Lost It At Work: Sent Home for a Four Day Weekend to Gather My Thoughts (rant, vent)

[clinicalteach]

So for the past few months, i've been trying to keep my head above water as the Dir. of Residential services at an assisted living. its a seventy bed higher than it should be acuity building, and it was severely under the barr for what state would say was passable. i have been working basically seven days a week since then from home or from the office. I have tried everything I know, to get the staff to document properly, follow policy and procedure that they have forgotten about, med room practices that are abominable.

I finally had it, when i found out about one care attendant being rough on a resident and flipping another off , only to be followed up by going through the mars and finding that things had not been signed for with the following answers, "I was going to do it, but i forgot", "i was going to do it, but didn't have time" and then the holy grail of irritation, "oh , well i pulled the narc, and gave it to the night staff to give later on, since they aren't medtechs and couldn't pull it" ...this one happened after I did a narc audit and one ativan was missing and i found it in the residents room in a sealed cup with her name on it..lying on the floor.

I admit, i exploded..I yelled and might have let a few four letter words spring forth. my boss took me into his office this afternoon, after having had some of the people i came down on compalin about me. he says during his investigation, the reviews were half behind what happened and half said, nope..i am not verbally abusive on a normal basis.

Anyways, i'm looking for any help to get staff to do their crap and i guess boost morale, even tho i will admit, i'm the one that needs some morale boosting. My boss is pressuring me for things to get done, in order to get them done i need the staff to do what is required of them to do. They inturn don't so my boss takes it out on me and tells me that i am not completing anything properly, yet ...i see him with the same stack of crap trying to do exactly what I was doing (filling in the blanks that the staff left empty)...i guess i'm just burnt, ****** and sad all at the same time. Please forgive typos, mispellings, poor grammatical sentence structure in the above post...i am just to tired to edit at the moment.

Thanks !

[Nascar nurse, ASN, RN]

You need to start off with a big deep breath. Slow and easy....in and out. Better?

Now listen up. You must hold people accountable beginning immediately. I would begin with a mandatory meeting for all related staff. I would have an outline of all my expectations ready to go and have policy and procedure book ready to back me up. I would also review the discipline process at that time.

From there you determine your greatest problems and begin routinely auditing these processes. Those that are not in compliance must be help accountable thru the discipline process. Make sure when you write them up you are being objective in your wording. When you call the employee in to discuss this you need to have your administrator in the room as a witness (then he/she knows you really are working on this as well has having someone to back up what you said to the employee).

I predict you will end up terminating one or two and then everyone else will shape up because they will quickly understand you are serious.

Remember, as a manager, you always criticize in private and praise in public. Do your best to offer sincere praise as often as possible - it makes the criticism a little easier to take later if need be. It's also really easy to just lose it as a manager. Try to get ahead of that and before you get too stressed step away from the situation..even if only for a few minutes...breath..then go back and deal with it. Good luck

[VivaLasViejas, ASN, RN]

Nascar covered just about everything, so there's not much I can add except my sympathies. :hug:I've held this same position in both good AL facilities and bad, and if you don't have great chemistry and teamwork between your director, your staff, and yourself, it makes a decent job difficult, and a difficult job impossible.

FWIW, I think assisted living facilities are all pretty much high-acuity now. We're getting the kind of residents who would have gone directly to nursing homes 15-20 years ago---moderately to severely demented, incontinent of B & B, sliding-scale diabetics, chronic wounds, 2-person transfers and the like. At my building, about the only residents we won't take are those with feeding tubes, wandering issues, dysphagia, or who need mechanical lifting devices.......and those will be coming in the next 5 or 10 years, I'm sure.

In the meantime, you have to get control of your staff and make them respect you; if they will not accept direction or follow your facility's policies, they need to go. Which means you'll be burning the candle at both ends for many days and nights until you can hire and train new staff, but far better this than for your facility to be in stop-placement because of their shenanigans. I also cannot over-emphasize the necessity for both you and your director to have each other's backs and speak to the workers with a single voice, because lower-level team members are often experts in "staff splitting", meaning they play one supervisor against the other like kids running to Dad for a cookie after Mom says No.

Good luck to you. You are going to need it! And please feel free to come here anytime to vent, ask questions, or cry on our shoulders. Nascar, CapeCodMermaid, and I all have years of LTC management experience; we're here to help. :)

[achot chavi]

You need to set a management policy for correcting professional behavior. For example, in our facility, if something was not done or done not according to policy or good nursing practice, first they get an oral inservice and explanation of how we want the nurse or CNA to do whatever it is. Usually this is backed up with a written memo in the staffs file. If the problem persists, it is a written letter to the staff also cc'ed to the personal file. Usually if we have a written in-house policy on the problem then we attach a copy of the written policy and the original signature of the staff when she or he was oriented and signed on the policy. If the behavior re-occurs (a third time) the file with a brief letter of explanation goes to the Director. The Director tells the staff that this is a last chance and if it happens again, he or she will be fired.

Of course if the infraction is serious enough, either I or my boss will fire the staff on the spot.

You will then in the position of training new staff. This is a key to obtaining cooperation and improving standards. I put a lot of my energies in training new staff and it usually pays off. What I cant stand is if old staff (devils) try to curropt them. I take that seriously and then am all over the devil like a wet blanket, writing up all her infractions no matter how slight. The devils out there get the message real quick.

I would also suggest you praise staff when you see them doing the right thing, dont take things for granted.

If you want to make a staff of the month award, with a picture and posting at the entrance, a letter to their file and a symbolic present , that might be good motivation.

Every once in a while, have a staff meeting to explain policy, what needs to be improved (DONT embarass one by pointing out a specific persons problems, but talk in general and explain, "I dont want to point fingers so I am telling everyone...". Bring a (chocolate) cake or cookies or the like to these meetings to create a positive environment.

Never criticize in public, I am sure that was said before, but it is an important point, as it just puts people on the defensive and as we know a good offense is the best defense- the staff will start attacking YOU!

Good luck, keep taking deep breathes and remember you are not alone.

[tyvin, BSN, RN]

All good info...keep your head up and know that if you take the advice offered here you can't fail. Your employees need a confident leader to take control in order for them to be successful in their work. It may get ugly before it gets better but stick to your guns. Make a plan of action and hold the mandatory meeting talked about in the previous posts. Good luck to you.

[jwkwildland]

i dont know if this will help but on my old fire crew, we used to have the CrewBoss (equivilant to your boss) > The CB Asst. (like you) > then we had Squad Bosses > then leads > then crew members (like new Techs and CNAs). maybe find a way to set up a solid chain of command, that doesnt necessarily mean pay difference, but could include a trading of responsibilities:

you dont have to do this as often anymore, but you are responsible for keeping these guys in line.

this would take some weight off your shoulders but your still responsible. delegate. i hope you have SOME reliable help.

But really, take a break first. you need it. dont even think about work.

[caliotter3]

If your boss does not support you in disciplining the workers, up to and including termination, then it is time for you to start looking for another job. Don't let the boss undermine you by not supporting your efforts while holding you accountable.

[clinicalteach]

I could just give you all great big hugs! I spent the weekend thinking about this, mulling over everything and rereading your suggestions! I've got a plan formulated, i spoke to some of my staff that came to me after this all occurred and was told that they had my back, that I was fair, they respected me and the only people that were ******** were those I was starting to hold accountable for their actions...they gave me names of the girl that had gone and complained. It seems she did not like that I am holding them accountable especially her since she's been there for ten years and knows better. Anyways, the audit begins tomorrow. Fine tooth comb with a checklist sheet , myself and my assistant put together, so that the audit matrix is there. I will then begin to write up and terminate. thank you so much you guys!

[Nascar nurse, ASN, RN]

Good luck and let us know how it goes. Remember, you need to expect it to be rough at first but when it does finally come together it will have been so worth it.

Make sure you let the boss know what you're doing and who/why you are disciplining. This will help to prevent your problem people from trying to split you and your boss.

Best of luck - I'll be cheering you on.

[VivaLasViejas, ASN, RN]

As will I. Go get 'em.......you KNOW you are right!!

[achot chavi]

You sound so much better, I am glad that you put your time to good use. Your success reflects on all of us!! We are all behind you.

Somewhere out there, Florence Nightingale is clapping her hands.

[noc4senuf]

All good advice that everyone gave. I must add that you need to find time for yourself not only when you are away from work BUT while you are at work. A 5-10 minute walk outside or even go sit in your car and listen to your radio. It should never get so bad that our voices are raised in anger. I find I intimidate the staff more when I speak slowly and quietly....