Are these yellow flags or red flags?

Ruby Vee, BSN · Feb 15, 2018

I interviewed at a rehab that I got a good impression of on the whole but there's a few things that flew yellow flags in my head. On the one hand I'm a new grad and I hear my dad's voice going "A job's a job you can't be picky in this economy!" But on the other hand I don't want to be kicking myself for ignoring the things that concerned me about this place...
The good stuff-
Ratios: 30 pt, 2 RN or LPNs, 1 unit supervisor, 4 CNA's. (Pretty Reasonable)
3-4 weeks orientation with extra time given if needed especially for new grads.
Not bad turn over rate, they said typically new grads come for a couple years experience and then go to the hospital and some stay for many years. Their average is about 5 years and their longest standing employee is an aide who's been there for 50 years (!)
2 LTC floors and 1 subacute floor, I expressed my interest in wound care/future certification and they said the subacute would be a good fit for me as they have many dressings and fairly frequent wound vacs, they have a wound nurse on site as well 2x a week.
She wasn't sure what shifts were available or what the pay would be b/c the DON who was supposed to interview me was sick and he does those calls, she's the QA nurse and fills in for supervisory roles.
The bad news -
They don't use an EMR, they only have computerized assessments. MAR and treatment documentation is all by hand on paper. I asked her if they would be updating to EPIC or Powerchart/Omnicell, ect any time soon and she basically said "No, our older staff really is pushing against making the switch even though the state is pushing us to convert. This gives me a secondary concern that the older staff is unwilling to change and this may lack evidence based practice relying on "the way we've always done it".
She also mentioned that on this subacute they're mostly walkie talkies but the call lights never stop because and I quote "The patients want what they want and won't stop calling til they get it". (???) This makes me concerned that management will view patient satisfaction over nurse judgement/education.
Last bad thing mentioned was that as far as admissions/discharges it wouldn't be uncommon to have up to 3-4 in one shift. How does one do 4 hand written admissions with 10 patients' med passes and treatments?
Do you think this place would be a good place to get wound care experience or should I keep looking? Please advise...

Paper charting isn't in vogue these days, but it isn't that difficult to learn. As I understand it, most places will be forced to go to EMR at some future date, and you would be in a great position to be an EMR superuser or trainer when that happens. You might prefer computer charting, but I don't see paper charting as that big of a negative. (I've done both and I love the EMR, but I don't think paper is a deal breaker. Especially not in that environment.)

The phrase about the patients "want what they want and won't stop calling until they get it" sounds to me like the manager is predisposed to value nurse judgement over patient satisfaction. Or at the very least as though she understands that patients may not be satisfied because they've had to wait 20 minutes for their third bowl of ice cream while you were dealing with a patient fall. I'd move that one into the good news column.

3-4 admissions or discharges on a shift may be MORE doable with paper charting than with computerized charting. Likely most of the forms are check boxes, "circle all that apply" or have you write in brief phrases. It's a whole lot easier to tick off a lot of boxes on paper (once you're familiar with the forms) than it is to tick them off on a computer, wait for it to reload before you move on to the next page, tick off more boxes and wait for the computer to reload . . . . Nursing software is notoriously slow. It hangs, it freezes, it reloads endlessly, and if you get up to answer a light while it's reloading, it may sign you off without saving your work so you have to start over from scratch.

Sounds like a great place to get experience! Go for it!

RNingaround · Feb 17, 2018

Thank you so much for these comments! It was hard for me to discern between the lines of the interview and this really helps give me some perspective.

Orion81RN · Mar 17, 2018

Paper charting isn't in vogue these days, but it isn't that difficult to learn. As I understand it, most places will be forced to go to EMR at some future date, and you would be in a great position to be an EMR superuser or trainer when that happens. You might prefer computer charting, but I don't see paper charting as that big of a negative. (I've done both and I love the EMR, but I don't think paper is a deal breaker. Especially not in that environment.)
The phrase about the patients "want what they want and won't stop calling until they get it" sounds to me like the manager is predisposed to value nurse judgement over patient satisfaction. Or at the very least as though she understands that patients may not be satisfied because they've had to wait 20 minutes for their third bowl of ice cream while you were dealing with a patient fall. I'd move that one into the good news column.
3-4 admissions or discharges on a shift may be MORE doable with paper charting than with computerized charting. Likely most of the forms are check boxes, "circle all that apply" or have you write in brief phrases. It's a whole lot easier to tick off a lot of boxes on paper (once you're familiar with the forms) than it is to tick them off on a computer, wait for it to reload before you move on to the next page, tick off more boxes and wait for the computer to reload . . . . Nursing software is notoriously slow. It hangs, it freezes, it reloads endlessly, and if you get up to answer a light while it's reloading, it may sign you off without saving your work so you have to start over from scratch.
Sounds like a great place to get experience! Go for it!

I'm having the same issue with a place at which I want to work. I love EMR. I've only had good experiences. I lasted only one day at a place with paper MAR. But to be fair, the whole facility was a mess, so I don't have any other paper MAR experience to go by. I might turn down the job solely because it is all paper. My friend and old coworker works there now and likes it. She says its better than our last place, more organized, and she actually has time to do med pass on time AND toilet patients.

So, I feel like I could be an idiot to turn that down. Because the rest of the places around here are ltc with the typical terrible pt to staff ratios.

RNingaround · Mar 27, 2018

Update! I just had my follow up interview with the DON today.

Down sides- he was 30 minutes late to the appointment, couldn't find my paperwork, overall disorganized.

Plus sides- very nice/gracious and helpful, didn't feel like he was trying to rope me in but genuinely hoping we'd be an employee/employer fit

They were working on swapping around a few nurses (night shifter moving to eves, eves moving to supervisor, another eves leaving to pursue a hospital position, supervisor stepping down) And he told me that likely there'd be both a night and eves opening. Hourly rate was not discussed since an offer wasn't officially made/available, I didn't press it because I don't think I'll be taking the offer if one is made in 3 weeks (which he implied would be the likely outcome). He said he really liked me and I seemed kind articulate and knowledgeable, that he'd like to have me on the team but even if I find work somewhere else in the meantime to take his card and call/email him any questions and he'd be happy to help me if I ever needed advice.

What I learned from this whole experience watching how they run is that management cared very personally about their nurses at this place and I think that plays into what makes them get such high medicare quality scores. They don't strong arm their staff into staying and it seems those who want to stay have opportunities to grow/shift as they grow in the profession, those who want to move on are encouraged and the bridges aren't burned.

Mostly what's keeping me from feeling like this is the one is that it's in a dense urban area an hour away from where I live I don't know that the commute is worthwhile.