RN or busperson? - page 2

:uhoh3: We have NO feeding assistants at my facility. Feeding patients is one thing (not my favorite thing, but understand it's part of the job - there just aren't enough CNA's and the LPN is... Read More

  1. by   ktwlpn
    Quote from NursesRmofun
    I don't know. It's not that a RN can't bus tables or feed residents/clients, but is it making good use of the nurses time? .
    While the cna's are transporting to and fro and feeding and the LPN's are passing meds what do you suggest the charge nurse do? -many would chat on the phone or read a magazine at the desk.....I believe that all aspects of the residents care are ultimately the nurse's responsibility..Nutrition is a very important aspect of resident care in LTC...The cna's may have to feed a half a dozen residents.The charge nurse can jump in and make sure the residents get their requested substitutes,condiments,additional fluids...and assess for the appropriateness of their diet...If helping to bus the dining room helps the cna's get through the meal and continue with resident care then do it....If it enables the cna's to sit and chat with each other while feeding the residents or catch an extra smoke break then don't.....I don't see where this type of thing is beneath any of us-you do the same thing in acute care if you use the primary care model and don't have cna' on your unit...I'm charge on a 22 bed unit-I trim eyebrows and ear hair if the barber misses it....I'll pick noses,too.I also shave hairy chins and chests of trach pts...If someone drops a bomb while ambulating to the bathroom I'll pick it up...I'll also empty overflowing trash if we are short of housekeepers....If they are chit chatting down the end of the hall I will call them over to do their job....It's all for the resident and their visitors....
  2. by   lisasmom
    Quote from ktwlpn
    While the cna's are transporting to and fro and feeding and the LPN's are passing meds what do you suggest the charge nurse do? -many would chat on the phone or read a magazine at the desk.....I believe that all aspects of the residents care are ultimately the nurse's responsibility..Nutrition is a very important aspect of resident care in LTC...The cna's may have to feed a half a dozen residents.The charge nurse can jump in and make sure the residents get their requested substitutes,condiments,additional fluids...and assess for the appropriateness of their diet...If helping to bus the dining room helps the cna's get through the meal and continue with resident care then do it....If it enables the cna's to sit and chat with each other while feeding the residents or catch an extra smoke break then don't.....I don't see where this type of thing is beneath any of us-you do the same thing in acute care if you use the primary care model and don't have cna' on your unit...I'm charge on a 22 bed unit-I trim eyebrows and ear hair if the barber misses it....I'll pick noses,too.I also shave hairy chins and chests of trach pts...If someone drops a bomb while ambulating to the bathroom I'll pick it up...I'll also empty overflowing trash if we are short of housekeepers....If they are chit chatting down the end of the hall I will call them over to do their job....It's all for the resident and their visitors....

    I would love to work with you, so sound like my kind of nurse!!!!
  3. by   NursesRmofun
    Quote from ktwlpn
    while the cna's are transporting to and fro and feeding and the lpn's are passing meds what do you suggest the charge nurse do? -many would chat on the phone or read a magazine at the desk.....i believe that all aspects of the residents care are ultimately the nurse's responsibility..nutrition is a very important aspect of resident care in ltc...the cna's may have to feed a half a dozen residents.the charge nurse can jump in and make sure the residents get their requested substitutes,condiments,additional fluids...and assess for the appropriateness of their diet...if helping to bus the dining room helps the cna's get through the meal and continue with resident care then do it....if it enables the cna's to sit and chat with each other while feeding the residents or catch an extra smoke break then don't.....i don't see where this type of thing is beneath any of us-you do the same thing in acute care if you use the primary care model and don't have cna' on your unit...i'm charge on a 22 bed unit-i trim eyebrows and ear hair if the barber misses it....i'll pick noses,too.i also shave hairy chins and chests of trach pts...if someone drops a bomb while ambulating to the bathroom i'll pick it up...i'll also empty overflowing trash if we are short of housekeepers....if they are chit chatting down the end of the hall i will call them over to do their job....it's all for the resident and their visitors....
    [font=franklin gothic medium]well, that is nice. however, we seem to have enough cnas to do the hygeine and personal care while the lpns give out the medications, do treatments, and chart notes....and i (as a unit manager) am learning how to do mds and pris, making sure all the paperwork is done, i&as are investigated or the careplans updated, talking to families and the doctors, rounding and picking up orders, etc. after all, i am responsible for that too. in other words, i do have work to do...not sit and read magazines. i also hope the nurses' aides are not reading magazines except on a break. i am not currently working in acute care, although i have very recently been working in acute care and am very familiar with how things go with primary nursing. we do/did have cnas and techs even in primary care settings. it is not that it is beneath me, but it's not part of my job description right now. however, there is one rn that currently does man the feeding room at lunchtime in my facility.
    Last edit by NursesRmofun on Apr 12, '04
  4. by   ktwlpn
    Quote from nursesrmofun
    [font=franklin gothic medium]and i (as a unit manager) am learning how to do mds and pris, making sure all the paperwork is done, i&as are investigated or the careplans updated, talking to families and the doctors, rounding and picking up orders, etc. after all, i am responsible for that too.
    i believe firmly that ltc charge nurses need to be more closely involved with the direct care of the residents on the unit-i don't mean performing it...i mean monitoring the staff that are...we have an rnac with a team of nurses that perform the mds.we are responsible for the monthly summaries and tracking sheets only.they do the rest and are responsible for the care plan(we update it prn,of course) the mds is the bottom line-no way can the charge nurse give that the attention that is required and do everything else....we also have a quality assurance nurse-she follows up on all incident reports....as the unit manager or charge nurse or whateveryou call it i am responsible for making sure the unit runs smoothly and the residents are receiving the care they need.....along with my routine duties (med,tx,,body checks,wound measurements daily and monthly charting ,aims,braden scales,etc)) i ,too am rounding with the docs,ordering supplies and since i do not have a full time unit clerk i am also ordering supplies and prepping each months paperwork.i make sure i am monitoring the staff-i have some of the best aides in the facility but they have days off....some of the rest will cut every corner when they think no-one will notice.i believe that the most important part of my job is to notice...the nurse that runs around all day with blinders on totally focused on her paperwork does not get my respect..i am no desk jockey-in fact i have a hard time sometimes making myself sit down to do what i have to do...i would rather be on the floor closely involved with the residents............it looks like i have it pretty good right now,doesn't it? these threads remind me to appreciate my job....my job description ends with the phrase "and any other duties as assigned and necessary" i have worked in a primary care in a hospital that laid off all of the cna's.....we did it all....if we admitted a diabetic late in the evening we even unlocked the kitchen to get them a meal.....
  5. by   NursesRmofun
    Quote from ktwlpn
    i believe firmly that ltc charge nurses need to be more closely involved with the direct care of the residents on the unit-i don't mean performing it...i mean monitoring the staff that are...we have an rnac with a team of nurses that perform the mds.we are responsible for the monthly summaries and tracking sheets only.they do the rest and are responsible for the care plan(we update it prn,of course) the mds is the bottom line-no way can the charge nurse give that the attention that is required and do everything else....we also have a quality assurance nurse-she follows up on all incident reports....as the unit manager or charge nurse or whateveryou call it i am responsible for making sure the unit runs smoothly and the residents are receiving the care they need.....along with my routine duties (med,tx,,body checks,wound measurements daily and monthly charting ,aims,braden scales,etc)) i ,too am rounding with the docs,ordering supplies and since i do not have a full time unit clerk i am also ordering supplies and prepping each months paperwork.i make sure i am monitoring the staff-i have some of the best aides in the facility but they have days off....some of the rest will cut every corner when they think no-one will notice.i believe that the most important part of my job is to notice...the nurse that runs around all day with blinders on totally focused on her paperwork does not get my respect..i am no desk jockey-in fact i have a hard time sometimes making myself sit down to do what i have to do...i would rather be on the floor closely involved with the residents............it looks like i have it pretty good right now,doesn't it? these threads remind me to appreciate my job....my job description ends with the phrase "and any other duties as assigned and necessary" i have worked in a primary care in a hospital that laid off all of the cna's.....we did it all....if we admitted a diabetic late in the evening we even unlocked the kitchen to get them a meal.....
    [font=franklin gothic medium]i certainly respect your work ethic. i don't plan on having blinders on by any means. i don't work that way. i want my residents to be well cared for. however, paperwork is a part of my job. we do not have a unit secretary. we *currently* do not have an mds coordinator. all facilities run a little differently. i am not afraid of hard physical work...i have done plenty of it....but the job i have now requires a little more paperwork than some other jobs. i will do what is needed, but i can also allow other people to do the jobs for which they were hired. if i need to pitch in, i will and i do.
  6. by   miss_nurse2004
    In our facility, for each meal, there is always a department head present in the cafeteria...whether a nurse or the head of medical records. They monitor the trays as they are passed out, and also help the cna's with whatever needs done. The post meal groomer also helps pass trays until residents begin to finish their meals and are ready to leave. Whether lpn or rn or cna...it's all our jobs to make sure these people are taken care of, even if it's helping to fetch a glass of tea or passing meds.
  7. by   rascalsmom
    As a DON in a 135 bed SNF, I can tell you my opinion and the practice in my Center is for everyone.. including Social workers, activities, etc to be involved with mealtime. No one takes a break or goes out to lunch during the meal time. RNs, LPNs and CNAs and Speech Therapy and OT feed patients or assist in the dining rooms. The SWs and non clinical staff (including my secretary) are out passing out trays, taking trays up and helping in one of the 3 dining rooms we have going. There is a department head assigned to each dining room every day including one to come in on weekends for the mid day meal. Even our maintenance man serves lunch or buses tables. Because of the mandates put on us to serve meals hot and within a certain time frame, and because nutrition is one of our primary foci in LTC, we feel it is one of the most important things we do. I can explain to my Regional folks or the owner of my chain why an MDS might have been late (doesn't happen often by any means) but no way can I get away with a patient having unintentional weight loss or a patient going hungry. As for hiring someone to "bus tables", true.. no budget in the business can handle that. Our reimbursement from Medicare and Medicaid has been cut so much I wonder how in the world we can do what we do. My RNs and LPNs jump in and get the job done at meal times even to the point of changing med pass times to accomodate the meal schedule so they can help out. occasionally I will have a nurse say that "her work wasn;t getting done".. well, anything to do with patient care is "her work".. I do not condone the RN or LPN having to help out if the CNAs are not doing their share. I tell my nurses and CNAs during orientation that I expect everyone of them to toilet a patient, etc when needed but I do not expect that nurse to stop a med pass to toilet a patient while the CNA is sitting at the desk or visiting around the unit.

    But I have been in nursing for 34 yrs and in LTC for 14 of them. I would never go back to any of the other areas I get my best feedback from patients when I sit and give them a manicure or a pedicure and they fill me in on all the happenings around the Center. I am in one of the dining rooms daily for lunch and supper and my Administrator is as well. We try to lead by example. I do not ask my nurses to do anything I would not / could not do myself.

    Well, I have rambled on enough here.. think I made my point. I understand where you are coming from with feeling like you are doing things that can be done by other than an RN and there are things you need to be doing that a CNA or feeding assistant cannot do.. but if we all remember that we are here to provide care not only with our hands, but with our heart, everything will get done.. maybe not according to our timetable set in the morning, but it does manage to get done. Of course, I am fortunate to have the best nursing staff in my area and we have the best reputation for quality care and customer satisfaction as well. I have very little turnover and over 1/2 of my CNAs have been with us for over 15 yrs and many of my nurses have been for 10 yrs. have a few nurses who have been here for 20 yrs and many CNAs who have 18+ yrs in.

    gonna hush now.. can you tell I am wired? Worked 15 hrs today.. had 7 am UR/QA meeting, did my DON day.. and then stayed to help new nurse on 3-11 and do some inservices for evening shift. going to sleep in in the morning.. or this morning rather.. just realized it is almost 2 am.

    nice to meet you all.. Nursing in LTC is the best.

    Bre
  8. by   jyoung1950
    . . . . I would be proud to work for you. You sound reasonable and fair.


    The DON at the facility I work at has occasional screaming fits where she seeks out the CNA's and has hysterics right in front of everyone - workers, residents, whatever.
  9. by   rascalsmom
    thank you for your kind words. c'mon down.. might have an adon position coming open.. my adon has been offered the don job at a sister facility. going to kill my regional for even asking her , but would never stop her from moving up.. as i don't plan to go anywhere for a while.

    btw, i have my screaming fits sometimes too but i do restrict them to my office alone... or in the administrator's office. she is my sounding board. :angryfire i never let my staff see me sweat or scream.. and hope i don't.. now 25 yrs ago when i was supervisor in the ed now that was a different story .. the irish in me came out often.

    brenda


    Quote from jyoung1950
    . . . . i would be proud to work for you. you sound reasonable and fair.


    the don at the facility i work at has occasional screaming fits where she seeks out the cna's and has hysterics right in front of everyone - workers, residents, whatever.
  10. by   jyoung1950
    don't think i could make it as an adon - i'm just a cna and no nursing education.

    need cna's????!!!!!


    Quote from rascalsmom
    thank you for your kind words. c'mon down.. might have an adon position coming open.. my adon has been offered the don job at a sister facility. going to kill my regional for even asking her , but would never stop her from moving up.. as i don't plan to go anywhere for a while.

    btw, i have my screaming fits sometimes too but i do restrict them to my office alone... or in the administrator's office. she is my sounding board. :angryfire i never let my staff see me sweat or scream.. and hope i don't.. now 25 yrs ago when i was supervisor in the ed now that was a different story .. the irish in me came out often.

    brenda
  11. by   rascalsmom
    always looking for good CNAs .. and btw, there is no such thing as "just" a CNA.. like I tell my nurses, CNAs are my eyes and ears.. they know more about the patients than my nurses. If a CNA comes to me and says Mrs. Smith is not right.. I jump. And it is the grand nursing care that has kept our SNF free of inhouse developed decubs for 13 months.. :hatparty:

    so if you get to SC let me know... :-))

    brenda



    Quote from jyoung1950
    Don't think I could make it as an ADON - I'm just a CNA and no nursing education.

    Need CNA's????!!!!!
  12. by   Alast
    To me, as a RN, and yes I have and still do work LTC and Acute-care both. it is my job to do whatever is needed by both my patient/resident, other staff members, and family member. Sometimes it is hard. Pulled in 15 different directions at the same time and not enough min's in a day. But when a fellow staffer or resident smiles and says thanks for the help. It sure makes it worth while,
  13. by   debRN0417
    Thank you.....I just initiated this at my facility. Everyone needs to feed, and if you can't feed, you can get water, open milk, help set up, whatever. No one should have to wait for their meal. Thank you!



    QUOTE=rascalsmom]As a DON in a 135 bed SNF, I can tell you my opinion and the practice in my Center is for everyone.. including Social workers, activities, etc to be involved with mealtime. No one takes a break or goes out to lunch during the meal time. RNs, LPNs and CNAs and Speech Therapy and OT feed patients or assist in the dining rooms. The SWs and non clinical staff (including my secretary) are out passing out trays, taking trays up and helping in one of the 3 dining rooms we have going. There is a department head assigned to each dining room every day including one to come in on weekends for the mid day meal. Even our maintenance man serves lunch or buses tables. Because of the mandates put on us to serve meals hot and within a certain time frame, and because nutrition is one of our primary foci in LTC, we feel it is one of the most important things we do. I can explain to my Regional folks or the owner of my chain why an MDS might have been late (doesn't happen often by any means) but no way can I get away with a patient having unintentional weight loss or a patient going hungry. As for hiring someone to "bus tables", true.. no budget in the business can handle that. Our reimbursement from Medicare and Medicaid has been cut so much I wonder how in the world we can do what we do. My RNs and LPNs jump in and get the job done at meal times even to the point of changing med pass times to accomodate the meal schedule so they can help out. occasionally I will have a nurse say that "her work wasn;t getting done".. well, anything to do with patient care is "her work".. I do not condone the RN or LPN having to help out if the CNAs are not doing their share. I tell my nurses and CNAs during orientation that I expect everyone of them to toilet a patient, etc when needed but I do not expect that nurse to stop a med pass to toilet a patient while the CNA is sitting at the desk or visiting around the unit.

    But I have been in nursing for 34 yrs and in LTC for 14 of them. I would never go back to any of the other areas I get my best feedback from patients when I sit and give them a manicure or a pedicure and they fill me in on all the happenings around the Center. I am in one of the dining rooms daily for lunch and supper and my Administrator is as well. We try to lead by example. I do not ask my nurses to do anything I would not / could not do myself.

    Well, I have rambled on enough here.. think I made my point. I understand where you are coming from with feeling like you are doing things that can be done by other than an RN and there are things you need to be doing that a CNA or feeding assistant cannot do.. but if we all remember that we are here to provide care not only with our hands, but with our heart, everything will get done.. maybe not according to our timetable set in the morning, but it does manage to get done. Of course, I am fortunate to have the best nursing staff in my area and we have the best reputation for quality care and customer satisfaction as well. I have very little turnover and over 1/2 of my CNAs have been with us for over 15 yrs and many of my nurses have been for 10 yrs. have a few nurses who have been here for 20 yrs and many CNAs who have 18+ yrs in.

    gonna hush now.. can you tell I am wired? Worked 15 hrs today.. had 7 am UR/QA meeting, did my DON day.. and then stayed to help new nurse on 3-11 and do some inservices for evening shift. going to sleep in in the morning.. or this morning rather.. just realized it is almost 2 am.

    nice to meet you all.. Nursing in LTC is the best.

    Bre [/QUOTE]

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