Could use some advice/opinion please...

1. I'm new to this forum and I hope you don't mind me jumping right in and asking for your advice/opinion, but here goes.
   I work in a nursing home and I'm the charge nurse on the afternoon shift. Basically, I'm the only nurse on shift with the exception of a nurse that comes from 6-9pm to help pass evening meds and do evening treatments. When I first started working there, (this past June), the 6-9 nurse was a great help and asset- whoever worked that shift always got all the meds and treatments done on one hall and usually all the treatments too -- this hall has anywhere from 22-24 residents. Now the problem: about a month and a half ago, a nurse (she's been an LPN for atleast 20 yrs I believe and has worked here for about 8) that was working the night shift was written up because after a resident fell, she supposedly did an assessment, said there were no injuries, and put the resident back in bed. The resident was also ambulated to the BR during the night. The next morning the am nurse noted an obvious internal rotation of the leg -- the resident was sent for x-rays and found to have a broken hip. This is the second time she's done this with a resident. As a result it was decided she could not be a charge nurse, needed to be under the supervision of another nurse and so has become the main nurse to work the 6-9 shift. UGH!!! It's been nothing but a nightmare for me! I've already given her verbal warnings for several things to which her reply is "I need an attitude adjustment." One particular thing she was warned about --- one of our resident's has a suprapubic catheter that we flush with Renocidin qod. This nurse proceeded to "flush" it using the balloon port -- she was forcing 60cc of fluid into an already filled 25cc balloon. The balloon of course burst, and guess who had to change the catheter -- me!! There are times that I have seen her giving scheduled meds as much as 3 hours late, she makes the decision to hold a med and doesn't notify the doctor, doesn't tell me she did it -- and I get the blame for it. She continually
   stays an hour to an hour and a half over and there are still treatments and meds not done, which I then have to go back and finish up. There are nights that I don't get a dinner break just so I can keep up with everything of mine to do, and what she leaves undone. I have gone to the DON and to our staff development coordinator numerous times -- and somehow it all keeps coming back as my fault --- I'm the charge nurse, so I should be going to her at 9pm and ask her for report and tell her it's time to go home. And I should write out a detail of what needs to be done and when to help her out (apparently she's not expected to be able to follow the MAR like the rest of us). I did write this out just to say I've tried it their way -- she looked at it and set is aside. They've already had one of the other nurses come in and work a shift side by side with her to show her the routine and now they're asking me to do it again. I said "NO" -- she's already been shown and nothing changes. Am I just being overly sensitive here or am I getting the short end of the stick? When any of the other nurses work the 6-9 shift, everything is done, including all the charting that needs to be done for that hall -- and I go home on time! I have worked that shift, and on that hall, myself, and know it can be done, but she has the DON convinced that all there is time to do is pills and no treatments. I even do the most time consuming treatment on that hall, which is a wet to dry dressing on a ladies legs that have ulcers -- this lady will not allow this nurse anywhere near her and has told the DON that personally!
   Ok, sorry, I'm rambling, but I really would appreciate your input.
   Thanks!

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2. 

   About mtgirl63

   Joined: Dec '01; Posts: 77; Likes: 3
   Nursing Home - charge nurse

   9 Comments

   Topic Closed
3. 
   Dec 14, '01

   Is this a unionized facility or something, where it is harder to fire staff? You are NOT being overly sensitive. For crying out loud, is she related to the DON or something? Anyone else would have been fired by now.
   
   Start taking notes, document everything. The other nurses who work 6-9 need to tell the DON this amount of work can be done. Isn't it funny how they can't see the forrest through the trees. They give this loser every possible chance to improve, and she clearly doesn't care (maybe she wants to be fired so she can collect unemployment), to the point where eventually they will lose a good nurse (you.) Is it really worth it?
   
   I don't know what to tell you, seems like you've done everything you can, I guess the DON just wants someone with a pulse to fill the slot. Good Luck.
4. 
   Dec 14, '01

   No, we are not a unionized facility. They even fired this nurse
   once (I don't know what for) and then hired her back. When the
   other nurses raised a fuss about re-hiring her, they were told by
   the DON, "well, she can't get a job anywhere else." DUH!!!!!! I wonder why. I am documenting everything --- what she does, says, what work she leaves for me to finish and then I'm also documenting when other nurses work that shift -- what time they leave, what work they DON'T leave me to do, etc. Other nurses have told the DON that the work can be done, but she doesn't seem to believe it or care or something. Well, pretty soon they'll want to know why I'm not clocking out for lunch, and why I'm working over time (especially now, our census is down, and we're supposed to be losing 4 nursing hours a shift right now) --- I'll show them my notebook and tell them WHY --- again!!! I don't know if it's worth it either, except that this is a small town and my only other option for a job is the hospital, which to me isn't an option. They work 12 hr shifts there and have to cover the ER too. I've tried it there and although I could do the 12 hrs, the ER is NOT for me. I admire the nurses that can work ER.
5. 
   Dec 14, '01

   I know how you feel. Sometimes it seems more trouble to have help than to not. Unfortunately Hoolahan is right, if she hasn't been fired by now she probably won't be. It probably doesn't help that you are relatively new to the facility, maybe she has built some relationships with somebody above you. There's no easy solution. Basically you have three choices:
   1.stay and work with her
   2.stay but refuse to work with her--this option isn't good you could end up alone with no help
   3.leave
   
   It's been my experience, however, if your DON doesn't back you from the beginning and take some action, I'd really think about leaving that facility. Doesn't sound like she's really supporting anyone, including your residents.
6. 
   Dec 14, '01

   I would love to leave and find a facility with a more supportive DON. I want to stay in geriatrics and this is the only nursing home in town. The next one closest is a 20 mile drive one way, which wouldn't be bad except in the winter --- Montana winter roads can be a bear and my husband is not for me driving every day, and I'm not either. I know, that leaves me with the choice of staying and working with her, or refusing to work with her. If there were a full time opening on a different shift, I'd take it. For now I have to wait for that opening I guess. It just helps to have a neutral opinion from someone who doesn't know this lady and I guess just to know that I'm not over-reacting. So thanks!!!
7. 
   Dec 15, '01

   Mtgirl, if you are documenting all of this stuff about this other nurse, be sure and document your conversations with the DON and others- dates, times, conversations, etc. because if something happens to a resident and that residents family sues the facility and it comes up in court that you're aware of her incompetence, your license may be on the line unless you can prove that you have notified your superiors and THEY were the ones who did not follow through. CYA when you are dealing with someone who may harm a patient!
8. 
   Dec 15, '01

   EXCELLENT advice JennyP! Let's pray it doesn't come to that.
   
   mtgirl, we have all been where you are, that's how we know. I certainly can understand why you don't want to leave there. And having commuted 26 miles one way for 13 years, I can relate, though our roads were only NJ roads in winters, they can be bad at times, but I know not nearly as bad as your roads.
   
   Man, your DON is really giving your resident's and her staff the short end of the stick. Tell her, that is what unemployment is for! This girl does not belong in this field then! There are dozens of other jobs she could give this girl, how about dietary, housekeeping, etc, she can give her a job, just not as a nurse if she feels sorry for her! (I am serious here.) Just watch out, I have seen where nurses like this become your supervisor b/c they can't handle the hands-on. This is NO offense to supervisors in general, but just I have seen it happen many times in this kind of situation.
9. 
   Dec 16, '01

   They are pushing the responsibility for her mistakes onto you and off of themselves. I think what they are doing stinks. All those managment people hiding behind your little license like they are naked and it is a fig leaf.
10. 
    Dec 17, '01

    First of all she is a lawsuit waiting to happen. Like the others who responded to your dilemma if the DON doesn't respect your actions time for you to step! It is like beating a dead horse. Why wait til she does something that will cause serious great harm. Then you will be in sling! Personally I never had that problem but I worked in a LTC, and I had to assign the CNA'S their assignments. Well we had a very difficult patient that satan didn't want to deal with but it was understood we rotate this patient so everyone can have a break. Well one of the CNA's refused and clocked out and went home. In my book that is automatic termination. I returned to work to find that same CNA working as if nothing happened! I was furious. My DON was not in my corner so I resigned the next day. Never to return. Not only did that undermine my position as charge nurse, I had no support from my superiors. I know this is not as serious but it is the same. You have done what you are suppose to do and yet this nurse is very incompetent and dangerous. I stay get out. You worked hard for you license. Don't let someone else screw up your reputation! I wish you luck. I hope you find some resolution.
    
11. 
    Dec 17, '01

    I too left LTC after an incident where there was no support and I was left holding the bag. Never again. Although I liked my job, that was the end for me.
    
    For everyone, there is a point where its not productive to continue. I would advocate for a written letter to DON and ADMINISTRATOR and company headquarters documenting all your observations. I would state in writing that I expect a written reply within X-amount of days. If no suitable answer was forthcoming, I would quit.
    
    Its simply a matter that if you're not part of the solution, then you're a part of the problem. Sorry, maybe I'm too harsh. But, I think you know too that you can be reprimanded by your state board of nursing if you know about less-than-adequate care and do nothing about it.

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