Im going insane!!!!

TooBusyRN · Mar 19, 2004

I don't know what state you are working in or whether your state Office of Long Term Care sets staffing ratios, but here in Arkansas if our LTC nurses had only 8-12 patients to care for they would think they had died and gone to nursing heaven! In my 115 bed facility with a current census of 93, we have three LPNS on day and evening shifts and 2 on night shift. That's a considerably greater ratio than you are talking about. I know it's hard on a new grad, but you can do it!! First, you need to assert yourself to the off-going nurse that you want a complete report on ALL of your residents that will be under your care. Then take a few minutes after you've gotten report to organize your thoughts and get yourself prepared for what you have to accomplish on your shift. With all the demands placed on us to give the best care AND get all the required paperwork done, supervise CNA's, pass meds, etc ORGANIZATION is the key. If you don't get yourself in the right mind set and get organized at the beginning of the shift then you can't accomplish what you have to do. Second, make sure your CNA's know exactly what you expect of them and enlist their help as much as possible within their scope. Your CNA's are the backbone of your team and if you don't establish good rapport with them, you might as well throw in the towel. Good luck and keep your head up!

pj_marie · Apr 8, 2004

Second, make sure your CNA's know exactly what you expect of them and enlist their help as much as possible within their scope. Your CNA's are the backbone of your team and if you don't establish good rapport with them, you might as well throw in the towel. Good luck and keep your head up!

As a CNA, I thank you TooBusyRN.... you sound like a few of the nurses I work with. Now, a question..... How do I as a CNA get my nurses to GIVE report?!?!? For that matter, even getting report from the 10-6 night shift would be a HUGE benefit!! But, as it turns out, when I clock-in at 6, there are no CNAs in sight from night shift to ask about resident status. I had a resident tell me half-way thru my shift today that "I am not to use my walker for a few days, just the wheelchair..... Dr. orders" Why did it have to come from the resident and not the floor nurse, especially after having her use the walker for 4 hrs.??? This can not be a good situation for either one of us, especially the resident! Sorry, I needed to vent about this..... I have been at this LTC facility for almost 2 weeks and of all the things I have seen/not seen, this one really irks the hell out of me, followed by the lack of using gloves to clean BMs by my trainers which, I am sorry, is gross beyond belief! Thanks for hearing me out.... any tips on how to "buck" the system to get report would be a benefit though.

PJ

Town & Country · Apr 9, 2004

As a CNA, I thank you TooBusyRN.... you sound like a few of the nurses I work with. Now, a question..... How do I as a CNA get my nurses to GIVE report?!?!? For that matter, even getting report from the 10-6 night shift would be a HUGE benefit!! But, as it turns out, when I clock-in at 6, there are no CNAs in sight from night shift to ask about resident status. I had a resident tell me half-way thru my shift today that "I am not to use my walker for a few days, just the wheelchair..... Dr. orders" Why did it have to come from the resident and not the floor nurse, especially after having her use the walker for 4 hrs.??? This can not be a good situation for either one of us, especially the resident! Sorry, I needed to vent about this..... I have been at this LTC facility for almost 2 weeks and of all the things I have seen/not seen, this one really irks the hell out of me, followed by the lack of using gloves to clean BMs by my trainers which, I am sorry, is gross beyond belief! Thanks for hearing me out.... any tips on how to "buck" the system to get report would be a benefit though.
PJ

If there are no offgoing aides to give you report, and the nurse doesn't give it to you, ask her for it.

Don't go onto that floor without some kind of report.

TooBusyRN · Apr 9, 2004

I absolutely agree with Shezam...NEVER go onto the floor without some kind of report. The off-going aides should care enough to let their relief know if a resident is having some kind of problem or special care needs - even if they are short-staffed. The LPN's should be giving each other shift report and counting narcs before they hand-off as well, so if your LPN doesn't voluntarily give you any information, then ASK her/him if anything out of the ordinary is going on with any of your residents. If you consistently ask every shift that you work, then perhaps the LPN will get the message that you care and begin to give her team a report without having to be asked.

One more suggestion...if your facility doesn't have a CNA council, at your next inservice or staff meeting, suggest that they start one. Talk with your DON or ADON (whomever directly supervises the CNA staff and LPN's) about the things that you are concerned with like not getting reports. They are ultimately responsible for making sure you have the knowledge, skills, and resources to do your job correctly.

miss_nurse2004 · Apr 17, 2004

I also agree! I find myself stopping the outgoing lpn and basically making her give report before she leaves. I am responsible for approx. 30 long term residents, and there have been times when I've come in on Monday a.m. after being off the weekend, and walk in to an ambush! The peg tubes are stopped up, the cna's are calling in, the treatment nurse is "taking the day off"...it goes on and on. And while I sit there charting, passing prn's out the wazzoo, I watch as the nursing supervisor, the medicare coordinator, the care plan nurse and other staff walk right by me to the smoke porch. What would happen if one of them stopped and asked, "Can I help with anything?" My head would probably explode! That's one of our problems. They always say, when you need help - ask us! We're glad to help out! But when you DO ask, they are always too busy doing their jobs. We have an RN that comes in twice a week to help out, and she takes care of much of the labwork to be done. She just about bit my head off the other morning when she walked in and saw all the lab to be done on the calendar....not MY decision, I didn't order it all! But I took the chewing. What a way to start the day....:angryfire

Justus · Apr 26, 2004

:rotfl:"CNA council"? oh tell me more! Have thought many times that such a thing would be great. Perhaps help alleviate some of the frustration etc. that CNA's feel. I think most would agree that as low man on the totempole their opinions and such are not valued.

We currently have a "b*tch box" - serves absolutely no purpose other than furthering one of my pet peeves ...cliques vs. teams

Hellllllo Nurse, BSN, RN · Apr 26, 2004

When I was a new grad LPN on a skilled Medicare rehab floor, I had 30 pts, on days. 8-12 sounds like a dream.

Mister Chris, MSN, NP · May 5, 2004

I have to vent a little. Thanks for letting me vent!:stone

Yes, Hang in there. Bin there and done that too! But I still work with the Aged care/long stay/palliativecare clients and yes you can get left sometimes when a whimp or two go sick on you or do not give adequate reports. Look at the client who can recognise you and catch a smile from them - or give them one of your smiles so that they may have a smile to give back to you when you need it. It is sometime a thankless world in nursing, so hang in there and cherish the few 'thank-yous' that you will get. Compassion with a great attitude will pull you through. Love you!

LaShell · May 5, 2004

Yup, I'm a new (

In an 8 hr day, after subtracting a a couple of hours for meals (at my facility they cut food service to save money so the nurses dish up food for everyone, which includes going down to the basement to look for supplies, then do the dishes); then subtract another hour (at least!) for paperwork such as medicare, 30 day, weekly charting, new orders, monthly treatment sheets and med sheets; then subtract another hour for basic patient care like toileting, a shower here and there, changing linens (yes we're always short of aides, plus we try to act as a team); another hour dealing with families on phone or on the floor.

After all those basics are done, we have to do our treatments. You get the point. And yes, I hear all the time how easy 11 patients must be. But frankly, I don't how anyone could manage 30 patients like these. Even with only 11 or 12, it seems like the 1 or 2 stable patients get totally ignored.

Sometimes I feel like I'm getting better at my job, but then is it because I'm become as crusty and tough-shelled as the rest? haha :rotfl: And yes oh yes, I hate calling on call docs on nights and weekends too! The oncalls get perturbed if you call for little things but if you don't it just gets left for day shift who then feels a grudge.....

Somebody's got to do it???

Lovenursinganyx · Jun 4, 2004

I wanted to start of by saying thank you to all who replied. Things have gotten worse and better at the same time. Our nursing ratios have increased to 22 - 24 residents, but in another month I am being promoted to weekend- supervisor. I have really been trying to perform daily tasks without letting anything get to me but my time was up. I found myself being tired of smiling.

Has anyone ever felt that? I went and talked to the DON about my concerns and that was when she offered me the position. So it will be a challenge! I"ve been a nurse only for 1 1/2 years but I deff. think I am cut out for the job! Thanks again to everyone for their encouraging words and keep in touch!!!!

CHATSDALE · Jun 4, 2004

I Have Been Reading In Disbelief....no Gloves For Cleaning Pts----must Be From Dark Ages.....our Aides Would Walk Out And I Could Not In Good Conscience Blame Them......and What Is This About Serving Food ---please Don't Let This Get Around I Would Hate For It To Get Started In Louisiana

As For The Other: People Calling In At Last Minute And No One Trying To Call In Coverage, Pts Divided By Counting Heads And Not Realizing That Some Require A Lot More Care Than Others. Not Being Able To Find Supplies Because They Have Not Been Ordered By Week Day People, Well I Guess That Is A Nurses Life Because I Find It Evry Time I Clock In

nursecompassion · Jun 4, 2004

i currently work in ltc as an stna and i totally feel for my nurses on nights. there is one unit thats really unfair for nurses to work. at night they give the alzheimers (17 r), unskilled unit (21 r), plus she has to pick an additional three rooms (8 -9 r) on a hall that is not even hers! on top of that she has to take in the meds when they come (the nurse on the joining hall never helps!). (she has to pass meds and do treatments on all of those) (they do the majority of their treatments at night at our ltc)

she is lucky we had an rn supervisor last night that passed half her meds and really helped her out! of course he is the ony exception!

what is really infuriating is the fact that during the day the alzheimers unit has their own nurse, but not at night!

julee