HELP with ALOT of problems on my unit

Hi,

I just took over a unit as manager that the unit is a mess. there are things that aren't being done that should have been done for months etc. I like the challenge but am having a hard time thinking of ways to get my main issues organized and easy for staff to comply such as weight monitoring, skin monitoring. anyone have any suggestions???thanks,

Weights weekly/monthly need to be done by the same STNA's and preferably at the same time of day. Many facilities have the restorative team do them as it has shown to be the most accurate. Skin checks can be done on shower days.

On our units we do admission weights within 24 hours of admission and weekly for the next 4 weeks and then monthly after that unless they have specific orders for different. On the long term units we do monthly weights during the first week of the month on their shower days. EVERYBODY should have a weight done within the first week of the month with this method, however we do have a problem if we need re-weights. They never seem to be done timely. We have nurses sign weekly for a body audit. They must do one head - to - toe weekly and they are responsible for this. CNA's must also report anything they see shower days or during their daily care. Wing nurses must do a note monthly on CWC's and positioning plans. Again, these are done during the first week of the month so that by the middle of the month, I as resident care coordinator have all information for that month for our follow-up and plan of care. Start there and ask for opinions. When nurses and CNA's are included in the plan, you might get a great response. I find they like to be asked rather than be told what they have to do. Maybe they will have some great ideas for you to clean up this unit. Good luck.

One thing you could do is take over each floor nurse's assignment for a couple of hours, so she can get these things done.

By doing this, you will set a great example for your staff, and they will know that you are:

1.Serious when you are telling them that these things need to be done. So much so, that you are willing to help them get them done.

2. You will gain the respect and admiration of your staff by working the floor to help them. Wow! A supervisor who works the floor! Unheard of!

3. You will get a good feel for how things really are at your LTC. You will have real, concrete experiences to use when determining goals for your facility, and how best to reach them.

hey everyone, thanks for all your help. let me clarify how things are done right now...1st of all monthly summaries are not being done..2ndly weights are distributed throughout the month and are put on the daily worksheet but are not being transcribed in the charts (WHICH IS MY MAJOR ISSUE)because then calculations are not being done as to who is significant weight gain or loss and also my admission weights are off because all my patients after they have been at the facility for 2 weeks have gained or lost like 10 lbs. Right now all the CNA's do their own weights on their patients. so i was thinking of on an admission that the nurse has to do the weight or the nurse has to be present for the weight so 2 people witness the weights. I had a lady on admission assess state she was 99 lbs now 2 weeks later she is 138 which is not even possible because her pants are lose on her etc. so i bet the admit weight was wrong...

on my skin issues...the skin assess are split into shifts and days and 1/2 the time they dont get done. (i think i am going to need a skin sheet for everyone) but not sure...b/c if they dont have any impairments they dont put anything in the book (so why make paperwork for themselves just say they dont have any skin impairment then they have a stage 2 a week later. anyways,,,any suggesstions would be helpful and i like the idea of weighing people in the 1st week but is it possible with 50 patients????

Would you say this is an instance of staff not doing their jobs, or of having too many tasks assigned for the manpower allotted?

i think it is a little of both...they have so many papers to fill out for everything but for 50 patients i have 2 nurses 1 med tech and 6 nursing asst which i think is good staffing...

I was RN team-leader on nocs for quite some time at a LTC.

I got my weekly skin assessments done, but I always felt really bad about waking pts up in the middle of the noc to do skin checks.

I could not do it in the am, as I was doing a huge med pass, doing accuchecks, etc.

Maybe you could schedule some CNAs who want extra hours to come in on off days to catch up on the weights.

Put a bright red sticker on the work sheet that says "Weights MUST be transcribed to the charts"

Assign one CNA for each shift whose responsibility it is to ensure that accurate weights are done on all admissions.

We went to a "lead CNA" program where I worked. This CNA is given responsibility of over-seeing the other CNAs, and ensuring everything that needs to be done, and filled out is done. This CNA reports directly to the nurse. That way, the nurse does not have to chase down all the CNAs, the lead CNA reports to her before the end of shift.

This saves the nurse time and trouble, and she has moore time for her stuff.

Also, if things on a checklist are not done, it will show on the lead CNA's checklist. So, you will not find out later that info is not there when you need it, you will know before hand. The CNA who missed a weight or whatever can be called on it right away.

A lead CNA should be one who is experienced, hard-working, has a good attitude and is well respected by other staff, not a CNA who is lazy or causes problems.

Also, this gives the CNAs hope of getting "promoted" as lead CNAs, and that their jobs are not "dead end" jobs.

Try not to reinvent the wheel. Did that make any sense?

Do you have any P&P in place for any of these things? I take it you are not corportate owned or part of a chain? We have a policy for everything (following them is another thing)

What are the other managers doing with these problems?

BTW, your staffing is great. We have two nurses and 5 cnas and occasionally a restorative that does wts.

Weights used to be a big issue for us, too. Now we have one CNA that does the monthly weights (our restorative CNA) I think she gets them all during the first week of the month. We took our wt sheets out of the chart and placed them in a wt book. She is responsible to document them and will notify the nurse if there is a change of more than a few lbs. Our dietician or dietary director reviews this book too, so wts are also picked up by them.

As far as new admits, the CNA assigned is responsible for getting it and the nurse documents it on our admit assessment.

All new admits are weighed weekly for a month.

Skin issues.....biggy for the state feds...look in the new guidelines.

I think someone posted in the LTC forum about this.

We do an initial admit skin assessment. Anything noted goes on our TAR and we are to monitor weekly until resolved. A pressure area goes on that sheet and then in a pressure ulcer book.

Every week on shower days a nurse will assess the skin areas and document on any concerns. This includes measurements.

We all know that paperwork can get out of control, so keep it simple and remind them of accountability.

Don't you have a treatment nurse? And where I work the CNA's do the weights.

Don't you have a treatment nurse? And where I work the CNA's do the weights.

no i have 2 nurses that do treatments, gtubes and insulins and a CMA that does all the PO meds and the CNA's and they usually get the weights but i think if they are in a rush they put down any number b/c i am getting like 30-40 lb weight gain/loss...i want to make it mandatory for the CNA to get the nurse but we are so busy this probably will go tothe wayside. also, alot of times i dont have time to look at the weights.

I'm reading a lot of "too much" and "no time". Is there any opportunity to at least hire one more nurse?

I can sympathize with your frustration here. At my facility there are four different ways to weigh people-the total lift, the sit to stand lift, the weight chair, and the whirlpool tub. If we don't weigh our residents in the same way every time, the numbers are always way off. My regular nurse always stresses to us that the residents need to be weighed in the same way every time, but it's hard to know what device the aide before used because they don't document how they weighed them. ---hey, that's a good point to bring up at the meeting thursday! And it doesn't help that some of the nurses where I work really don't pay close attention to these types of things.

We weigh the residents every day for the first week they are there, and after that, once per week on one of their bath days.

Something fairly new that our DSD/skin nurse just came up with is a pocket sized book with pictures of blank bodies on each page. We CNA's circle which part of the residents body is red, irritated, broken down, ect., and we give one copy to our nurse, one copy to her, and keep one copy. That way if it is reported, the nurses have no choice but to take a look at it and do a skin sheet or whatever they need to do.