Can This Be fixed? LTC

[starlisa14]

I am an RN and 2 years experience in mostly LTC. I took a supervisory position and have been working it for 1month and a half. I have spent that time familiarizing myself with residents, coworkers etc. As I've seen areas of improvement I've approached them as teachable moments (the educator in me) for the staff. It has come to the point that there are so many major issues that I do not feel addressing them with my 11p-7a shift is going to be adequate. I realize LTC has its own unique problems from staffing ratio to supplies. I have fear because "these nurses have worked here a long time" "these are good nurses" so here I am a new employee and its obvious that the lack of following policy/procedures did not just occur over night. So my question is, can this be fixed? Specific problems include:

-108 residents/2 sections with 2 LPNs on each section/5 sometimes 6 CNAs on 11p-7a

-I find residents with O2 orders heads flat, O2 not connected, humidifier empty and wrong settings

-Tubefeeders while being infused are flat on their back

-Tubefedeers feeding is running but is not even connected to them so there is 6 hours of glucerna 1.5 and water flush in the floor next to bed

-I find 5pm and 9pm meds on the cart not given...even including insulin filled syringes

-blisters on bottom and back of inner thighs

-people are soaked beginning and near end of shift

-hardly anyone charts or fills out 24 hr report (I fixed this recently since I've been here) so it has improved

-resident stated there is a lack of discipline within the previous shift, so much so that with a call light on for an hour and even them stepping out into the hall they cannot see one person

As I've met these problems I immediately call the CNAs and Nurse and show them the problem and say, this is why we MUST do rounds...tubefeeding in the floor thats been running since 6pm should have been caught long before 1am.

The CNAs seem to be listening..but the nurses I get the stated above, "We are good nurses" "We've worked here for years" "Weve never had to do that" "I held it" etc

I've also been running myself ragged trying to take up the slack for the lack of training or just down right laziness.

But finally I've had enough and I told the DON, I cannot wait till next week to talk to you, it has to be today and I will come up whenever you can see me (mind you I've worked all night so when she said 4 oclock I said, "great, see you then." I will not sleep, can't sleep.

[RN&mom]

It can all be fixed, trust me I came into the same situation as you. Be persistent but STOP picking up the slack for others! This is showing your weakness! If a pt is not in imminent harm (and consider how long these things have been going on & they are ok), trust me, I'm OCD at work & it's hard for me too but I've found if I give 1 warning with the explanation that next time will be a write up. Docent each time you talk to a staff member about an issue, to cover your and the facility's butt, and if they do not comply write them up! Also, I will leave notes, for example when I started quality controls on blood sugar machines were almost never being done... I didn't want to write staff up over this so I did 2 warnings with no luck (yup I make exceptions)... So I taped a note to the nurses station written in black sharpie. They got the hint & it's been getting done. Please stand your ground though, it's one thing to help but another to pick up the slack of another consistently... Good luck to you :)

[Salisburysteak, BSN, RN]

Yes it can be fixed! I do not get why the ADON or DON is checking up on this stuff!

It seems the only solution would be to start doing coachings on those who are not doing what they are supposed to be doing.

I would stop covering for them too. The problem is they are complacent with their jobs. No one it seems has been checking up on them. I am sure you have heard the old mantra "But we have always done it this way."

I am not a supervisor. I am a charge nurse in a LTC facility. I always try to do a quick check on the residents after report. I want to know where they are, and also to check on tube feedings and those with O2.

I am sorry you have to deal with this....