Help developing leadership/accountability in our nurses

[HeyHeyitsMaay]

I work for probably the most amazing skilled nursing facility I've ever seen. We truly love our residents, rehab patients and staff with all of our hearts. I've been the ADON for about a year now and I'm having an issue with our evening shift.

Our nurses work 12's, 6-6. Our med aides and CNA's work 8's. Our evening shift aides start work at 2p and since I've been at this facility, we historically have an issue with aides disappearing and/or standing at the nurse's station talking while call lights are going off. The nurses are pretty busy and I'd like to see responsibility on their part for answering call lights a lot more than I am right now. Needless to say, by the time dinner rolls around, hell has broken loose as this is also when our hospitals send new and re-admits.

Myself and our 2 unit managers rotate through each day of the week with a late night to make sure we're there to support and assist during this time of the day, but it's to the point that when we're not there, we all worry about the level of care that's being provided because of the ethic we're seeing during this shift. I'm wondering how I can motivate our nurses to take more of a leadership role with their aides.

I had an incident tonight where a family member got upset that her mother wasn't put to bed in what she felt was a timely manner and she got pretty inappropriate with one of the nurses. As this family member was walking around asking who the med aide cna and nurse were assigned to her mother, the nurse stood next to me and said under her breath "I told them to get her in bed before her daughter got upset". I intervened, took time to educate the nurse on how to approach this situation as far as communicating what she'd done to get the situation taken care of and to give a time frame as to when her mother would be given her meds and put to bed. In the middle of this, shift change and report was imminent with the next shift nurses there who could have offered to help but weren't available to do so because we had two sundowning residents who's behaviors were off the charts disruptive and they were both a danger to themselves.

Does anybody have any ideas of things we can implement to anticipate this time of day and expectations we can give our nurses and then how to implement those?

Our DON is absolutely uninvolved and not helpful at all. So she's out. Thanks in advance for your help!

[bendyprissy]

I have a question and a comment I suppose. If you know the aides are sitting up at the front during call bells going off, not doing there job, why have you, as management, not done your part in reprimanding the persons not doing their jobs versus adding yet another responsibility to the nurses that you say you see are busy?

[Nascar nurse, ASN, RN]

I have a question and a comment I suppose. If you know the aides are sitting up at the front during call bells going off, not doing there job, why have you, as management, not done your part in reprimanding the persons not doing their jobs versus adding yet another responsibility to the nurses that you say you see are busy?

Because the ADON is likely circulating around the building at any given time. The nurses....the ones who work side-by-side the aides need to be setting the standards of behaviors. If not, everyone jumps when management hits the floor but goes right back to poor habits as soon as they are gone. If the nurse is making the aides do their jobs then it happens for the entire shift!

[silverbat]

Both management and the charge nurses need to address this when it is noted.. IMMEDIATELY.

[HeyHeyitsMaay]

I reprimand both nurses, med aides and cma's when I see this happening. Our culture in our facility is such that even our administrator, maintenance and house keeping answer call lights (and respond to the extent of their licensure or lack of it...the point is customer service and letting our residents/patients know that someone sees their light and are on the way to get help with their issue if nothing else) And all nursing management intervenes when we see that it's not getting done. It's this one shift that has the issue and I know it's also going on when we're not there at night. Just running out of ideas as to how to address it.

When management isn't around, nurses have to answer for what happens, or does not happen to and/or with their assigned residents. If their residents aren't being turned, repositioned, hydrated or having their briefs changed with proper pericare, they're going to have to answer as to why. It's nice, and necessary - to know that they have the leadership ability to guide their aides to make sure that patient care is getting done.

[DedHedRN]

It would be nice if management would give the nurses tools to use to talk to her aides all night long while also doing her own job. Walkie talkies with ear buds have worked well in places I have worked, it improves communication like you wouldn't believe. Also saves everyone time, and aides and nurses are able to coordinate work easily.

But some places think that by reprimanding the nurses that it will improve things. When in fact it doesn't change anything. Nurses by nature do the best they can, with the TOOLS they are given.

[HeyHeyitsMaay]

I love your answer Isis. I'm actually working on our administrator to get us something like CareRight Voice to help with ADL charting to make it easier on our aides. I can't stand constant reprimands their jobs working on the floor are already hard enough and Medicare changes aren't making it any easier. I had walkie talkies in a facility I was at years ago and they were awesome. I know our administrator is iffy about them but I'm going to take it to her again on Monday and see if I can couch it in more positive terms that she'll be receptive to.

[NurseGuyBri]

I agree with Isis! You are right on. I too work for a wonderful facility, but we have little support at times from corporate. I think walkies with the earbuds is an awesome idea, I'm going to see what we can do!