Need opinions please? I work in an assisted living caring for 42 patients. 6 diabetics. 5 total cares. Home health involved so also doing wound vacs. Wound care 5 days a week. 2 RCA for 42 residents. All admissions. All patient hospital transfers. Nurses are responsible for 11 direct care patients, including all medical records for all 11 patients ie: chart thinning, all health assessments, all physician orders. All weights and vitals. Now are DON has informed that he cannot do his job and also complete insurance authorizations, so another tasks is added to nurses. I have been a nurse 22 years so I am no means short on time management, prioritizing. Also, just to add to the chaos. Our Executive director has zero medical background and also feels that we must cater to every whim of residents and their families. We are to drop all our tasks if a patient's family wants 20 min or 1 hour of our time. Total counter productive. So now to the issue. Med pass starts immediate after report takes from 3pm to 6 pm to complete.( every nurse that works these carts that is the timeline.) 6 to 7 pm is sending meds back or catch up because we had to drop what we are doing to cater to every need of families no matter how inconsequential. 7pm to 9:30 pm is second med pass. 9:30 to 10 pm is wound care sometimes longer 10:15pm. Oncoming replacement nurse comes in @ 10:30 pm. So now when do I chart? Take off orders. Complete daily medical records duties. And now they want us to take over insurance authorizations. My DON has pretty much outright stated. There will be a lot of punching out @ shift end and staying 3 to 4 hours over each day we work to complete all administrative duties. No staff backup plan in building for call offs. Vacations etc... Just enough nurses RCA's to cover each shift. No prn pool. No agency. I was told I cannot cut my hours to 32 because there is no one to replace me. But DON just let day shift nurse cut her hours to 32. Oh yes, I almost forgot, as you can see no lunch breaks for any nurse. But we must write down we took 30 minutes. If I write no lunch I am disciplined. This is absolute humanly impossible to complete in 8 hours. Everything administrative is months behind etc.... and all that keeps happening are write ups and revolving door of nurses because our Exec director cannot see that expecting your nurses to care for 42 residents and approx. 4 hours of administrative duties daily is not possible to complete in 8 hours period. Oh and also we are not allowed to inform families of severe shortage of staff. If there is one RCA for 42. Same workload expected as if there were 4 RCA's. I forgot to mention, there is absolutely not even 5 minutes allotted for falls, which on average there are 3 to 4 a night due to severe understaffing. We have to take our walkies in to bathroom and must answer even if we are indisposed in the bathroom. You must get up from lunch for every call. We are not allowed to refuse any call to eat.
One place I worked at turned off the ability to clock out at the end of 3-11 shift. You had to sign out and have a supervisor sign off on it if you were clocking out late. Everyone ran down to clock out at 11:30, then back up to the unit to finish working. Charting in a computer which shows you illegally working off the clock. Literally 1 minute late, and you could not clock out. And there were no supervisors at night to see the justified reasons we all had to stay late.
If the problem is so bad you have to actually TURN OFF the ability to clock out, then it isn't just a few nurses with time management issues. I remember PT/INR results always came on our shift. And of course everyone and their mother was on Coumadin. 30 residents plus dressing changes....please tell me when I am supposed to enter the new Coumadin orders. After 11, that's when. Change the time so that nights dose matches. Of course non if this includes the inevitable falls and random crap that pops up in the day.
I'm honestly tired of hearing commenters harp on posters with...."Why don't you leave?" When these very same people advise to tough it out and stay a year.
It has been bad at every.single.facility I have worked for. Sure, you can quit, but you either won't have a job, or you have to take a drastic paycut to work in a different specialty, which is what I chose after my last 2 year SNF gig. We are hurting severally financially because of it.
Disclaimer, OP, yes, I WOULD leave this place. It does sound even worse than 99% of the places I worked for.
What you are describing is a nightmare. Has anyone (you) contacted the department of labor? What about HR? The environment sounds hostile towards the staff and definitely unsafe for the patients.
Specializes in Nursing Education, Public Health, Medical Policy.
You are putting your license in jeopardy- seriously- I have worked with Boards of Nursing as a consultant. When a tragedy happens- and it will- you will be held responsible by your Board because what you have described puts your patients at harm. You have also made the information available to investigators because you have posted on a social media site.
Get out now- you do not want to experience having a complaint on your license and probation ( if you get to keep your license).
The DON being from Kenya can have something to do with it. People with different cultural backgrounds can have different work standards and work ethics.
What is the process/ mechanism for the Boards of Nursing to ensure that nurses know how and where to report healthcare facility business practices that put nurses at risk for violations of generally accepted standards of practice/standards of care?
What are the Assisted Living Regulation in the state specific to:
Staffing Plan and acuity/level of care, Nursing Services, Incident reporting and Quality assurance practices specific to e.g. falls, Resident Rights specific to:
receipt of treatment, care and services based on comprehensive assessment, level of care requirements, interdisciplinary collaboration(wound care, medication administration, ...
Become familiar with how and to whom to report violations of regulatory compliance (minimum standards of practice) to licensing/third-party payor agencies). Allow these agencies (state licensing body, CMS ..,) to investigate compliance through complaint which can be anonymous.
Report back to schools of nursing these experiences and opportunity for research projects which again bring outside presence into settings for positive reasons ( e.g. staffing ratios and workload management...) , student nurses, pharmacist internships so our external teaching agencies / clinical instructors are making a real time assessment what clinical setting expectations of program graduates will be and provide opportunities for graduate program research
CMS is looking at pharmacy review to reduce medication errors. In some states pharmacy review is already a practice in the Zssisted Living setting. THe research would take leaps forward including data already generated amongst pharmacy community , staffing acuity research in Assisted Living setting was last conducted in 2006, it is time to revisit the topic .
When are we going to take the opportunity that this forum provides to produce data that identifies the problem and articulates the changes that support quality client care no matter the setting and treatment of nurses as experts who are integral and critical in the establishment of centers of excellence in treatment of staff and patients/residents/participants/clients.
I can tell you in the state of Florida, they go by staff hours per residents in ALFs not staff ratios to residents. This makes it impossible for anyone, including the aides, to determine if the facility is lawfully staffed at any time. I can also tell you that my mother was attacked by another resident that was known to be violent on many occasions. My mother spent 4 days in the hospital. I reported to ACHA, DFC, and the Ombudsman program. Nothing was done. The resident that attacked her was medicated somewhat and had a sitter part time. I had to move my mother. It's absolutely unacceptable and I would love to get the system and laws changed but I don't know where to begin when the state doesn't care anyway.
I can tell you in the state of Florida, they go by staff hours per residents in ALFs not staff ratios to residents. This makes it impossible for anyone, including the aides, to determine if the facility is lawfully staffed at any time. I can also tell you that my mother was attacked by another resident that was known to be violent on many occasions. My mother spent 4 days in the hospital. I reported to ACHA, DFC, and the Ombudsman program. Nothing was done. The resident that attacked her was medicated somewhat and had a sitter part time. I had to move my mother. It's absolutely unacceptable and I would love to get the system and laws changed but I don't know where to begin when the state doesn't care anyway.
Report to: Medicaid/Medicare, BON, your Congressmen (federal and state). They're most times the funding and lawmakers. The BON will set standards and guidelines for nursing. If nurses work against those guidelines, then it's on them when they lose their license. Facilities will then have to change how they function.
I'm beginning to think we're being played. OP has only 4 topics since 2014, all about horrible working conditions. Despite this thread having 55 replies they haven't replied since July 1.
The DON being from Kenya can have something to do with it. People with different cultural backgrounds can have different work standards and work ethics.
This is a myopic assumption. The DON is an individual, not a representative of an entire nation. Such blanket assumptions can never indicate causation, just narrowminded speculation, unfortunately.
Orion81RN
962 Posts
One place I worked at turned off the ability to clock out at the end of 3-11 shift. You had to sign out and have a supervisor sign off on it if you were clocking out late. Everyone ran down to clock out at 11:30, then back up to the unit to finish working. Charting in a computer which shows you illegally working off the clock. Literally 1 minute late, and you could not clock out. And there were no supervisors at night to see the justified reasons we all had to stay late.
If the problem is so bad you have to actually TURN OFF the ability to clock out, then it isn't just a few nurses with time management issues. I remember PT/INR results always came on our shift. And of course everyone and their mother was on Coumadin. 30 residents plus dressing changes....please tell me when I am supposed to enter the new Coumadin orders. After 11, that's when. Change the time so that nights dose matches. Of course non if this includes the inevitable falls and random crap that pops up in the day.
I'm honestly tired of hearing commenters harp on posters with...."Why don't you leave?" When these very same people advise to tough it out and stay a year.
It has been bad at every.single.facility I have worked for. Sure, you can quit, but you either won't have a job, or you have to take a drastic paycut to work in a different specialty, which is what I chose after my last 2 year SNF gig. We are hurting severally financially because of it.
Disclaimer, OP, yes, I WOULD leave this place. It does sound even worse than 99% of the places I worked for.