What keeps you motivated?

LibAnne10 · Nov 24, 2007

This is the first time that I have posted, but I feel compelled after reading this thread. I am a DON in LTC. I started out as a part time charge nurse at my facility almost 13 years ago. On many occasions it was me and one CNA for 20 residents, but we worked together to give the best care we could. After years of many complaints from residents and their family members, more staff was hired each year.

I have been the DON for over 5 years. During these 5 years we have worked to train our staff, created a CNA mentor program, trained the charge nurses in coaching supervision and were first in the state to receive a special licensure. Every survey we've had has been deficiency free. Last year our CNA turnover was 10 percent. The only time we lose a nurse is if they retire or sadly pass away. We do not pay as much as some of the facilities in this area, but our staff feel valued and appreciated for what they do. We do not have to advertise for nurses or CNAs. I have stacks of applications and not enough openings. All of them are from our current staff telling their friends about their great workplace! The changes that we have made did not happen over night, but they did happen!

Ours is a non profit facility and from what I've seen profit is the only factor keeping others from doing the work it takes and our government officials are the ones that make that change.

Simplepleasures · Nov 24, 2007

This is the first time that I have posted, but I feel compelled after reading this thread. I am a DON in LTC. I started out as a part time charge nurse at my facility almost 13 years ago. On many occasions it was me and one CNA for 20 residents, but we worked together to give the best care we could. After years of many complaints from residents and their family members, more staff was hired each year.
I have been the DON for over 5 years. During these 5 years we have worked to train our staff, created a CNA mentor program, trained the charge nurses in coaching supervision and were first in the state to receive a special licensure called NCNOVA. Every survey we've had has been deficiency free. Last year our CNA turnover was 10 percent. The only time we lose a nurse is if they retire or sadly pass away. We do not pay as much as some of the facilities in this area, but our staff feel valued and appreciated for what they do. We do not have to advertise for nurses or CNAs. I have stacks of applications and not enough openings. All of them are from our current staff telling their friends about their great workplace! The changes that we have made did not happen over night, but they did happen!
Ours is a non profit facility and from what I've seen profit is the only factor keeping others from doing the work it takes and our government officials are the ones that make that change.

Wow, very impressive. Do you know of any other LTC in the country that compares with yours? Just curious.

LibAnne10 · Nov 24, 2007

I don't keep up with places around the country, but I know of one other facility in my state that was able to be awarded the NCNOVA licensure. I'm involved in NADONA (DONs in long term care) and most of the members are not as fortunate as I am to work in a facility that puts residents before profit margins. If we have better jobs it leads to better care for the residents. It doesn't take alot of funding and could lead to higher reimbursement for the facilities that are willing to do the work. I hope more LTC leaders will accept the challenge.

Thank you for the work you do to help our seniors.

pumpkin92356 · Nov 25, 2007

It sounds like you feel intimidated by the majority of the staff there at your facility. Well number one you are not going there every night or day which ever shift you are on to make friends you are there because its your job and you are a nurse. It sounds to me that you are a very caring nurse at that. Well think about it with this question in mind, "What if that was my mother in that bed requiring medications around the clock" "Would I still feel like "Narky Nurse"? Or would you do what is right? and nip this stressful situation in the bud. You could say to those staff that are not doing their jobs that it makes you uncomfortable and please not to do this around you. Stress the "I" feel uncomfortable with what you are doing. Using "I" will not make it sound like an attack rather a personal feeling of your own. Also stress that you expect your wishes to be respected when you are there. If this method doesnt work report those people because it is the right thing to do.

Sassy5d · Dec 6, 2007

thank you to everyone who has replied!A lot has happened since I first wrote.. I picked up more shifts at night... so I'm getting a bigger/better grasp on things around the facility.. Before I was only working 2 days a week, with 4 day gaps in between.. When you work saturday and sunday and don't return until friday and only work 1 day.. You kinda feel like a lost duck.I've done a lot of thinking also, since I last wrote.. I keep thinking about why I became a nurse in the first place, why am I still a nurse... If I wouldn't be a nurse, what else would I do with my life...If it was a perfect world, I probably wouldn't be having the feelings that I do.Most of my later childhood, from about 10 on, I helped take care of my sick mom. While I did at times, resent the fact that I missed out on a lot of things because of it.. I still had this feeling that it was my calling to help take care of others.. I was pregnant at 18, just graduated highschool and when my daughter was 3 months old, I lost my mom due to complications from her diabetes.I figured if I wanted to be a nurse, I should at least get my feet wet and become an aide. So that's what I did. After being an aide for 4 years, I decided I was ready and I took the plunge into lpn school.I remember the frustration I felt as an aide, dealing with lazy nurses.... telling nurses about problems and changes with my residents and being ignored.. after all, I was "just an aide" what the heck do I know right? I mean, I only saw my residents completely naked on a daily basis... I didn't just walk in their room and throw a med cup at them and tell them to have a nice day. I saw changes in their body, new areas, noticed changes in swallowing or mental status... You don't have to be a highly educated person to know when somethings not right. I witnessed many a person die over careless, lazy, couldn't be bothered nurses... I burned out as an aide.. My handle, I "earned" that nickname as an aide.. They all called me sassy because, that is what I became.It's my life long experiences that have made me who I am today.. I can't make others understand my experiences.. or have the feelings that I have... I get frustrated because of the aides.. I get frustrated FOR the aides.. I know they have it hard.. I know they don't pay them what they deserve (although, the pay they get now is waay more then I was getting paid when I was an aide) Half the time I just want to shake them and yell and say.... How would you feel if that was your mother lying in that bed?!?! I can't tell you how many times I've wished I'd be able to get some restraints and tie people down to beds and leave them for 8 hours... having it all upstairs, with no ability to grab a drink, reposition themselves or go to the bathroom...I'm frustrated because I'm ultimatly responsible for the aides.. and I can't trust them.. this causes me a great deal of stress... I had a fall the other night.. I'm betting mostly because the man's bed alarm was never checked.. It wasn't plugged in.. so we had no way of knowing that he was getting up without help. He said he laid on the floor for 20 minutes! I guess I have to just make myself a list of all the things I have to go around and check because the aides can't be bothered.I'm frustrated because of the other nurses I work with. I know they are stressed, they are burning out, they don't want to work there.. they all have negative attitudes about everything.I'm frustrated because I work 3rd shift... everyone seems to have this thought process that 3rd shifters are either sitting in front of the tv all night long snacking and laughing and going on 10000 smoke breaks, or we're hiding in rooms sleeping... So let's write orders and leave them in the chart, or throw huge stacks of labs and progress notes in the bin to be filed or anything else we can think of we're going to push off onto 3rds because they have nothing to do all night. I spent 4 hours filling out pharmacy return sheets for iv's and equiptment and dc'd meds because my medroom looked like a bomb shelter. People that had died or have been dc'd 6 months ago still had meds to be returned in the medroom last night.my question has turned into my vent session, sorry for the novel.. I feel a little better. I know a lot of you can understand... So yes, I think about my current situation and my feelings towards nursing. I wonder which resident is going to sue the facility... wonder if I'm ever going to be called into court for something.I still don't know how to stay motivated... I feel frustrated so much of the time. I feel like I try so hard to be a good nurse and it means nothing.. I try so hard to do my best and do things for others to make their lives easier and it means nothing.. I get self conscious thinking that people think I'm trying to be a know it all, or a "do-gooder"... It's like a no win situation... If I report every tiny little thing, I'm a nag.. If I don't, I'm negligent.. If I report things that happen with my coworkers, I'm a nag, making more work for others..If I don't.. well.. If I call the docs they get upset and wonder why I call and bother them with piddly stuff, if I don't call them, well then they are mad..LOL I think this is enough for me today..LOL You guys get the picture

Sassy5d · Dec 6, 2007

I tried to edit and add spaces for my paragraphs but they jumbled up again...hmmm.. sorry!

joprasklpn · Dec 7, 2007

Wouldn't it be nice if only people who give a crap could be nurses. I can relate to every thing you are going through. I worked nights in LTC and ran around like a nut because I cared about doing a good job. I now do peds homecare because LTC just about drove me crazy after so many years. I also wish the government would start to show some respect for the elderly in this country and increase staffing minimums. I mean really, who are they kidding we are taking care of people not manufacturing candy bars.

Weeping Willow · Dec 7, 2007

I've been an lpn in geriatric ltc for almost 5 years now. I think I've about seen it all.
I'm looking for some encouragement...
What do you do to stay focused and motivated?
How do you handle co-workers who are lazy? I fear some sort of retaliation if I report the nurse I work with. She would know it was me. Everyone I work with seems to have this "Hear no evil, see no evil" approach to things. They just can't be bothered when someone does something neglectful.
I wrote up an aide last week and she was fired over it. She wasn't doing rounds at night, she was sleeping on the job.. and she did it in front of everyone. They all found out it was me and it caused some animosity.
I work with a nurse, every night I work, we have the same rotation.. who refuses to check her patients. Any time any of them complain, she tells the aides that they always do that and she ignores it. Theres a resident who gets around the clock medications, and she works full time, and i know she's not giving them to him.. she never really leaves her spot unless it's to grab something to refill the cart.
Everything in my heart tells me to report her...but I feel like I'm just turning into the Narky Nurse.
Im just aggrivated and bitter and don't ever look forward to going to work. If I'm not listening to complaints about how so and so doesn't do their job, even though they aren't doing theirs either, I have to listen to the dayshift nurse complain about how busy it is and thats why she can't ever get anything done.
The sad part is, I know there is no other place that is better. This is what nursing has become. It's no longer about the patient care, it's no longer about the patient.. It's just about bickering and complaining about how rough everyone's job is, and no one is doing anything.
And don't even get me started on the aides.. I'd love to know how they sleep at night, let alone pay their bills.. the fact that they call off constantly, 10 minutes before the start of their shift.
So how do you deal with this? How do you stay motivated and enjoy being a nurse? I need some pointers!

Well, if you are certain that the nurse is not passing her meds, if you are certain that the aides are not dong their work, you have an ethical and possibly legal requirement to report these situations to your boss,your Administrator, JCAHO, yhour state inspectors, and maybe your TV and newspaper and radio stations.

Maybe your charge nurse and the physicians are unaware of what's going on.

Have you tried talking directly to the other nurse and telling her what you see and saying you are wondering about her behavior? How can you be sure she is not giving all the ordered meds unless you are following her around all night? Not saying you're wrong, just not sure how you can be sure. Just a thought - it makes you wonder if they really need all those meds if she's not giving them and they are doing well. I know - it's not up to us to decide this. I'm just thinking out loud. I feel your pain, friend.

Not all places are like this, though. There are better places out there.

Daytonite, BSN, RN · Dec 8, 2007

i've been an lpn in geriatric ltc for almost 5 years now. i think i've about seen it all.
i'm looking for some encouragement...
what do you do to stay focused and motivated?

what i started realizing years ago was that ltc offers you so much opportunity to become an expert in something that no one else is willing to do. in my case, i've always been a stickler for documentation and paperwork. one of the things i got into was getting the mars and tars better organized. i mean, some of the crap and old orders that were being printed out on them was ridiculous. no one was willing to tell me how to get the crap cleaned off of them, so i started calling people at the pharmacy service and they told me. when the end of the month reconciliations came around i made sure i had a hand in it and i made of list of my resident. over about a 6-month period i targeted about 6 charts a month to get corrected. during the month i would get written orders to d/c or add certain orders and during the reconciliations i found out how to communicate to the pharmacy service exactly how to re-write or change administration times on the mar/tar printouts. after about 6 months i had those puppies organized. and, when the state surveyors were around they commented about them! another thing i did, because i liked working on my computer, was create fax sheets to fax information to our doctors for different things like lab results, patient falls, and skin tears. all the nurses had to do was fill in the patient names and pertinent information. it helped cut down writing time in creating these communication things. and, they got used a lot. i also went to work on the aide assignments when the don didn't seem to be interested in them. i often did regular cleanings and organized the drawers of the med and treatments carts. you'd be surprised at the old junk you'll find in these carts. ditto on the cupboards. i used my computer to create and print out nice labels for the med and treatment carts. someone has to do these things, but no one wants to. however, when you've mastered and know all the other things you have to do, you start looking for other little projects. pick a procedure that is done a lot, research it, become the unofficial teacher of it for the facility, maybe even do inservices on it (the boss will love that as it fulfills a few state requirements)

now, you may not like the same ones i chose, but i'll bet if you look around you'll find some things that need doing that you'll cotton to. make a maintenance round to check for and make a list of lightbulbs that are burned out and need replaced, stuff that needs to be nailed down, etc. (as a head nurse in the acute hospital, i had to do this once a week on my unit). think of ways to reorganize the cnas or the way you charge nurses are doing certain little things. it helps make you feel better (and more important) about your job. as i said, you can usually pretty much pick something because no one, generally, wants to do any of it, or they'll tell you they're too busy to do it.

as for writing up a cna who ends up getting fired, this happens. you can feel bad about it, but you must realize that the cna is the one who screwed up, not you. the good people who work with you know this. all you can do is be fair in the way you supervise. one of the biggest challenges i faced and learned the most from when i worked ltc was dealing with the people i was supervising. it is something that nursing school really doesn't prepare you for. it is, nevertheless, a supervision task that as a supervisor and charge nurse you must learn. it is hard because many of us who are in charge would never act the way some of our subordinate help does and we feel bad when discipline has to be instituted. but, it's no different than correcting a child who does something wrong--it you let it continue, a monster develops. i had two books that helped me out a lot, plus one book that we were required to read in my bsn program that provided a lot of insight into people's behavior:

games people play: the basic handbook of transactional analysis by eric berne, m.d. - this book talks about one-upmanship and how people use their behavior to manipulate others
managing difficult people: a survival guide for handling any employee by marilyn pincu
working with difficult people by muriel solomon