I'm about to crack...read this and help!!!!

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Specializes in Med-Surg.

Hello, my fellow nurses. It's so good to be here. I need your opinions on this situation.

Okay, I currently work in LTC on a rehabilitation unit/skilled nursing facility. Before I came on, they used to do 12 hours shifts. Now they are doing 8 hour shifts. Anyone who has ever worked on a rehab unit in LTC knows that it is near impossible to get anything done in 8 hours. Well, when they went to 8 hours, no one made adjustments to the work load. I work 1st shift. So, therefore, all of the treatments are scheduled on 1st shift. In addition to the normal duties; 2 med pass, treatments, charting, dealing with various issues, we sometimes get 7 and 8 admissions on 1st shfit. I have 25 patients that mostly are post-surgical and need pain medication on a regular basis. And it seems that recently, we have been having to send a lot of them back to the hospital as soon as they get there. These people have been butchered and develop so many problems.

So take 25 patients, plus discharges and admits, plus treatments, 2 med passes that seem endless because you have constant interruptions, plus family member's concerns, and you barely have time to look up before the end of the shift has come. I often stay over to finish up what I couldn't on my shift. Well, as you know, I am getting the blues from management for staying over because I am going into overtime. I told my manager that I just cannot, with a clear conscience, leave without doing my treatments and my charting. It is not the patients' fault that we are inadequately staffed and overloaded. They came there for good and care and by George, they are going to get it from me. So, she said, cool, do that. But she is telling me that if I stay, i must clock out and work off of the clock. I don't think that's right, but I guess i have no choice. But it's really taking a toll on me, physically and mentally. And I have only been there for 3 weeks. I'm already burned out.

This is where I need your advice. What should I do?

My manager says that it's understood that I won't be able to do everything on my shift. But if I don't do it guys, it won't get done. The 2nd shfit nurses won't finish anyting because they feel, "Well, that's 1st shift's responsibility". And I don't want to always leave them something to do. They don't deserve that. Also, I fear for my license. If I never do my treatments and leave them everyday, I'm afraid somebody's foot may rot off. And you know that in a court of law, they aren't trying to hear that I couldn't get it done. All they will hear is that I didn't do it. So, I am sometimes leaving an hour or two past getting off time and that is without being paid. I don't know about anyone else, but my time is valuable. I have a child that needs me. If I am going to be there, I feel that I should at least be paid, right?

By the way, we have a treatment/wound care nurse, but she won't touch a patient. She never does any treatments, except when the corporation comes in or state comes for a survey. Even then, she lied about doing the treatments. And get this, management knows about her, but they want to jump on me for staying on doing my job. And the CNAs cannot be counte on. They are nowhere to be found when you need them. They all go on break at the same time They run the floor and will tell the nurse what they are and are not going to do. And they even will sometimes tell the nurse what to do. The situation seems hopeless. Besides leaving, what options do I have? What's a girl to do? I just started this job 3 weeks ago and with all humbleness, I can honestly say, i am a pretty good "floor" nurse. I have worked in the hospital setting and left acute care to "get away." But I can honestly say, I don't think the hospital is as bad as this. I am at my wit's end. I am so tired, physically and mentally. I feel like crying everyday when I finish. And they schedule you to work 6 out of 7 days sometimes 4 days in a row before you get an off day. Somebody help me before I leave the profession for good. I need some inspiration and some advice. And it will all be much appreciated. I'll be waiting to hear from you all.

Good day!!!

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:flowersfo Dont crack, they (your pts.) apparently need you. Isnt it illegal for you to work off the clock? Stand your ground and keep your head up. Dont let the tx. nurse get away with not doing a job and getting paid. You can't keep this up much longer i'm sure. Remind admin. that the pts. are the only ones that truly suffer in the end. Hang in there.

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Specializes in burn, geriatric, rehab, wound care, ER.

I don't believe you have any other option but to leave. It seems that you are the only one working and apparently doing the work of at least 3 people. Your manager is not doing her job, the treatment nurse is not doing her job, the CNA's are not doing their jobs - and they are getting away with it and using you as a doormat in the process.

Go do some registry work for a while so you can really check out a place before you commit to work there full-time. And give the State an anonymous tip-off on your way out - these patients shouldn't be subjected to such mistreatment.

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Specializes in CVICU-ICU.

Nursing is a 24/7 type of job..that is why we have the 2nd or 3rd shift. It would seem to me that whatever was done when the 12 hour shifts were in effect could also be done with the 8 hour shifts because you still have the 3-11 nurses working. You surely can't be the only nurse working the 7-3 shift so find out from the other 1st shift nurse if they are finding that the job duties are not fairly distributed between all 3 shifts and then head to management with the facts. You have to remember that the shift following you should also have patient care in mind. Is it a matter of you wanting to do things that could/should be left for the next shift?

As far as punching out and then staying off the clock to finish your work you are just asking for trouble when it comes to that. What if after you've punched out and are working off the clock you injure yourself.....you have a big problem at that point because you are technically not working. You really need to protect yourself. Also I do believe that if you are taking care of a patient off the clock and something happens I'd wonder if your employer would back you on that either. It is against the law for any employer to demand you work off the clock so if you get nowhere by talking to management there is always the labor relations board to appeal to however I think that unless you have other nurses also not able to finish their required work in the 8 hours and proof that your employer insists you stay to finish you might have a hard time and also I would use that as a last resort.

I also would keep written track of what was done for what patient and also of anything not being done by the CNA's or wound care nurse that should be done and present that to management. If you get no satisifaction from your immediate supervisior go one step higher.

Good Luck with whatever route you take.....sometimes I find that no matter what you do its a matter of management however I've also worked with some nurses that no matter what kind of a shift they had they couldn't find the time to get things done and it had nothing to do with patient load but with their own time management skills. I dont want to suggest that is what the problem is here but might I open the door and suggest you take a look at your time management skills and if you can honestly say that you are well organized and manage time/stress well then you'll have a better idea on which way to proceed whether it be going to management or finding another job.

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Specializes in Med-Surg.
:flowersfo Dont crack, they (your pts.) apparently need you. Isnt it illegal for you to work off the clock? Stand your ground and keep your head up. Dont let the tx. nurse get away with not doing a job and getting paid. You can't keep this up much longer i'm sure. Remind admin. that the pts. are the only ones that truly suffer in the end. Hang in there.

Well thank you very much for your encouraging words. I do believe it is illegal to work off the clock, but let them tell it, it's not. I guess they have never had anyone bold enough to go to the labor board as of yet. My manager even said that it was hard because she had to work the cart one day. Well, I'm like, if you know it's so hard, why not do something? But the DON just sits on her tail on complains about how bad we are. I would like to see her to a wack at it. But again, thank you for your encouragement.

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Sounds impossible to me. I've been doing LTC for the last 10 yrs. Mostly 8 hr shifts. 8hr shifts are doable if the work is divided. In one place I worked the tx were heavy on 7-3, but 3-11 was the shift that got all the admits. At my place now, we split the treatments (3-11 seems to have more) and the admits mostly come at 2pm or on the 3-11 shift. Days will start an admit, 3-11 will finish it. We have an unwritten rule that if an admit comes in by 2pm, days will at least verify orders,the next shift will finish it. Without these little concessions by both shifts...I don't see how you will be able to manage it esp if management is unwilling to look into the issues.

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Specializes in LTC and MED-SURG.

Your posts describes the atmosphere at LTC's that I am familiar with. My place of employment is not quite as bad, but you show the reasons why I don't like LTC and want to get out ASAP.

Hello, my fellow nurses. It's so good to be here. I need your opinions on this situation.

Okay, I currently work in LTC on a rehabilitation unit/skilled nursing facility. Before I came on, they used to do 12 hours shifts. Now they are doing 8 hour shifts. Anyone who has ever worked on a rehab unit in LTC knows that it is near impossible to get anything done in 8 hours. Well, when they went to 8 hours, no one made adjustments to the work load. I work 1st shift. So, therefore, all of the treatments are scheduled on 1st shift. In addition to the normal duties; 2 med pass, treatments, charting, dealing with various issues, we sometimes get 7 and 8 admissions on 1st shfit. I have 25 patients that mostly are post-surgical and need pain medication on a regular basis. And it seems that recently, we have been having to send a lot of them back to the hospital as soon as they get there. These people have been butchered and develop so many problems.

So take 25 patients, plus discharges and admits, plus treatments, 2 med passes that seem endless because you have constant interruptions, plus family member's concerns, and you barely have time to look up before the end of the shift has come. I often stay over to finish up what I couldn't on my shift. Well, as you know, I am getting the blues from management for staying over because I am going into overtime. I told my manager that I just cannot, with a clear conscience, leave without doing my treatments and my charting. It is not the patients' fault that we are inadequately staffed and overloaded. They came there for good and care and by George, they are going to get it from me. So, she said, cool, do that. But she is telling me that if I stay, i must clock out and work off of the clock. I don't think that's right, but I guess i have no choice. But it's really taking a toll on me, physically and mentally. And I have only been there for 3 weeks. I'm already burned out.

This is where I need your advice. What should I do?

My manager says that it's understood that I won't be able to do everything on my shift. But if I don't do it guys, it won't get done. The 2nd shfit nurses won't finish anyting because they feel, "Well, that's 1st shift's responsibility". And I don't want to always leave them something to do. They don't deserve that. Also, I fear for my license. If I never do my treatments and leave them everyday, I'm afraid somebody's foot may rot off. And you know that in a court of law, they aren't trying to hear that I couldn't get it done. All they will hear is that I didn't do it. So, I am sometimes leaving an hour or two past getting off time and that is without being paid. I don't know about anyone else, but my time is valuable. I have a child that needs me. If I am going to be there, I feel that I should at least be paid, right?

By the way, we have a treatment/wound care nurse, but she won't touch a patient. She never does any treatments, except when the corporation comes in or state comes for a survey. Even then, she lied about doing the treatments. And get this, management knows about her, but they want to jump on me for staying on doing my job. And the CNAs cannot be counte on. They are nowhere to be found when you need them. They all go on break at the same time They run the floor and will tell the nurse what they are and are not going to do. And they even will sometimes tell the nurse what to do. The situation seems hopeless. Besides leaving, what options do I have? What's a girl to do? I just started this job 3 weeks ago and with all humbleness, I can honestly say, i am a pretty good "floor" nurse. I have worked in the hospital setting and left acute care to "get away." But I can honestly say, I don't think the hospital is as bad as this. I am at my wit's end. I am so tired, physically and mentally. I feel like crying everyday when I finish. And they schedule you to work 6 out of 7 days sometimes 4 days in a row before you get an off day. Somebody help me before I leave the profession for good. I need some inspiration and some advice. And it will all be much appreciated. I'll be waiting to hear from you all.

Good day!!!

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Specializes in Med-Surg.
I don't believe you have any other option but to leave. It seems that you are the only one working and apparently doing the work of at least 3 people. Your manager is not doing her job, the treatment nurse is not doing her job, the CNA's are not doing their jobs - and they are getting away with it and using you as a doormat in the process.

Go do some registry work for a while so you can really check out a place before you commit to work there full-time. And give the State an anonymous tip-off on your way out - these patients shouldn't be subjected to such mistreatment.

Thanks for responding. I have had an offer for a job in LTAC, and I am kind of contemplating it. But I wonder will it be 2x as worse as where I am now. Well, at least I know I wouldn't have 25 patients.

LOL!!! I'm sorry if I sounded as if I was the ONLY one working there. I think I am exaggerating a bit, because one or two of the CNAs really do work hard, but the rest have been there a while and I guess they resent me coming in and asking them to do something for me. For example, I had a pt I had to send out to the ER. Well, while I was running trying to get everything done, I asked her to assist me with one simple tasks and that was to make sure that woman was dry before EMS got there. She basically told me she wasn't going to be able to because she was going to lunch. Not that I minded doing it, but I had other priorities. It would have really helped me for her to take that one tasks off of my hand and she wouldn't even do it.

I was thinking about traveling for a while, but I feared that I needed to be in nursing for at least 2 years before being considered, so I have never applied. But someone else told me to that as well. I know that next fall, I plan on going back to school to embark on a new career. I would really like to stay in nursing, but since healthcare has become so business oriented, it really has been hard to be a good nurse to the patients. I have prayed and prayed about it, but it seems as if things are not getting better, only worse.

I got into nursing not for the money, but to make a difference in someone's life. But we nurses are only human. I believe they take us for machines. Our bodies are going to strain and break under all of the pressure that is put upon us. I have had so many older nurses tell me that nursing is not what it used to be. But I guess maybe they've been in it for so long that they don't want to get out.

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Specializes in Med-Surg.
Nursing is a 24/7 type of job..that is why we have the 2nd or 3rd shift. It would seem to me that whatever was done when the 12 hour shifts were in effect could also be done with the 8 hour shifts because you still have the 3-11 nurses working. You surely can't be the only nurse working the 7-3 shift so find out from the other 1st shift nurse if they are finding that the job duties are not fairly distributed between all 3 shifts and then head to management with the facts. You have to remember that the shift following you should also have patient care in mind. Is it a matter of you wanting to do things that could/should be left for the next shift?

As far as punching out and then staying off the clock to finish your work you are just asking for trouble when it comes to that. What if after you've punched out and are working off the clock you injure yourself.....you have a big problem at that point because you are technically not working. You really need to protect yourself. Also I do believe that if you are taking care of a patient off the clock and something happens I'd wonder if your employer would back you on that either. It is against the law for any employer to demand you work off the clock so if you get nowhere by talking to management there is always the labor relations board to appeal to however I think that unless you have other nurses also not able to finish their required work in the 8 hours and proof that your employer insists you stay to finish you might have a hard time and also I would use that as a last resort.

I also would keep written track of what was done for what patient and also of anything not being done by the CNA's or wound care nurse that should be done and present that to management. If you get no satisifaction from your immediate supervisior go one step higher.

Good Luck with whatever route you take.....sometimes I find that no matter what you do its a matter of management however I've also worked with some nurses that no matter what kind of a shift they had they couldn't find the time to get things done and it had nothing to do with patient load but with their own time management skills. I dont want to suggest that is what the problem is here but might I open the door and suggest you take a look at your time management skills and if you can honestly say that you are well organized and manage time/stress well then you'll have a better idea on which way to proceed whether it be going to management or finding another job.

Thank you for your reply. Yes, the other nurse that is on the other cart was questioning why all the dressing changes are being put on 1st shift. And she asked the manager why that it so and the manager shrugged it off as usual. By the way, the manager is so non-chalant, it does no good to talk to her. She is not supportive at all. All she cares about is that someone is there so she doesn't have to take the cart. She got mad at me one day because I couldn't work until 11pm one night. She literally ignored me when I asked her something. She is very vindictive and useless. I expect nothing from her.

I do think that I want to stay and finish the treatments because I know that 2nd shift won't finish the ones that I can't get to during my 8 hours. And I know that the patients are there for us to care for them. They deserve to have their dressings changed as ordered. Also, form a legal standpoint, the blame will fall on me if there is ever any legal action taken against us if a problem arises with the dressings not being done. I've worked hard and long for my license to have it taken away for something like that. If my license goes, i will be giving it up myself.

I kind of figuered that it wasn't a good idea to work off of the clock. I know that if somethings happens off the clock, then I am not covered. But I have been threatened, by my manager, with a write-off if I keep staying on the clock past 3:30pm. What option do I have? The nurse on the other cart never stays no matter what happens. If she has not finished charting, treatments, whatever, she doesn't stay. She is very protective of her time and I don't blame her. But my conscience won't let me leave the work knowing that no one will finish it. When they went to 8 hour shifts, they should have given some of those treatments to 2nd shift, but they didn't.

I don't feel that it's a time management problem. I am not one to stand around. I am on my feet from the time I get there to the the time I leave. I don't take breaks, I don't take my lunch. What am i doing wrong? I'm not staying the patient's rooms except when I have to go in there. And even then, I give them their medicine and sometimes take them to the bathroom while on medpass. That really slows me down, but they always ask me to do it. I can't say no. I don't sit down for 8 hours, except when I chart, IF i get to chart while on the clock. I don't get it. The other nurse takes numerous smoke breaks plus her lunch everyday, and she leaves on time. I don't know what i can do differently.

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I used to be in your situation, but I don't make a good martyr and I got out. By working for free, trying to do it all, you're doing some of the things described in this book-

http://www.amazon.com/Stupid-Things-Nurses-Self-Destruct/dp/0962724637/sr=11-1/qid=1162909940/ref=sr_11_1/103-3117820-6426268

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Specializes in Med-Surg.
Sounds impossible to me. I've been doing LTC for the last 10 yrs. Mostly 8 hr shifts. 8hr shifts are doable if the work is divided. In one place I worked the tx were heavy on 7-3, but 3-11 was the shift that got all the admits. At my place now, we split the treatments (3-11 seems to have more) and the admits mostly come at 2pm or on the 3-11 shift. Days will start an admit, 3-11 will finish it. We have an unwritten rule that if an admit comes in by 2pm, days will at least verify orders,the next shift will finish it. Without these little concessions by both shifts...I don't see how you will be able to manage it esp if management is unwilling to look into the issues.

I do believe that teamwork is the key. If the shifts would all have an equal load of work, it could be done. But the admits have been heavy and most come on 1st shift. So, if it comes before 2pm, we have to do it all. That's no problem, but then you have your normal duties that have to be done as well. We really need an overhaul of management as well as the administrator. This place has gone through 60 nurses in a 3 month period. They should see that something is not right. But I wonder do they care?

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My manager says that it's understood that I won't be able to do everything on my shift. But if I don't do it guys, it won't get done. The 2nd shfit nurses won't finish anyting because they feel, "Well, that's 1st shift's responsibility".

Unfortunately I have seen the "shift mentality" where one believes certain things HAVE to be done on a specific shift and will refuse to do that which they think the previous shift should have done. Management needs to be proactive on this issue. If you have passed something on to the next shift and find it is not done because of this type of behavior, it needs to be reported and addressed by management. As another has stated nursing is 24/7 for a reason. If a treatment or even a bath was not done on days, there is absolutely no reason it cannot be completed by the follwing shift.

Do not clock out and continue to complete work that can be performed by the next nurse entrusted with the care of your patients. It is also their responsibility to ensure that the patients receive care, irregardless of whether or not they feel it is "day shifts" responsibility.

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