Assessment Manager

Guttercat, ASN, RN · Dec 3, 2011

Hi,
I just received information that one of us RNs are to become the Assessment Manager, and I think that someone will be me. Can anyone explain to me what this will entail? The info that I received was become an assessment manager making sure everything is done. All I know is that I do get my assessments finished on my pt and I also finish my careplans on time, but does this mean I have to make sure everyone elses are finished also, and if so do I have to finish the other nurses assessments and careplans. It seems as if I'm being punished for having my work done.
Of course extra work, with no extra pay. I'm beginning to HATE! HATE! HATE! this new company. What do they expect us to get done in 8 hours? since they cut our hours down.

Ooooh! Fancy new title. Lucky you.

The rules of the game, are that the rules change and you must comply.

Now be a good robot and get cracking.

Joni's Mom · Dec 3, 2011

LOL

I guess this robot will get done what she can get done. I will not be taking my work home, as I have been doing. . I just wonder what kind of Bonus my manager is getting. It sure does seem to be a crooked company.

Oh and "All for One and One for All" are we having "FUN"

Guttercat, ASN, RN · Dec 4, 2011

LOL
I guess this robot will get done what she can get done. I will not be taking my work home, as I have been doing. . I just wonder what kind of Bonus my manager is getting. It sure does seem to be a crooked company.
Oh and "All for One and One for All" are we having "FUN"

For-profit chains, like (cough cough) Davita and Fresenius (cough cough), have the monopoly on the market for a number of reasons, some of which are ill-gotten but that's another story...

They know how and whom to place where and when to obtain the greatest possible profit, often at the expense of those delivering the actual care.

If you're at the bottom of the food chain in this gig, i.e., a staff nurse or technician...you will see the least amount of return on your investment in the company.

Up to you whether you choose to play the game. No skin off their nose(s), there's plenty of replacements waiting in line to fill your empty space.

Guttercat, ASN, RN · Dec 4, 2011

And don't forget Boss's Appreciation Day:

http://www.renalbusiness.com/blogs/keith/2010/08/davita-ceo-ranked-80-in-most-influential-list.aspx

Oh and of course our nation's Health Czar, another Davita shining star:

http://www.renalbusiness.com/news/2009/03/obama-names-former-davita-director-health-czar.aspx

In other words, there's a reason these companies have gained a stranglehold over not-for-profit dialysis centers.

Joni's Mom · Dec 4, 2011

Your certainly right about there being many in the wings to fill the open holes left by exiting staff, I do wonder though if that would leave a black mark on the Manager if she lost staff, since training staff would also cost the company money.

Also what would they do if the assessments weren't done? Tell me the facility will lose some of those almighty points, that go to nowhere. Haven't seen a promised bonus yet.

Guttercat, ASN, RN · Dec 4, 2011

Your certainly right about there being many in the wings to fill the open holes left by exiting staff[b'] I do wonder though if that would leave a black mark on the Manager if she lost staff,[/b] since training staff would also cost the company money.
Also what would they do if the assessments weren't done? Tell me the facility will lose some of those almighty points, that go to nowhere. Haven't seen a promised bonus yet.

Heck no.

That's a feather in a the cap of a company manager.

As to bonuses for staff, the model seems to be that if a facility meets certain, nationally accepted patient outcome criteria, it will receive a (meager) bonus.

It's not a bad plan "on paper" but the problem is in staff that are serving a majority patient population that are of poor socioeconomic background. Those units will have poorer outcomes, i.e., if you work at a unit providing care to a large demographic of drug abuse and non compliance, good luck getting your raise.

The big dogs in corporate dialysis know this. They rely on underachieving units, to make up the cost in raises and bonuses to staff of those units with stellar patients. Much like the heavily insured patients of any given facility will help eat the cost of providing care to the under and uninsured patients.

just keep swimming · Dec 4, 2011

I am so sorry that you both feel this way. I do have to make the point that it's all about the individual units management. I work at a large inner city unit that used to be in the bottom 15% of DaVita. We had crappy FA's who did not advocate for their staff. We were always short, to the point where I dreaded coming into work because half the time, not a single opening PCT would have shown up yet when i walked in the door 30min before we opened a 28 chair unit! We never got bonuses either. 3 years ago we got a new FA who started weeding out all the bad seeds, got the patient behaviors under control (we used to have an armed gaurd because it was so bad), and fought for what the unit and staff really needed, sometimes all the way up to KT. We are now in the top 20% of DaVita!

My point is that it is easy for management to let us believe that all the hardship we go through is the companies fault when really the blame falls on them. It takes a lot of work to get a unit running well, but it is so worth it in the end! A large company is just that...it is up to us to make the company work for us and it can be done!

As for bonuses, they are not all based on pt outcomes, each unit gets to choose their quarterly goals. These range from staff retention to vaccinations. There are some we control and some we cannot...kinda sounds like life, huh?

This is just from my experience in 7 years of dialysis. Not trying to attack or discount anyone elses experience...just my 2 cents.

Joni's Mom · Dec 4, 2011

Hi thanks for responding,

I too think it is all about the management. We have a smaller unit, 6 chair, and our FA manager is pulling it and us apart. We lost a favorite and talented tech d/t the fact she was unable to pass her test, she was left go, this FA has no intentions of replacing her and has the attitude that she wasn't needed anyway.

The FA only has 2 staff on our unit that she talks to, and these 2 staff come back and tell us other 2 what the FA said. This drives me nuts thinking there should have been a unit meeting with all present so we are all on the same page. I don't know how you did it but I'm glad to hear that you where able to get rid of the bad FA, like your facility I don't believe our FA is advocating for us either.

The bad or good part, I haven't decided yet, is that I truely love dialysis, so I think I'm stuck.

Like Guttercat said just be a good robot and do what is asked.

Guttercat, ASN, RN · Dec 4, 2011

I am so sorry that you both feel this way. I do have to make the point that it's all about the individual units management. I work at a large inner city unit that used to be in the bottom 15% of DaVita. We had crappy FA's who did not advocate for their staff. We were always short, to the point where I dreaded coming into work because half the time, not a single opening PCT would have shown up yet when i walked in the door 30min before we opened a 28 chair unit! We never got bonuses either. 3 years ago we got a new FA who started weeding out all the bad seeds, got the patient behaviors under control (we used to have an armed gaurd because it was so bad), and fought for what the unit and staff really needed, sometimes all the way up to KT. We are now in the top 20% of DaVita!
My point is that it is easy for management to let us believe that all the hardship we go through is the companies fault when really the blame falls on them. It takes a lot of work to get a unit running well, but it is so worth it in the end! A large company is just that...it is up to us to make the company work for us and it can be done!
As for bonuses, they are not all based on pt outcomes, each unit gets to choose their quarterly goals. These range from staff retention to vaccinations. There are some we control and some we cannot...kinda sounds like life, huh?
This is just from my experience in 7 years of dialysis. Not trying to attack or discount anyone elses experience...just my 2 cents.

Always good to hear an alternative perspective. And I'm glad to hear of a success!

I have to disagree that it's "all about the individual unit's management." I agree they can make a unit miserable both for patients and staff, or make it run at optimum. But, their control is limited like it has never been before.

As an anecdote, remember there was a day when the only patient care staff in a unit, were RN's. When I started 18 years ago, there was one RN and one tech to every 4-6 patients. And that was a very large, very well-run unit.

We've come along way medically, in understanding and treating ESRD and in that regard, the patients have advantages over their counterparts of 20 years ago.

However, they were also receiving very, very personalized care each and every time they walked into the unit. We knew them inside and out.

Economically those ratios of days gone by are unsustainable, and we have what we have now.

Very interesting evolution to watch.

just keep swimming · Dec 5, 2011

Always good to hear an alternative perspective. And I'm glad to hear of a success!
I have to disagree that it's "all about the individual unit's management." I agree they can make a unit miserable both for patients and staff, or make it run at optimum. But, their control is limited like it has never been before.
As an anecdote, remember there was a day when the only patient care staff in a unit, were RN's. When I started 18 years ago, there was one RN and one tech to every 4-6 patients. And that was a very large, very well-run unit.
We've come along way medically, in understanding and treating ESRD and in that regard, the patients have advantages over their counterparts of 20 years ago.
However, they were also receiving very, very personalized care each and every time they walked into the unit. We knew them inside and out.
Economically those ratios of days gone by are unsustainable, and we have what we have now.
Very interesting evolution to watch.

You are right that their control is limited. I was speaking more toward the culture of the unit than staffing ratios etc. How great would it be to have half the patients!

I think that one major problem in DaVita (can't speak to FMC as I have never worked for them) is that almost anyone can be an FA.

I'm all for promoting from within but when you put a PCT in a management position with no management or supervisory experience, besides possibly having been a preceptor, you're asking for trouble. That's beside the fact that they do not have a license and I have a real hard time with nurses being supervised by non-nurses.

madwife2002, BSN, RN · Dec 6, 2011

Since bundling came in to control dialysis companies, it has become more about the dollars than ever before.

Payment from the government is controlled by outcomes which are fixed and each dialysis unit has to meet this outcomes or be penalized by a percentage drop in payment.

Do you honestly think that the for profit companies are going to take this loss of money sitting down.

NO they are no longer bothered if they lose staff, they don't care if the patient ratio is higher than ever before because it means less wages and less benefits-therefore profit margins increase.

Pressure on the managers has increased for them to make sure their units perform-and if they dont well there is the door!

Managers have to work and earn money too.

I am not sticking up for your manager but believe me a lot of pressure goes on behind closed doors