Charge nurse:how to supervise LNs who lost trust in mangement?

Laught3r · Nov 18, 2006

I am an LPN and have noticed that due to the nursing shortage not only are LPN's getting away with a lot of BS but so are RN's . I almost hate to say this but if the management of your facility is afraid to act due to fear of not having any nurses then maybe you should look for another job. I would run from that place as soon as possible. I would even make a report to the BON I am sure that the facility would not back you up. Hope it goes well.

nursehellokitty04 · Nov 18, 2006

i have to agree with the other lpn i am a lpn myself and i worked for a facility that was the same way and they hid alot of stuff till something came down of the DON and guess what she found someone else to blame the new lpn so i was accused of something i didnt do was forced to resign and at the time i was scared for my license now i am just mad if i where you before something happens get out because when it comes down to it they will blame anyone but thereselves

Daytonite, BSN, RN · Nov 19, 2006

If there is one thing I learned working in LTC it's that you have to be strong and learn to be a supervisor and manager. It is inherent in the title of RN, charge nurse and/or supervisor. Your situation has nothing to do with lost of trust. It has to do with insubordination, poor attitudes on the part of these LPNs and your DNS not doing her job. This kind of slacking off on the job has to do with disrespect and poor work ethics. And, they are doing homework for what? To become RNs? That's a real laugh. Maybe your DNS has finally realized what a huge mistake she made by ignoring the bad behavior of the other nurse. If you are supervising these LPNs and continue to let their behavior go like this, then you, as their supervisor, are not doing your job either. The longer you let it go, the more difficult it will be to correct. They're most likely talking and sneering about how they are walking all over you and the DNS. You need to stop it. Stop being a wimp and sit down with the DNS and tell her what is going on and what you plan to start doing so she knows what's coming. Start enacting disciplinary processes. That will get their attention very quickly. Keep working the process even if the DNS ignores what you do. Eventually, she has to take notice or you can legitimately go to the next person up the chain of command to complain about her failure to support your position and her lack of effectiveness as a leader. I kept copies of all write-ups I did on subordinates in case of a DNS throwing out or ignoring my documentation. I had to actually tell one DON who just wouldn't do anything about a nurse who she knew (because several of us had supplied her with plenty of proof) wasn't giving patients their medications and was making up blood sugars that I was going to report the nurse to the board of nursing myself before she finally, relunctantly, did something about her. I didn't care if the DON was mad at me. It was the patients I was concerned about. The attitude of your LPNs will get noticed by the CNAs who will pick up on it and start acting the same way as well. Then you're going to have an even bigger mess to deal with and eventually staff turnover as these bad apples who remain run off any "good" nurses that try to work there and pick up the slack.

Sorry if I sound harsh. When you are a supervisor you have to be tough with subordinates who are acting the way yours are. In any case, I'm not as mean as I sound. Welcome to allnurses! :welcome:

CapeCodMermaid, RN · Nov 19, 2006

We had the same problem at my facility. Lots of nurses and aides were slacking off and nothing was done about it. Well...I took over and started disciplining the people who needed it and giving public compliments to those nurses and aides doing a good job. More than a few people were fired for either being insubordinate or just not doing their jobs properly. The ones who tried to improve were all given a second chance. Some of them have turned around and now are doing the right thing, but some couldn't step up so they left. The morale in the building has dramatically improved. People are taking pride in their jobs again and patient care has gotten better as well.

Are we perfect??? Far from it, but we all care about our residents and about doing the best job we can. Supervisors have to stand up for what is right...the nurses supervise the aides, the Supervisors the nurses and the upper management supervises the supervisors...if anyone of these pieces isn't doing what it's supposed to do, the whole thing falls apart.

I'd much rather have a few really good nurses than a building full of slackers.

banditrn · Nov 20, 2006

Daytonite & Capecod - it's good to hear from both of you, and your advice. I can be a stronger leader if I know that MY leader is strong.

Some of these situations are so new to me, as they are to the OP. I've worked hospital for many years where I was basically responsible to and for myself - now I have 6 mo. LTC under my belt, and I know more that I did, but it didn't come easily - because we really don't have good strong leadership at the place I just left. And especially at nite, because there was no one there to ask when situations came up.

One continuing problem there was one particular CNA at nite - he'd been there for a long time, and had basically bullied the young, full-time LPN that was there - it was her first nursing job.

Well, I work part-time, but I'm older, and don't take that bullying well - basically, he felt the nurse should follow him around on his rounds, do half the work - he was telling nursing who to give PRN's to, etc. Then, when his rounds were done, he'd go back to the lounge and sack out.

The first nite with him, we had a major deal, because I told him that we were going to do things a little differently, and he was a total jerk - well, I don't tolerate jerks well, and I'm not a young push-over.

But I didn't know about 'write-up' sheets, etc. - toward morning I called the admin - as usual, the DON was unavailable - she came in, and we went over everything. She kinda laughed, and said he'd been trying this stuff for years.

OK, so during the next few months, the other nite nurse had gotten some courage, and we both turned him in for sleeping - both written, and multiple times by calling the DON. She always said that she needed to come in some nite and catch him! But she never did. And awhile back when I asked her what she'd do if State came in some nite and caught him sacked out, she blamed us, saying we'd never written him up! Now I wish I'd have kept copies of everything!

Daytonite, BSN, RN · Nov 21, 2006

That is so sad. Your DON is not a very well-trained manager and supervisor. This, unfortunately, is all too often the caliber of person that gets a job like this in LTC as contrasted with the acute hospitals. When you have two different charge nurses turning in documentation of observed wrong-doing and the DON chooses to ignore it, something is wrong with her. I would just continue to write the little toad up, keep copies and I would ride his sorry butt and make every shift he worked with me as miserable as possible for him. I would keep him on a short leash. I'd be watching for the perfect incident to hang him out to dry. It'll happen eventually because of his character. Just be prepared when opportunity knocks. Document. Preserve evidence. Report him to the state registry before the DON even has the chance and get rid of him. As a charge nurse you have a lot more power than he does, believe me. Just follow facility policy which I'm sure he doesn't even know where to look to find it and you should be OK.

I have a copy of every single report or disciplinary action I wrote up during my positions as a supervisor, head nurse or nurse manager. I never made a big deal about letting on that I did this, but always felt that it was for my own protection in case anything ever came up in the future. It's also helpful for future write-ups when you are racking your brain for the right words to use. For patient falls, I often drew stick figures of how the patient was positioned when they were found in relation to the furniture. I also drew simple pictures of wounds as well. In LTC I often did write ups on my computer when I got home in the form of memos so they looked nicely typed and composed. I always felt they were less likely to get thrown away than something that was hastily written on a blank piece of a doctor's progress note and then shoved under the DON's office door.

Here's an idea for you. Get a disposable camera and take pictures of Rip Van Winkle along with someone holding a big sign with the date and time of the night printed on it in the frame of the picture. Send it to both the state nurse aide registry and the state department of health that licenses the facility along with copies of your write ups that the DON has been ignoring along with formal complaints against these two jerks and see what happens.

MurseNeutron · Nov 21, 2006

long term scares me. my first job out of school was in LTC. i worked for four months before i quit and went to acute care. the lack of care seems to be inevitable there. there is no pharmacy support, no doctor support, and the over all attitude is frightening to the human way of life. in all honesty i think i drove every person in that place insane and probably had a few docs, that love to shove there job on nurse practitoners and PAs, only to show up maybe once a week, calling in death threats on me. its scary the work load, the bed sores; LTC needs a reform, more than that a destruction and rebuilding phase. geriatrics i feel deserve so much more than poor cna's, attitudes, and stage four bed sores. it drove me crazy. now i know that all LTCs are not this way and some exteremly good facilities exist, but lets ask our selves in these excellent facilities. are they private? i understand that better health insurance (or more money) the better the care, but are there not standards that we support when we sign on to this profession.

btw anyone who dares to go this route and stands up for the cause in LTC i salute you with much respect. it is def. a tuffy (out of curiosity do you smoke?) every LTC nurse i met always seemed to smoke. just a curious george question.

banditrn · Nov 21, 2006

Daytonite - :chuckle I love the camera idea! Fortunately last nite was my last nite there. Have you seen my posts about my new job? I'm hoping it will be better - I think it will. The DON seems to have a LOT of experience, seems like a no-nonsence type person, and I have a feeling that she gets things done. This new place almost never advertises, so I'm hoping that's a good sign.

banditrn · Nov 21, 2006

[quote=MurseNeutron;1933791

btw anyone who dares to go this route and stands up for the cause in LTC i salute you with much respect. it is def. a tuffy (out of curiosity do you smoke?) every LTC nurse i met always seemed to smoke. just a curious george question.

No, I don't smoke, why do you ask?

Now, I have to tell you that I think some of your statements are not valid, if you're implying that pressure ulcers and smokers only occur in LTC and not in hospitals.

I spent 16 years in the hospital being fed up with having to cover for all the smokers going on breaks. And I saw skin break down there, too. In fact, I believe they're more cognizant of it in LTC than anywhere else.

Hellllllo Nurse, BSN, RN · Nov 21, 2006

No, I don't smoke, why do you ask?
Now, I have to tell you that I think some of your statements are not valid, if you're implying that pressure ulcers and smokers only occur in LTC and not in hospitals.
I spent 16 years in the hospital being fed up with having to cover for all the smokers going on breaks. And I saw skin break down there, too. In fact, I believe they're more cognizant of it in LTC than anywhere else.

Don't turn this into a smokers vs non-smokers thread. The lazieiest slacker nurses and aides I've ever worked with have been non-smokers. One particularly lazy nurseswould say "I don't smoke so I never take a break. " Well, that woman's whole damn day was a break.

But, weather a person smokes or not is not the point. If a person has a good work ethic, smoking or not won't change that.

Simplepleasures · Nov 21, 2006

LTC facilities seem to have their own agenda, and from my experience in LTC as an LPN with 27 years in the trenches, Id say it is not the care of the patients. Money is the bottom line.Management seems to only sit up and take notice when their own necks are in the noose. This goes for the so called non profit places too. Until all hospitals and nursing homes are unionized the management will not give a rats bottom for the legitamite concerns of its nurses. or patients.Maybe there are a few good LTC facilities out there, but good luck finding them.