First Day....

[arabstarRN]

Well today was my first day at the SNF/LTC facility I got hired at. Really busy, and really tiring! My preceptor was great and did a great job trying to show me everything she could... there is just so much to do with that many residents... We spent all morning passing meds and tracking patients down because therapy didn't let us know they were taking this resident or that resident, so we would have meds to pass and find the resident MIA. The aides are great!! There was four of them on the floor for almost 50 residents, and they all worked really hard to get things done and the patients taken care of. I was really impressed... when I did clinicals at a LTC facility the aides didn't work near as hard as these aides did. I will be on midnights and I have been forewarned though that the midnight aides can be "lazy" and "sit around and chat instead of answering call lights". Since my position is a charge nurse, this will have to be dealt with if it happens on my shift. I am not saying that they cant relax and have a conversation, but if there's still work to be done and patients' call lights are going off, I would hope they aren't sitting there ignoring them. I consider myself to be a fair manager, and just want the patients to be taken care of well and work to be done - I don't believe that is too much to ask, especially on a slower shift like midnights.

Anyway, It was a good day and there are many opportunities for me to learn, and lots of acuity!! Once I learn the residents better and their individual information/transfer status/toileting status, I will feel much more comfortable and really look forward to the job. Right now it's extremely hard since I don't know anything about any of the residents, except what I can get from my preceptor and the care plans I get a minute to look at... I don't have time yet to flip through every chart and so far, I haven't found a book that has the care plans... It will all come with time... Good successful day over all though!!Does anyone have any tips that may help me adjust to the job? I don't intend to be the nurse that calls the CNA for every little thing - I will do what I can, when I can in order to help them out. I will value my CNAs, they are a blessing to the nurses in my opinion... as long as they do their job correctly and provide good care to the patients.

[nohika]

One thing I'm going to say (beyond congrats on the job!) is ignore what the people have been saying about the midnight aides. It's likely to bias you against them before you've even met them. :)

They may be lazy, they may not be, but it's always better for you to discover at least somewhat by yourself. :)

[arabstarRN]

Yep and I know they just hired a bunch of new aides on all shifts at the same time I was hired, as they were in orientation with me, and those girls all seem nice - and of course, them being new, the current employees have NO idea about these girls... not that I have a clue either since I only met them in orientation, but still - they all get a chance in my book. Even if the midnight aides are "lazy", they are still help to me because they know the residents and more about how things work than I do!!

I dont see myself as a micro manager, and in the management positions I have held, I have had no problem with employees not doing their work... I think I am pretty fair and just expect reasonable things. My nursing instructors thought of me as a good leader, so hopefully they are right and I can be a part of a good team. that's my goal :-) my goal isn't to make anyone's life miserable or micro manage or get the aides in trouble; its to provide excellent care to the residents and make it an enjoyable (as enjoyable as possible) place for them to be as 90% of them would rather be somewhere else....

I look forward to meeting my team in about a month and working side by side with the aides for the good of the patient :-)

[NICU Kristen]

This sounds VERY similar to the snf/rehab facility where I work! I am currently contingent and only work one weekend a month because I got a full time position at a hospital. CNAs in this type of job work very very hard. It is A LOT of work for both the CNAs and the RNs. I have never worked midnights and I have heard it is much more relaxed. Day shift is busy and stressful. GOOD LUCK!

[classicdame, MSN, EdD]

try working some night shifts to ge the feel of what really goes on

[mazy]

I would say to get to know your job well before you start worrying about the aides. You will have enough on your plate without stressing out about that.

In LTC/SNFs "charge" is actually a very fluid concept -- really you are just there to take the blame for any problems and clean up any messes and CYA. I have worked charge many times and never once went in thinking about myself as a manager but rather as a member of a team trying to steer all of us to provide good care -- as a team.

Managing CNAs or anything in LTC/SNF is like herding cats. If you focus too much on that you will steer your team right into a wall. If you've never worked as a CNA you will also, as part of your learning experience, have to learn what makes a good CNA and what you need from each other.

If there are aides there that have been there for a while chances are they know the unit and the patients a whole lot better than you do right now and can be a great resource for you while you are learning your job. At the same time they will be teaching the newbies how to do their job.

Also, everyone says the night shift staff is lazy. Soon they will say that about you. It's a topic that has been discussed a lot on this site. You will soon find that night shift has some huge challenges of it's own.

But it sounds like you are coming in with some very good energy so just keep on keepin' on. You'll do great.

[keepleaRNing]

Some midnight aides can be very lazy, and unfortunately, you will discover this. However, that doesn't mean that just because an aide is sleepy constitutes laziness. I have witnessed some very fatigued aides work their behinds off. I have also seen other NAs park overbed tables near the residents' doors, put their heads down, and go right to sleep. I am not suggesting that you micro manage, but do ENFORCE your stance in the no sleeping policy from the BEGINNING of your starting out, "I know that we all will feel like just dropping and going to sleep @ some point during the shift, I know it can be tough to stay awake. But I ABSOLUTELY cannot allow anyone to do that during our shift...." Midnights are generally more laid back, but still, it is not a time to catch up on sleep. That usually puts the patient in danger, the aide's job and the nurse's job on the line. P.S.= other people from different departments rat out nursing staff when they see them sleeping too, and all h@?! breaks forth! Be friendly, be down to earth, but be firm, and you will be fine! All the best to you:nurse: