New DON

Exactly. The staff know they won't get fired because they are already short staffed so they will continue to "do nothing" and there are no consequences for them. There are certain staff members who are totally selfish and self-centered and have no business working in nursing. But alas, you will always find these kind of people in assisted and LTC. The nurses are not "charging" because the CNA's are  not going to listen to them. The CNA's know they can "do nothing" and get away with it. I use to try to be a "charge nurse" and reported all of my concerns to management. Did nursing management  ever do anything about my concerns? Of course, not. 

The problem is the CNA to patient ratio.  If they have a lot of total care patients they aren't going to do oral care on everyone.  They'll probably only do it on those who request it - its awful. 

I try to explain why its so important so they are more likely to do it - this only works on the ones who truly care, though. 

I make sure all dentures are removed and soaked overnight by the 3-11 CNAs and I make sure if anyone is at risk of aspiration I explain the rationale to the CNAs. 

Peri care should be done no matter what.  (so should oral care but I digress)

Have you tried asking them what would help them?  Sometimes the assignments aren't even and the ones who don't pull their own weight are getting away with too much. 

Also empower your floor nurses and hold them accountable for overseeing the CNAs. 

You can't just hire anybody. the one's with the attitude you have to weed out. Right where you said you are short staffed, that is a problem you have to look in to. Sorry, nurses aren't going to pick up the slack for admins problems. Maybe offer incentives, extra pay.

I would start by meeting 1: 1 with all employees this way you know who you want to weed out.  Start on one problem at at time.  She if you can hire a nurse manager for the unit, an MDS nurse, an IC nurse and  a staff development nurse to help you. 

I had the great displeasure of working in LTC when I first became a nurse. Something that really helped were the days I had a MED TECH! In that facility, it was a CNA who took an approved medication course, and was certified to pass meds, which is a huge portion of LTC. This allowed me to do actual "nursing" duties like tending to emergencies, handling orders, etc. Management, though, would mesh this person's schedule together, adding double the work onto her. So if you were to go this route, I would hire a med tech specifically for passing meds and nothing else.

Also, editing to add, having more than one nurse staffed at a time is a great idea. One nurse for an entire building is too much.

Hi, let me just start off by saying welcome to LTC. Although I am an LPN and have never been a DON, I have been working in LTC for 11 years. I’ve been an Asst. in the Activity Department, a CNA, then a floor nurse (LPN), an MDS coordinator, and a Assistant Director of Nursing as an LPN. It sounds as if your facility is in dire need of staff and getting rid of them will be more detrimental than beneficial. What I have seen work, instead of cracking the whip, employee rewards. Get your current staff to want to work for you. Show them that you will appreciate the good work they do. Examples, all nurses that complete all routine charting we’ll be placed in a drawing for an extra paid day off, or a 50$ restaurant gift card. For the CNAs maybe a turn reward program. Place a ticket in the resident room that could be daily prize for the CNA 20$ gas card, a free pizza. It will not solve all of your problems but I gurantee employee rewards will increase production. As far as you not having a lot of LTC experience, find your tenured LPN or RN floor nurses that are held in high regard and listen to them. Make them your number 1 advisors. These nurses know the refs and the rules of LTC inside and out, don’t dismiss them because your the RN, LTC is a different animal and no degree or amount of acute care experience will prepare you. Good luck 

6 hours ago, downsouthlaff said:

.... LTC is a different animal and no degree or amount of acute care experience will prepare you. Good luck 

Truer words were never spoken!