What can we do to improve working conditions in Nursing homes?

Antikigirl, ASN, RN · Feb 9, 2005

I 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!!!!!!!

zuchRN · Feb 10, 2005

Well 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. :smokin: 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.

southern_rn_brat · Feb 10, 2005

ohhhhhhhh my gawd!

the back stabbing and gossip mill!!! :rolleyes:

drama drama drama!! (I walk around at work under my breath going MARCIA MARCIA MARCIA! cuz thats what they remind me of:rolleyes: )

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 :rolleyes:

I think I better just shut up :chuckle

BSNGUY · Feb 10, 2005

No 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...

jblvn · Feb 10, 2005

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Simple, increase reimbursement from medicaid. The increased income to the facility can be directed towards salaries. Then all levels of caregivers salaries can be increased....Oh I forgot, the increased revenue would be shifted to profits for the facility instead of to the caregivers. After all we need to increase the profit otherwise we couldn't stay in business. Thus you can be thankful you still have that underpaid and unappreciated job.

Just thought you would like to know President Bush is planning to cut medicare by 24 billion dollors to SNF in the next 10 years. I just read on nursing news.

germain · Feb 19, 2005

WHY do we have FOR PROFIT Nursing homes. Please excuse me for being a horrible communist, but some things should not be for profit.

UNIONIZE NURSES AIDES. Better pay/ better benifits/ better staffing=skilled staff that STAY. SEIU (Service Employees International Union) has a drive to unionze caregivers. Its the fastest growing union in the country, and the LTC aides they have sucessfully unionized are better paid and have better staffing ratios. You should work and suppor the unionization of your aides.

REPLACE AIDES WITH RN'S? :rotfl: Please. THere are good aides, really there are, but they are smart and don't work for you because they can make more money for less work elsewhere. You don't need to go to nursing school to take good care of people.

FutureNrse · Feb 20, 2005

I have wrtitten to my elected officials several times concerning nurse's working conditions and pt safety. All I've ever gotten in reply is form letters.

Then write again...and again...and again...

Seriously, it takes perseverence. Organize a letter writing campaign. You can write a form letter of your own, outlining the major problems that you want to address, then give it to anyone else who agrees with you (like all the folks on this site), and they can use it as it is, or change it a little to personalize it, add thier own ideas, thoughts, experiences. Do a little research online to get the mailing addresses of anyone and everyone with even the tiniest bit of political clout in your area, assemblymen, gongressmen, mayor, governor, heck PRESIDENT too!

Then you have everyone make numerous copies of thier letter and send one to every politician on the list. Then have them do it every week. And keep recruiting, spread the word.

I learned this method from a college professor that I still remember fondly. She was a very prim and proper looking woman who preached activism and civil disobedience. She was something else :)

And boy could she get things done!

OC_An Khe · Feb 20, 2005

The terrible working conditions in some hospitals and SNF's are a result fo staff putting up with them. When all members of the care giving professions say enough is enough that is when it will end. The shortage will also dissappear.

Don't accept a position, or stay in a position, where the patient ratio is poor, or where frequent mandation od OT is prevalent, where its difficult or impossible to get a vacation. Don't stay for the sake of the patient as in the long run you are harming the patient. When people refuse to work under the conditions prevalent in some facilities today and those facilities can't hire the people they need, they will either close or change their ways. Until then SOS.

CapeCodMermaid, RN · Feb 20, 2005

WHY do we have FOR PROFIT Nursing homes. Please excuse me for being a horrible communist, but some things should not be for profit.
UNIONIZE NURSES AIDES. Better pay/ better benifits/ better staffing=skilled staff that STAY. SEIU (Service Employees International Union) has a drive to unionze caregivers. Its the fastest growing union in the country, and the LTC aides they have sucessfully unionized are better paid and have better staffing ratios. You should work and suppor the unionization of your aides.
REPLACE AIDES WITH RN'S? :rotfl: Please. THere are good aides, really there are, but they are smart and don't work for you because they can make more money for less work elsewhere. You don't need to go to nursing school to take good care of people.

Another person seems to have bought the union line...the union won't stop callouts, which, at my facility, is the reason staffing is short. The union can't manufacture CNA's to replace those who have called out. Part of the problem is the aides themselves and their horrible work attitude. The union won't fix that and, in the long run, will most likely make it worse. They promise things they will never be able to deliver.

James Huffman · Feb 20, 2005

WHY do we have FOR PROFIT Nursing homes. Please excuse me for being a horrible communist, but some things should not be for profit.

Hey, I won't call you a horrible communist. A pinko, maybe. :chuckle

I have found no evidence that for profit facilities are any worse than non-profits. "Non-profit" only means that profits don't accrue to individual shareholders, and that is no guarantee of some type of angelic goodness. I worked -- very briefly -- a nursing facility which was non-profit and horrible. The people were well-meaning, but the ratios were terrible, and the place very badly run.

But all of this begs the question: why should we NOT have for profit nursing homes? Our food system is for profit. (Grocery stores, etc.) Most medical practices are for profit. Most child care facilities are for profit. Why should nursing homes somehow be different? The problem is not from the profit motivation.

Jim Huffman, RN

rstewart · Feb 20, 2005

I can only confirm what many of you have already said.

Obviously, clear, appropriate staffing legislation would be helpful. What is needed for adequate care has been calculated for the industry but only in the form of recommendations rather than requirements. If the experience in California is any indication, health care providers will fight implementation of mandated patient nurse ratios tooth and nail..........and try to reverse them once implemented. So there is a very real disconnect here. For many years providers pretended that they didn't know staffing's impact on patient outcomes. They no longer have that excuse, however they continue to oppose legislated minimum staffing standards.

Then there is the CNA problem. Mandating staffing ratios is a helpful first step but budgeting for them is equally important. As we all know, CNA work is back breaking, many times thankless, is required 24/7 etc.----in short, in many respects undesirable. Yet in my state, nursing homes do not pay CNAs nearly what they might earn in other jobs requiring similar education and experience. So basically LTC gets what's left at the bottom of the employment pool and in insufficient numbers at that. Several posters have mentioned the negative effects of call-ins on morale and patient care. Call-ins occur because: 1) You can not attract enough people with a good work ethic due to low pay and 2) Facilities are reluctant to terminate employees who call in frequently because deep down they know they will have trouble replacing them due to low pay. The proverbial vicious cycle. The only way to break that cycle is significant reimbursement increases targeted for CNA pay. But as one poster correctly pointed out reimbursement is scheduled for decreases. So again there is a major disconnect between what must occur to improve care and what is actually occuring.

What if we had put those multiple $80 billion dollar payments used in the Iraq war into senior health care and LTC? With adequate controls for fraud and waste I think you would see vast improvement. It's clearly a question of priorities, and taking care of our most vulnerable citizens is not a high priority in this country.

Simplepleasures · Dec 29, 2006

Another person seems to have bought the union line...the union won't stop callouts, which, at my facility, is the reason staffing is short. The union can't manufacture CNA's to replace those who have called out. Part of the problem is the aides themselves and their horrible work attitude. The union won't fix that and, in the long run, will most likely make it worse. They promise things they will never be able to deliver.

California Nurses Association helped get state mandated nurse patient ratios, could a strong union do the same in LTC? Not if we keep falling for this anti union propaganda.