Fix This Nursing Home

[eveningsky339, LPN]

A little thought exercise.

You just received a magic RN license in the mail last week. You are hired as the new Director of Nursing at a (fictional) nursing home on the outskirts of town called Pine Bluff Manor.

You arrive to take a tour of the facility, and find that it is in very bad shape. Morale among staff is extremely low, patient care is sub-standard, and place is filled with the stench of urine and feces. Here are the big issues that you will need to address as the new DON:

- The facility is infamous for poor patient care. Skin breakdown, falls, and pneumonia are very common. Staff at the local hospital have been overheard using the term "Pine Bluff" as an adjective for poor quality, and several residents have been transferred to other nursing homes by their families.

- The staff are just... yuck. Each shift is short one CNA, along with at least one call-out per day for obviously bogus reasons. Every last one of the staff smokes, and this translates into about one 15-minute smoke break per two hours for each caregiver. There are only two part-time RNs; the rest are per-diem because they can't find a job at the hospital. CNAs routinely yell at residents. The facility hasn't received a job application in five months, and the average CNA resigns after about six months.

- Aside from those general problems with staff, there are unique problems for each shift.

- Day shift is dominated by "bully" CNAs who think that the evening and night CNAs are idiots. Only a few bed baths are completed per shift, it takes two hours for breakfast to be finished, and residents are often left sitting in the dining room until lunch arrives. Residents are only changed once, when they are gotten up in the morning.

- Evening shift is generally careless. If residents are not laid down by day shift, they remain in their wheelchairs. Though passing snacks is on the evening shift checklist, this has not been done in three years. Dinner is quickly "force fed" to residents so that they can be put in bed as soon as possible. PM care consists of being changed and wiped down with a wet washcloth; no soaps or peri-cleanser are utilized. (You look at the bottles in the patients' rooms and find that most were purchased last year, yet are still full.) Residents only changed once. Fall mats only put down occasionally.

- Night shift likes to sleep. A lot. You find blankets and pillows in one of the supply closets close to the nurse's station. You talk to some AOA residents, and they claim that they are changed and repositioned only once. Some say that they are only repositioned and not changed. You find that the average time it takes for a call bell to be answered on night shift is two hours, assuming it is answered at all. Some CNAs deliberately put the call bell out of reach so that the residents can't ring. It is night shift's responsibility to get some residents up early, and with a little prodding around you find that these residents are dressed and in the dining room at about 0230-- three hours before they are to be woken up.

You leave Pine Bluff Manor and head home, completely overwhelmed by the challenges you face. Regardless, you decide to sit down and come up with a plan of action to improve the quality of the facility as a whole.

How do you fix this nursing home?

[CoffeemateCNA]

I don't know if I could.

No way in Hades I would continue to work there.

I'd grab that shiny new RN license and run out the door like a madman before it gets revoked.

Then call the state.

I don't think it can be fixed. In my opinion all the residents should be transferred to different facilities and the building shut down.

[eveningsky339, LPN]

I don't know if I could.

No way in Hades I would continue to work there.

I'd grab that shiny new RN license and run out the door like a madman before it gets revoked.

Then call the state.

I don't think it can be fixed. In my opinion all the residents should be transferred to different facilities and the building shut down.

Your optimism and perseverance are like rays of hope.

[CoffeemateCNA]

I'm not much of a management type :) but if I were. . .

I'd start by fixing the CNAs. They seem to be 90% of the problem.

If day shift insists on changing briefs only once, I will FIND some dirty briefs to chase them around with until they comply. It's like dodgeball, but a whole new level.

Evening shift needs to be held down and force fed also. Puree hamburger, anyone? I'll come over to their house on Saturday night and throw them in bed at 6:00pm and see how they like it.

Any foaming peri cleanser remaining at the end of the shift will be used to decorate employee vehicles.

Night shift needs some surprise rounds from me and some other administrative people. Fog horn

[topher-67]

Survey says:

[KimberlyRN89, BSN, RN]

First I'd sit all the staff down & tell them that today is a new day. I would tell them any signs of abuse I see would be immediately reported to the state & they'd be out of a job. Anyone who could not tolerate that could resign right then & there, no questions asked.

Whoever remained(and I doubt alot would) would be re-trained, the right way. I'd also hire new staff, making sure that day & evening shift each had 6 CNAs , and night shift had 4 CNAs. I'd also try to increase employee morale, because I think this another problem that nursing homes have. Staff parties,where prizes are given away is a great idea! Also I'd give everyone a raise. Another reason why employee morale is so low because the pay is often terrible. I'd also make sure that the facility is well stocked with peri wash, wipes, QUALITY briefs (ugh I cant stand those cheap ones that tear soo easily), and gloves! And finally, I'd be a helpful DON. Some of the DON's I've worked for dont really have a clue what is going on in their facility. I'd make sure I knew every CNA,LPN,and RN personally. I'd also make sure I knew my residents by name too! If there was a problem I'd want them to come to me so I can help address the issue. That's the only way things can get accomplished.

Last but not least, I'd have a grand re-opening of the facility(complete with a new name), letting the people of the community know that we are a new & improved place that is focused on quality care.

[Poi Dog]

good question.

steps i would take:

-secure a bigger budget.

-hire an advertisement team.

-complete exterior renovation (new name, fresh coat of paint)

-interior renovation (new staff right down to the cockroaches that inhabit the place)

-mandatory monthly in-service

-employee incentives (fun stuff to keep morale up)

-open door policy in effect.

-new supply room where supplies are recorded and checked off.

-hire 2 people strictly for ordering supplies.

-like someone else mentioned, i will get to know each person working for me (recognition).

-three strikes you're out policy (verbal, written, termination)

-provide the employees with a bigger break room that is functional and cozy.

i am on a roll here

more to come....

[CoffeemateCNA]

Everyone is mentioning things that cost $$$.

Just curious as to where it is going to come from?

Can't get more money unless we get more beds. To fill those beds, we need residents to fill those beds. And it sounds like with the current reputation, not many people are willing to do that. With more beds, we also need more staff, who are not exactly flocking to the facility.

Being broke is a vicious cycle.

[caroladybelle, BSN, RN]

I would have checked this out beforehand and not taken the job.

[sharpeimom]

i would have checked this out beforehand and not taken the job.

that would keep your license safe but every one of those unfortunate people would still be trapped

in dantes inferno. how is that fair? :crying2:

kathy

shar pei mom:paw::paw:

[eveningsky339, LPN]

Everyone is mentioning things that cost $$$.

Just curious as to where it is going to come from?

Can't get more money unless we get more beds. To fill those beds, we need residents to fill those beds. And it sounds like with the current reputation, not many people are willing to do that. With more beds, we also need more staff, who are not exactly flocking to the facility.

Being broke is a vicious cycle.

I was actually planning on deducting it out of your bank account.

Anyway, Kohala and MisszKimberly are hired... Anyone else have some reforms in mind? Any ways to get some money without robbing Coffeemate?

EDIT: One more thing. What's the new name of Pine Bluff?

[Poi Dog]

I was actually planning on deducting it out of your bank account.

Anyway, Kohala and MisszKimberly are hired... Anyone else have some reforms in mind? Any ways to get some money without robbing Coffeemate?

EDIT: One more thing. What's the new name of Pine Bluff?

The Elder Shelter