What can we do to improve working conditions in Nursing homes? - page 4
NOTHIING......until the exact ratio of CNA's and licensed nurses to residents are mandated in the State and Federal Regulations.... Read More
Aug 10, '04Joined: Nov '02; Posts: 6,056; Likes: 9,192Oh, and by the way, my residents do not die in a "cold, crowded environment"...the staff is present 99% of the time when someone dies. And another thing....after meeting some of the families, my staff takes better care of and is more compassionate than the family.
Aug 11, '04Occupation: Independent Nurse Practitioner Joined: Aug '03; Posts: 191; Likes: 17I work as an independent Registered Nurse in several Nursing homes. Some private and some Church owned and run, and one Government owned.
I have in the past attempted to care for a parent at home and I came to a very swift decision - I could not do it and give my mother the care she deserves at home, on my own. Part of the problem was the ammount of money I needed to fulfill the care around the clock that had to cover food, sitters or shoppers and an occasional assistant for other chores, leaving me to do most of the hands on care. (If I did not go to work then my income was at a level of almost zero - unemployment benefit + mothers' aged pension do not pay a motgage and keep a car on the road, and also pay all the usual household expenses like Gas, Electric, Water, Food, etc.) To give responsible care to a loved one 24 hours a day takes devotion, dedication, most of your own personal time, and money. I was fortunate to have the chance to get my mother (and my father when he was alive) into a great nursing home. I still work in that nursing home part time and can help and oversee the care my mother gets. I earn a reasonable (pittance! but more than unemployment benefit) income that enables me to take out my mother frequently in the car and also purchase anything that she needs from clothes to pills, potions, lotions and extra food and treats. Yes there are some nursing homes that I would not like my mother to be in - I know because I work in some of them!
It is not easy to get good care, but I feel that I am doing everything I can at present. I really feel for the Guys and Girls that have to care 24 hours a day for a loved one - at home. All I can say is if you can find a nursing home that can share some of the load then take it. Even if it is only respite at first.
I still think about what I was told many years ago by a friend who had nursed two parents and one in-law parent. Do not try and do it all - get help when and wherever you can and accept restpite and a chance of a nursing home bed for your parent. Because if they are at home with just you - and something happens to you, what then happens to them? (He fell sick whilst out at the corner store shopping for them.)
I suppose that I am lucky that I do have the chance to oversee how my Mother is and do have a first hand part in her on going and daily care. I can also have a bit of a life for myself too.
Love to all you nurses and carers.
Aug 11, '04Occupation: Director of Nursing Joined: May '04; Posts: 347; Likes: 4Quote from earle58Amen to that! AND how about some of the "homes" of loving families that the elderly stay in and avoid nursing home placement! GEEZ!while i agree that staying in one's home is the ideal, it is just not realistic for many.
and while i agree that there are some shabby facilities, there are also many that provide superior, warm, compassionate care and the patients are very happy and safe.
obviously you have not had the good fortune of encountering any of these specific facilities.
Feb 8, '05Occupation: RN Specialty: 13 year(s) of experience in Med Surg/Tele/Ortho/Psych ; From: US ; Joined: Dec '04; Posts: 199; Likes: 40To: email@example.com
Subj: short staffing in nursing homes
From: your email/name
Date: todays date
Write your concerns and feeling about the short staffing at your nursing home and how you want to see something done about it because our elderly people are the ones who are suffering.
This email address is one that I found on a site for 2005 Bush's Nursing Home Improvement Plan. Thank you.
Feb 8, '05Occupation: Medical Imaging RN~Special Procedures CT Specialty: 33 year(s) of experience in OB, M/S, HH, Medical Imaging RN ; Joined: Aug '04; Posts: 6,708; Likes: 1,449We better start writing if we want anything done by the time were ready for the old folks home. I don't know about the rest of you but I think I'd rather stop eating, stop taking meds and go to my reward before going to a nursing home. My heart aches for the patients in the nursing homes. I don't want to live that way.
Feb 8, '05Occupation: nurse Joined: Aug '01; Posts: 45In reading the replies to this post, I am hearing that mandated staffing ratio's are the "answer" to our problems. I encourage everyone to ask what their facility ppd is. We have a ppd in our facility which is higher than the proposed state minimum and is higher than the mandated ppd in California. Usually it is not a question of the facility having the hours--it is a question of finding the staff to fill those hours. As a DON, I am not afraid to work the floor and do not hestitate to do so. I make a point of helping in the dining room etc. You also have to remember when the BOH comes in, they must link poor clinical outcomes with inadequate staffing. Very difficult to do in some cases. I have to say that I do not know one DON who wants to "screw" the staff when someone does not come to work. Realistically, you can only work so many hours in a day. However, I also firmly believe that the residents are number one and if it is needed I will work the floor. I would venture to say that most people have absolutely no clue what they are getting into when they accept a DON position. I keep thinking that there has to be a way for us to work together rather than being a us v. them issue. We could accomplish so much more working as a team rather than bickering. How can we accomplish this? I know that everyone is always going to have a boss--I don't like listening to the administrator pretend to be a nurse anymore than you like the DON talking about overtime. I still think there must be a way to evercome this way of thinking that DON and adm is lazy and doesn't understand versus their point of view of the CNA's and nurses taking too many breaks or they just don't understand what management goes through. Also, I recently took a trip sown to our state capitol and was able to lobby to our legislatures..actually talked to them in person. I would encourage everyone to personally visit the people rather than write. Sometimes it is easier to ignore the written word.... Thanks for listening.
Feb 9, '05Occupation: RN LTC From: US ; Joined: Jan '03; Posts: 3,757; Likes: 1,820Yep....PPd.. we were told that if the DON works the floor (to fill in for a call off etc) her hrs wouldn't be counted??
Feb 9, '05Occupation: Director of Nursing Joined: May '04; Posts: 347; Likes: 4Why not? When I work the floor to fill in for a callout, my hours count. I am providing direct patient care, no matter what my "title"!
Feb 9, '05Joined: Jun '04; Posts: 280; Likes: 37I have noticed that when we have just one more person than usual scheduled that the attitude of the CNAs changes. When they are less stressed they seem to really work together as a team.
The problem is, that no matter how hard the DON fights the administrator for that one extra person, call ins ruin it. Then the CNAs get angry because they are short and tend to blame administration but in reality if their peers had all come in as scheduled they would have not been short.
When I remind them of this as they are yelling at me for "being short again" they don't want to hear me.
since I changed positions last summer and took the weekend supervisor position I have noticed this alot. I tend to overstaff on the weekends just in case of call ins. Now I hear the CNAs say often how much they like working on the weekends because they arent short. I also let them do their own assignment in the mornings and just watching them work together as a team to make sure everyone has an even number of patients makes me proud. I don't have alot of call ins on the day shift on the weekends now and I really believe it is because they have seen how much they can accomplish when fully staffed and working as a team. Somehow, I can't get this thru to the evening shift though . Someone calls in EVERY weekend and they all come in to work dreading to see their assignments. The difference of the two shifts is amazing. Why the evening shift doesnt "get it" is beyond me. They keep fussing and I keep preaching "talk to your peers about their call ins". The very ones that are fussing today will call in tomorrow too!
What I have noticed is a change in their attitudes on the day shift. It is pride! They have become proud of getting their job done, proud of being able to do the "little extras" that all the patients need.
I can talk all I want, give inservice after inservice on team work but it won't do any good until they make the change themselves.
If I never had to hear a staff member tell a patient or family member "I cant do that right now because we are short" again, I would be so happy.
What I am trying to say with my rambling is that even when our staffing numbers are decent we still have a problem because of lack of work ethic by all the call ins.
It's not like we work in industry where it's ok if we don't show up. If we don't show up for work, someBODY suffers. I don't understand not going to work when scheduled. I feel a personal responsibility to be there when I am scheduled. I wish I could teach this to some of the people I work with.
Feb 9, '05Occupation: Happily in Nursing Education! Specialty: 13 year(s) of experience in Education, Acute, Med/Surg, Tele, etc ; From: US ; Joined: Oct '04; Posts: 2,757; Likes: 415I really do believe that it would be helpful if we were back to being considered professionals! For some reason this has been overlooked in our area of practice, and it is about time we gain our profession back!
A nursing department should be that...a nursing department (mine includes LPN's and CNA's!). This should be a totally utterly separate department with chosen representitives or DON's that know the particular needs of the facility and of the nursing staff. Any managment suggestions (I am talking the money hounds who run the facilites), changes or comments should go through channels before implemented to the nursing staff, and voted upon or discussed and comprimised. Yes, kind of like a union...but perhaps not with the title of being one if that would make this impossible to achieve. (I don't have enough staff to make a real union I think).
And why can't there be hiring practices that can distinquish those that would like bedside vs paperwork? (although you have to do paperwork as bedside...but how many of us have to do Quality Assurance stuff, Assignment/delegation reviews, Incident report investigation and follow up, med room audits, investigate med errors, etc while they are busy running around doing floor duties as well??? I DO! And I tell you, it is TOO MUCH! Seeing a patient..yeah right in the hallway as I run to the next documentation CYA~!).
I really believe that their should be a separate staff to handle the non immediate bedside paperwork, like chart audits and what not, and leave the bedside to patient care and interaction! We work for them...best for a nursing staff to actually be there for them instead of spending so much time writing on dead processed tree parts!
And that paperwork nurse should be representitive to the nursing needs and facility needs too...we hired a consultant that turned everything inside out and upside down because she didn't work there and demanded things that were out of line, and managment...not knowing a blister from a bedsore took what she said as law! We are still struggling to redo the damage that nurse did to our facility for 2 years (she was fired finally via some threats from us nurses and cna's leaving!).
How about another nurse to handle the medicare/medicaid situation (or doesn't have to be a nurse, but helpful I think). One more professional that can help with this area and get things moving smoothly for patients and the staff!
Yeah, I guess I am saying that a Nursing department is necessary but must be run like a business with the facility, patient need, staff, and paperwork considered in little mini departments so the flow is better with staff that wishes to be in that area. A department that is protected and respected as its own separate identity of professionals that should be highly respected and appreciated and well...PAID and taken care of! If it wasn't for nursing department...well...you don't have a facilty! We should get more respect than we do!!!!!!!
Feb 9, '05Occupation: nurse Joined: Aug '01; Posts: 45Well said Triage and southern. I agree whole heartedly that professional nursing staff does not demand the respect they deserve. I have had to talk with nurses about gossiping and not liking each other and he said she said stuff. What a collosal waste of our time and energy. How can anyone respect us when we so obviously don't respoect each other? I took the time one week to account for all the time I spend dealing with interpersonal issues between professional nurses. Between my time, the 2 parties always involved, there was a total of 42 hours in one week. This is just mindless. This is 42 hours that could have been devoted to better resident care. I was absolutely mortified today to have 2 nurses come to me to complain that they hated the other nurse because she was a "close" talker. I was so completed dumbfounded that I told them, "so what?" Why do people complain when someone sneezes the wrong way? I would like to believe that this is isolated, but I am sure that you have all been a part of this at some time in your career, and every minute we spend doing these mindless things is one more minute we are not focused on the resident. Also, in Indiana the DON hours worked on the floor do not count as part of the ppd as far as state is concerned unless your bed occupancy is less than 60. However, as far as patient care is concerned, we very much count.
Feb 9, '05Joined: Jun '04; Posts: 280; Likes: 37ohhhhhhhh my gawd!
the back stabbing and gossip mill!!!
drama drama drama!! (I walk around at work under my breath going MARCIA MARCIA MARCIA! cuz thats what they remind me of )
I swear I think it is all because they are so miserable they want EVERYONE to be miserable around them!
and GOD FORBID they think anyone does one SECOND of work less than them
I think I better just shut up :chuckle
Feb 9, '05Occupation: RN Specialty: med/surg, day surgery, psych as a CNA ; Joined: Feb '05; Posts: 29; Likes: 8No offense to CNA's out there reading this, but replace all CNA's with RN's and LPN's. Never going to happen, never going to have better conditions in a nursing home. Just my opinion. Worked as and aide up to the care manager RN in a nursing home. My biggest problem was always the CNA's... Not doing what they're supposed to, late for work, neglectful, etc, etc. This is just general. I know there are a lot of good CNA's out there too...