I never want to hear those words from you again

Long Term Care Columnist / Guide · Sep 14, 2010

Heh.
From the admin to me, this morning, about staffing. My magic words were, "We're always short."
We have 120 beds. 38 are mine. 20 of those people are totals. Hoyers. We are supposed to have 17 aides on days, 6 on my unit. Total today 15, 2 called off, 13. 4 on mine. One leaving early, another who works as "the early girl*."
Ooookay. We are, on occasion, staffed at less-than-ideal levels. Now is it not an elephant in the living room?
* I cringe when they are referred to as "the girls."

Gee, are we in kindergarten here?? How condescending can your upper management be? :uhoh3:

Honestly, I thought it was bad where I work now. Of course, I'm only a lowly charge nurse, but I was hired "to provide some badly needed leadership on the floor". So then I find out that we charge nurses aren't allowed to take residents off alert (and the care managers will often 'forget' to take them off for two weeks or more, even when the only reason they're ON alert is for an increase in their Colace :devil: ). Nor are we allowed to use our nursing judgment to put an alarm on a SNF pt. (fractured hip) who keeps getting OOB without help and has already fallen twice because, in the admin's words, "alarms are undignified".

I'm all about patient dignity, but when I have to nurse with one hand tied behind my back and a blinder put over my one good eye, I fear for my license.

Sorry for your difficulties, Sue. I feel for you, I truly do.

limey · Sep 14, 2010

I wish state with all their rules and regulations would sit down and figure out how three aides to forty residents can do all they are meant to without breaking the rules.
It's a game.

Not only that. it should be required that state work the floor with the CNAs and nurses. I have often wondered why it is not a requirement in all states that anyone filling the position in a LTC as an administrator, DON or nurse work the floor or all halls for a couple of weeks alongside a CNA. This way they have an idea what CNAs responsibilities are. I'm really fortunate to have worked as a CNA for several years before becoming a nurse. I respect my CNAs and what they do. I make sure they do what they are supposed to be doing but I also help them if it is necessary and if they ask for my help.

VeronicaWileyRN · Sep 14, 2010

Ladies, As a person that has worked on the manager side, states set the minimal amount of staff needed. Corporate or the owners decide above the minimum. I will agree that often corporate minimum and defintely state minimum is not enough to care for the amount and type of residents that most facilities have. State will tell you that we are to staff to patient needs and not strictly by numbers. Corporate/owners often don't want to staff per patient needs because it takes money out of their pockets.

Calling female C.N.A. women girls, I agree is not appropriate. If you will correct that person enough times they will eventually get it. It just isn't right, would they like being called the little boys. I don't think so.

shiccy · Sep 14, 2010

The thing that surprises me is that someone hasn't sat down and taken a clicker and a stopwatch to time how long it, on average, takes each total bath to do, and see how many hours in a day it takes to get these baths accomplished as well as all the other things aids and RN's do during the day... And then after all is said and done give the ability for breaks and a bit of rest here and there.

Folks think a human body can walk and/or run 12 hours straight and not die of exhaustion or be *really* unhappy with their jobs.

DizzyLizzyNurse · Sep 14, 2010

I wish state with all their rules and regulations would sit down and figure out how three aides to forty residents can do all they are meant to without breaking the rules.
It's a game.

I wish I could give this 1000 kudos. How about 2 LPNs passing meds to 43 people? How do you do that in 2 hours? (Hour before, hour after.) And of course sometimes someone will have pills ordered for 1700, 1730, and 1900. Really? One of our nurses figured out how many hours it would take to give all the pills, inhalers, eye gtts, etc and take the correct amount of time to administer everything. I forgot how many hours, but it was hours and hours, not including talking to the dr, residents, residents families, charting, writing orders, etc. Doesn't make any sense.

DizzyLizzyNurse · Sep 14, 2010

And we're not allowed to tell any residents or family members when we're short staffed. So if we have 2 aides to take care of 43 residents how are we supposed to do the 6 - 8 showers assigned on the afternoon shift? Especially with the gem of a new resident who has to be 1:1 because he beats the living crap out of everyone and has fallen a bunch of times because he's out of control and his family won't let us medicate him. So instead it looks like we're giving all our attention to 1 resident and are too lazy to take care of the others. How is that better? You just make the aides and nurses look bad.

jkaee · Sep 14, 2010

Gee, are we in kindergarten here?? How condescending can your upper management be?

I had to laugh when I read this, because the exact same words came out of my mouth this morning.

My husband has worked in a financial setting for most of his career, usually in a large city. It is absolutely mind boggling how different his field is from nursing/health care. Despite all of our titles, degrees, certifications or responsibilities, nurses are NOT treated professionally, not by a long shot. It's seen in our relationship with some directors/admin, in the quality of staffing ratios, in the quality of the equipment/supplies, pay, breaks, h*ll, just in the way we are spoken to....the list goes on and on. And in this economy, it's even worse. A while back, our DON made the comment in a meeting, "I have a stack of nursing applications this thick, so if you're not happy....." We are completely replacable, so don't rock the boat.

What drives me batty in my current position as an staff educator is that I can't use many websites because they're blocked. Everything is blocked....university sites, youtube, etc. etc. I guess I'm a child and can't be trusted not to abuse computer time.

So, OP....I feel your pain as well. Admin. knows they can pretty much do/say whatever they want, especially now with so many nurses wanting jobs.

txspadequeenRN, BSN, RN · Sep 14, 2010

lol, i too have been told to shut my pie hole about staffing....my response is...uhh it is what it is... if you don't want to hear about it then fix it. most ltc's need a total overhaul in staffing and management... been there and done that....

heh.
from the admin to me, this morning, about staffing. my magic words were, "we're always short."

StNeotser, ASN, RN · Sep 14, 2010

The thing that surprises me is that someone hasn't sat down and taken a clicker and a stopwatch to time how long it, on average, takes each total bath to do, and see how many hours in a day it takes to get these baths accomplished as well as all the other things aids and RN's do during the day... And then after all is said and done give the ability for breaks and a bit of rest here and there.
Folks think a human body can walk and/or run 12 hours straight and not die of exhaustion or be *really* unhappy with their jobs.

Yes, someone really needs to audit and find out how long each task takes. However, they won't because the truth will cost too much money.

I can't tell you how angry I get when someone from a different department waltzes up to me as I am passing meds, and says "Mrs So and So needs the bathroom - where are the aides?" I am now giving them all a stock response "There are three CNA's to twenty-seven patients. Logically, they're all giving care to other patients and will get to Mrs So and So when they are finished"

The way they ask the question "Where are the aides" always has a tone to it as if the CNA's are sunning themselves on the breakroom terrace or gossiping in a corner. :mad:

Moogie · Sep 14, 2010

Gee, are we in kindergarten here?? How condescending can your upper management be?
Honestly, I thought it was bad where I work now. Of course, I'm only a lowly charge nurse, but I was hired "to provide some badly needed leadership on the floor". So then I find out that we charge nurses aren't allowed to take residents off alert (and the care managers will often 'forget' to take them off for two weeks or more, even when the only reason they're ON alert is for an increase in their Colace ). Nor are we allowed to use our nursing judgment to put an alarm on a SNF pt. (fractured hip) who keeps getting OOB without help and has already fallen twice because, in the admin's words, "alarms are undignified".
I'm all about patient dignity, but when I have to nurse with one hand tied behind my back and a blinder put over my one good eye, I fear for my license.
Sorry for your difficulties, Sue. I feel for you, I truly do.

Alarms are undignified.

So is falling out of bed three times during the noc and lying on the floor because the only three staff members for fifty residents (one licensed nurse, two CNAs) are busy helping someone else.

I realize that LTC facilities cannot staff for every possible situation but it seems that if administration wants people to not have bedside alarms, they need to get their backsides over to the facility and sit with these people in the middle of the night so they personally can alert the nurses and CNAs when these residents fall.

Maybe I am idealistic but I happen to believe that safety is a dignity issue, too.

JB2007, ASN, RN · Sep 14, 2010

Alarms are undignified.

So is falling out of bed three times during the noc and lying on the floor because the only three staff members for fifty residents (one licensed nurse, two CNAs) are busy helping someone else.
I realize that LTC facilities cannot staff for every possible situation but it seems that if administration wants people to not have bedside alarms, they need to get their backsides over to the facility and sit with these people in the middle of the night so they personally can alert the nurses and CNAs when these residents fall.
Maybe I am idealistic but I happen to believe that safety is a dignity issue, too.

I could not agree more!! Laying on the floor and yelling for help is far from dignified.

Who really wants the right to fall? Yes, I have been told that the resident has the right to fall! Makes me mad everytime someone says it too. For the record, when I am 80 years old and demented I do not want the right to fall! It hurts like nobodys business to fall at 37 and I do not want to know how bad it hurts at 80. Put the rails up and put an alarm on me for crying out loud.

VeronicaWileyRN · Sep 15, 2010

I did have a company that came into look at a floor nurse posiion. The reason being I had a nurse that had an injury at work and insurance company was trying to get her back to work. The looked at how pounds it took to push and pull a medication cart. How far would she walk, could she set down between time? How high would she have to lift something? etc. I am sure some where someone has done a time study. The only problem with a time study in long term care is that one person may only take 15 minutes for a bath and then another person could take 30 minutes or even 60 minutes. A time study would not be worth while because of these elements-people.