HELP with ALOT of problems on my unit

Nikki69 · Oct 18, 2005

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. :rolleyes:

Marie_LPN, RN, LPN, RN · Oct 18, 2005

Is there any prefered method of weighing (aside from the pt. condition)?

CoffeeRTC, BSN, RN · Oct 18, 2005

how many pts do you have?

Weights need to be done consistantly. We have two scales. A regular doctor office type (but its digital) and the lift thing.

Everyone who can wall to the scale or stand unassisted gets the stand scale. Everyone else gets the lift. Is there any way you can designate 1 or 2 cnas to do the weights? Of course a reinservice is inorder for everyone.

rn/writer, RN · Oct 18, 2005

Talk with your staff. Lay out the problems and ask for input on why there seem to be such discrepancies in the weights and why information is not being transcribed. Let them know that you are open to looking at impediments and resolving difficulties as long as they don't just dump and run. The state has clear expectations (and federal guidelines apply as well if the majority of your residents are receiving medical assistance), and your unit needs to meet them. Communicate to your staff that you understand the time pressure and other obstacles that occur but tell them firmly that for this to work, everyone has to be part of the solution.

Speak with them individually, even if only for ten minutes. Find out what motivates each of them--praise, good written evals., leadership possibilities, more flexibility in scheduling, etc. Maintain enough professional distance to be perceived as in charge, but connect wherever possible. Determine if they understand why mandated items are important and what their significance is.

The new attitude needs to be that you are all a team working to accomplish an important agenda. If you find one or two bad apples who do not respond to encouragement, praise, negative consequences, or other tools to reshape behavior, you have to consider the effect on group performance and morale and most likely let them go.

If you set the tone that regardless of what has happened before, this is a new day and you will all work together to get a good job done, you should see positive differences.

People like to know that their input matters. They regard their own role in the big picture as more important if someone is aware of whether their tasks get done or not. One of the biggest problems in motivating front line staff is that after months and months of doing battle with various problems, that's all they see. It's up to you to give them a new vision, restore their pride in the job they do, reward and broadcast within your group good assessments and attitude, and get your people invested in what happens to the unit as a whole.

You have a great opportunity to turn your corner of the world from an obstacle-based and reactionary unit into one that is focused on suucessfully meeting objectives as a team.

If you can show that you care about your staff and your residents while still maintaining leadership, you will have a powerful approach to getting this important job done.

Go for it and good luck!

Hellllllo Nurse, BSN, RN · Oct 18, 2005

Mranda, great post.

rn/writer, RN · Oct 19, 2005

Mranda, great post.

Thank you.

Years ago when I worked in LTC, one of the biggest drains on everyone was low morale and the feeling that what we did just disappeared into the void. I saw people cut the corners they thought wouldn't be noticed, not necessarily because they were substandard CNAs or nurses but because they had no cohesion as a group and the resulting inefficiency meant there weren't enough hours in a shift to do everything.

I have always been inspired by leaders in any field who take the time to listen to their staff from the bottom up. Often, it's the people on the lowest rung who can see past the corporate psychobabble to the real problems. Executives think they know what's what. The staff in the trenches really do and would gladly share the information if anyone wanted to listen.

I hope the OP can make a big difference in the lives of her staff and her residents.

Take care,

gentlespirit · Oct 19, 2005

Do you have a unit/ facility supervisor? These issues that you describe are ones that should be handled by you - you need to educate and then delegate the responsibility to the appropriate person. As DON of a 168 bed facility, all of our weights were obtained by one person (assisted by CNA staff). All weights were then turned in to the ADON who reviewed and then requested re-weights. Re-weights had to be performed the next morning by the "weight CNA" and returned to the ADON to review. Once all the weights were approved, they were entered into our MDS program, which did all the math.

Even the most basic MDS programs have weight management tools, as well as many other options that you may want to check it out.

In my experience I believe you are probably dealing with a couple of underlying issues:

1. No one is taking responsibility for the work.

2. No one is demanding accountability for the work.

3. There has been a lack of communication and education for quite some time that has lead to erosion of morale and poor work habits.

What do you think?

Good luck and God Bless you.

dian57 · Oct 19, 2005

I'm in the same boat as the OP. New unit, low morale, no accountability, inconsistent work results.

The first thing I instituted was mass report. All staff working the shift gathers to hear report on the whole unit. Cuts down on the "not my side/resident" thing. My presence also stopped the sassy backtalk to the nurses. I take this daily opportunity to make announcements, introduce new forms or policies, ask questions, request suggestions. This also cuts down on rumors as they're all hearing the same thing at the same time. I'm generally present for day and evening report, takes 10 minutes at the most.

Monthly weights are due by the 5th of the month. The residents are either bed or chair scale weights. Bed weights are done by 3-11, chair by 7-3. The weight of the chair is written on the weight worksheet for easier subtraction. The weight book is reviewed weekly at the careplan meeting by the RD and nurse (We had a deficiency years ago for a 5 lb unnoticed loss that was regained within several weeks. This was our POC).

Hope this helps a little.

Nurse_Pauline · Oct 21, 2005

Also have had deficincies on wgt losses. On my unit (60 beds, lots of hoyer lifts) 7-3 obtains the weekly wtgs (pts that have hx of wgt losses, g-tube pts, new admissions for 4 weeks) 3-11 obtains the monthly wgts. It works out about half and half ,which is fair. I use two worksheets, one for my weekly wgts one for monthly. Just easier to keep track of. With 5 cnas on each shift, each is responsable for three wgts a day. I highlight the pts on the assignment sheet and at the end of the day shift transcribe the wgt to the wgt sheet. This way i can easily see if a reweight is needed and i can grab the cna at that time. Same thing for monthly wgts. I transcribe the wgt from the assignment sheet to the wgt sheet. At a glance i know if there is a big discrepancy. Once a month, i input all the wgts into the pts charts. I keep all the wgts sheets in a seperate notebook just to refer to if needed, plus the wgt is on the assignment sheet to cross reference. All the monthly wgts are obtained by the 15th if the month, and reweighs if needed. Wgts are obtained on shower chairs only currently. I think it is the best way to obtain the most accurate wgt. The dietican reviews the wgts weekly, and i update her on any losses or gains over the last month. This system cuts down on going into the charts multiple times and is an easy and quick way to see if there are losses. It also helps to hold cnas responable if they are consistanly making up wgts or just not getting them. Good luck,Im sure there are many of us out here who can smypathize with you.