Charge nurses

[Nightowl_lpn]

A little background on my self. I graduated nursing school last July so I'm still a fairly new nurse. I struggle with being in the "charge" nurse position at times. I would like to know how you, as the charge nurse, would have handled this situation. An aide came to me to tell me a resident was on the floor at 0530. She's incontinent with dementia. I witnessed the resident laying in floor, no injuries were noted, but she had a brief on that was soaked, and her bed was brown ringed. I was upset to say the least. So I ask the cna when is the last time you checked this resident. She stated she changed her at 0400. I didn't believe this to be true. I told her she shouldn't have been brown ringed if she was changed an hour and a half ago and it most likely contributed to her fall, that this was a verbal warning and if I found another resident in that condition it would be a written warning and we would be in the don's office if I seen it again. Do you think I handled it okay? I was a cna for two years so I understand it's not an easy job, but I took care of my residents and I'm responsible for the care they get now as a lpn. Your input would be appreciated. Thanks for reading.

[NutmeggeRN, BSN]

Do yuo have any other reason to distrust her? Some people lie like a rug! It sounds with the brown ring, that she had been wet for a while, probably longer than 90 min. One question to consider was the concentration of her urine. If she is really concentrated (dehydrated) then it might show up darker sooner than someone whose urine is light yellow.

[Nightowl_lpn]

Thank you for your reply. I'm new to the facility, I've been there a little over a month, so I'm still learning the employees and residents. I'm also the youngest employee on noc shift. I help out answering call lights and with care when I can, I just get so sick of other shifts c/o nights not doing anything. I want the shift to run like clockwork, and everyone have the mentality of team work, and understand they are getting paid to provide care to the residents so just do it and there's no problems. I wish I was more assertive and not get anxiety when it came to confrontation. Thanks for any advise

[misstrinad]

Even after over a year of being a nurse on the same unit I still get a flutter of anxiety when I have to confront a staff about the care they provided. I suck it up and remember the pts are priority and take a deep breath before I speak. I make sure to explain myself, sometimes they really didn't know better and other times they darn sure knew better.

On our fall paperwork we have to identify the Cna assigned to the res and the last time they were toileted. Make sure to back your observations up in your nursing notes and report it to the unit manager/supervisor. I lean on my manager for follow up of corrective action and he does disciplinary actions as well. Since I am not there every day he is the best one to handle it. If those tasks fall to you directly (no manager that handles it) make sure you know the policy for disciplinary action so you don't end up telling them a course of action you can't actually follow.

That said I think you handled it correctly, letting them know you knew they were 'mistaken' about having checked the resident 1.5 hrs prior and putting your foot down firm that was not okay. I have found there are quite a few noc shift aides that are down right lazy. There are just as many good ones as well. If you continue to suspect issues with rounds make a point to assist them with one round a shift. Some units at my facility require that on nocs. We have a white board in our back staff room on the unit and I frequently put reminders on there so all the staff that work the unit can be reminded of standards of care that seem to occasionally get forgotten.