Need advice on job problems

[powell2010]

Hi, A friend of mine and myself from nursing school ended up working in the same nursing home together. We are both only 3 month old nurses. We are very discouraged and need advice.

We work in a place that we are each responsible for 40+ residents. We have cna's that work with us that unfortuanatly have a long history of "being in charge" when the DON or ADON leave the building. I will not go into everything they do but would give a few things so you will understand. When one is asked to do something, they will tell you what their opinion is and do that no matter what you say. When told they are doing something different from what DON has said to do, they will do it their way or say you were screaming at them, they call in and just say they dont feel like working, when getting ready to give meds to a patient sitting next to nurse they took the patient to the shower room and lock the nurse out, tell the nurse how to give meds, patient care is not the best but not the worst either. Basically the problem in this facility has been the cnas have been allowed to do what they want and how they want it for years just to keep staff. We have reported food fights, cussing in front of residents, not turning patients, their attitudes, all of it. They talk to the aides but nothing changes because they know they wont lose their jobs due to low number of workers. We have agency in to pick up staffing numbers.

We have been told by the nurses that are there this will not change. That they stay because of the residents. We have been adviced by them to just go in and do your job and let them do what they want. We care for over 40 a each...meds, tx, NOR ect...it takes us every minute we have to do our job. But we have to stop and do the cna work to make sure our patients are cared for. I do not mind doing that...it is just they are sitting in the break room while we work their job. They say they are short staffed and cant do it all. But even when they are full, less gets done.

It is not a bad place to work but I do have some concerns such as we are both charge over our sides of the home without anyone of any experience around to ask questions of. We have had to learn crash courses in how to handle many situations. On the postitive side, we can and do, call our on call supervisor for advice or to find out how to handle a situation.

How does a new nurse deal with all this? I have been an aide for years, never have I seen aides this out of control or allowed to run the place. I knew taking this job it would be a challenge learning the nursing skills and all the procedures for paperwork and such. I never realized that the aides would be over me and I was to say nothing.

Am I wrong in being frustrated. It has been reported over and over....even wrote one up.

[caliotter3]

This is common. You can expect problems getting anywhere in dealing with it if you have no support from your supervisors. However, you need to address it with verbal and written counseling. Although nothing will happen, if you submit written warnings, then no one can accuse you of not doing the supervisory aspects of your job. On the other hand, your attention to the problems, might get managers to start moving and some of these people might be looking for work elsewhere. Better to be shorthanded than to entertain lazy workers with bad attitudes.

[GHGoonette, BSN, RN]

This is common. You can expect problems getting anywhere in dealing with it if you have no support from your supervisors. However, you need to address it with verbal and written counseling. Although nothing will happen, if you submit written warnings, then no one can accuse you of not doing the supervisory aspects of your job. On the other hand, your attention to the problems, might get managers to start moving and some of these people might be looking for work elsewhere. Better to be shorthanded than to entertain lazy workers with bad attitudes.

I absolutely agree with this. If these aides are not pulling their weight they might just as well be outside the door anyway.

[classicdame, MSN, EdD]

many studies have shown that one bad apple spoils the whole barrel. Bad attitudes are contagious -and will affect patient care no matter how hard you try to prevent it. It also leads to burnout. I would discuss, in private, with DON and recommend awareness teaching first (what is wrong, why it is wrong, what are the expectations, etc.). Another suggestion is to give all the CNA's a raise (at least $1/hr) then give them a "contract" or code of conduct to sign. When they break the contract get rid of them. It is easier to find replacements if you are paying them well enough. Otherwise, you will be fighting this forever.

[mentalhealthRN]

I think I worked where you are!lol seriously......my advice......RUNNNNNNNNNNN. As fast as you can. Your license is not worth it nor is your sanity. I tried to change this as the staff educator and one of only 3 RNs in the building of 120 residents. They didn't want to learn a darned thing and all I got was harrssed and ignored. I would put up signs for in services and they would write on them.... Calling me bad names. Don't get me wrong there were a few I loved who worked hard and took really good care of the residents and were professional and respectful. But unfortunalty the bad eggs outweighed the good. I was planning to leave and looking but when the new DON they got started and was a nasty drill sergant and disrespected me like I was one of these slacker CNAs--I gave my notice and avoided her for 2 weeks then RANNNNNNN as fast as I could. I have seen that LTCs are just a set up for losing your licence. They are never staffed enough and 20-40 patients is beyond rediculous. Never again will I work in LTC.

If you really are determined to stay you could try calling the state. See if that helps. If not I would reccommend you and your friend get out fast. Good luck.

[indynurse '87]

I have been in your situation before. Keep up with the write ups as needed, be sure to make copies and keep them for yourself, as they sometimes can "somehow get misplaced". Also keep a journal, CYA!, keep following the chain of command to voice your concerns, and presenting the write ups. If you still find no satisfaction, or the problem is not resolved take it to the Corporate office. If they do not know what is happening, they cannot fix it.

[limey]

Sounds like where I work. If you are not a brown-noser to the higher ups, you are nothing and can get nothing done about the lazy CNAs and Nurses who don't care. So disgusting...it's like the inmates running the assylum.

[itsmejuli]

Screw that. I'd be looking for another job.

[w3ndiscott]

There are too many jobs out there to tolerate this. Obviously this system works for them and the administrators are not in control of the situation. I would look for another job, thats my opinion.

[indigonurse]

IMHO a new grad should not be supervising until they have at least one year of experience under their belt. There is a learning curve that lasts for a good long while when it is all you can do to learn about the rules, regulations, and long term care nursing. Yes, we come out of nursing school with some clinical experience. What most nurses do not have is a clue about management. I think it would be very beneficial for anyone who is planning on taking a position that requires supervision to take a really good class in management. The one thing I have learned through my experience is no one ever gives you power you take it. And the other is respect is earned. Going up to an aide and giving a directives, writing them up, etc. will do nothing but foster hard feelings. Communication is the key and consistency. You need to decide what the priority issues are, get your staff together and and communicate this to them. The next thing you need to do is recognize the ones that are doing a good job. And be consistent. Work on one problem at a time. I once had an issue with storing hygiene products properly. I got the team together, discussed it with them, asked for their input, we all agreed on a solution. Then I made sure that I complimented the staff who were doing a good job. I even went home on my computer, made little certificates and bought a bunch of candy bars and handed them out to the ones who were doing the right thing. I ignored the ones that didn't. Many had tears in their eyes and before I knew it they were all enjoying doing right and being recognized.

[powell2010]

Thanks for all your input. I have decided to leave the nursing home. Unfortunatly I do not believe the aides plan on changing. I do NOT speak down to the aides or give orders. I ask nicely for them to do something, then if not done I state in a normal tone voice that it needs to be done according to the DON. In either case, we get one of two responces.....they turn and walk away and do as they want or stand and argue. As for being in a superviso ry position, I dont like it but each nurse is in charge of their own section. They will not bring in another nurse to be in charge of both section. I have suggested they schedule us with a experienced nurse. One new nurse and one experienced. That way the new one has a person to ask questions of and get directions. When it came to having to walk someone out of the building, each time the experience nurse put it on me. Stating she did not want to have to deal with the aides. I do not like having to spend my time learning to babysit when it should be spent learning nursing. I have come to the conclusion the RUNNING is the best thing to do.

As for the advice as to having team meetings, that was tried by two other nurses and it did not work. During the team meetings the aides would get up and walk out saying they did not have time for this. As for giving them pay raises, the company is not going to do that. During orientation we were informed raises were no more then 25 cents a year.

Everyone at this home is completely over worked and tired. Nurses and aides both. We are expected to work with skeleton crew and do more work then is possible for anyone to get done.

Today I was offered a position in a doctors office and have accepted the position. It is less pay but better hours and have others there to learn from.

Again thanks for your opinions. It helped in making the decision.

[CloudySue]

IMHO a new grad should not be supervising until they have at least one year of experience under their belt. There is a learning curve that lasts for a good long while when it is all you can do to learn about the rules, regulations, and long term care nursing.

This is SO true. When I first started, I spent a good two-three months concentrating on MY job, trying to do the med pass without killing anyone and within the time frame allotted, making sure the dr's orders, paperwork and documentation were all done correctly, learning how to do treatments and wound care (very little training there, but that's another rant) and other nursey stuff like that. The last thing I could do for the first few months was to concentrate on the CNAs' jobs and understand all they had to do, and follow up with them. But I worried about them the whole time. They got away with murder, I'm sure, but I knew I had to focus on learning my own responsibilities first. Learning how to be a nurse is such an ongoing process, you really need a long time to ease into proficiency, like the saying about eating an elephant, you must do it one bite at a time. Unfortunately LTC's let you nibble on the trunk for a week or two and then shove the rest of it down your throat afterwards.

But the problem I had later was, CNAs were used to easier days when they were working under me. Once I started paying attention to them and holding them to a higher standard, I had some pretty ticked-off chickies on my hands. Once I wrote one of them up, though, things got better.