New LPN, going on four months at LTC facility. HELP!!

NurseHopefulInOH · Jul 29, 2011

First thing that comes to mind is you need to get control of you NA situation.Part of what we learned in school is delegating. You are their supervisor. They need to be feeding the residents and checking in with you when they leave the floor and back in when they come back for breaks. Yeah I help out and answer lights but its not my main responsibility.Sounds like they are taking advantage of you because you are new to the job and new to nursing. I'm pretty sure the other and or older nurses dont take crap from them. The med pass gets easier the longer you do it. I like to write down every time I give a narc and the time just to double check at end of shift.

mkahnlpn · Jul 29, 2011

this is so familiar, and one of the main topics on this website (IMO) But, honey, I feeeeeeeeel your pain! Like NursehopefulInOH said, the medpass does get alot easier. I agree with her entire reply. I too struggle with my delegation skills. I find it hard sometimes to not help someone in need, thats just in our blood as women, and as nurses. But as time goes on, it WILL get easier. Just hang in there, or...do what Im doing (continuing my education) :) BEST OF LUCK...

silverbat · Jul 29, 2011

I agree that you need to get control of your aides. IF your DON will not help you, go above her to the administrator. He/she will not allow CNA's to run over a nurse. Would your DON consider a CMT to pass meds for you? That would allow you to do the very important treatments, and other duties, or perhaps a treatment aide part time to do treatments? I would suggest you have a long talk with your DON about the realities of your job. I know that being new is also a factor, but after four months, things should be going alittle more smoothly, so enlist her help. Best wishes!!!

mazy · Jul 29, 2011

then i'm popping pills like a crazy woman..trying to remember to sign the narcs out when i get them. i've cut back on my time a little by combining a few medications that i know can safely be taken together. i cheat a little bit by giving meds before and after the "hour long" window. window? i need a dang garage door.

ok. well good to see you still have a sense of humor. :lol2:

i agree with the others. it sounds like the big problem here is the aides. time management is something you will get better at, but i don't see how that will happen if you are being pulled away from your nursing duties.

and why are you supposed to be feeding the patients? that's med pass time. and they yelled at you for not being on time? who is running this dump?

i think you need to what is probably one of the hardest things a new nurse needs to do, and that is, put your foot down with the aides and get them to do their jobs. if they give you attitude, ignore it, repeat your request, and move on. use polite language but make sure that they know you expect them to do their jobs, do not engage in any kind of dialogue, ignore the rolled eyes, and if you can't get it to work out, go to management -- although i would do that after exhausting every resources to get your aides to cooperate.

believe it or not, if you have good aides there, they are probably also extremely frustrated with the bad aides because they are also getting stuck with their work. they are most likely hoping that you will put your foot down so that their lives will also be easier. if they see that you are willing to advocate for their well being, you will be able to form better relationships with them. think about how you work with the manager who doesn't do anything about staff problems and the manager who goes in their and fights for their staff. who are you willing to go the extra mile for?

the aides can't leave the floor without telling you. next time you're missing an aide, when that aide turns up, ask where they were and then tell them that they cannot leave the floor again without telling you. rinse, lather, and repeat until they get it. if they don't you can go to management and say that you repeatedly told this aide to do something and the aide repeatedly ignored it and now management needs to reinforce this.

ltc can be challenging in so many bizarre ways.

Psychtrish39, BSN, RN · Jul 29, 2011

Yes as others have said get those CNAs under control and do with them a little mini report at the beginning of shift see who is assigned where and tell them you will help if you can but you have your own responsibilities and what you expect from them. Tell them they are your eyes and ears and as other posters have said try it for a few days if their work and attitudes dont improve write them up and go to the DNS and Management if they wont help you I would look for another place. I have to say working LTC as long as I have 90 percent of CNAs are wonderful those chicks are just taking advantage of you. I know it is not fair it happened to me too.. Sometimes managing people is like herding cats. Not easy and the cat has to want to do it.... :) Hang in there you sound like a great nurse already and I have been an RN for a while and LTC is the hardest nursing there is due to patient load and all the responsibility

Forever Sunshine, ASN, RN · Jul 29, 2011

I'd start by taking that write up from the Kitchen Manager or whatever the title was and toss it in the shredder.

I have said this countless times on this board. After resident safety, my medpass comes first. You are putting chemicals into peoples bodies. If you make a mistake, it can be deadly. Take as much time as you need and definitely get your CNAs in gear. Make them clear of your expectations. No sitting at the nurses station eating chips (call me a witch) when theres call bells going off and residents are all over the place. Enlist the help of the ADON or DON if they give you trouble.

NurseHopefulInOH · Jul 30, 2011

Just wanted to add that what helped me with my aides is making them feel like you are all a team. Like someone said I give them a mini report and give assignments and make sure they are helping each other with 2X assists. We work together. I answer call lights for them or do small tasks as much as I can and they help me to position a resident for tx's or making sure someone in in their room for before meal FSBS and insulin. We work out these things ahead of time and I coordinate my care with their rounds. I find most enjoy helping and feeling like a bigger part of the residents care. The lazy ones well... if you have decent management those situations work themselves out in the end. Some just need a little extra guidance and prompting from you. If you are asking them to do things that are repeatedly not getting done its your job to report them to upper management. I think this is a skill set that you are not being able to utilize and practice in nursing school and when you get into the real world and have 30 residents instead of 5 its a big shock how much you need to rely on others. Good luck! it gets easier!

Ms.RN · Jul 30, 2011

I think part of it is because they are testing you because you are a new nurse or it might be because your facility sucks.

Most of facilities I've worked at have a treatment nurse. Because nursing homes have to be compliant with state regulation they have to have somebody to measure all the wounds, monitor effectiveness of treatment etc.. So who does all this at your facility? Also nurses from different unit rotates to come to the dining room and assist with feeding. Are you only a nurse working on your unit or do you have another nurse with you? you might want to rotate with another nurse if possible. We also have unit managers and MDS nurses come to the dining room and assist with feeding.

I agree with other posters that your aids wiill make your job difficult or easier. Get a control of your aides. Try not to let anybody interrrupt you during your med pass. First year was really difficult for me but it got easier,so hang in there

pixie120 · Jul 31, 2011

I'd start by taking that write up from the Kitchen Manager or whatever the title was and toss it in the shredder.
I have said this countless times on this board. After resident safety, my medpass comes first. You are putting chemicals into peoples bodies. If you make a mistake, it can be deadly. Take as much time as you need and definitely get your CNAs in gear. Make them clear of your expectations. No sitting at the nurses station eating chips (call me a witch) when theres call bells going off and residents are all over the place. Enlist the help of the ADON or DON if they give you trouble.

As a DON, I would appreciate a nurse that came to me with this problem and I would gladly problem-solve, all nurses know who the good cna's are and the "bad" and it's quite possible they are testing you, and they need to hear it from theother nurses that this isn't acceptable however, that can back fire on you, if they perceive you a weak. I think treatments/wound care is every bit as important as med pass, and as I posted at another place, some of those meds are very unnecessary and it's a win-win if the meds get consolidated and/or go bye bye, so start asking your Doc's to review and reduce unnecessary meds. Fax them a list that YOU think might be unnneeded and then they can say yeah or neah. Make the aides sign in and out for breaks, lunches and no eating at a nurses station, period. Call-lights are the priority, for all staff.

Lapishsunsmile · Dec 30, 2015

I'm a cna. We have 22 people on the hall I work. Two cnas work as a team and there's one nurse. If a resident asks a nurse for something and the nurse is doing med pass or is just busy in general, she will tell us and we have no problem doing it as soon as we can. With only two cnas on a hall that most people are 2 assist, we get pretty busy and sometimes we are stuck in a residents room for what feels like an eternity. Your cnas sound like they are making excuses though and if they can't account for their whereabouts i would advise writing them up. Some cnas think they can get away with anything because of seniority, cliques, etc. you need to show them that you aren't afraid to put your foot down. Cutting out interruptions during med pass will help you wonders. Even if you have to leave a resident until you see a cna walk by, you can at least say you had the intention to tell someone. When a specific one of the nurses is busy, she turns on the call bell on her way out of a room. I find that very helpful as a cna.

Penholder · Dec 30, 2015

I didn't read through every reply..

As a CNA-you don't have a nurse problem, you have a CNA problem. CNA are primary responders to call lights. They should be feeding residents. Breaks should be scheduled so that no one is on break at care times (generally 830-1030) and during meals. Pregnant or not pregnant, she should not be behind the nurses station EVER. The patient who requires 3 for turning should be evaluated by PT for a better way to do that. If you only have 3 aids they should not all be tied up with one patient, it puts the rest of the unit at risk.

And for the love of infection control, NO ONE should be eating in a patient area! Also-find a way to nix the smoking. Huge time suck.