Do we expect little of people these days?

banditrn · Feb 9, 2007

More money does not make a bad nurse better. Legislation will not make dumb people smarter. You can't legislate good a good work ethic. I'm glad your nurses are getting a raise but more money isn't always the answer....making what we do in skilled facilities valued by the other members of our profession and by the public in general is a bigger part of the answer.

Capecod - you're right - all the money in the world won't make 'dumb' people smarter - it's having the time to do their jobs adequately without so much pressure put on them to do 'task' work.

I came at LTC from many years in Critical care, and sometimes I get frustrasted with how things are - but I'm not putting total blame on the nurses. I feel that they've been 'tasked' to death!!

If the meds aren't passed in a timely manner - if the treatments aren't done on time - if they don't do their weekly vitals exactly when they're due - if the charting isn't exactly right - and that all has to be done without overtime.

The nurses in our facility have to help get the residents to mealtimes - and help get their food ready for them to eat.

These are the priorities that are stressed over and over and over to these nurses - and heaven forbid if they don't carry them out in a 'timely' manner!!

My p*ss off lately has been the BM's - at noc we prepare a list of who has gone more than 3 days without one. Ideally days would start treating them - but they aren't - so I've started doing it early in the AM. I talked to one of the day nurses' about why they pay NO attention to that list, and she told me that they don't have TIME. And I believe her.

I also talked to the ADON about it - she's OK with me doing it, but she needs to make sure all nite nurses do it that way, because when state comes in and takes a look at their BM book, they're gonna crap!

As I mentioned in an earlier post, this place does NO inservices!! Some of these nurses have worked here forever - they need updating on things like pain meds, etc.

SitcomNurse, BSN, MSN, EdD, RN · Feb 17, 2007

"....you didn't fail if you tried"...nice thought SitCom but tell that to the surveyor or the attorney or anyone else who really doesn't know what we do. ......When I turned in my resignation, the VP of Corporate said, "But you're such a great nurse why do you want to leave?" They don't understand either. ....... I know they are busy...I used to be a staff nurse...but what is good practice is good practice no matter how much you have to do.
Zowie! I didn't expect to rant on like this. I really hope the next part of my career brings me more satisfaction than I have now. I'd really hate to think that all the good nurses are bailing from LTC because someday I might be old and sick and need someone who is smart and caring to be MY nurse. .... I'm not holding my breath.

I think what I meant to say is... YOU didnt fail. systems and people failed around you. YOU tried to rise to the occasion. You cant soar like an eagle when you are surrounded by turkeys...

YOU did your best. I would have liked to work under you, and been 1 nurse that you needed to feel like you werent fighting the tide. Sometimes the tide is a riptide though.

And I agree with what you said in your post, that I excerpted for the above quote... Im just of a different mindset, that change is good, if it weren't, we'd all be dead of TB or still cranking our cars at the radiator to get them started.

The system was set up to fail, because even admin. didnt have your back. Not firing one cuz ya dont know what your gunna get is the mindset my facility used to have, but they found that by keeping the 'turkeys" the eagles were not soaring higher. They let a few go, morale boosted, more good nurses came(nurses always come after a while), and VIOLA! Comraderie, and team work. Yeah, we still have the goslings about, but they too will go, eventually.

The situation may have been a disaster, but you were willing to try it.

I hope I m conveying what I really mean, cuz its late, im tired, and I still have to go do my treatments. :)

:smilecoffeeIlovecof

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brendamyheart · Feb 19, 2007

I am having a problem similar but not the exact same. I took over MDS et skilled nursing in my facility. I revamped the nurse notes to make them easier, put in charting guidelines so that they will know what to gear their charting towards for each patient et what they are there for, and am constantly in contact with the floor nurses making sure they have what they need et know what is going on with each patient skilling wise. Just the other day, a couple of them told me that they do not understand or see the point of what we are doing et they are just flat out not going to do it. If is very frustrating because our charting is one thing that has come up at state inspection et we have a woman who comes in for chart review who looks at our charting like state does. She also says that we are not sure where we need to be. I am at my wits end with it and it has only been since November since I started!! Very frustrating! Not sure what to do to get everything where it needs to be.

I too do MDS. I do PPS. I do not look good in jail orange!! I cringe at the nurses notes! I also have a cheat cheat for them to document. In service to death!!In the nurses defense, document ion comes last. do to the fact that our patients are very ill. They must care for their need first and document later, which is at the end of the shift. No overtime is allowed. So patient care is given, but cannot prove it do to lack of documentation!!!!!!!!!!!!

fultzymom · Feb 19, 2007

brendamyheart,

Glad to know I am not alone with the charting and MDS. We just had ANOTHER meeting with the nurses. I tried to explain AGAIN that it is required for Medicare payment and they can refuse payment if it is not done. And if they reveiw and we have already been paid there will be fines and consequences to it. But I also just left the skilled unit for this job so I do understand that your documentation is the last thing you do in the day. I try my best to help out on doctor day (every Wednesday) so that they are not doing all the orders by themselves and I try my best to help out when an admission comes. But as you know, how much you can help out depends on my MDS load for the week (we have a 150 bed facility) and two MDS nurses. If it was not my behind out there, I would almost be willing to say, "I give up. Let the chips fall where they may." But a lot of them would fall on me!!:nuke: So I am not going there. One complaint I got at this last meeting was that there is so much to document. I told them that they only have to document on the back (narrative notes) what is NOT on the check charting on the front. I think that some of them thought they had to document their head-to-toe charting and then also document in the narrative part (we have it all there you just check what applies to your patient). For example: one box for pulmonary and inside of it has CTA___ wheezes ____ anterior____ posterior_____ rales, ect. and all you have to do is check what applies to your patients status. The whole head-to-toe is like this. And a seperate box for each area starting with mental status and cognition all the way through safety issuse such as side rails, alarms, restratint, ect. So lets say your patient has PNE. As long as it is all covered on the front in the check charting, they do not have to document in the narrative execpt for something that may be wrong, labs, ect. I think part of the problem was that they thought I wanted it in BOTH places and they did not want to double documentation. So maybe that will help. How are your nurse notes set up for the nurses? I just revamped ours but they are not so sure they like these either. They said it takes longer but what I tried to do was make it to follow a MDS assesment so that there was less narrative charting to be done and more check charting which takes less time. But they say there is more of the check charting now so it takes longer. Is there any way to make everyone happy and get done what needs to be done?!?! :confused:

Leslie

banditrn · Feb 20, 2007

Fultzy - I see 'over-charting' in LTC just like I used to see in the hospital. In the last facility everthing was done in long hand, but in this facility, we have a combination of check-off boxes, and narrative sheets. As nite shift, I start the sheet for each day, but I see other nite shift nurses repeating the vitals that they've put at the top, into their narrative. I use the narrative for anything that is specific to each skilled resident that isn't covered in the check-off part, such as their progress, things they've said to me, problems, etc.

I don't know why some of them make it so difficult.