I'm new to a large SNF with 3 units. All nurses are excepted to float all units ("so nobody gets in a rut", but really it feels like nobody is able to get into a time efficient groove because of this). We work 8.5 hour shifts. There are frequent call ins on both the Aides and nurses behalf. There is high staff turnover. Worse is, the schedule is poorly staffed to begin with. Nurses and aides are asked to work doubles ALL THE TIME, and we get called on our days off to cover shifts. It's crazy. It's making me feel like I should just move right in to the facility so I can be available at a moment's notice. (Kidding of course, not that I WANT to be available all the time). There are 2-3 aides per unit, no bath aide, and each aide generally is assigned 12-13 (sometimes more) residents. The nurses get 18-25 patients a piece. There is no admission nurse, unit coordinator, or assistant so if by chance an admit gets put on your unit (with no notice of course), you have to suddenly fabricate 2 hours of time in your already completely busy day to complete the 600 pages of admission charting. There is no team work, as in, the next shift accepts responsibility for following through with uncompleted admission charting. The onus is on the nurse who was on shift in the unit during the time the patient was admitted, not that they had any say in the matter. I have come in on my day off to complete admission documentation because of this. Imagine getting two admits? (shivers)
Are these staffing issues normal where you work too? To me, this is completely insane and I may have to become part of the "high staffing turnover rates" because of it.
Last edit by paddler on Feb 5, '12
Feb 5, '12
This does not sound unique to me. Chances are high that it would be the same set of circumstances or similar at the next job.
Feb 5, '12
Thanks Cali, maybe I am just burnt out on nursing in general, eh?
Feb 5, '12
You are not the first that may be a little disillusioned. It happens to almost everyone some time after they start out. Trick is to figure out how to continue without letting your disappointment cloud your entire existence, but that could be said for many lines of work.
Feb 5, '12
I found it a little difficult to get used to people complaining all the time about shift to shift transfer of duties. Nobody could understand the concept of "24 hour operation", but then, I was not the type to slouch around and leave tasks for others that I could have accomplished on my own shift.
Mar 8, '12
I can relate to the short staffing/call-in issues. At my facility it happens all the time. As a result of this, staff end up getting mandated to stay (RNs work 12-hour shifts, CNA's work 8 hours) while the staffing coordinator tries to find someone to come in. The staff is getting burned out, which I believe is contributing to the increase in turn-over and call ins. Positive reinforcement and praise goes a long way in helping someone realize that they are important and are needed at the facility.
Mar 8, '12
We have plenty of call ins at my facility too. It's mostly CNA's. Don't have much of a problem with most of the nurses. One, in fact, has a two year perfect attendance record! And teamwork? Ha! I have started a new program this year to try to help that. We have monthly team work awards. We have a box to put the votes in, staff votes for the co-worker they think deserves it. I bought prizes--nothing fancy, a "great teamwork" badge holder pin for the nurses, a special CNA badge holder pin for the aides, a sports bottle and they get a framed certificate which is hung in the staff break lounge for all to see. They have to write a reason the person deserves the award (to keep from ballot stuffing). Those with the most votes at the end of the month wins. We have a little "ceremony" in front of everyone to announce the winners. One nurse, one CNA each month. I've tried having "mini muffin Mondays"--I spend all day Sunday baking and take them in. I've bought lunch for the weekend staff. I send messages thanking them for all the hard work on Caretracker. In all these efforts, nothing seems to work much. We still have call ins and turn-over. I know you can't "buy" them but I thought showing them a little appreciation would help. If anyone comes up with an answer, please share!!
Mar 24, '12
I agree this is totally insane. A place I know has the same nursing and cna shortages on a daily basis, I feel bad for the staff. They are union and agreed to mandating in their contract, but it's the same people over and over again. Management will not hire any more for whatever reason. It's a very difficult cycle.
Mar 26, '12
My facility was finally able to hire more staff, but I'm afraid that the people with negative attitudes about staffing/call-ins and the new hires seeing people get mandated will scare them away. A few of the new staff are right out of school. I'm doing my best on an individual basis to make it a point to tell the new hires how glad we are to have them and that we appreciate their hard work. Retention is a big issue in our facility. If things get tough or challenging, staff quit. Any other ideas on how to try and retain my new nurses/aides?
Mar 27, '12
Quote from MK1908
Any other ideas on how to try and retain my new nurses/aides?
My biggest rule for myself as a manager is always praise in public and give constructive criticism in private. I make it a frequent point to give a shout out to someone who did a great job.
With new staff I often find myself needing to re-educate them on something. I usually put a "love note" on their time card asking them to come see me and I really call them a "love note". It's just my way of saying "Hey, come see me and don't be afraid you're in trouble but I need to explain something better". The first couple times they come in hesitating but after a bit, they walking in smiling asking "What did I do wrong now" with no real fear. I actually love hiring new nurses and I love helping them to become really good nurses. I am so proud of them as I see the constant improvement and watch them gain confidence in themselves. Many are very eager to learn and willing to accept and learn from mistakes. Admittedly, some don't get it, don't want to get it or whatever - they just eventually gotta go. The good outweigh the bad by miles.
Apr 1, '12
Nascar, this sounds great. I like your "Praise in public" theory. We hardly ever hear praise, and I have seen nurses crying while they were being lectured in front of others. 2-3 nurses/aides are being let go almost every month. I am a nurse and I have 23 years at my facility and I am worried that it is my turn. I am not perfect, but I do listen and I do the best I can and I know I am a good nurse. I have seen so many others let go that I can not even keep track of them.
Apr 3, '12
It was my experience that most all SNFs operate this way; hence the reason I left. Repeated call-ins feed the negative cycle of working short shift to shift. Bonuses, public praise are great ideas to help establish a positive environment.
The sad truth is that SNFs are businesses and money is the main concern so insufficient staff and low pay are a norm. Until those two factors are changed, the negative atmosphere(for flavors thereof) will prevail.
I worked in many places where, when CNAs called in, the nurses were also responsible for a patient or two in addition to the nurse's own duties. Then when the nurse's duties weren't completed in 8 hours and that nurse had to stay over, the DON chided him/her for the OT and the nurse was told to clock out at the end of the normal workday and finish the work unpaid. That was asinine but..who wanted to argue? Who wanted to risk getting fired? Many of those places have employees over a barrel...and have for quite awhile now in this poor economy.