Truth or B.S. !!!!!!!!!!!!! - page 2

From a recent association meeting this week, much discussion and focus of the meeting was on the medicaid resident in long term care r/t the budget and that dental, vision, podiatry will not be... Read More

  1. by   RhondaRNConsult
    Fran, what I was saying is that when our shortages hit, we took a look at why they were there.... What could we do to keep our staff, and worked together to form an unbelievable team.... much like your facility did! The shortages are there, no doubt, however..... we can & will get through it.....
  2. by   RNIAM
    Athough your team work concept is great in theory. the realitly is if you don't have the staff to begin with then you can't have a team. I hav been through enough of these homes to know there are many problems and team owrk alone will not cure that. I was a CNA. thank the Good Lord my husband took another job so that I can focus on school. I will nevr again be a CNA, bless the hearts of all that do it for a living. I would rather be an RN. You are right however that finding out why their is a shortage is important. The shortage of CNA's is simple, just look at previous threads. Thirty residents to one CNA? How owuld you feel? I know I would feel overwelmed and seroiusly underpaid. That is exactly how I felt and then to put insult to injury. I watched the nurses atthis faciltiy sit and watch as we the CNA,s worked our AS@es off. Sorry if this hits home but reality sucks. the nurses all five of them were sitting around gossiping while the CNA's ran around trying to get the resident fed,showered and dressed for the day. I think that is a great place to start,don't you?
  3. by   RhondaRNConsult
    ah, thus the 'teamwork' effort comes in to effect. Without top management in the teamwork loop, you have no team. It only takes one person to start the teamwork....... If it comes from the administrator showing the teamwork effort, the DON showing the teamwork effort, it goes right on down the line. BUT it all starts with upper managment having policies and following them. Why were those nurses able to sit and watch C.N.A's? I too was a C.N.A. for many years before becoming a nurse. I understand and have worked with many fellow nurses that would ask me why I was assisting a resident up in the morning while I was Charge nurse.......... I guess it comes from 'being' there......and having a deep love and commitement for the elderly.... at one facility I worked upper managment had a policy that C.N.A's couldn't take breaks with the nurses. (LPN's or RN's) ..... that facility is short of C.N.A's .... the C.N.As are migrating to facilities where they feel wanted, needed, and appreciated!

    In the facility I talked of where we had a tremendous team effort, it was lead by our Administrator. Our team was appreciated and given rewards. Behaviors such as calling in, no shows etc were not tollerated. We may have worked without our staff numbers for a few months, however, we let those go who were NOT what we wanted or needed to work with. The negative attitudes have a tremendous pull on the positive attitudes!

    Think about this for a moment.... If you went to work every morning with a staff that had the positive attitude of: we have a job to do, let's get it done....give it our heart & soul every minute... would you want to work at that facility every day? would you put in extra hours?

    On the flip side... if you were scheduled on the wing where the negative person was that got lost on her shift, had better things to do, to think about it, and always called in so you didn't have a clue if she'd even come back from her lunch break would you want to work in that facilty every day? would you soon burn out?

    it's the 'crabs' that pull the positives down into the 'crab' bucket. By rewarding staff and sticking to policies, they will take ownership of their positions.........
  4. by   RNIAM
    Athough I agree with some of what you are saying. I still have a problem. You say it has to start with upper management. How? How does that happen? In what ways can this be acomplished. I am sorry but even in the best facility with the greatest team work, if you told me that I would be working with a med nurse and have thirty patients. I would walk out that door. there is no possible way you can meet the needs of that many residents. Depending on their needs. Some night I would have ten residents and be exausted by morning. Try turning and positioning at least 6 out of ten of them every two hours with attends changes and toileting, in between getting drinks and snacks, not to mention anything else the nurses may find for you to do when they see you have sat down for a minute. Now you might think that I am a little jaded, that is because I am. I loved what I did for a living until it became painfully obvious to me that I was usually the only one who did care. I would go home in the mornings in tears knowing that some of the residents did not get changed, or toileted as they should have been. I do not think there is a quick fix, but if you give me some real useful plans to see this happen, then you can bet that when i am a nurse manager. I will see this implemented on my floor.(some day, well we all have dreams right?)
  5. by   RhondaRNConsult
    it all begins with having a team that has the same goals..... and works with the mission statement.... setting up and following policy & procedures..... getting a 'kick butt' quality assurance team put together..... and going for the gold. It's all in the attitude...desire.... and drive for 'what's best for our residents'....
  6. by   Fran-RN
    Most homes have a staffing ratio of 2.5 staff/patient day. If you have 30 residents this means you have 75 hrs avilable for nursing staff each day. take out the 24 hrs for the licensed staff, that leave 1.7 hrs for the direct care staff per resident per day. with this 1.7 hrs the CNAs are expected to feed 3 meals a day, toilet, turn and reposition every 2 hrs, do restorative nursing, document, bathe, dress, transfer in and out of bed, 2-3 times a day. Sometimes part of management nursing hrs are charged to this 75hrs available. Most reimbursement is from the state and federal government. they set rules about quality of care then tell us what they will pay us to deliver this care. The reimbursement is not always enough to deliver the care that is demanded. Check out how many homes have gone bankrupt in the last 2 years. If the government is going to control this industry ( they already do) then they are going to have to cough up more money. ramble ramble. sorry!!!!!
  7. by   RhondaRNConsult
    That's why we have a Quality Assurance Coordinator & team ..... If the MDSs are being completed accurately, and if the team is heading in the same direction then it can and does work. It's when, as I said earlier you get one 'crab' pulling the rest down that it doesn't work.

    The government sets regulations for a reason......It's our job to provide care above and beyond those regulations...... to find solutions & make system changes for our problems within our facilities (thus the QA team) .....

    Ah yes, I may be in a dream world with wanting quality care for our elderly, however, what type of care do you want to recieve when you get there?

    I'd rather have it where the government doesn't have to set the regs so tight, however.... it's a scarey thought when you think why they have set them so tight!!!

    I know one thing... I won't settle for one bath a week when I get there!! I won't settle for being tied up in a chair if I get a bit wound up... and I surely won't settle for being told I have to go to bed at 7 pm ...... why should we expect that they do????
  8. by   RNIAM
    1.7 OMG that is horrid. I lived it but never thought of it in those terms. How rediculous is that? It is a sad state of affairs as far as I am concerned. "a kick butt quality assurance" only means to me one more management position created and more wages to be paid. How about treating all the staff as if they were the greatest things since sliced bread? How about a your the best lucheon every month! How about awards for CNA of the month, Nurse of Month etc... How about handing a great employee a slip that intitles them to one day off with pay? How about using some of those wasted dollars creating yet another management area to make the employees that really matter feel that they are respected and admired for what they do? I can tell you that in my perfect world people,all people would know just how important their work is to the grand scheme of things. sorry I just leaped onto this soap box and now its time to get off it. If you are in anyway in a management position, please squeek the wheel for your CNA's and Nurses. Let everyone know that now is the time to give out incentives and bonuses for extra time worked. Offer a free lunch or dinner once in awhile. How about one every few months just walk around and say hey I have noticed just how hard you've been working and I am proud to have you here with us!
    enough said.
  9. by   RhondaRNConsult
    without that quality assurance coordinator, it's doubtful effective system changes will be made... which department head has time to audit, and implement changes so desperately needed within our facilities? The Quality Assurance Coordinator takes a load off the Director of Nursing so she can concentrate more on her duties instead of all the system changes needed to make her facility run smoothly.

    Quite possibly a new position doesn't have to be created, in the facility I worked, it was incorporated into the Staff Development/Infection Control/Quality Assurance....... yes, I also trained Nursing Assistants for the state Certification test, and yes it was a big load to carry, however....... the benefits the facility reaped were outstanding.

    Celebrating successful system changes is key in setting up a team. It doesn't have to be monetary in value. A hand written 'thank you, you are appreciated' note attached to a time card just may lift a few spirits, and make the difference in job ownership. It's a start...
  10. by   Fran-RN
    I agree with the quality of care issues. I argue all the time at the home I work at for humane treatment. But the fact remains that nursing homes are a business, and money drives behavior. Seems most of us want the best care for our residents but maybe disagree on the path to get there. It is such a complicated issue that I feel it will take many solutions not just one.
  11. by   Fran-RN
    My husband lived in a nursing home for 4 and 1/2 years. he was 49 when he was first admitted. The home he went to was defiency free, and had a good staffing ratio, I worked there so I knew the staff was kind and caring. but even with that there were problems. I had to call the ombudsmun several times. He was alert and oriented but a quadriplegic, the result of a brain stem stroke. he also had severe swallowing and resp problems.
    It was a constant battle to have him treated as a human being with feelings and not just another problem to correct.
  12. by   catlady
    You must operate in a different reality, Rhonda. The facility I just left had exactly four nurses in management--the DNS, ADNS, and two unit managers (me being one of the latter), for 98 beds. Among the jobs shared here are staff development, infection control, day supervisor, MDS coordinator, care planner, PPS coordinator, staffing coordinator. No nursing secretary, no ward secretaries. Where does this magician QI nurse fit in?

    And as for your teamwork concept, you've most likely never worked in a union building.

    If I'd had a little less government-mandated paperwork to complete, I might have had a little more time to make sure our residents got the best possible care!

    (soooo glad to be getting out of LTC)
  13. by   bandaidexpert
    Hey tex! That's BS. The Government is busy handing out rope for LTC facilities to hang themselves with. Why would they waste all that time? The NAC site might ease some of your stress.
    They can't make it without us!

    Remember......when you get there.....there you are