From real good to real bad overnite

[Hospice RNCM]

All,

I am an RN, ADN working at a local nursing home/rehab ctr. During the past 3 months, I have seen everyone from the ADON's (2 of them) to the Administrator either fired or resigned. The new DON ironically was the same one who interviewed me and hired me last year, and was then fired before I even reported to work! I was kind of suspicious but decided to stick it out and give the new folks a chance, and for a while, things were looking really good. The new DON told me during the first week that she had heard a lot of good things about me from both fellow staff and family members of residents. I found myself being praised by name at the last several payday inservices, and was fortunate to be posted to a wing where I was in charge of some of the most difficult patients in terms of degrees of skilled nursing care. I had (and still have) a fine team of CNA's who getm the job done with a minimum of supervision, and I had a Medication Aide who always volunteered to stay extra hours to make both of my evening medication passes, freeing me up to do nursing work.

Then overnite, everything changed. Suddenly, and without any warning, all medication aides were prohibited from working any hours except 7-3. My shift is 3-11. My resident count was increased to one short of my hall's maximum, and suddenly I was short my med aide, forcing me to have to pass my meds myself. At our facility, the first 3-4 hours of the 3-11 shift is extremely busy, what with people returning from dialysis with new orders, family members wanting to speak with me about the care of their loved one, doctor's offices calling, and problems with individual residents requiring my immediate attention. On the first day I had to make do without a med aide, I was totally unable to start my med pass for 4 pm until well past the dinner hour. During this first day, I was approached by a resident who asked me if I would please followup on an appointment he was supposed to be having. I told him I would get back to him, and that I really needed to get my medicines passed right now before anymore time passed. Somewwhere during the next 2 hours, this resident took care of his problem himself on the upstairs phone. He approached me at that time and said "Hey thanks for NOTHING!" I told him that I had fully intended to get back to him, but I was too far behind with my medicine passes, I was short-handed, and I just wasn't able to get to it. I felt at the time that getting my meds out was a slightly higher priority than checking on an appointment.

The next day, I was called into the DON's office and presented with a Disciplinary Notice by the ADON, who told me that the angry resident had approached them that morning and told them that I refused to help him. I told them this was not the case, and that I was busy pasing my medicines, reminding them that they took away my medication aide on very short notice. I was then given a lecture on what constitutes negligence and irresposibility, and told by this ADON (an LVN by the way) that my immediate responsibility was to attend to his question. I told them that checking on an appointment was hardly a higher priority than getting the medicines out to people who needed to take them either before or while eating their dinner meal, and since I was already late by having to deal with other issues, was I now going to make them wait longer? The ADON told me that this is exactly what they expected, and from now on when this resident asks for help, my responsibility is to drop whatever I am doing and take care of him. I was also given a stern lecture on how they came from working at other facilities where they had no medication aide, were in charge of 30-odd patients, half of which were G-tube fed, 2/3rds of which were diabetic, and they got everything done including new admissions, and treatments, and did so in timely manners. I was also told that I would NOT have a med aide anymore, and I was just going to have to accept that as will all the other nurses on the evening shift, and there will be no further discussuon on that issue. When I left the office, I felt as though all the satisfaction of working there had just gone out of me. I had to try very hard to contain my anger all the rest of the night. Somewhere during the night, I found that one other nurse had been written up in quite the same manner, for "not being on top of her CNA's." This nurse had angrily told them "what do you expect? I have this, and this, and all THIS to do, and by myself all of a sudden." She got the same lecture as me, that this is how it is going to be from now on, no med aide, and she is going to just have to do her job without one.

What bothers me is that in both of thses instances, we were judged guilty before we even walked in the door. The disciplinary notices were already typed up, and our main purpose was to hear them tell us what lousy jobs we had done, sign, and rebut if we felt like it, and get back to work. No chance to air our side of the story, introduce conflicting evidence, or otherwise show that we are doing the very best with what we have been handed.

I have always prided myself on giving 110% and more to my work, but suddenly 110% is no longer enough. I feel now that I am under the gun. I have never before been accused of anything even remotely called negligence, and to suddenly be called negligent and irresposible galls me to no end. And more so, because this same resident has put me on notice that he intends to report me to the DON again because he didn't like the way I helped him change his colostomy appliance. I have also noticed too that the full-time medication aides we have now are being vastly under-used. During the last week, my former hallway med aide was only able to work 25 hours.....and she is supposed to be full-time. Most of the others have experiences the same. In addition, this same med aide is being watched by the front office, and every time she is seen conversing with a staff member other than a nurse, that staff member is called into the office to be asked what were they discussing?

I suppose that the time has come to move on to something else.........still it perplexes me as to why our facility would change so much overnight from a place where everyone wanted to be there to a place that everyone can't wait to get away from.

Any thoughts?

[KaroSnowQueen, RN]

I have seen this happen in other LTCs. My primary thought is somewhere up above, management has changed, maybe in a main office somewhere, even in a different city and/or state, and the bottom line is money. It seems everyplace is cutting staff, as payroll is the biggest expense.

My advice, as one who has been there, is to find a new job. They will indeed expect you to do two or three people's work and to do it in an unbelievable time frame.

My last LTC job, six years ago: on hiring five years before that, I had a med aide and five CNAs on day shift, and a med aide and two aides on second shift. When I quit, I had no med aide on any shift, three aides on days and one on second. And one week a month, I had to serve in the dining room, leaving the aide to pass trays to 40 pts and feed about six or seven alone.

And was supposed to get supper meds passed before all this!

[LoriAlabamaRN]

What a horrible situation! I can't imagine why they would change so much, perhaps a lawsuit against the facility was settled and the budget had to be cut drastically? That might also explain why so many of the higher-paid staff members were fired or asked to resign and replaced by lower paid staff (you mentioned the new ADON was an LPN).

Regardless of the reason, you need to start looking for another facility in which to work. It sounds to me as if you have been treated shoddily, and I would not put up with it. Find a great place to work, put in your notice, and get out of Dodge.

[SilentfadesRPA]

Steve

First of all I am glad you are not taking responsiblity for this incident.

As well I am sorry you are having to put up with this?

If I read your post correct did you say that DON was an LPN ? That there should tell you that this administration is to say the least pathetic and the most operating illegally.

I think you are realizing that this is the time to go before any other situations occur that you are being put in trouble for.

If this occured for me I would have an attorney (perferably one who deals with medical situations )after I leave write at letter protesting the note of negligence and put them on warning for legal action unless that is removed immediately and your given a reference that is what your work was par excellance -- if or not you carry that out is not as important as getting a legal rebuttal so that if they reported you to the BON this is on file.

I would also write letters to the state onbudsman and any other agency that oversees the staffing this type of facility after I got myself free from this type of situation.

They are setting you up for legal reprecussions and as well have put you in a very dangerous situation. Get out now before any other situation occurs as it sounds as if your in a no win situation.

You do have choices and it sounds like your up against a system that has stripped you of all sense of fairness and is not concerned with your emotional physical or professional wel being.

My resignation would be short sweet and simple -- " I am resigning effective ____ as I have taken another postion. Thank you for the expirience here.

Sincerely

Should one more situation or warning occurs I would leave after my last shift yes without warning -- that is not abandonment it is self preservation and removing yourself from a very dangerous situation.

Some say it is not professional however being put in a dangerous situation is not anything that anyone should tolerate for any amount of time.

Also here in NY state you can get unemployment for a hostile work enviroment and if this is not hostile I dont know what is. It also sounds if they are asking you to go against the nsg act by this type of insurmountalbe work.

I sincerely wish you well and hope that you have the strength, personal integrity and loyalty to yourself and your profession to do what you have to do for you.

Marc

[catlady, BSN, RN]

I've never worked anywhere that had a medication aide, so I can't speak to that, but the attitude you're getting from administration should tell you what you need to do in terms of career move. Surely you can find another position where you will be respected and not be a marionette on the strings of a particular resident. To be presented with a writeup when they haven't even heard your side of the story is unprofessional, to say the least.

And those who've read my posts know I'm very pro-LPN, but what's this having an LPN as the ADON when there are RNs in the building??? That doesn't seem kosher to me.

[Hospice RNCM]

THanks folks, for your quick replies.........it heartens me to know I hae at least some "disinterested outsiders" apart from the situation on my side. I do intend to begin seeking employment elsewhere.

The DON is an RN. The THREE ADON's are LVN's and the four unit managers are LVN's. In the previous regime, the DON was an RN...........who also was a classmate of mine in Nursing School. He had already been at the facility for 6 years as an LVN, which is how he got to rise to be DON. Under him there were two ADON's one and RN, and the other an LVN. It was while the former regime was tehre that we wre able to finally hire and keep both floor nurses, and Medication aides. We had gone through a period where we were losing nurses faser than we were hiring them. We even had nurses show up for their first day, and quit after the first shift. The only way to counter this trend was to hire more medfication aides, particularly in the evening shift hours where the number and amount of medications was the greatest, which is what they did. During this time frame, the nurses experienced the greatest freedom to be nurses instead of pill-pushers, and we became fully staffed finally. Now overnight, it has changed. The med aides we have, I sense, are being forced out by virtue of being underworked, and there are no plans to replace them if they leave. The nurses' morale has plummeted, along with an inversely proportinate increase in workload.

During the first week I had to do without a med aide, I didn't get out of there until 1-2 in the morning, because I will not leave any amount of work undone for someone else to do.

I have my doubts about hiring an attorney but just to be safe I have taken to documenting everything that goes on every day.

Again, thanks to all, and keep those threads going.

[jaytek13]

Sorry wrong post

[clee1]

Run, don't walk, out of that hellhole - NOW!

Your license is at risk, and the administration has already demonstrated that they are willing to throw you under the train.

[KarenGeorgeBSRN]

Good Morning!

In LTC an ADON can be a LPN or LVN as long as they have a 4 year BS in Nursing as myself on board. This is common practice.

Steve you likely belong to a large system; there are several in the U.S. and currently there are a lot of companies going under new ownership; that might make your Administrator and DON insane so to speak.

I think if you and others on evenings continue doing your best you might be surprised. Give it some time!

Thanks,

Karen G.

[nghtfltguy, BSN, RN]

wow!~~

that is such a crazy situation!!

take charge.....

i don't know what it all entails.. just do it!

take charge!!

be the damn boss yourself@@@

you have the power within you... just use it!!!!!

i wish you the best of luck...

[KarenGeorgeBSRN]

Dear Steve,

No this is standard practice entirely! I have several specialties and have run a NIP network for close to 10 years (nonmalignant intractable pain) but consider myself a "generalist" and this my best specialty for it allows what we all need today; to integrate all systems as one--in today's acute care crisis LTC is the future.

The larger corporations have vision and this vision includes opening sub-acute units, wings, and teams of staff trained to treat acute care elients non covered by insurance (cost effective care), and the key is "all of us" will be affected. In a positive light there is nothing negative to deal with if we as a profession are moving with change; not expecting what worked in the past to work today.

I encourage anyone in LTC with issues to ride the wave; it will not always be a tidal wave and a nurse with endurance will make his or her way up as long as they communicate, document and dedicate.

Have a good day!

Karen G.

wow!~~

that is such a crazy situation!!

take charge.....

i don't know what it all entails.. just do it!

take charge!!

be the damn boss yourself@@@

you have the power within you... just use it!!!!!

i wish you the best of luck...

[banditrn]

THanks folks, for your quick replies.........it heartens me to know I hae at least some "disinterested outsiders" apart from the situation on my side. I do intend to begin seeking employment elsewhere.

The DON is an RN. The THREE ADON's are LVN's and the four unit managers are LVN's. In the previous regime, the DON was an RN...........who also was a classmate of mine in Nursing School. He had already been at the facility for 6 years as an LVN, which is how he got to rise to be DON. Under him there were two ADON's one and RN, and the other an LVN. It was while the former regime was tehre that we wre able to finally hire and keep both floor nurses, and Medication aides. We had gone through a period where we were losing nurses faser than we were hiring them. We even had nurses show up for their first day, and quit after the first shift. The only way to counter this trend was to hire more medfication aides, particularly in the evening shift hours where the number and amount of medications was the greatest, which is what they did. During this time frame, the nurses experienced the greatest freedom to be nurses instead of pill-pushers, and we became fully staffed finally. Now overnight, it has changed. The med aides we have, I sense, are being forced out by virtue of being underworked, and there are no plans to replace them if they leave. The nurses' morale has plummeted, along with an inversely proportinate increase in workload.

During the first week I had to do without a med aide, I didn't get out of there until 1-2 in the morning, because I will not leave any amount of work undone for someone else to do.

I have my doubts about hiring an attorney but just to be safe I have taken to documenting everything that goes on every day.

Again, thanks to all, and keep those threads going.

Steve - if they want to cut staff, why not cut a couple of those ADON's? Too many chiefs and not enough indians!!