not enough CNAs

[SleeepyRN]

Sorry for the vent. I just care deeply about my residents, and today was by far the most difficult day of them all. I'm usually positive, and find as many positive points throughout the day I can. BUT

Any other nurse out there who is struggling and at your wits end, not because of nurse resident ratios, but because you don't have the CNA coverage you need to get your job done? How am I supposed to pass roughly 800 meds in one shift, accuchecks and insulin, answer very interruptive phone calls at the worst times from family, answer family questions (who are at the bedside) that are THE LAST PRIORITY on my list when compared to the other residents who truly need me at the moment, not the pillow fluff the family wants, assess residents who have a change in condition, page MD, enter the new orders or send resident out, pharmacy/lab reqs, ....I could go on and on, AND keep all my fall risk residents from falling? Not to mention CHARTING????? I know, welcome to LTC/SNF but there are certain places where they are sooo short in CNAs it makes the facility completely unsafe. Unfortunately, I have to take what job I can get in this over saturated market. Plus, I truly care about my residents, and pray for them all the time that they get quality care.

[Here.I.Stand, BSN, RN]

I would LOVE to hear what the nurse had to say. That sounds like you handled it perfectly.

She said nothing, but she did get up and help someone to the commode!

[CapeCodMermaid, RN]

I completely believe that before anyone is allowed to be a nurse, they spend at least a few shifts as a CNA. Walk a mile in someone else's shoes before you say anything about what they do. AND, I think every nursing student should have to spend time as a patient.

[pinkiepieRN]

I think every nursing student should have to spend time as a patient.

I definitely agree with this. I have staff members who work with residents as if they're not people too and I can't wrap my head around how that's okay to them. I've been a psych patient four separate times and I know all too well how it feels to be powerless and have to ask for things that would normally just be available to me in the home environment.

[Chrissy Lou]

The irony of this post is that tonight we were short nurses. Pm shift. 3 halls. 2 nurses splitting one of the halls. This is a psych/skilled unit. Extremely challenging. So I was to have 55 residents with trachs, g-tubes, wounds, plenty of accuchecks, so so very many scary fall risks. The 2 ADONs refused to come in as well as the other supervisors. Luckily!!!!!A nurse came from the easier (a&0 × 3) first floor after the first 2 hours of this 2 nurse disaster on our floor to be the 3rd nurse on our unit. (Still leaving first floor understaffed in RNs)I stated I don't know squat about ADONs. But I know I don't want to be one. Because a competent one should have viewed the scenario as an unsafe environment for residents and staff and have done ANYTHING to make sure each unit was covered.

The ADONs get on us nurses and the CNAs about petty things, then go and leave their building, their residents, understaffed? We nurses talked about calling the state. The staffing is in such chaos.

Unfortunately, my job as the ADON is pretty much.....everything that no one else wants to do plus a little more-whatever I can fit into a 50-60 hour work week...lol! (Yes that is for real-every week- hence the reason I do not fill a hole on the floor- it's also because I am "salaried"- I am not paid overtime to work the floor) Seriously though, my job does involve working with the scheduler to cover the units, (again, another job that no one wants), and there are days I could pull every hair in my head out trying to do that. There are times when no one, and I mean no one wants to pick up a shift or even a half shift. We do "mandate" people to stay over a few hours when people call in to give us time to find replacements. Also in our building, once we hit a "critical level", all managers are called in to assist, even if they aren't nurses. (Therapy, MDS, Staff Educator etc.) The thought is that EVERYONE can answer lights, pass ice, adjust blankets, help with phone calls etc, which helps free up the direct care staff to focus on patient care. Now, I can tell you, that if I put out a warning that we may "mandate managers", everyone sure jumps on the bandwagon to help find staff to fill the holes. It helps, and it also helps those managers who have not been aides or a nurse to appreciate the direct care staff more. Unfortunately, the other part of my job is to pick on the "petty" things, but experience has shown me more than once that those "petty" things are often what trips up the staff when State is in the building- you know tags for "holes" in the MAR, not bagging linen, the little things. Yes, I am not always the most popular person in the building, but I am forever watching out, being an advocate for our direct care staff- pushing them to be the best caregivers they can be, and searching out little ways for them to feel appreciated.

[SleeepyRN]

I completely believe that before anyone is allowed to be a nurse they spend at least a few shifts as a CNA. Walk a mile in someone else's shoes before you say anything about what they do. AND, I think every nursing student should have to spend time as a patient.[/quote']

My point was quite the opposite. We need more CNAs staffed!!! These poor CNAs can't do it all while keeping everyone safe. While it's extremely hard on the CNAs (and I was definitely there, a proud former CNA/PCT myself) the extra work lands on the nurses too, taking away our valuable time as well. This poor staffing leaves CNAs, nurses and patients in a sad state of being. As a side note, since you mentioned it....I've been the patient in the ED, ICU, in surgery, in recovery....it's a pet peeve of mine when patients act like they think we health care workers are immune to the same diseases, afflictions and conditions as they have and that we couldn't possibly have an inkling of what they are going through.

[SleeepyRN]

......and searching out little ways for them to feel appreciated.

THIS makes all the difference in the WORLD.

As far as the beginning of your post, working 50 to 60 hours a week, salaried. .......sadly (and quite illegally) even though I am a .8, I still work close to 50 hours a week on average, (I work the 3-11 shift and actually worked 2pm to 3:30am today, no break.) That's 5.5 hours FREE that should be at the least paid to me, at the most paid OVERTIME to me. I will NEVER see that money. An admission, a death, a fall and a skin tear along with 600 meds to pass and insulin to give and MDs to page, orders to enter....are all common to one nurse in one 8 hour (HA!) shift. Hence getting out at 3:30 am.

I didn't mean to turn that into a competition. I respect your job, and appreciate you sharing your responsibilities as an ADON. It's always beneficial to get insight to the other side.

[Natasha A., CNA, LVN]

I totally can relate with all you. I'm a CNA part time and it seems like as of 2014, our patient ratio went from 2:18 to now 1:22. One staff with twenty-two patients. You literally are working your full shift and more importanlty ignoring the patient care and safety because we are busy doing everything by ourselves. Its like hospitals, nursing homes, etc are big on ways to continue to be " cost effective" versus our license/safety and patient care. I hope things change soon.

[Chrissy Lou]

It's sad isn't it? I love and hate my job at the same time. I thought that by moving up it would give me more opportunities to really make a difference, to help further training, mentor.....instead I crunch numbers, am told to ensure compliance or it's my job.....I am sad for our residents. I keep trying though, for if we don't keep speaking out, who will?? Who will be the advocates for our elderly?

[Natasha A., CNA, LVN]

Chrissy- its interesting that you mention "patient advocate". I decided to volunteer to help improve our hospital setting and asked my DON if their was anything I can do that will advance my "leadership" skills to add to my resume and she said "Help me figure out how to reduce the amount of patient discharges because the hospital loses money each time a patient AMA." So I started to research and found out that having a patient advocate in a hospital setting helped 30% of patient discharges. Simple. Now when I presented tht to my DON she said that it will be costing the hospital more money to hire one. I told her that I would like to take on that role if necessary because our patients need a person they can go to in a time of need.she is thinking about it because I'm a cna but no patient advocate experience, my passion is what makes me a valid candidate. So we will see. In the mean time my DON doesn't have an assistant so I also volunteered to help her to add to my resume in the future. I plan on going to LVN school and I read that LVN's can be assistant DON's if they have experience. So now a days we have to think outside the box if we want to move up and creeate our own opportunties.

[Natasha A., CNA, LVN]

I feel like if a hospital setting says "do this do that or its your job" shows lack of respect for their employees. My thing is if they are going to reduce staffing,then we should have more advance technology or ways to do our work in half the time.