I'm beginning to think my nurses are on the edge of mutiny. I am a LTC DON with a great ADON, SDC, UM's and some really good nurses. They are all overworked, by no underestimation of the word. "Overworked" does not do justice. I have experience as a LTC LPN, Charge Nurse, Supervisor, ADON and ICU in acute care as an RN. Here's what the undertones are:
Nurses have 30 patients each. The patients are sicker, more acute, and need hospitalization more often. New nurses are coming in and leaving faster than I can say, "WAIT! It gets better!" which is unfortunately untrue. My unit managers are completely overwhelmed and my long term nurses (I have 4 that have been with us longer than 10 years) who are excellent, but we cannot seem to get the team back to a safe place.
We are missing things. The E.H.R. is so slow that we wait more on it to respond than we do in the rooms. Blood sugar of 30 never gets documented because the nurses barely can get the paperwork and information to send him out before they are behind on every single med after that.
Our team is still hanging on. We are going through changes (new admin) and hiccups (new systems not working well) and high turnover that we have never experienced (we don't pay enough and ask for too much and new LPN's are *NOT* prepared for 30 patients each). My hands are tied with reducing nurse/pt ratio, but what I do have is my heart and compassion, along with our team drive to do better. We're just having trouble figuring out HOW to do better.
I need some assistance with a working program/ system to help improve the new nurses tenure (of course, I can't get more $$ for training). All I have (and this is half the battle) is a great management team and some really great nurses on the floor. I have managed before, and I have done well, but this.... This is the most difficult thing I have ever done and I'm missing something that experience has yet to teach me.
So, my plea is to any CNA, LPN, RN, LTC, Acute, **ANY** venue that can give me some insight on what we can offer with just our time, of which is already precious and stretched thin. I know what the books say. I know how to be fair, how to educate, accommodate, and support- but it's not enough. What have you done or what has been done in your facility/ team to help improve the atmosphere? Is it a QA program? Being on the floor more (I already help out and intend to help more)? Is there an incentive program? Do I need to fire my good nurses (who are unbearably slow)?
My old DON would not have put up with any of the new personality issues that are arriving, that is why she retired. I'm exhausting myself quickly and wish to get out of LTC only because I cannot seem to get the group to a good place, and they deserve to be led there, but I also know that they will not get a more compassionate, understanding DON if I leave. I am not a deserter, but I think the floor is close to mutiny!
30...just 30? I'm a Floor nurse on the behavioral hall, and I have 45. 30 is a doable, if someone said I just had 30 I would jump for joy. Yes nurses are over worked sometimes its not the over worked that upsets me its the taken advantage of. The last place I was at I have 50 sometimes the entire facility because of nurse turn-around. After a while you just can't handle it, its not fair that some of the nurses get taken advantage of, and its usually the hardest workers, (shows up on time, will pick up a shift, gets work done, doesn't have any complaints against them, has a great attitude, helps out other members of their team, ect.) In my case work a month straight and then get one day off and get called in because of people don't understand paper work and they couldn't handle my unit.
Maybe your administration should do something nice for your staff. Show them that with out the Nursing Staff, STNA's, all the departments actuallty, all the normal functions of the facility couldn't happen. Maybe a dinner, and don't do that whole well its going to be at 10AM, thats messed up, the facility I was at did that for nurses week, no one was impressed actually everyone was more willing the leave after that. It was a bagel bar, all the midnight staff couldn't attend because well we work til 6AM if we want bagels we can get them at home when we wake up at 2 and from what I heard it was hard bagels and the fruit was less than nasty. Do something special for each shift. Make all the nurses feel like ok, they have their downfalls but they are at least attempting to fix them, and they truly do care about us.
Now the budget issues for this whole production. Ask your higher ups. Can we really budget if we have 4 nurses leave and due to that, morale of the residents will go down, then you know they will tell their families, or the families will notice, and then they will leave? There goes your profit. Then to have new nurses come in, well depending on experience will want X amt. of pay, or if they are new in their career will need X amt of days training, along with all the other things needed to hire someone. I'm not in your shoes, nor would I ever want to be, I'm pretty content being a worker bee. But I'm just giving you a perspective from my eyes.
Specializes in critical care, ER,ICU, CVSURG, CCU.
med aides, can you utilize them, cost is lower, and nurses can do more, with med audes i was able to have a charge nurse handle spsome 40 residents....just a thought
30...just 30? I'm a Floor nurse on the behavioral hall, and I have 45. 30 is a doable, if someone said I just had 30 I would jump for joy. Yes nurses are over worked sometimes its not the over worked that upsets me its the taken advantage of. The last place I was at I have 50 sometimes the entire facility because of nurse turn-around. After a while you just can't handle it, its not fair that some of the nurses get taken advantage of, and its usually the hardest workers, (shows up on time, will pick up a shift, gets work done, doesn't have any complaints against them, has a great attitude, helps out other members of their team, ect.) In my case work a month straight and then get one day off and get called in because of people don't understand paper work and they couldn't handle my unit.
Maybe your administration should do something nice for your staff. Show them that with out the Nursing Staff, STNA's, all the departments actuallty, all the normal functions of the facility couldn't happen. Maybe a dinner, and don't do that whole well its going to be at 10AM, thats messed up, the facility I was at did that for nurses week, no one was impressed actually everyone was more willing the leave after that. It was a bagel bar, all the midnight staff couldn't attend because well we work til 6AM if we want bagels we can get them at home when we wake up at 2 and from what I heard it was hard bagels and the fruit was less than nasty. Do something special for each shift. Make all the nurses feel like ok, they have their downfalls but they are at least attempting to fix them, and they truly do care about us.
Now the budget issues for this whole production. Ask your higher ups. Can we really budget if we have 4 nurses leave and due to that, morale of the residents will go down, then you know they will tell their families, or the families will notice, and then they will leave? There goes your profit. Then to have new nurses come in, well depending on experience will want X amt. of pay, or if they are new in their career will need X amt of days training, along with all the other things needed to hire someone. I'm not in your shoes, nor would I ever want to be, I'm pretty content being a worker bee. But I'm just giving you a perspective from my eyes.
I agree with most of your post, but having 40-50 residents in behavioral help is different than 30 residents with higher acuity as OP stated. I worked both, admittedly for a short period, but that's why I feel qualified to answer that question.
I agree with most of your post, but having 40-50 residents in behavioral help is different than 30 residents with higher acuity as OP stated. I worked both, admittedly for a short period, but that's why I feel qualified to answer that question.
Not to mention the beginning of your post was condescending. You may have well just called her incompetent.
How about having UMs do treatments and IVs or use a nurse for a four hour shift or so to help. Have UMs do admissions. See if aides can legally do blood sugar checks
You are all hitting some great points. I see the solution to my situation, but that won't happen until it is a regulation. 30:1 is not safe, not on any floor, not anywhere that has both NF and SNF residents. On average, my nurses have approximately 8 skilled patients of their 30. That's not even the issue. The NF residents are becoming more and more demanding. The "skill" in SNF is just for money. I have many NF patients that require more time and work but they have exhausted their benefits. If we want better outcomes, we have to reduce the workload.
My workplace is starting a new preceptor/mentor program. They are pairing up new grads with nurses who've been at the facility for awhile. Then again at my facility a large amount of the nurses have been there for more than a year. It sounds like you wouldn't have a lot of nurses to pair your new grads with.
As someone else mentioned look at the medications your resident's/patients are on. Is vitamin XYZ really going to do anything or providing and benefit for the patient? If not get it D/Ced. Is Mrs. Smith getting large doses of oxycodone through out the day? See if Oxycontin BID would be a better option. Is Mr. Jones getting frequent PRNs? Get them scheduled. Is Ms. Johnson receiving a PPI that she was prescribed in the hospital for gastric protection r/t hospital stresses? See if it can be tapered down/D/Ced. Our elderly really are over prescribed medications. As someone else said look at the times you are giving medications. Honestly having EVERY med scheduled at 8am is awful. I've only picked up on days once or twice, but hell I was drowning with the amount of medications I had to hand out at that time. If some had been pushed to the 12p pass it would have been much nicer.
Get other services involved. Get pharmacy on board doing med reviews and making suggestions to eliminate medications. Have them evaluate those with frequent falls and/or behaviors to see if medications may play a roll. Less falls and behaviors is less work for the nurse. Do you have patient's declining? Get them on Hospice. Seriously. I ******* love hospice, they make things easy on the floor nurses.
Someone mentioned putting new grads on nights. I've only ever worked nights and I think nights as a new grad can be very difficult. While you don't have all the freaking medications, you tend to be the ONLY nurse on the floor. You also have much less resources than nurses on other shifts. New grads need a nurse, manager, something there frequently to bounce ideas off of.
Thanks casi! You are right on target. I am working with pharmacy to help reduce some of these meds, but I get such push back from our physician and NP. Advocating for patients is sometimes more difficult with them than it is with the families!
mellster, LPN
24 Posts
Viva, I wish I could work at your facility. And it is so true about the DON setting the tone. If you don't have a strong DON morale really goes down!!