Need advice and/or maybe shoulder to cry on...

[Beary-nice]

So, a little over 4 months ago I took a RN position at a long term care facility close to my home and my children...littlest just started kindergarten. When I was looking at this position and then had agreed to it, I had an understanding with the DON that I was interested in using the RN education that I worked so hard for. She said she would work it out so that I could do some QA type work, which I am doing and that I would really have to work very little on the floor. Okay, this much is true. I have really nice hours, can come and go if I wish during the week though really haven't taken much advantage of that and I work on the floor every 3rd weekend.

So, you may be wondering what the deal is??? This is what's up. I am enjoying the challenge of doing QA. It is a new experience for me and I'm learning alot, however I am extremely overwhelmed. I am supposed to be taking on infection control at some point. I do the employee health stuff, the monthly med sheets, the incident investigations etc...the list goes on and on. Oh, and I am like the medical records person including typing out dictation. You name it, I do it. It is way plenty. I have written policies, made flow sheets on and on. The thing that bothers me the most is I feel I get nothing done partially because I'm still figuring out what is going on and part because of constant interuptions. I also do all of the weekly skin assessments. We are small potatoes compared to some places. I wish I could feel real good about things, but I don't. I want so bad to do this job but get irritated about being overwhelmed and I feel like I am always having to play back up for the nurses on the floor. The DON comes to me to ask me to get an order for this or an order for that, or check this res. O2 sat, or assess this res. or make sure this nurse did this or that. I hate that! I ask myself when are these nurses going to be accountable for their practice? Because I feel that is what it amounts to. I don't mind pitching in when stuff is crazy on the floor, don't get me wrong, but I feel I am caught between the DON and the nurses she doesn't feel she can trust.

I am all about education. I have offered to do some education, but have been encouraged yet shot down in making this happen. The DON feels that the majority of the nurses are beyond help she says. Big things keep getting missed and I have to go pick up the pieces. I am no stranger to long term care. Have been in and out of it many times in the past but most of my experience is acute care.

I don't know what else to say, I think I bantered on long enough.

I just feel like ....nothing more.

[Beary-nice]

Okay, I figured out it is just me.

Thanks to all who took the time to at least read this.

I made my bed, I shall lie in it or move on.

[nursej22, MSN, RN]

{{{{Beary}}}}

Wow, I am overwhelmed just reading your post; I can't imagine how you must be feeling.

It sounds like you have accomplished a lot in just 4 months, and have brought in a lot of necessary structure.:wink2: I am guessing you have been there long enough now to see how much better things could be if only....... It has been some time since I was in LTC, but I remember it always seems like there were so many things that could be improved, but there were never enough hours, staff, or interest in getting it done. At least until the state came around.:icon_roll

Still it sounds like you have lots of issues and perhaps you need to examine and prioritize the things that are most important to you. Also I am not clear exactly what your position is, but it sounds like you are performing many managerial duties.

1) There seems to be a disconnect between what you want to do and what you DON expects. Do you have a job description or were the agreements made on hiring put down on paper? If not, you might think about drafting something and discussing with your DON.

2) Try presenting the value of education in a different way--its cheaper to prevent an error than fix it. Is the staff wanting education? If so can they tell the DON and make a commitment to participating? If the staff are better educated, then maybe you won't have to be backing them up!

3) You have been there long enough to know the strengths of the staff. Can you delegate some of your tasks so that you are less overwhelmed? Is there any office personnel who can transcribe dictations? How about a skin committee that can share the skin checks?

Anyway,step back and examine the situation and decide what you really want. Then make a plan and go for it!

Best Wishes,

j

[Beary-nice]

{{{{Beary}}}}

Wow, I am overwhelmed just reading your post; I can't imagine how you must be feeling.

It sounds like you have accomplished a lot in just 4 months, and have brought in a lot of necessary structure.:wink2: I am guessing you have been there long enough now to see how much better things could be if only....... It has been some time since I was in LTC, but I remember it always seems like there were so many things that could be improved, but there were never enough hours, staff, or interest in getting it done. At least until the state came around.:icon_roll

Still it sounds like you have lots of issues and perhaps you need to examine and prioritize the things that are most important to you. Also I am not clear exactly what your position is, but it sounds like you are performing many managerial duties.

1) There seems to be a disconnect between what you want to do and what you DON expects. Do you have a job description or were the agreements made on hiring put down on paper? If not, you might think about drafting something and discussing with your DON.

2) Try presenting the value of education in a different way--its cheaper to prevent an error than fix it. Is the staff wanting education? If so can they tell the DON and make a commitment to participating? If the staff are better educated, then maybe you won't have to be backing them up!

3) You have been there long enough to know the strengths of the staff. Can you delegate some of your tasks so that you are less overwhelmed? Is there any office personnel who can transcribe dictations? How about a skin committee that can share the skin checks?

Anyway,step back and examine the situation and decide what you really want. Then make a plan and go for it!

Best Wishes,

j

Bless you and thank you for responding. I was giving up. I become disappointed when I come here which isn't very often anymore just out of busy-ness, and I leave feeling ignored. I am really stressed right now, I am sorry.

I wish something was on paper, I tried to get that to happen, but the administrator said no. So first and foremost, my bad for proceeding on with a job with too much gray area...clearly my fault.

I offered some educational services at the last nurses' meeting. Not one soul spoke up in interest. I guess they know what they are doing??? I just think it would help, even if it were simplified. I can do that and put it in terms that maybe could be better understood. I don't know why we have to wait for ultimate badness to happen. What will happen is the State will be coming and all the sudden it will become an issue and dumped in my lap.

I took over and revamped the skin program per the DON's request as we were not even close to meeting the standard of practice on anything including documentation. Most of the groundwork I have been trying to lay gets so screwed up that I just have to make certain things are done. I don't know how to make things any simpler. I wish someone could transcribe besides me, the secretary was doing it for awhile, but I guess it wasn't good enough, she didn't like it...I don't know...now it is my problem.

You are right, I need to make a prioritize, I need to make a plan. My "title" is clinical coordinator/QA coordinator. I think if anything, I came into the place at a bad time. It is bound to get better, I hope. If anything I clearly enjoy the residents. If I can make anything work for their benefit because they deserve it, I will do it.

[Straydandelion]

It sounds to me like your job description is ADON and hope you are getting the pay for ADON but doubt it. Being a relatively small facillity however there may be a possibility down the road. You seem to have accomplished a lot however and fulfill a vital role. The only thing I would question however is

typing out dictation

, this can be done by someone else at the facillity and I would discuss with the DON letting someone else pick this up.

[Beary-nice]

It sounds to me like your job description is ADON and hope you are getting the pay for ADON but doubt it. Being a relatively small facillity however there may be a possibility down the road. You seem to have accomplished a lot however and fulfill a vital role. The only thing I would question however is , this can be done by someone else at the facillity and I would discuss with the DON letting someone else pick this up.

Sometimes I wonder about the ADON thing, but no one has indicated that and I don't know what ADON pay is, I think I make not too bad of a wage, not near what I was getting but I was working every weekend for that wage.

Thank you for encouraging me and telling me I play a vital role. Sometimes I just don't feel it or see it through the overwhelming stress. It has as I said earlier been a challenge and a learning experience. I guess that what keeps me going otherwise I would have bugged out some time ago.

I agree about talking to someone about the dictation. It isn't alot of dictation but it is just "one more thing." I wish we had someone whose job was to do that and jockey around with the charts. I know squat about charts. Spent over two week trying to get 38 charts back into order. I just think my services would be better spent on other things and its frustrating.

Thank you with all my heart for your response.

[suzy253, RN]

Oh Beary...I'm sorry you're going through this. You sound like you are doing a great job...to say the least...

But I agree about the plan.

Need to sit down with the DON and go over what you have done and remind her of her interest in you doing education which has never come about. Must be very frustrating to say the least.

And the secretary 'won't' transcribe? It brings to mind a saying of a dear friend of mine.

'favors turn into duties'. ya know?

Hugs

[Beary-nice]

Oh Beary...I'm sorry you're going through this. You sound like you are doing a great job...to say the least...

But I agree about the plan.

Need to sit down with the DON and go over what you have done and remind her of her interest in you doing education which has never come about. Must be very frustrating to say the least.

And the secretary 'won't' transcribe? It brings to mind a saying of a dear friend of mine.

'favors turn into duties'. ya know?

Hugs

Thanks for the support Suzy. I agree I need to sit down with the DON. I have been trying to do that for the past 3 weeks. She is hard to corner. Her and I get along fine. I have worked for her before in the past, just on a different level. My greatest fear is disappointing her. I just can't come to terms with her about the education thing. Maybe now is not the time to push about it, I don't know. I just don't feel it is right to resolve that "nothing can be done" and that "no one will get it it's not worth the time." She doesn't seem to have alot of faith in the nurses, and in some terms I can see what she is saying, but why let them continue on if you are not happy with what they are doing. My thing is throw a little education out there, hopefully it will help, if even a little, if not they or we can't say that it was never offered. I am afraid that is what will come up. The nurses just seem like they either can't or are afraid to think just a little bit out of the box. Alot of these people, it is the only place they have ever worked, and many of them have been there for 15 plus years. (I think I just answered part of my question)

Thank you and bless you!

[nursej22, MSN, RN]

Congrats on revamping the skin program! Unfortunately getting people to adapt to change takes a long time and lots of push. But the results of intact skin will be worth it.

Sometimes when you are feeling bogged down you need to look at where you started and how far you have come, as well as what your goal is. Think about going on a strenuous hike. You are nearing the end, but you're hot and sweaty, your feet hurt, your legs ache and all you can see up ahead is more steep rough trail. Time to stop for a drink of water and look at the view. Behind you are miles of trail through thick forest, lots of mud, and icy cold streams. Across the green valley are snowy peaks in the distance and a gorgeous blue sky. You catch your breath mop your brow. Heck, you've come this far, let's see how this sucker ends. Soon you will be able to say I did it!

Hopefully next year you will be able to demonstrate decreased occurance of skin problems. In your spare time you might want to research ways to implement changes in the workplace.

It must be disappointing about the lack of interest in education. I am such a geek that it baffles me when folks don't want to learn. How about informational posters? Or a simple Did you know? or fact o' the day on the bulletin board or on the restroom wall. Maybe a new topic each week. Leave some nursing journals in the break room. Even if your nurses aren't interested, I'll bet some of your techs/aides are.

Give yourself some more time. And please take care of yourself.

j

[truern]

I'd suggest that the DON monitor the staff that she doesn't trust. She needs to know whether or not they're up to par.

I'd definately delegate the dictation!!

Then I wouldn't "ask" about education...if part of your job is staff education, I'd "tell" them about inservices.

I'll bet in another few months you'll think back about how overwhelmed you felt now and wonder how you got so danged smart in such a short time :-)

[FireStarterRN, BSN, RN]

Sending good thoughts your way. LTC is tough, real tough. It's hard to make a difference, there are so many obstacles. I have no advise, but send my prayers and good wishes.

[Midwest4me]

My heart goes out to you, beary. Sadly, it strikes me as though you've been hired as a back-up floor nurse since you're being pulled away from your duties to help out other nurses. Frankly, I wonder if that will change at all(unless you really put your foot down) given the fact that LTC is very overwhelming, the work NEVER seems to get done, and the question "can you lend an extra hand?" may be directed to you more often than you want it to be. Sit down with the DON and outline your exact job responsibilities and priorities. Good luck!