keep them till about 5 they can bill for a whole day and if we get em about 5 we also can bill for a whole day so guess when they come - about 5 - and whats about five- supper - try to get admits done when trying to feed 80 plus residents. and then the paperwork - i have done admits - as much as possible but no less than what is required in frts 8 hours ( skin assess in 2 hours - fall risk and chart together, as well as initial careplans ) and the rest i can come back 3 days later and its not done. matter of fact i dont usually leave any of it cause i KNOW it will be there - well last week when i had a particularly bad day i got only the minimum work and the powers that be wondered if i was sick cause i "always get it done" - made me think - well guess what - made me realize they use me cause they know ill do it so from now on i am not busting my butt to get it done - there are more tan me that can do this stuff. add in the fact i have to go do any flushes and trachs cause the LPNs aren't trained and IVs etc - and the wound vacs - nah - i just ain't doing no more.

close