LTC Nurse & How to get along w/ Managemnt!

[dass4]

I am a new nurse in a new LTC facility in my hometown. I am only part-time right now and will be added to full-time when the census #'s increase. I can deal with that, however, the current shifts are complaining of being too busy to contend w/ all the clients they have and need further assistance from the part-timer's. I understand every medical facility is always run a little "tight" on help, but this is getting ridiculous! We had a mtg. yesterday and they will accept NO OVERTIME from anyone. They expect the full-time shift nurse to only have an extra RN/LPN for 4 hrs. then deal w/ all her daily issues by herself w/ 2 CNA's. That may be o.k. in a quote "normal" nursing home, but this is HIGH END facility. I mean where the residents feel like the are at Embassy Suites & you are expected to make every demand! We are a no lift facility as well...some residents need a lift just to help them bathroom or transfer. That can take up to 20 minutes just for a toilet time w/o my CNA!! It is becoming ridiculous. They also have no computer system for charting...still done by hand. REALLY!!! They could have done w/out a few of the paintings or pool table (that no one uses) & been a pilot campus for a computer system for the nursing. NOW the management tells us that if we would just go around and ask everyone if there is anything they might need that would help cut down on call lights....are you freakin' nuts!! Even if you ask them, it doesn't mean they aren't gonna have to move their bowels in 15 minutes while you are trying to pass med's! I wanted to tell them they needed to get their butts on the floor & take a shift to see what REALLY happens. Those answers look really good in your "HOW TO MANAGE" book but true nurses know that nothing EVER goes according to plan! You have to go to extreme lengths for these residents. It's all about what people "think" they see, instead of what real care may look like. I respect the cleanliness and comfort they want us to give -- no problem there--- but management is soooo controlling. They tell us they will "let us know" (with lifted eyebrows) if we are missing paperwork, yet when you tell them you can't get to all your paperwork because there isn't enough time & help on the shift the next breath they say ---"leave it for the next shift"!!! Ummm....isn't that double standard?... I don't feel I can trust any of them to truly go to and put forth a real complaint or statement on how things are really going for me. Do all other places have this type of issues & I am naive to understand the merry-go-round of politics? I don't know if I should just keep things under wraps or stand firm w/ the other nurses who are also feeling this way?

[ddunnrn]

I only ever worked in LTC as an aide, and that was back in the dark ages. However, what you describe is similar to what I've experienced in a state psych hospital, and prison psych. I know some of the folks here on Allnurses have had wonderful management, but pretty much everywhere I've worked, which mostly are govt. supported, the management is totally clueless, having not actually worked on a unit in ages. I had to decide what I could accept, and try to leave the aggravation at work. I enjoyed working with the patients, who appreciated me, even if mgt. didn't. I always thought that it was odd that the one thing nursing school didn't prepare you for was working with management and co-workers, and that was the hardest part of nursing.

[Nascar nurse, ASN, RN]

I don't even know where to start...

1. You are a brand new nurse in LTC. In every type of employment setting there will always be a set of employees that would complain if the world was full of sunshine and roses. Do not fall into the trap of complaining for the sake of complaining because that is what everyone else does. You are new. It will take time to have the time management skills of a more seasoned employee. Take this into consideration before jumping to judgement.

2. You never really said what the staff to patient ratio was and the care level being provided. This makes all the difference in the world. The ratios that some post on her are truely astonishing and very unsafe. My own facility has a 1:22 ratio and my nurses complain everyday that the job can't be done timely. WRONG

3. You say that nsg school never taught you to deal with managers. Well, nsg school never taught the managers to be managers either. Most of us have learned by the trial and error method. I personally have tried to mimick the previous managers that I admired and avoid the mistakes from the managers I couldn't stand.

4. "Managers that haven't worked the floor in ages" - There may be some truth to that but I did work in your shoes for years. How many shifts have you put in walking in a managers shoes? Someone has to ensure that all compliance issues are met according to state/federal laws. Someone has to keep the budget in line or the facility will go broke and close their doors. If the DON doesn't do these things, he/she will be fired and replaced by someone else who will make sure things are in line. You will have a boss. You will be accountable. This is true in any kind of employment setting you choose to be in.

[BrandonLPN, LPN]

I'd be interested to know your staffing ratios, too. You say it's a "high end" facility, which leads me to believe most your residents are private pay or at least Medicare. Come to a "low end" all Medicaid facility and you might sing a different tune about your place.

Just give it time. ALL new nurses feel overwhelmed when they start in LTC. You'll find your groove. The place hasn't been shut down or burned to the ground or something, right? So it must be more doable than it seems now.