LTC PM shift staffing and responsibilities

  1. I'm hoping to get some insight here about PM shift staffing. I work in a LTC facility that has a DON who does not seem to realize that the PM shift has half the nurses and CNA's and only one 5 hour ward clerk (verses 3 full time day ones). We have been getting many late hospital readmissions, Doctor coming on rounds and the left over work from Day shift. She (the DON) doesn't have a clue or want to have a clue about what goes on. Can any DON out there explain to me why this is a dumping shift? Do administrators think that half of the residents go home after day shift leaves? We still have falls,ER transports, family members to help, and all other routine that is expected of us. I really want to know why it is this way.
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    About mar326

    Joined: Feb '05; Posts: 10


  3. by   barefootlady
    Get a clue, they do not care as long as the work gets done. When this happened here, some of the work was not finished, new orders that where not life threatening were passed on to AM shift, needed PT consult, needed Diet consult, such were passed on, meds, o2, and those things were done. As long as you work with half the staff and get it done, they will continue to dump on you.
  4. by   CoffeeRTC
    Well, anyway you can ask the DON to stick around for a 3-11 shift or do a time study? I have to agree...each shift is busy with its own. I wokr 3-11 but have also done days and nights. 3-11 seems to be getting all of the admits. Sometimes 2-4 at a time (we are a small facility, so this is alot) we have the same # of nurses, but less CNAs and all the support staff is gone. Some of the admits come right at change of shift and some will come in really, really late. I think there are two ways around it...ask the social worker or admit person to aske the hosp to space out the admits and quit staying OT to get all of the admit stuff finished because 11-7 "won't do them"
  5. by   CapeCodMermaid
    As a DNS, I suggest to the other poster that SHE get a clue. The DNS has no control over when the admissions show up. It is up to the admitting hospital and these days most docs do rounds late in the day so the admits come late in the day.
  6. by   travel50
    I take exception to the statement that we (directors of nursing) do not have a clue and do not care as long as the work gets done. I most certainly do have a clue and I absolutely do care. However, there are some things over which we have no control. If corporate says I can only have x amount of nurses and aides on a shift, then that is all I can have unless I want to pay their wages.

    In my case, I had not wanted to be the DON, but when the previous one quit, I was the only person in house qualified to take the position. Corporate really wanted me to take the job, so I made them agree to give me some leverage. They had to agree to do some things I wanted. I did not ask for lots of money for myself, just to be able to do things like I wanted. That was 4 yrs ago, and sometimes they probably regret that decision. I got my aides pay bumped up $1 an hour and the nurses $2 and hour. I kept close watch on falls, mistakes, missed orders, etc., and the majority was on evenings. So I got them to let me have an extra aide for that shift. Then corporate found out I was staying late in the evenings. They complained b/c they said I would get burned out. I agreed, but pointed out that there was way too much on evenings for my nurses to effectively manage. The end result was wonderful. Now we have an RN on from 7P-7A. The ADON does not come in until 11, and so stays until the 7 pm RN gets there. The RN has specific duties. She does not just supervise. She does all the treatments, has to help chart, do new admits, assess pts and yes, help the aides. So please do not say that DONs do not care. I cannot adequately describe how important my residents and my staff are to me.
    Last edit by travel50 on May 21, '09 : Reason: word ommission
  7. by   achot chavi
    I dont think that CCM implied that she doesn't care, I am sure she does, she was just spelling out the reality that we all (even outside of the USA) are dealing with. We have no control over when admissions arrive, we all have less staff on the evening shift than the morning and the pt load is the same- supposedly there is less work in the evenings- fewer meds, fewer meals and baths, no PT etc....

    Yes we deserve more staffing, we are doing superhuman work, no question about it....
    This is why there is Nurse Appreciation week and no Administrator Appreciation Week.

    I dont mean to sound critical, we are all in the same boat, we do care, we should be supporting one another.

    A helpful tip, if there is too much work on evenings and the admissions are too much, ask to leave some of the admission processing work for the following shifts, see what work can be left for another shift to do,
    Investigate what hours are quieter and try to even out the work load, and if that is impossible, then appeal to your administrator with hard facts of why you need more staff.
  8. by   noc4senuf
    I do look at all the issues mentioned above as to why the PM shift is difficult. I also know that each of the shifts is difficult for their own reasons. Does any one shift have it easier than another? Nope. Admissions are what pay all of our salaries. By the time the doctors round at the hospital and then the discharge planners try to find transport, it ultimately ends up being a PM admission. I have often times told my admssions person that we can only handle "x" number of admissions on a particular day but, we can accomodate them immediately the next morning. I don't like to do that very often as the hospital discharge planners will just send them to the next home that is willing to take them and make a note that we were not accomodating. Not good for marketing.

    If you want to gripe about how i staff, step into my shoes and perform my job for a day or two.