How many wounds? Other Tx nurse responsibilities?

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I've been treatment nurse at a 100bed SNF for the past year, and recently our acuity has ramped WAY up with regards to wounds. We got a well known specialist on staff and now we are getting admits left and right.

In addition we have a new DON.

Looking back at my paperwork I averaged between 15-20 patients daily in the past few months. That number has jumped to 25 or so patients...with 38 wounds that I am expected to personally treat each day, some twice a day.

In addition I am supposed to do 12 skin assessments a day, measure and monitor all skin tears and surgical sites at least weekly, careplan, monitor pre-albumin levels and report to dietitian, make wound rounds and check that patients are being turned every 2 hours, clean the biohazard room, order supplies/clean the treatment area in the supply room, inservice CNAs, attend the daily meeting which takes an hour, round with the MD weekly (takes about 2-3 hours) go to the QI meeting which takes 2 hours, call all families weekly (which ends up being a recitation of all their grievances about every little thing in the facility and I have to fill out complaint forms constantly) and measure, and also fill out "Pt noncompliance" and "Pt education" forms DAILY in addition to documenting daily about noncompliant patients.

In addition I am supposed to be a "unit manager" all of a sudden, this was never formally part of my job duties before --I helped out the ADONs when my census was low, but now my new DON expects this on a daily basis and if I say that I can't do something because I'm busy I get a very negative response from her. The ADONs understand but she is very hostile towards anyone saying they have too much to do. SO now I also have to deal with issues like pharmacy recommendations and checking admissions etc along with conducting part of new employee orientation.

I end up turning all these bed-bound obese patients by myself, changing their briefs and doing incontinent care, wrapping legs with ACE wrap, putting on TED hose, putting lotion on, toileting, etc just because if I do not do it or if I ask a CNA to do it I will be waiting around for hours or it won't get done (I have experimented with not doing it/writing up the person for not doing it and it just doesn't work.)

I don't think of myself as "above" this care but it does take a lot of time out of my day. Anytime I delegate anything it just does not get done, period. The DON's response to this is to do it myself because "it'll just take a couple minutes." I understand that changing one person's brief "only" takes 20 minutes (because there are never supplies and by the time I get in there the person is guaranteed to be covered in diarrhea or dry, sticky BM) but when I have to do it for 10 patients on top of the actual wound care--it does not work. I get yelled at constantly and told "It's in your scope of practice" if I request that a task be directed to another person.

I just don't know what is reasonable for a LTC/SNF wound nurse to expect. The weekend wound nurse is also overwhelmed, she told me she feels that what we are being asked to do is completely unreasonable, and she does not have to do half the things that I do (care plans, family updates, any of the unit manager stuff.) These things have all been irritating since I took the job, but with the sicker patients we have, it's becoming overwhelming. I tried to speak with the DON about this and she just threatened to fire me and get someone who can do the job... I think I do as good of a job as I can with the resources that I have, but I cannot do all these things in 8 hours, nor do I want to keep working 14 hour days (and now I am getting warned about overtime.) How do I get her to understand that I am not being lazy or "passing the buck" but that this is just too much? I offered for her to come and shadow me for a day but she said she is too busy to do this.

Should I just cut my losses? I really like doing actual WOUND CARE but all this other stuff... it's getting to be too much.

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Specializes in LTC,Hospice/palliative care,acute care.

That sounds like a very heavy load..To start making it more manageable when speaking with family members regarding the wound refer them.and their complaints to the appropriate party,don't even go there.Our wound team does NOT track uncomplicated skin tears.You MUST delegate the care you are doing.....Let the unit nurse follow up with the staff if they are noncompliance,you have to roll....Unit nurses should be doing the routine skin checks,scheduled to coincide with the residents shower.....

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See that is the problem. I am not being allowed to delegate anything. Corporate policy is that the treatment nurse must do all skin checks because the charge nurses weren't doing it. I am held responsible if a skin tear gets infected and I have to monitor their progress again per corporate. it's just too much!

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Specializes in LTC,Hospice/palliative care,acute care.
See that is the problem. I am not being allowed to delegate anything. Corporate policy is that the treatment nurse must do all skin checks because the charge nurses weren't doing it. I am held responsible if a skin tear gets infected and I have to monitor their progress again per corporate. it's just too much!

You can delegate family complaints not relating to wounds,ditto hygiene,etc after you complete a treatment.Can you hit those skin checks first thing in the morning?Some residents will not allow that but you can get a great start by knocking them out before breakfast Wouldn't it be a better use of your time to monitor the skin checks for completion prior to the end of your shift?You can make sure they are done....

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I had been getting the skins early in the morning but now the DON wants me to work the same hours as the rest of the office staff so she has "more accountability" and "knows where I am" (aka, she can't ask me to do things if I'm not there at the same time she is. I do not sit in an office all day so it makes no sense because she isn't going to know "where I am" at all times anyway unless she hunts through rooms... have tried explaining that it is easier to do treatments if I work 6-2 or 7-3 because therapy and activities and meals interferes greatly with my ability to do things working 8-5 (Especially since I have to go to stand up which takes an hour out of that time!!) but she wants us all to work the same hours and will not give me a reason why (the ADONs are mad too because they previously had one work 7-4 and the other 9-6 so we had greater hours of coverage but nope all nursing management is now 8-5 no matter what your job is...)

Whenever I relay complaints I am told to fill out the grievance myself and if I don't she comes after me asking for it, same thing for stuff like "patient got a skin tear in therapy and the charge nurse didn't call the family so now it is your responsibility." She is even trying to dump other things on me like telling me that since I have to call a particular family weekly about the patient's wound I also have to tell them about the patient's weight loss and increase in hallucinations, other nontreatment related things. I tried to explain to her that it would probably be better if the ADON did it so they could discuss the patients' overall health and the family's other complaints (of which there are usually many) and she again got mad at me and told me that I am a nurse so that it is in my scope of practice and therefore I can do it so I should because "it'll only take a couple minutes." I'm being nickel and dimed to death.

you know, typing all this stuff out just made me realize there is probably no real answer other than to quit because she doesn't respect me or my time. I have been doing most of these things for a year and have managed my time fine, but all this "just a few minutes" things have been adding up to hours out of my week.

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I think you should shadow HER! Have her show you how all of that can be done in 8 hours. Hopefully this would be eye opening. If not...PEACE!

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I was given the infection control program in addition to wound care. I got another job ;) floor nurses and cnas should be applying any lotions/topical treatments and applying Ted hose. Make the staff sick of you and in service them as many times as possible when they fail to do so.

A nurse who doesn't follow the policy and attempt to contact family regarding a skin tear should also be in serviced. Always document that you have provided education to staff. After that you can give write ups if there is truly a problem. From my experience.. Your DON or ADON should be present during write ups.

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The DON is basically having one nurse do the job of 2 people.

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