Just wanna vent, we just hired a new nursing home administrator (who has no previous nursing home experience)started this new idea of nurses having to answer call bells in their assigned halls. I have 2 aides in 30-bed hall who answers these call bells. I don't mind helping out to boost someone in their bed or get their water pitcher and whatever crap but this is insanely ridiculous. Nurses have already too much in their hands. On top of that, she ordered that all of the charts to be out in plain sight, where our desk is so that we could attend to our residents and families' needs. We used to do our charting in the back room of the nurses station, now the only person that is allowed to be in there is the clinical director and the unit secretary. All the nurses should be out at the desk to answer phone calls, do your change-of-shift reports, do admissions, carry out orders and etc. I don't think this is a good idea. Being interrupted or distracted increases the risk of committing mistakes especially doctor's orders. The desk in the station has so much stuff around it like paperwork so we don't have enough space to use. And when its a weekday, all members of the healthcare team gather around the desk to do their notes leaving no space for nurses to sit down and chart. Plus we don't have a fax machine in our hall so we have to run down to the other wing to fax all our orders to pharmacy. Our cordless phones are not working so when you're down the hall, you have to come up to the station and answer these phone calls. I can't believe that there are people around there that doesn't take a quick second to answer these calls because they believe that its not part of their job description. I understand that we are understaffed but it doesn't mean that the nursing department have to carry all the burden. Its sad to see that there are nursing aides that left this facility because of always being understaffed. Sorry this was long..
Now my question is, is this allowed (the charts being in plain sight)? I don't feel comfortable giving report to an incoming nurse when other people could hear it. Their medical condition is confidential and non-employees doesn't have to hear about it. If this is a violation, can I get a link for this fact?
Your points are very valid. I would not feel comfortable giving report where other residents/family may over hear. Hippa violation.
I also firmly believe that Med pass in LTC should NOT be interrupted (unless of emerg. situation/ falls, bleeding, etc) So for me, I very rarely will answer call lights during med pass times. Answering the phones?? also not during med pass times (unless expecting a return call from MD)
Nurses are not high paid secretaries, and NH admin. need to hire "adequate" staff/ CNA's to answer these lights durings these times. Either that, or they can leave their offices and Help to answer these lights.
Also, as far as sitting near reception desk...not when writing orders, doing admit MAR/TARS, etc...those times, I NEED to concentrate..and not be interrupted every minute. YOU do what you feel you need to do, to provide good care, and yet protect your license. No one else there will protect that license for you, from the sounds of it.
That being said, I will and do help my CNA's when I am not med passing, or when one is gone on breaks, etc. I am certainly not above direct care duties, and actually really enjoy that part of the job. Though as nurses we do need to prioritize our time and duties too, and you know what, I am still there 2 hours after shift ended, and my CNA's almost always leave on time...It really sounds like your new admin. needs to get a clue. Things look very different from behind a desk, then they do to a floor nurse actually doing the work sometimes!
Specializes in Gerontology, Med surg, Home Health.
The charts may be out in the nurses as long as there are not identifiers. Patient initials,MD and Room are acceaptable. As far as giving report in the nurses station it is completely acceptable and family need to be politely asked to remain in patient rooms. Report needs to be kept to a low roar. Joint Commision favors the model of "walking rounds" where the off going and on comming nurse give report room to room and in front of the patient when new orders and plan of care is discussed. I believe it was Mayo clinic or Cleveland Clinic set the standards (I can't remember right now) and made the model for walking rounds. Nurses hate change but changes will come. I has been documented that with this format of walking rounds errors and missed orders had dropped dramatically.......both nurses look at the orders during report to limit errors. It sounds that you have some obstacles to overcome, ask the director to move the fax machine. Request a meeting to talk about how to get around the obstacles. Show her you are willing to change and show her you are bright enough to come up with a plan to make it work! BUt her plan is all perfectly legal and acceptable.
So walking rounds might be feasible in the hospital setting where you have at most 7 patients. In LTC, we have between 25 and 40 residents. Many of them wouldn't understand new orders. Their roommates would HEAR the new orders and the plan of care is sometimes 27 pages long. It is not at all reasonable to do walking rounds in LTC. We chart at the nurses' station but there is a wall between the desk and the patients. If they leaned over the wall, they could see the charts, so when we have to leave a chart for a moment or two, we are supposed to either close it, or cover it up.
And to the poster who said LTC nurses don't do a lot of charting.....MEDICARE regulations require charting on at least a daily basis.
We couldn't possibly have the nurses off the floor to chart. We are computerized so it's easy enough to lock the screen. And if the chart is open stick a marker in and close it.
I manage a unit and I answer bells and yesterday helped Hoyer and clean up a resident after a code brown. The aides can't possibly take care of every need that arises under every circumstance.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
So walking rounds might be feasible in the hospital setting where you have at most 7 patients. In LTC, we have between 25 and 40 residents. Many of them wouldn't understand new orders. Their roommates would HEAR the new orders and the plan of care is sometimes 27 pages long. It is not at all reasonable to do walking rounds in LTC. We chart at the nurses' station but there is a wall between the desk and the patients. If they leaned over the wall, they could see the charts, so when we have to leave a chart for a moment or two, we are supposed to either close it, or cover it up.
And to the poster who said LTC nurses don't do a lot of charting.....MEDICARE regulations require charting on at least a daily basis.
I agree! I was just using that as an example that there are alot of percieved HIPAA violations that are not true violations. To be honest I am not sure walking rounds are practical in the long term setting. I know that with 10 patients on the night shift walking rounds can be challenging in the AM. It is more geared for an Acute care setting or LTAC.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Your points are very valid. I would not feel comfortable giving report where other residents/family may over hear. Hippa violation.
I also firmly believe that Med pass in LTC should NOT be interrupted (unless of emerg. situation/ falls, bleeding, etc) So for me, I very rarely will answer call lights during med pass times. Answering the phones?? also not during med pass times (unless expecting a return call from MD)
Nurses are not high paid secretaries, and NH admin. need to hire "adequate" staff/ CNA's to answer these lights durings these times. Either that, or they can leave their offices and Help to answer these lights.
Also, as far as sitting near reception desk...not when writing orders, doing admit MAR/TARS, etc...those times, I NEED to concentrate..and not be interrupted every minute. YOU do what you feel you need to do, to provide good care, and yet protect your license. No one else there will protect that license for you, from the sounds of it.
That being said, I will and do help my CNA's when I am not med passing, or when one is gone on breaks, etc. I am certainly not above direct care duties, and actually really enjoy that part of the job. Though as nurses we do need to prioritize our time and duties too, and you know what, I am still there 2 hours after shift ended, and my CNA's almost always leave on time...It really sounds like your new admin. needs to get a clue. Things look very different from behind a desk, then they do to a floor nurse actually doing the work sometimes!
HIPAA VIOLATION........I know....but it drives me crazy to see it wrong all the time. I know how difficult it is trying your best to keep everything safe but we are also there for the patients..... We are the end all be all. The buck stops with us. I would hope that any of us would never consider ourselves above "direct care duties" I think this new director has a clue and is trying to get the nurses visable back on the floor and not behind closed doors. Long term care is very challenging more so than most people think......but the bottom line is to be there for the patients.
History of LTC and staffing issues, has been an ongoing issue for years. I believe this is more of a staffing issue. If this facility was staffed appropriately, there wouldn't be an issue with answering call lights in a timely manner. And providing quality care for residents, includes accuracy and safe practices as well.
Specializes in OB, Peds, Med Surg and Geriatric Nsg.
I truly believe that change can either be good or bad. But I just don't feel comfortable charting infront of the desk. Charting is one of those things that I need a good place to focus on what to write to describe the resident's condition. Being distracted or frequently interrupted with other things increases the chance of me forgetting what I should write which I already got a verbal warning for. It would be much appropriate if charts are behind walls where non-employees cannot see them. Our charts has their room number in it as well as their names in bold letters and their MDs. We already have 2 nurses that already gave their 2-weeks notice because of how things are being run by the new NHA. They hired 2 new grads to RN supervisors with no nursing experience. The old employees there are not too happy about it. We are still short of CNAs and I guess that they are trying to fix the problem by letting the nurses answer the call bells even during medpass.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I truly believe that change can either be good or bad. But I just don't feel comfortable charting infront of the desk. Charting is one of those things that I need a good place to focus on what to write to describe the resident's condition. Being distracted or frequently interrupted with other things increases the chance of me forgetting what I should write which I already got a verbal warning for. It would be much appropriate if charts are behind walls where non-employees cannot see them. Our charts has their room number in it as well as their names in bold letters and their MDs. We already have 2 nurses that already gave their 2-weeks notice because of how things are being run by the new NHA. They hired 2 new grads to RN supervisors with no nursing experience. The old employees there are not too happy about it. We are still short of CNAs and I guess that they are trying to fix the problem by letting the nurses answer the call bells even during medpass.
I don't get it..........I have been charting for 31 years and I have never charted behind closed doors.
Specializes in OB, Peds, Med Surg and Geriatric Nsg.
I don't get it..........I have been charting for 31 years and I have never charted behind closed doors.
We don't chart on closed doors but we have a room where the charts were placed before. We utilize that room for charting as well as calling MD's and updating their families with the resident's new orders and status changes.
Apparently the new administrator got the impression that the nurses were, in effect, hiding in the back room and this is her response to that impression.
I Charting is one of those things that I need a good place to focus on what to write to describe the resident's condition. Being distracted or frequently interrupted with other things increases the chance of me forgetting what I should write which I already got a verbal warning for. It would be much appropriate if charts are behind walls where non-employees cannot see them. Our charts has their room number in it as well as their names in bold letters and their MDs. We already have 2 nurses that already gave their 2-weeks notice because of how things are being run by the new NHA. They hired 2 new grads to RN supervisors with no nursing experience. The old employees there are not too happy about it. We are still short of CNAs and I guess that they are trying to fix the problem by letting the nurses answer the call bells even during medpass.
For charting, you may request a work accomodation, citing that the environment is too distracting. Especially after the incident in which you received a verbal warning. If you have an ADHD, or similiar diagnosis, an accomodation would be the first step.
Anytime that there is change, you will see some turnover with staff. You need to decide for you whether or not this work environment is suitable for you. Sometimes, after changes, it may actually create a better work environment, but things usually tend to get worse Before they get better. Good luck to you.
I know how difficult it is trying your best to keep everything safe but we are also there for the patients..... We are the end all be all. The buck stops with us. I would hope that any of us would never consider ourselves above "direct care duties" I think this new director has a clue and is trying to get the nurses visable back on the floor and not behind closed doors. Long term care is very challenging more so than most people think......but the bottom line is to be there for the patients.
Leelee2
344 Posts
Your points are very valid. I would not feel comfortable giving report where other residents/family may over hear. Hippa violation.
I also firmly believe that Med pass in LTC should NOT be interrupted (unless of emerg. situation/ falls, bleeding, etc) So for me, I very rarely will answer call lights during med pass times. Answering the phones?? also not during med pass times (unless expecting a return call from MD)
Nurses are not high paid secretaries, and NH admin. need to hire "adequate" staff/ CNA's to answer these lights durings these times. Either that, or they can leave their offices and Help to answer these lights.
Also, as far as sitting near reception desk...not when writing orders, doing admit MAR/TARS, etc...those times, I NEED to concentrate..and not be interrupted every minute. YOU do what you feel you need to do, to provide good care, and yet protect your license. No one else there will protect that license for you, from the sounds of it.
That being said, I will and do help my CNA's when I am not med passing, or when one is gone on breaks, etc. I am certainly not above direct care duties, and actually really enjoy that part of the job. Though as nurses we do need to prioritize our time and duties too, and you know what, I am still there 2 hours after shift ended, and my CNA's almost always leave on time...It really sounds like your new admin. needs to get a clue. Things look very different from behind a desk, then they do to a floor nurse actually doing the work sometimes!