Frustrating Workplace

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Hi everyone! I'm new here.

I just feel the need to vent. I work at a LTC facility with 17 patients/nurse and 9 patients/CNA. I know those aren't bad numbers but it has been a very stressful 4 months! I started in August and I came from a sub-acute trach/vent floor with 10-15 patients/nurse.

I'm not sure if I'm struggling because of my own skills or because of the workplace dynamics. It seems like the NM and ANM have only one volume LOUD. They yell whether I'm doing a good job or doing horrible. I was questioned by the ANM as to why I was doing a res shower! (The CNA had gotten mandated from nights and was relieved at 12noon by another CNA and I felt bad for them both so I did it for them) As if I'm not capable of doing a shower OR I felt like she was implying it was beneath me, and personally I think the aides have enough work every day they need help sometimes!

I've finally gotten to the point where I finish the med pass in 1 1/2 to 2 hours. Before it took me 2 1/2 to 3 hours. I help the aides where I can doing at least 2 washups or helping with transfers etc.

I also got "spoken" too about charting "charge nurse aware." The ANM asked me why I was charting charge nurse informed or charge nurse aware. I stated I would only chart that if I actually informed her of something. She said I know but why do you chart that? I said because I told you about it. She said but when you chart that it puts everything on me. I didn't know what to say to that and she said nevermind and we'll talk later. I'm not sure what to think. That's how I was taught to chart in school.

Anyway, I'm just frustrated by the management here. I live close to where I work and I've been trying to get in there for a while. I'm almost at my 6 months so I can transfer to another unit soon. I just feel bad leaving my aides in a crappy work environment. They're great girls and work so hard. I start my RN in January and I'm worried maybe I'm just not cut out for nursing. Maybe this is just the way it is...

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Specializes in LTC, Memory loss, PDN.

just a couple of quick points

i love that you're a team player and want to help the CNAs,

but if you're giving a shower, you're stuck in that location

and not available or easily accessible - that's potentially

dangerous

next time you're asked why you charted that you updated the

charge nurse, tell them that you want to demonstrate how excellent

the communication and continuity of care is in that facility

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
if you're giving a shower, you're stuck in that location and not available or easily accessible - that's potentially dangerous

I totally agree. Giving a shower means that you, the floor nurse, are stuck in a resident's room for a minimum of 20 to 30 minutes working on that one task.

What if a code blue happens during that time? You'll need to leave your naked resident in the shower to assist with the code. What if a resident complains of chest pain during that time? You'd better hope your nurse manager is available to intervene while you are giving your shower.

Always remember that, while you can help the CNAs/aides with their tasks, they cannot help you with any of your licensed nursing duties that are not within their scope of practice.

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Especially if a nurse was a CNA before getting their nursing license, I can see your point. It is easy to get caught up in the "well I am not too good to shower a patient" situation. Any of us who rely on CNA's for doing ADL's are just so darned thankful that they take pride in our residents and the care they give, that most nurses are more than happy to help out. Especially when med pass is done.

Unfortunetely, the pp are correct in that it takes the nurse off the floor. And usually for an extended period of time.

There are other ways to help out. "I am going to change the bed while you are showering the resident" "I will take your finger sticks while you are showering the resident" that type of thing--things that don't require you to be in the shower room for extended periods of time. Or even to ask, "I know you came in late, what can I do for you that doesn't require me to leave the floor?" It can also be a matter of reviewing what has happend, what needs to happen, and what your availability is to help.

There is some talk of CNA's not being helpful or "into" working. But I find that is the exception rather than the rule. So while your offer to help is admirable, you need to be mindful of your nursing responsibilities as well.

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If you have informed the charge nurse of something then it is within your right and wise for you to chart so. She does not want you to chart this because she wants to be able to successfully state that she was never informed should something go awry. Chart to document your own actions without being concerned with making it easy for someone else.

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I understand that you'd like to help out the cnas but, a lot of the time it's just not practical. I've never known a nurse to do showers in ltc, I've helped undress a resident or pushed them into the shower room for the cnas but, that's as far as I've ever helped with a shower. When I first started out I wanted to help all the time too but, I had a lot less stressful shift when I learned to just do my job and let the cnas do theirs. Plus you can help them out but, if that gets you behind then they can't really help you with your job. We'd always help each other when we could but, with 55 residents to 1 nurse and 2 cnas, that wasn't very often. Just remember, my job and duties come first. If you have spare time when you are done that's great! :-)

I always chart on call nurse notified, home manager notified (I work in a group home). Some places don't want anything charted, others want it like I usually chart and I've even seen it charted out with the name of the person notified.

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remember to give the name of the higher up that you notified.

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Specializes in LTC, home health.

We had some of the same problems at the long term care facility I used to work at. We were also told not to chart supervisor aware. The supervisors were afraid they would be held liable if something happened. It is their job to be aware of what is happening on the units!! I think that we should have been able to chart supervisor aware, but we would be in trouble if we did.

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Specializes in Emergency Nursing.

(generally speaking) RN nursing is different and much easier than LPN nursing, imho. Areas dominated by majority RN staff have better nurse to patient ratios (generally speaking). One LTC unit I know of that eliminated LPNs and now uses all RN staff has 7 patients to 1 RN. Med passes are done by CMA's in addition to ADLs. The RN is to focus on assessment and treatments to coordinate with the care plans. That's a LTC environment dominated by RN staff.

Acute care environments are almost always dominated by RN staff because most acute care environments are hospitals. Pt loads are generally pretty lenient and the work load is so incredibly manageable. Like incredibly manageable!!! My ER just made it so no RN is to have more than 3 patients at any given time... like how awesome is that? In addition, every 6 patients will be podded with an LPN or medic in the ER to assist the RN and patient. The floor is not to have more than 4 or 5 patients per RN. If the RN is to be responsible on the M/S floor for 6 patients they are to be podded with an LPN.

Where I did clinicals for my critical care training (which was a total joke since I've been an LPN in critical care for 4 years), there were no LPNs and the RN was the responsible caregiver in this small, rural hospital. The max the RN would be assigned is 2 if they were ICU type patients and 3 or 4 if they were to have PCU or M/S type pts. Talk about down time. There was sooo much sitting around that the RNs did.

My fellow LPN peers who started or currently worked in LTC all gawked and spazzed out at the amount of down time compared to all the hard and difficult work they, themselves did in LTC. We were all glad that we decided to go back for our RN because that type of stress and lack of management is too unique to LPN dominated fields.

However, being an LPN in an RN dominated field is not without its own problems... but that is why I'm working toward my RN. Get it, SMCKLPN!!

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Hi all thanks for the replies. I know I posted this way back in November but I got into a car accident two days after the post and honestly completely forgot about it until today when I was on the forum looking at info on RN schools.

Thanks for the varying perspectives. I 100% agree that if I were the only nurse on the floor being "stuck" in the shower room would be a huge risk for the floor if there was an emergency. On my floor there are four CNAs, two LPN's, a charge nurse, and the nurse manager for 34 residents during the weekday 7-3 shift. I alerted the other LPN to where I would be. It is also expected on my floor that the LPN does at least two wash up's on their side after they complete their med pass. I did end up speaking with the NM regarding why I was asked to chart a certain way and she said nothing was wrong with my charting and reiterated what you all said that the ANM wants to be able to say I never informed her.

Anyway, it doesn't matter now. I've been out of work on STD due to my car accident since November and they have posted my job. Once I am cleared to return (in another month or two) I will need to find another job within the facility or I will be terminated. I was actually surprised and impressed my NM held my position for as long as she did since I hadn't been with the facility for the full year she would have been able to post my job right away back in November.

Everything happens for a reason and I'm sure something better will come along. Thanks for taking the time to read my post and for all of your insightful replies :)

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