Assisted Living Drama versus Skilled Nursing Stress

Nurses LPN/LVN

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I will try to make this as short and sweet as possible. I have a dilemma and I would like to get feedback from other nurses.....

I am contemplating 2 very different job offers. :down:

The first is within Assisted Living. I was informed by the interviewing nurse that the position I am being offered is very challenging as far as drama concerning those I will be supervising (Nursing Assistants/Med Techs). She said the facility has "gone through at least 6 nurses within the last year" and "nobody stays". When I asked her why she said the CNA's provide excellent patient care, but are terribly rude and gruff with nurses whenever they attempt to provide any direction or change assignments, etc.. She further stated that she has tried new nurses and even nurses with over 20 years of experience and it always ends up the same-every nurse leaves. On the plus side, I'm sure you all know Assisted Living means very few meds, few treatments (skin tears mostly) and much less paperwork. It is a small facility, they still use paper paper charts and MARs.

The second is within a Skilled Nursing Facility and we ALL know what comes with that territory. Lots of wounds, trachs, IV's and of course the seemingly never ending med pass. This is within a very large facility, they use electronic medical records as well as electronic MARs.

I have been a nurse for 16 years and I have both skilled nursing and assisted living experience, but I really can't figure out which position would be better. (FYI- Both jobs are Full Time and the Assisted Living Position pays about $3 less an hour) I would love to get some help with this decision from other nurses-what would YOU do?? :nurse:

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Specializes in LTC,Hospice/palliative care,acute care.

I would go for the ALF at this point in my career. The cna's may have good reason to protest change ,most of the past suggestions may have been un-necessary. I would present myself as a member of their team. I would make it clear that rudeness would not be tolerated (I am assuming the admin and DON are going to back you) but I would not go in there and try to re-invent the wheel.

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Hi, I would take the assisted living job (saying you could afford the lesser amount of pay). You already know the CNAs provide excellent care (job #1). All you have to do is let them know you appreciate them and realize that they are a very important part of the whole team, and that this 'newest' new nurse will work with them and show them respect that they deserve ('if' they earn it, but respect, none-the-less).

Also, let them know (and see) that you will not be afraid to lay the smack-down on them if you need to, this means being written up and sent home if need be). It sounds as if there may be a bit of an us-vs-them thing going on. Those usually have a single ringleader.

My last two jobs I had a very good rapport and working relationship with the CNAs/aides because I really made an effort to show them respect by not only helping them when I could, but also taking some of their open shifts (as OT) so they wouldn't be constantly mandated. I also showed real quick that I would not tolerate the couple knuckleheads that were pulling crap.

When I started at the NH, I made it clear that I would definitely not be one of those nurses who didn't help, always hid at the desk, wouldn't get her hands dirty, etc. I said first and foremost, the nursing duties had to come first (med pass, tx, etc. I had to get the routine down). After that, I helped quite a bit and got a lot of positive cooperation from staff because of it. It all trickled down to the residents:yes:

I actually liked helping the aides because not only did it ultimately help the residents even more, the aides were sooo appreciative and returned the favor ten-fold (for the very most part, but worth it).

I say give it a shot, you may just be the one:yes:

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I have worked in both and this is a tough one. I hate, hate, hate drama in the work place. Even though ALF sounds better out the two, I'd probably go with the skilled facility if the staff and working environment is better. Hard decision either way though.

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Specializes in HH, Peds, Rehab, Clinical.

I kind of have to think that if they are STRESSING how they can't keep nurses because of the attitudes of CNA's, it has to be REALLY bad. Usually they try to blow smoke where the sun doesn't shine and let you discover the truth on your own after you start. I'd be leery, but maybe that's just me

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I appreciate all of the feedback! I am really struggling with this....

I understand that ANY job is going to have stress, it's simply a matter of deciding what TYPE of stress you want. The Director from the Assisted Living actually called me, wondering if I had come to a decision and I expressed my hesitancy because of what she shared with me concerning the "unruly" staff. She explained that she wasn't trying to scare me away, but she wanted me to be fully aware that dealing with the staff is a nightmare and that I needed to be "strong" and "prepare myself for the inevitable confrontations that will occur". The question that keeps going through my mind is this: If the Director of Nursing knows what the problem is, why isn't she resolving it before bringing in yet another nurse? If you never get to the root of the problem, then it stands to reason that history is most likely going to be repeated.

On the other hand, when I think of Skilled Nursing and everything that entails in regard to work load, I just feel TIRED. (After all, I'm no spring chicken anymore, LOL) I do know that the floor I would be working in this facility is half long term care and half rehab/subacute (30 patients total).

Ugh, this is driving me nuts!!!!!!!!:confused:

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I appreciate all of the feedback! I am really struggling with this....

I understand that ANY job is going to have stress, it's simply a matter of deciding what TYPE of stress you want. The Director from the Assisted Living actually called me, wondering if I had come to a decision and I expressed my hesitancy because of what she shared with me concerning the "unruly" staff. She explained that she wasn't trying to scare me away, but she wanted me to be fully aware that dealing with the staff is a nightmare and that I needed to be "strong" and "prepare myself for the inevitable confrontations that will occur". The question that keeps going through my mind is this: If the Director of Nursing knows what the problem is, why isn't she resolving it before bringing in yet another nurse? If you never get to the root of the problem, then it stands to reason that history is most likely going to be repeated.

On the other hand, when I think of Skilled Nursing and everything that entails in regard to work load, I just feel TIRED. (After all, I'm no spring chicken anymore, LOL) I do know that the floor I would be working in this facility is half long term care and half rehab/subacute (30 patients total).

Ugh, this is driving me nuts!!!!!!!!:confused:

"why isn't she resolving it before bringing in yet another nurse?"

You asked us the question, why aren't you asking her?

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Here's a thought--I would ask the DON what has been implemented before as far as attempting to make it work, what she is willing to do to support you, and if it means replacing staff that is not productive to the culture is that something that she would support?

Go in with your eyes wide open, but with an open mind. Sometimes it just depends on the mix of the team. Have regular meetings with the CNA's about what works, and what doesn't. But at no time is this gonna be a drama fest. That if you don't like your co-workers doesn't mean you are not able to work with them. That they all will have to take direction and may have to do different assignments at different times. Period. And that their disappointment over this at no time will be transferred to the patient. If this becomes an issue, there will be progressive discipline up to and including termination. Period.

People can appear to be gruff and rude. But still do as they are assigned. And do it well. That they are sassing like children to you is a poor reflection on them, but the moment they are fresh to the residents, then it needs to be dealt with. And call them on it "Seriously?!?! You are not 13, this is not a middle school, and I am not your mother. However, I am your supervisor, and this is what I need you to do today. Should you prefer not to take this assignment, I will gladly send you home now, and on your next scheduled shift we can discuss moving forward. So what is your preference for today?"

Increase your pool of per diems. That you hire. That way, you have a sense of the type of work that they do so if one of the current CNA/Med Techs can't get it together you have viable options. And that is the key. Give the current staff time to adjust but know that you have an option should they not.

Skilled care is awesome! Love it! Loved it better when I wasn't so old and crusty. Now it requires energy that I just don't have. So I get it. But it will always be there, and they are seemingly always looking for nurses. Plan B if this one just doesn't work.

Best wishes and let us know how it goes!

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"why isn't she resolving it before bringing in yet another nurse?"

You asked us the question, why aren't you asking her?

I suppose I didn't want to offend her before even starting the position.................

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Well, after much thought (my head hurts, LOL), I am going to give the Assisted Living a try. I may regret it, but as jadelpn said, Skilled Nursing will pretty much always be an option. Wish me luck and thanks again for so much feedback!

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There is always drama wherever you go, sometimes it's obvious and sometimes it's a silent 'undercurrent' (in my opinion the worst). The best thing you can do is to keep your mouth shut.

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Specializes in Allergy/ENT, Occ Health, LTC/Skilled.

Eh, I don't know about anyone else, but the few AL's I have worked in did NOT mean few medications or treatments. Actually, it was the opposite, I just had triple the patient load. They didn't receive the full load that LTC/skilled received but they would have quite a few medications AND they weren't always "AL material". Meaning they needed to be toileted and help getting anywhere/everywhere. With the drama in the AL, go with skilled. They need to be replacing the staff causing the issues. I too get annoyed with work place drama. Can't we all just come to work, do a fantastic job, and go home? Even if we don't like each other lol? I don't have to like you to work well with you....

Anyways, hopefully OP will come back and update, would love to know how this turned out.

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