I received a "write up" warning at my LTC

Published

Apparently, I have committed the terrible sin of "working overtime." How dare I want to be a responsible person and do the " medicare charting" before I go home. What was I thinking?

Specializes in LTC, Education, Management, QAPI.

Where I'm at, we have this thing called teamwork and trust... If something happens near the end of the shift, the supervisor steps in and helps finish it up so report can be completed. With the funding dropping the way it is, Overtime is more and more worrisome for employers. Some is inevitible. If you are consistently out late, it is a red flag to me that something is wrong. It's wrong to assume that it is the nurses problem. I'm betting that it's a mixture of things; things that can be adjusted or helped with.

Like I said, our facility would not survive without teamwork, that's what really makes it work. Any manager/supervisor worth a can of beans would sit down with you and try to come up with a solution before writing you up.

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Specializes in Geriatrics, WCC.

As a DON, I have faced the issues of nurses working OT for years. I have always put out the policy that all overtime needsto be approved by managment before it occurs. This way each time it can be looked at to see what the specific issue was at the specific time. Management also has their toes held to the fire for the budget. I have known DON's to lose there positions for letting the OT kill their budget. I also havew had issues where the same nurse would incur OT each time they worked but, no one else doing the same job had any problems with getting done ontime. Has a time study been completed? have you went to managment to see what it is they could help you with?

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Most of the nurses here have had to do overtime in order to complete their work. Right now, they are not writing anyone up, because they are losing nursing staff. There is one nurse here though who always has a lot of overtime. It doesn't matter if she had a "good night" or "bad night" she always has a lot of overtime. I don't think the management here would be interested in helping anyone. The environment here is harsh and unfriendly. It's

"Every man for himself ". No teamwork here.

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Specializes in Emergency Nursing.

Oh, I could write a whole post on this...... :)

First, it's nice to hear that people are having the same problems as me. I have found that I really do not like LTC. I love the residents, but I hate all of the paperwork and covering my and everyone's A** with paperwork. I hate being told that I can't use my nursing judgement, there must be an order or policy. There is some teamwork at my facility, but there is still an underlying hostile tone to the work environment.

I am not full time, but I do feel the pressure from others to clock out on time. (BTW I work second shift.) I had a nurse's meeting yesterday that I came out of very upset. The unit manager and DON basically just sat there and told us everything we were doing wrong. Of course, that is what the meeting is for, but a lot of was issues that could've been taken up individually. For instance, an EKG patch was found on a re-admit 2 days after she came back from the hospital. The unit manager was appalled and said, "How could she have had a good skin assessment when no one even noticed the EKG patch!" Well, I was the one that did the assessment (along with the RN supervisor), and yes, I was in a hurry and I didn't see the patch. I was in the middle of my 2000 med pass and I was only looking for bruises and open areas, etc.- not patches, the aides should have taken care of that. Yes, you have to do a super quick assessment when you know you have to go out and talk to the family, write up admission orders, make skin grids for all the stupid little bruises, care plans, etc., etc., etc....AND clock out on time. You HAVE to rush through almost everything! THEN, they told us that that now ALL skin assessments have to have 2 nurses co-sign. (Yeah, f***ing right.) The problem is, we already have a lot of bullsh** paperwork to do on every little f****** thing and now they are piling more and more on us. There are 2 of us on the floor and each of us has approximately 2 skin assessments a day (+/-). Now how is that going to help us manage our time any better? Plus, we were given assignments for change over. So I have 4 residents for changeover and I work part time. I may end up having to do all 4 on one night. How in the H*** is that going to happen and me still get out on time? It was going just fine with everyone working together on change over, why change it? What about teamwork? I never heard anyone complain.

Anyway, it all just makes me want to cry. So, I feel for ya. They keep giving us more and more. They actually told us that we were going to have to start signing out washcloths. Yup.

I don't know how any one could change this. It's management and medicare. It really sucks. I wonder, are all nursing homes this bad to work at?

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Specializes in LTC, Education, Management, QAPI.

I hate to hear all of the trouble with LTC. I feel for you, I do- but there are some things you have to short cut and some things you cant- an admission skin assessment is one that you cannot short cut. Before I get beat up, trust me- I know you are overworked and underpaid, you don't have to say it. I have been in LTC a while in many different hats, so I know. My facility has done the same yours has- with each thing missed, we have added a new step to cover it. We do that because LTC Regulation mandates that we self-audit and come up with a stable plan to prevent recurrence. WHen we identified a similar situation that you have with the patch, we reacted the same way because we can get in so much trouble with state over that AND it's substandard care. Now- please don't get mad, I'm only stating facts so far. I have learned that the above situation is NOT EFFECTIVE. Adding more paperwork does NOT fix the problem and makes it worse for you on the floor- but sometimes hands are tied and we have to try to find a solution that the survey agency will accept. I have started making deals with our nurses. When they make a mistake related to Admissions, orders, or skin, they get to make it once. If they make it twice, I have that nurse do the paper skin check (for example) with a sign off. Once they are consistently done right, I take them off again. I know I KNOW I KNOW it's too much work, but it just has to be done right. I dont think you should be beat up, either, for making a mistake, that's hostile. If your underlying environment is negative and lacking, you need to get out. There ARE GOOD LTC's out there! You sound like a conscientious nurse and deserve a break sometimes As for having meetings, we do that so that we can keep people on the same page- I don't like to go to people directly when a first issue is made, I make general statements to the group to be mindful and watchful. Then, if it continues, I go the personal 1:1 route. I feel the meetings are the most delicate and non-specific way to remind us what needs to be done. Not everyone agrees, that's fine. Also, Meetings should *not* be about telling you what you did wrong, it should ONLY be about what you need to do to make it right. I think you're in a detrimental place where you work :( I hope it gets better.

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Specializes in Emergency Nursing.

I agree 100% NurseGuyBri. Everyone has a job to do and (almost) everyone has someone over their head telling them how to do it better/different. Part of the anger in my first comment had a lot to do with my own feeling of inadequacy after the meeting. Something I am not used to feeling in my job and have NEVER felt in any job I've ever had. I AM a very conscientious nurse and I am not used to doing things half-assed. I have only worked there for about 5 months and it's my first LTC job in 9 years of being an LPN. After venting, and thinking a lot, I have come to realize that I will be a whole lot less stressed if I put my priorities in order. #1 being resident health, safety, and well being. This includes skin assessments (although, I still despise paperwork on bruises being perceived as more important than mental health, lung sounds, etc.). Clocking out on time vs doing my job well isn't going to stress me out anymore. I refuse to race against the clock. If they want me to sign out washcloths (still lol at that) then I will. I bow down to the management gods. I will do my job as fast as I can--BUT I will do it well, whether it takes 8 hours or 9 (or more--blah) If that isn't acceptable, then they can let me loose. :)

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Specializes in LTC, Education, Management, QAPI.

BEAUTIFULLY put :) If you make patient safety first and then do your best with time management, then only result should be improvement. If your management doesn't get that, then they're missing something.

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If you short of staff 3 CNA's on a floor with a bunch of fallers who wear alarms How you gonna do rounds and as a nurse do my work if all the alarms keep going off, Ive got a high risk faller sitting at the desk with me in w/c cause they can't keep their @&*% IN THE BED AND THE UNIT GOING HAYWIRE Nobody's coming to help cause most likely the supervisor has a cart ( somebody called out) and she tells you your on your own

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Specializes in LTC, Education, Management, QAPI.

ybanurse- It's the nature of the job, take it or leave it :) I'm not saying that to be mean, but it is what it is. I've been in your situation, and you do your best. You have to re-assess at some point, however, how safe is the care you're providing, and if it's not safe, you need to bring that to management. Not your supervisor, they're just as overworked and underpaid, trust me. Take it to a unit manager or the ADON. If they don't provide you with some sort of ideas or information, go somewhere else. I'll tell you this though, it's practically impossible to prevent call-outs. It's out of control, people just don't take nursing as seriously as they used to. We need to work on that, but it's an inherent level of self-worth and work ethic that prevents call outs. No management team can give an employee that.

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If you short of staff 3 CNA's on a floor with a bunch of fallers who wear alarms How you gonna do rounds and as a nurse do my work if all the alarms keep going off, Ive got a high risk faller sitting at the desk with me in w/c cause they can't keep their @&*% IN THE BED AND THE UNIT GOING HAYWIRE Nobody's coming to help cause most likely the supervisor has a cart ( somebody called out) and she tells you your on your own

Hey, I think we must work at the same facility.. on the same unit too!

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Specializes in Geriatric.
I hate to hear all of the trouble with LTC. I feel for you I do- but there are some things you have to short cut and some things you cant- an admission skin assessment is one that you cannot short cut. Before I get beat up, trust me- I know you are overworked and underpaid, you don't have to say it. I have been in LTC a while in many different hats, so I know. My facility has done the same yours has- with each thing missed, we have added a new step to cover it. We do that because LTC Regulation mandates that we self-audit and come up with a stable plan to prevent recurrence. WHen we identified a similar situation that you have with the patch, we reacted the same way because we can get in so much trouble with state over that AND it's substandard care. Now- please don't get mad, I'm only stating facts so far. I have learned that the above situation is NOT EFFECTIVE. Adding more paperwork does NOT fix the problem and makes it worse for you on the floor- but sometimes hands are tied and we have to try to find a solution that the survey agency will accept. I have started making deals with our nurses. When they make a mistake related to Admissions, orders, or skin, they get to make it once. If they make it twice, I have that nurse do the paper skin check (for example) with a sign off. Once they are consistently done right, I take them off again. I know I KNOW I KNOW it's too much work, but it just has to be done right. I dont think you should be beat up, either, for making a mistake, that's hostile. If your underlying environment is negative and lacking, you need to get out. There ARE GOOD LTC's out there! You sound like a conscientious nurse and deserve a break sometimes As for having meetings, we do that so that we can keep people on the same page- I don't like to go to people directly when a first issue is made, I make general statements to the group to be mindful and watchful. Then, if it continues, I go the personal 1:1 route. I feel the meetings are the most delicate and non-specific way to remind us what needs to be done. Not everyone agrees, that's fine. Also, Meetings should *not* be about telling you what you did wrong, it should ONLY be about what you need to do to make it right. I think you're in a detrimental place where you work :( I hope it gets better.[/quote']

I agree 100% NurseGuyBri. Everyone has a job to do and (almost) everyone has someone over their head telling them how to do it better/different. Part of the anger in my first comment had a lot to do with my own feeling of inadequacy after the meeting. Something I am not used to feeling in my job and have NEVER felt in any job I've ever had. I AM a very conscientious nurse and I am not used to doing things half-assed. I have only worked there for about 5 months and it's my first LTC job in 9 years of being an LPN. After venting and thinking a lot, I have come to realize that I will be a whole lot less stressed if I put my priorities in order. #1 being resident health, safety, and well being. This includes skin assessments (although, I still despise paperwork on bruises being perceived as more important than mental health, lung sounds, etc.). Clocking out on time vs doing my job well isn't going to stress me out anymore. I refuse to race against the clock. If they want me to sign out washcloths (still lol at that) then I will. I bow down to the management gods. I will do my job as fast as I can--BUT I will do it well, whether it takes 8 hours or 9 (or more--blah) If that isn't acceptable, then they can let me loose. :)[/quote']

BEAUTIFULLY put :) If you make patient safety first and then do your best with time management then only result should be improvement. If your management doesn't get that, then they're missing something.[/quote']

If you short of staff 3 CNA's on a floor with a bunch of fallers who wear alarms How you gonna do rounds and as a nurse do my work if all the alarms keep going off Ive got a high risk faller sitting at the desk with me in w/c cause they can't keep their @&*% IN THE BED AND THE UNIT GOING HAYWIRE Nobody's coming to help cause most likely the supervisor has a cart ( somebody called out) and she tells you your on your own[/quote']

I feel your frustrations personally. Similar dilemmas here. They hired me for my high work ethics and my specialty in customer service. Residents are #1 was emphasized in orientation. Boy howdy right there with me (I thought). Each night (7p-7a) proved the opposite. 1 person (regardless of stamina) cant do it all. Jobs are few so I havent left yet. I am searching. I will do what I can for the res. but have accepted defeat and handed it over to my highest chain in command "God".

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Specializes in Emergency, ICU.
I'll tell you this though it's practically impossible to prevent call-outs. It's out of control, people just don't take nursing as seriously as they used to. We need to work on that, but it's an inherent level of self-worth and work ethic that prevents call outs. No management team can give an employee that.[/quote']

I find these threads on LTC very scary and they've served to let me know to Never work there. But, I disagree with the statement above. Call-outs may be a result of poor work ethic in a small percentage of people, but the reality is that nurses are abused in the workplace by a healthcare system that does not value our input at all.

Most times I call in sick is really a mental health day because I have such anxiety about going in and working in an environment where there is no support for me or my nursing judgement and where I have to spend the day making sure I document to cover myself instead of taking good care of my critically ill patients. I just can't face being there again.

I take the time I need to provide care, but always running around. It sucks. There's no better way to say it.

Sent from my iPhone using allnurses.com

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