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

TrudyRN · Nov 24, 2006

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.

twotrees2 · Nov 25, 2006

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.

twotrees2 · Nov 25, 2006

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.

twotrees2 · Nov 25, 2006

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.

Simplepleasures · Nov 25, 2006

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? :confused:

twotrees2 · Nov 25, 2006

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.

twotrees2 · Nov 25, 2006

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.

yep - even the unit clerk , the administration and even at the last place i worked the damn hairdresser casue she was a CNA they counted her. anyone who doesnt even have idrect care to any resident is counted in stafing ratios and that is how they get away with staffing the way they do. matter fact the facility is now trying to hire a ADON ( then SHE can be counted too - ) so when state comes we look so over stafeed its pathetic.

twotrees2 · Nov 25, 2006

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.

heard this before- where is this website.

Simplepleasures · Nov 25, 2006

It's NNOC Index Page.

twotrees2 · Nov 25, 2006

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?

oh i did write a letter stating i felt they wrongfully fired me - told me id have to get a lawyer yada yad - cant afford that - ten they proceed to tell me likely cant prove it - though i proved in unemployment hearing they fired me and were wrong i still have no proof they fired me for calling state - they deny even knowing i did so though i know they are lying. as for the threats to falsify or more correctly NOT chart ( which to me is the same as falsifying) its my word against theirs so that would be hard to prove too cause its me against a lot of them. they dont tell you right out in front of everyone - to bad its illegal in Wisconsin to tape secretly conversation's ( i checked cause this was my other thought to "catch them" at their own game - cant do it) good luck in your case - pm me and let me know how it goes- hoe you get them but good. pm me where in Wisconsin you are - maybe we could meet and you could give me great advice once you been through it all so i could come up with a plan.

SaharaOnyxRN · Nov 26, 2006

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!!!

(Sitting here blushing) Did you say invaluable? Well thank you, I appreciate that. But, I'm just one. I'm not special or anything, I just really do care. It makes me mad to see management walking around all day doing nothing. They claim they have SO MUCH paperwork to do and they don't have time to stick around on the unit. I'm not saying that they don't have paperwork to do. But, they could at least stick around on the unit, and not in the smoke pit all day, so we can find them when we need them. There is no support. As long as they have someone taking those keys every shift, they have no problem. But lord forbid someone call in or not come in to get those keys, then they all panic. I guess they forget they are nurses and don't want to be bothered.

Well, I am happy to tell you that I have taken another position. And as common courtesy and professionalism calls for, I put in my two-weeks' notice. Do you know what the DON and ADON did? They tried to lay a guilt trip as big as California on me. They also asked me did I MEAN to put in my notice? I'm like, lady, what more do I need to do to show you that I am leaving? I guess they think they have mind control over me or something. That they DO NOT have. What they need to be doing is taking me seriously and getting someone to take over that cart. I hate to leave my patients, but this is not the place for me.

SaharaOnyxRN · Nov 26, 2006

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.

Thanks. I will do that. I am very interested in a union. I hope enough nurses will be interested in it as well.