Lost the 'CHARGE' in "Charge Nurse"

[Furwillfly]

I need some nursing management advice please. I have worked at my facility for 5 years now. For the last two years now, the Administrator and DNS have worked the floor quite often as we are very rural and short staffed. I genuinely like the two very much. Problem....they have their favorite CNA'S. I don't mind this unless it gets in the way of how the facility functions, which it has and I'm being the good little nurse and keeping my mouth shut. I use to open my mouth but it has gotten me NOWHERE. My other CNA'S are very hurt and frustrated by this.

I'm the charge nurse when my bosses think it nessacary to call me that. Other than that I'm just a glorified floor nurse. These two CNA'S get away with things like calling off for the most innane reasons, like ones husband and daughter had to go to town that day and they only have one vehicle, comes in early and leaves early without telling me, has told me I'm a brown noser. Has told the other CNA'S that nothing is my business. she has the other CNA'S come tell me stuff regarding the residents cause she chooses not to talk to me. I changed the dining room around to make it more feasable to feed residents properly, she changed it back. My boss told me I should ve asked my 'team leader', which she is, by my bosses choice. One time my boss changed the dining room to make it more feasible, on my days off and about a year later, and I said to her, "Did you ask your team leader and your charge nurse?" I laughed, but meant every word:confused:. Team leader does the schedule for the CNA'S. She also changes it anytime during the month to suit her needs. She has out and out not done something I've asked her to do for a resident.

The other girl calls in all the time, works another shift so don't have much dealing with her. except her calling in sick and then being out on the town within an hour of calling in. She does this repeatedly. I tell my other boss and nothing happens.

I could go on, but you get the idea.

I've lost the charge in charge nurse. I dont know how to get it back. I feel undermined and disrespected. I am angry at myself for allowing it to go on, but I need my job. My CNA'S turn to me to change things, but I can't. I have tried outside of turning in my notice. So, I reward the CNA'S that are respectful, hard workers and don't call in al the time. I love my job and co-workers and don't want to leave. we do have an attendance policy but it doesnt get followed anymore. Any ideas?? Thank you!

[Thornbird]

Is this a skilled nursing facility? If so Medicare regs forbid DNS and administrator from working the units except in dire emergency. You could plant an "anonymous tip" to the state about it.

Would it be feasible to ask for a conference to discuss these issues? Are these new bosses? If you have worked for them for a long time, they may be willing to work on the issues. If they were there all along, what has changed? Are the bosses also the owners? I know this is often the case with smaller/rural facility. If they are not the owners you could go to the owners or Board about it. This is undermining quality of care, something owners are highly invested in. Also, this may be the reason you are short staffed.

Being a rural area, I'm guessing that, even if you wanted to leave, another job might not be easy to find. One thing I can't work with is administration that undermines me as charge nurse. You really need to have that back up and policies need to be enforced without favoritism. It's one thing if you start a new job and it's that way from the start. You can just quit during the probationary period. When you've been someplace for years and administration changes, it can be heartbreaking. You get attached to your patients and your good co-workers. I hope it all works out for you.

[pielęgniarka, RN]

I feel for you--there's a lot wrong with this situation. Not only is it insubornation, it sounds like those CNA's are neglecting some of their duties. I would keep a list of the tasks you delegate to them and the job duties they are not completing, and present the documention to the DON and Administrator. Let them know that the residents are your priority and that the residents are not getting the care the deserve (according to the Resident bill of Rights!) and ask them what you can do to make the situation better. The facility I work at has a "dining team". We meet once a month or twice and talk about the dining rooms, who needs more help, what seating arrangements work out. The Dietician heads it, we have a kitchen aide, CNA, Nurses, etc all contribute. Tell your DON that you are seeing some problems with the dining room and that you would like to form a dining team. It might be up to you to spearhead some solutions. Good Luck!!!!

[Whispera, MSN, RN]

Re: Lost the 'CHARGE' in "Charge Nurse"

Is this a skilled nursing facility? If so Medicare regs forbid DNS and administrator from working the units except in dire emergency. You could plant an "anonymous tip" to the state about it.

If you plant an anonymous tip, the state must investigate it, and it could trigger a whole, complete state visit which is traumatic to most people! I'd say do other things before tipping the state!

[achot chavi]

I feel for you, It it hard enough to maintain control as charge nurse without all this undermining, I have a similar situation, I document every instance of insubordination. For example If this CNA wont talk to you but sent oral reports via other CNA's, I'd write it as a note to my DON and keep a record. In the future if you change the seating arrangement do it in conjunction with the CNA's and write it up as a staff meeting and a decision by all the staff.

Hang in there- this CNA is playing control games with you- stay calm because losing it is what she;s trying to acheive.

Re the calling in = keep a record for yourself of each call in and why and when she called in. If it is too much write to your DON.

Good Luck