morale/teamwork

  1. I am a DON of a 104-bed facility. We are going through a rough time right now. I have been there for about 3 months. Prior to my arrival, the weekend program was changed and people were to be paid a different bonus for the weekends- effective January first, Well, needless to say...I have had to replace nearly all the weekend staff. As you all know, as you replace a large amount of people, you have to keep replacing because not everyone works out (the interview crapshoot). Now, I am a DON who is not afraid to work the floor. I have worked the floor every weekend since October, as has the rest of the nurse managers team. This is not a problem.

    The problem that has taken shape is a lack of teamwork and low moral. I am also finding that a lot of staff just expect me to work no matter what...as an example...I was scheduled to work 1am to 7 pm a 18 hour shift. a newer nurse came in..one who had already called in for multiple orientation sessions ( she ended up with 16 hours orientation) She came in and demanded that I come in and give her additional orientation or she was walking. I attempted to explAIN that That would cause me to work a 24-hour shift and the nurse really did not care. I came in. I believe that this nurse has the potential to be a great asset to the team so I didn't rock the boat about it.

    At thi point, I am just a little tired and running out of ideas. I would like some suggestions on boosting morale and improving teamwork. Any suggestions would be greatly appreciated. thank you very much!!!!! Let me know the things that you enjoy and the things that mean the most coming from a nurse manager. I am genuine in my desire to do the things that will benefit the entire staff and make everyone happy.
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  2. 24 Comments

  3. by   debRNo1
    I just left a 102 bed facility at which I saw myself eventually being the DON after working my way up the ladder to unit manager from med nurse. I just left and will not look back. I have a bad taste about the whole LTC scene right now. Im sorry but I dont have ANY suggestions for you. Seeing me on the floor working like a dog didnt effect my "team" at all. Almost 1/2 my time as manager I was filling in as charge nurse with nobody covering my position and workload. Staffing is a major concern right now and most staff I found to have a major attitude and beleif that we staff short to begin with !!!!???? No it is your coworkers calling in and not showing up, many times its not dealt on paper in the form of a write up.

    A demanding nurse with NO RESPECT for the DON and who calls in for orientations is certainly not going to be an assest to your facility she will only get worse and if you give in to her demands you will create a bossy monster of a nurse. Walking out is abondoment and thats what I would have told her straight up !!

    Being a DON is off my list of things I want to do in life. I have seen them come and go and have seen very few be shown the respect they are due regardless of how they treated the staff. I wish you luck with your facility and hope that things get better and dont burn yourself out- speak to your administrator about it.

    good luck

    deb
  4. by   ChainedChaosRN
    Hi Zuch, each facility and locale is different, so I'm not sure if what I did will help you. June of 2001 I took on a 160 skilled bed facility in big trouble. Over 50% of the staff was agency, multiple call in issues etc - the usual for a bad facility which was also in trouble with the FBI. First off, I hired, over hired, hired more, rapidly. I set up a team to interview the minute someone walked in the door. We did orientations as fast as they came and buddied them up with a regular staff member. At the same time asked tons of questions, evaluated systems to see why people were not staying. Wages was not an issue, surprisingly. Lack of supplies, systems and leadership were. Go figure.
    Within 30 days agency was gone, we've never used them again.

    I could go on with more but I won't. Please feel free to email me if you like, I would gladly give you some morale support. You can't keep going at this rate, you'll crash and burn.

    Dawn
  5. by   BadBird
    I have a few suggestions, 1. use agency nurses to supplement your staff, some will even contract with you and most are dependable. 2. set clear policies for your staff let them know what is expected, 3. You are the Boss, do not allow a nurse to dictate when you will or will not work. 4. Be fair and consistant
    with all your staff, no playing favorites.

    It sounds like you are getting walked all over by your staff, I predict you will burn out quickly if you don't put a end to that. B
  6. by   ChainedChaosRN
    Hi Zuch...just one more thing. Your last sentence "I am genuine in my desire to do the things that will benefit the entire staff and make everyone happy."

    You are setting yourself up for failure there, you will never make everyone happy. Ever. Just do what is legal, right and fair.

    Dawn
  7. by   zuchRN
    badbird...I am not being walked on by my staff. I have been doing this DON thing for almost 5 years now. I absolutely love what I do. I am just a little frustrated right now. The thing is...I chose to terminate my night shift nurses because they were not treating the residents right, not doing assessments and they were just plain being poor nurses. I am not a person to keep people around just because I need "someone" to work the floor. I take turns covering the open shifts with the rest of the nurse manager team. I end up working every weekend though because of RN coverage...I am one of 3 RN's in the building.
    As for the nurse who called for additional training....The administrator and myself sat down with her and explained to her that that was unacceptable behavior. She gets the picture and knows that if she tries that kind of stuff again she will be termed. (she has a small problem with me because I am much younger than she is, I am 31 versus her 45-50).
    I am following the attendance policy and have taken it a step further...we have put into effect that if you have 3call-ins or tardies in your first 90 days it is auto term.
    I also will not leave them with inadequate staffing. The only ones who suffer are the residents and I am not willing to sacrifice their care to teach someone a lesson. There is a point where someone has to work.
    I know that I am idealistic, but I do have firm beliefs and the minute that I don't believe in these things is the time that I need to leave the long term care scene. I have done this for over 10 years now and I just love it more and more...just frustrating sometimes and it feels good to vent to people who know what you are going through. I have read a lot of posts here with a lot of negativity torwards long term care. I can understand why....but if no one sticks with it and quits and then goes out and bad mouths long term care...how will it ever get better?
    unfortunately, what I see from acute care is not anything wonderful. If I send a resident to the hospital, inevitably, they will come back to us with one of 3 things.....1)MRSA 2)pressure ulcers 3)filthy--nails, hair, eyes...everything filthy...and everyone has a catheter (for hospital convenience!!!).
    tHANKS for listening!!!!!!!!!!!!!

  8. by   Hellllllo Nurse
    Originally posted by ChainedChaosRN
    .....asked tons of questions, evaluated systems to see why people were not staying. Wages was not an issue, surprisingly. Lack of supplies, systems and leadership were.
    EXACTLY!!!

    I am an RN. I have worked for years in LTC/SNF as an RN, LPN, and CNA.

    I just quit a LTC job after only 2 days, and I will tell you why-

    Lack of supplies, lack of organization, systems not in place.

    I spoke to the DON for over two hours during my interview. I told her of my extensive experience in LTC/SNF, and the problems/frustrations I've encountered. The DON assured me that everything was running smoothly, and I had nothing to worry about.
    She was very much mistaken.


    Nurse:resident ratios are very rough in LTC- I've been the only nurse on nocs w/ up to 70 residents.

    Granted, this is a heavy load. But, I would be able to do it (without staying over), if the systems, supplies, etc. I need are in place.
    Well, my first noc, only one aide showed up, I was supposed to have 4. I pulled one from the other unit. We had only 5 pads for 58 residents. We used bath blankets, well of course, it was one total bed after another all noc.

    Report sheets were illegible, they'd been xeroxed so many times, and had out-dated, incomplete info. No copy paper on the unit. Finally got a ket to the ADON's office to get copy paper.

    I had a res in the middle of the noc whose sats were at 55-60%. (COPD, DNR). I got an order for HHN w/ Albuterol. The nebulizer machine I brought into her room, needed an adapter for the tubing, which was not available. 1/2 hr wasted looking for one. Finally had to put the machine back in the supply room and go all the way to the other unit, borrow a key and get one from their supply closet.

    Pulled stickers from "bingo" cards to stick on refill forms to fax to pharmacy. No copy machine on the unit, only a fax. Well, the stickers kept getting caught, and jamming the fax machine. I had to waste precious time covering the stickers with long strips of tape to keep them from sticking in the fax machine. Would have made a lot more sense ot have a copy machine, so I could have xeroxed the refill sheet, and faxed over the SMOOTH copy! Also- How about using black and white laser printers and faxes? Do you know what a time consuming hassle it is when ink cartridges run dry in the middle of the noc? And everyone uses a different brand, seems I've had to learn how to change cartridges and films in 10 different brands, when there are refill cartridges available!

    Used, back and white laser printers are cheap and easily available. I have one myself, an eleven year old laser Epson. It has never failed me.

    Went to change out syringes for tube feeders- they had the wrong kind.

    The facility is using a type of Kangaroo pump with a Y-connector tubing and 2 bags, one for flush the other for feeding. No one knew how to work them, and they shut off and beeped every two hours. More time wasted dealing w/ that. Cans of liquid nutrition were supposed to be stocked in pt rms. They weren't. Had to run all over the place, wasting time looking for some.

    In the am, no monoject was available. I had to do the FBS by stabbing the lancets in res' fingers manually. That hurts them!
    Housekeeping did not empty trashes, I couldn't find trash bags.
    Ran out of cups in the middle of the noc. Had to get the key to dietary and waste more time looking for cups.

    Very aggressive CNAs who think they run the place...and they DO, if allowed to. Many DONs keep bad CNAs (and nurses) on, as it is too much trouble to fire them and hire someone else. Insubordinate, inappropriate, aggresive CNAs are a HUGE problem in LTC. No matter how much I speak to them or write them up, it does no good at all if my DON DOES NOT BACK ME UP.

    I am a highly organized, intelligent nurse, with extensive experience w/ geriatric pts. I have excellent time mgmt skills, and I love working w/ the elderly.

    However, I cannot make bricks without straw. Nor can I take care of residents when all my time is spent running around lokking for supplies and dealing with rediculous time wasters like lack of copy paper, and illegible forms.

    I am at the point in my career where I really do not care much about the money anymore. All I want is a POSITIVE, WELL SUPPLIED, ORGANIZED working environment, where I can get just a little respect, and where STAFF AND MGMT REALLY CARE ABOUT THE RESIDENTS.

    Well, I have finally given up. I quit the job, and I have vowed never to go back to LTC again. I have worked LTC in two different states, and many different facilities, both as full time staff and as agency. The same, exact problems exist in all of them.

    I gave it my best, but I am done.

    I hope this info is helpful to you. It was helpful to me to vent!
    =0)
  9. by   Tookie
    Sigh
    No words of advise here - I am sorry - l wish l could come up with ideas - we are l think somewhat better off than some of the above descriptions - but aged care as l have said will never be better until we value the aged person - and the peopl who work in them - We can only improve by making all governments understand that they too will get old abd will need someone to care for them - where then will be the people with the skills and who care - no longer in the system - where ever that may be
  10. by   debRNo1
    Originally posted by Hellllllo Nurse
    Very aggressive CNAs who think they run the place... Insubordinate, inappropriate, aggresive CNAs are a HUGE problem in LTC. ........
    ......Well, I have finally given up. I quit the job, and I have vowed never to go back to LTC again.......
    ..........................................I gave it my best, but I am done.
    Hellllllo Nurse.........I hear you
    Ive been med/charge nurse and finally "manager" of a 51 bed unit
    in a small 102 bed facility Ive covered when there was no staff with no OT for "mgt" staff They call it comp time !!??
    Ive dealt with no heat and no hot water and telling my staff to fill up pitchers to wash their residents :imbar No syrup for dried out pancakes and kitchen telling us to use jam/jelly instead !!?? No thicket so residents might aspirate. No eggs how the heck do you run out of eggs and there is a supermarket next door !! It was like pulling teeth to get a sandwich but staff could get one easily and probably ate ALL the eggs too. So I send a CNA to the store with my money 3 times a week to get whatever we need to head off complaints from residents and families. I get reimbursed but nothing ever changes. The tub is broken, the roof is leaking, the phones are down, no towels, no sheets, no blankets, no gowns, no tx supplies and ultimately NO STAFF. Anyone remember the nurse who used the enema bag when there were no feeding bags- bad decision- but DON who later denied it told her to use it and improvise when she was called in the middle of the night!!!??

    The CNA's are another issue, when they do decide to "show up" the nurses are afraid of them and begin to doubt themselves and their skills when they are confronted and abused by these bossy controling insubordinate CNA's. They are allowed to behave like this- monsters are created and become the nurses nightmare. It becomes a dangerous situation when the CNA's have control and the nurse is intimidated by them and afraid to tell them to answer a bell- so she runs day and night answering the bells..............Too bad they cant give out your meds or do your charting

    I had more DON's and administrators in my 8 yrs at that facility then I can count. Many had their own agenda-it looks nice on a resume Some try-some do not and the constant change in mgt does not help the issues of leadership/systems/supplies.

    Im not sure exactly what made me decide to leave but the issues mentioned can pretty much sum it up. Never thought I would leave but I did and I have never felt better. There is a huge wht off my shoulders, no more middle of the night phone calls for nonsense-no more BS- no more CNA's abusing me-I do miss my residents and some staff but Im done and will not ever ever go back.

    I dont think its badmouthing LTC to share our frustrations we got
    burnt from the constant/continuous frustrations and abuse we have had to deal. The bottom line is-it takes away from the care we are SUPPOSE to be giving. I did it for 10 yrs and LOVED it for 10 yrs BUT needed a drastic change so I left too
  11. by   KaroSnowQueen
    I left LTC after several years. It seemed no matter where you went to work,no matter how good the facility seemed, after a while, this same old thing came into play.
    My last facility had a corporate office who wouldn't pay our bills. One Friday afternoon, the electric company came to turn off the lights, honestly!!! The administrator paid from her own checkbook and made the company reimburse her.
    We used agency nursing staff for a while, but then corporate wouldn't pay the agencies and nobody would come anymore. In this atmosphere, I began to get paranoid that our paychecks would bounce. They never did, but we did get them postdated more than once!!!!!!!!
  12. by   angelbear
    I dont know what the answers are but I did work LTC only brave enough to tough it out 2 yrs. I absolutely loved the work and the residents (didnt even mind the non nursing mundane 3rd shift tasks) I was 3rd shift charge right out of nursing school (lpn) for 50 residents with 2 aids. I was pretty good too and not afraid of hard work. However I was very afraid of losing my license. One brand new lpn in charge of 2 aids and 50 residents is REDICULOUS. I left due to short staffing, controlling and bossy stna's, non supportive management and not enough pay. I would go back in a heart beat if there were some major changes in staffing levels and nurse friendly management.
  13. by   Hellllllo Nurse
    AMEN!

    Maybe we should start an organization of burnt-out, disillusioned FORMER LTC nurses?!

    I, too, have dealth with no hot water, no towels, no clothes to dress residents in the am. I have brought in my old clothes to give to residents and shopped at thrift stores and Walmart to buy them clothes w/ my own money.

    I stopped at Walgreen's a few times on the way to one job I held for years and bought cups, straws, tissues etc. w/ my own money. A couple times, I called my husband and asked him to pick up needed supplies and run them over me at work.

    But I was not thanked for this or even reimbursed. Instead, I was b*tched out for "not going through proper channels" to get supplies. Well, how are we going to pass meds and try to keep the residents hydrated in the 3 or 4 days it would take to get cups and straws through "proper channels"?

    Well, DebRNNo1, I'm sure we could both go on for days!

    I'm just glad for the both of us that we are outa' there!
  14. by   debRNo1
    Originally posted by Hellllllo Nurse
    Maybe we should start an organization of burnt-out, disillusioned FORMER LTC nurses?!


    Where do I sign up ????

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