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New house supervisor...

Geriatric   (3,135 Views 8 Comments)
by moots.rn moots.rn (New Member) New Member

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I just accepted a 2nd shift house supervisor position in an 80 bed 75% capacity skilled nursing facility. I worked long term care as a CNA/CMT (nurse and medication aid) for 9 years but, went to the Emergency Department for four years then a clinic setting for two as an RN. In the hospital, house was the ultimate go to person- they would get you a bed, calm an irate pt or family member, get you a sitter, BE the sitter... Curious about the perception of the role in long term care. Is it the same? Would love to hear experiences, opinions, expectations, etc from those who work in nursing homes- as house or not. I want to do well so appreciate the input!

Edited by moots.rn

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6 Likes; 45,102 Visitors; 4,978 Posts

Any supervisor position in LTC works best if you can just be the super, that is, not taking a team AND all the supervisor duties. You will be hampered if you have to take a cart AND supervise also.

Major areas of responsibility - staffing, admissions, rest of pts, dinner, pt/family referee, supervise staff, extra duties as assigned, EMERGENCIES, CRISES.

**Know your census and # staff in house. And have a current employee phone list and one for facility admin, DON, dept heads, physicians, xray, lab, dialysis, PHARMACY, COMPUTER/PYXIS CONSULTANT, etc . Don't just expect that 'oh, yeah, the list SHOULD BE ON THE UNIT'. DON'T LEAVE IT TO CHANCE!

**Do you have any agency staff of duty? They might need help. As super, you will be responsible for staffing (handling callouts and schedules). RULE OF THUMB - before your 11pm you CAN call day shift staff for extra coverage. Don't just leave it for the 11-7 super. She will not have any luck for 7-3. And it is your responsibility to try whatever you can to cover safe, minimum staffing for the next ****. And always look ahead to trouble shoot staffing issues for you and other shifts.

You'll most likely be taking calls for hskpg and dietary too. If a second dietary or hskpg staff calls out on your time, I used to call the dept head to give them a heads up. Even if I only left a message or text.

New admissions need to be settled in. They need their adm assessment, MD orders called in and meds made avail (as best as poss). You shouldn't be omitting any meds just because the pt is new. Special attn to IVs, wounds, VS, glucometer, etc. Make sure they get some kind of meal as able. And all the paperwork needs to be started. Dialysis or any other appts tomorrow? Transportation?

Facilities are 24/7, so 11-7 can pick up some of the details like if it's a late adm.

How's everybody else? OK? Anybody out NOW at MD appt or hosp for visit? Anybody critical (what's DNR status and DOES FAMILY KNOW)? Anybody fall or other incident status? Any IVs? Anybody going out tomorrow needing a prep or special attn? Transportation?

As your shift starts, try to get report from somebody like the previous super, ADON or UMs. You should just check out for yourself any new admits. Any critical/incident/falls, etc. Any IVs - ask the nurse about it too. Read the 24 hour report.

Supervisor sometimes monitors the dining room.

 

**As super, you should be called for any unusual pt care issues, like falls, incidents, new bruises, unstable pts (like temps, crazy BPs, IV/GT/FC problems, pump problems, etc).

**You will address family and pts issues. Please be super vigilant about questionable pt abuse issues and pt-to-pt issues, like fighting or touchy-feelies.

And while you're doing all these things, you will be checking out your staff - who's good & who's not so good. Who's sitting at the desk, whose med pass always seems to be done quickly, why callbells are always ringing, why can't you find someone, etc. I found I like to help the CNAs with some pts randomly. Just to check out the aide. and I would try to help nurses with some things, like glucometer sticks and Iv ABTs. And always be prepared to take over a cart if a nurse can't be covered, or has to leave.

Then you have all those other good assignments from your DON, like chart auditing, inspections, in-services, etc.

**Now you have your CRISIS situations. Fire drills are fun, but the whole place must respond even if a drill and most esp if those **** bells go off without explanation. And the whole facility STOPS to locate a missing pt (KNOW your elopement policy!!!). If you hear a S*T*A*T over the intercom go out... if there's a code... or you need to respond to an expiration ASAP (you may have to pronounce in your facility, so know your policy (with computer password))...if the Dept of Health walks in (oh yeah, they do that too).

And you can do the go-fer supplies, and babysitting...

Now all the above assumes that you're just supervisor. If you wear two hats, you'll still have to respond to some things that are just yours and yours alone to handle. Others you will have to depend on your nurses to call you (and oh, they will!)

NO NEED to elaborate this - be ready to respond to any narcotic issue. NO NURSE leaves until the issue is resolved with a written report as nec.

If you feel you need to touch base with your DON, then give a call if nec. But that is WHY you've been hired to handle the regular things, so think about it & PRIORTORIZE. Don't ever let her be the last to know something critical, like no heat in a blizzard and the maint man is there and can't fix it. Or the FIRE ALARM/security system is down. Or a real fire or an elopement. I figure I've gone up my chain of command for liability issues. I'll make an isolation room decision and I'll move around pts as nec for broken air conditions.

Hope this helps! If I think of something more, I'll come back!

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misstrinad has 1+ years experience and works as a RN.

1,725 Visitors; 84 Posts

Any supervisor position in LTC works best if you can just be the super, that is, not taking a team AND all the supervisor duties. You will be hampered if you have to take a cart AND supervise also.

Major areas of responsibility - staffing, admissions, rest of pts, dinner, pt/family referee, supervise staff, extra duties as assigned, EMERGENCIES, CRISES.

**Know your census and # staff in house. And have a current employee phone list and one for facility admin, DON, dept heads, physicians, xray, lab, dialysis, PHARMACY, COMPUTER/PYXIS CONSULTANT, etc . Don't just expect that 'oh, yeah, the list SHOULD BE ON THE UNIT'. DON'T LEAVE IT TO CHANCE!

**Do you have any agency staff of duty? They might need help. As super, you will be responsible for staffing (handling callouts and schedules). RULE OF THUMB - before your 11pm you CAN call day shift staff for extra coverage. Don't just leave it for the 11-7 super. She will not have any luck for 7-3. And it is your responsibility to try whatever you can to cover safe, minimum staffing for the next ****. And always look ahead to trouble shoot staffing issues for you and other shifts.

You'll most likely be taking calls for hskpg and dietary too. If a second dietary or hskpg staff calls out on your time, I used to call the dept head to give them a heads up. Even if I only left a message or text.

New admissions need to be settled in. They need their adm assessment, MD orders called in and meds made avail (as best as poss). You shouldn't be omitting any meds just because the pt is new. Special attn to IVs, wounds, VS, glucometer, etc. Make sure they get some kind of meal as able. And all the paperwork needs to be started. Dialysis or any other appts tomorrow? Transportation?

Facilities are 24/7, so 11-7 can pick up some of the details like if it's a late adm.

How's everybody else? OK? Anybody out NOW at MD appt or hosp for visit? Anybody critical (what's DNR status and DOES FAMILY KNOW)? Anybody fall or other incident status? Any IVs? Anybody going out tomorrow needing a prep or special attn? Transportation?

As your shift starts, try to get report from somebody like the previous super, ADON or UMs. You should just check out for yourself any new admits. Any critical/incident/falls, etc. Any IVs - ask the nurse about it too. Read the 24 hour report.

Supervisor sometimes monitors the dining room.

 

**As super, you should be called for any unusual pt care issues, like falls, incidents, new bruises, unstable pts (like temps, crazy BPs, IV/GT/FC problems, pump problems, etc).

**You will address family and pts issues. Please be super vigilant about questionable pt abuse issues and pt-to-pt issues, like fighting or touchy-feelies.

And while you're doing all these things, you will be checking out your staff - who's good & who's not so good. Who's sitting at the desk, whose med pass always seems to be done quickly, why callbells are always ringing, why can't you find someone, etc. I found I like to help the CNAs with some pts randomly. Just to check out the aide. and I would try to help nurses with some things, like glucometer sticks and Iv ABTs. And always be prepared to take over a cart if a nurse can't be covered, or has to leave.

Then you have all those other good assignments from your DON, like chart auditing, inspections, in-services, etc.

**Now you have your CRISIS situations. Fire drills are fun, but the whole place must respond even if a drill and most esp if those **** bells go off without explanation. And the whole facility STOPS to locate a missing pt (KNOW your elopement policy!!!). If you hear a S*T*A*T over the intercom go out... if there's a code... or you need to respond to an expiration ASAP (you may have to pronounce in your facility, so know your policy (with computer password))...if the Dept of Health walks in (oh yeah, they do that too).

And you can do the go-fer supplies, and babysitting...

Now all the above assumes that you're just supervisor. If you wear two hats, you'll still have to respond to some things that are just yours and yours alone to handle. Others you will have to depend on your nurses to call you (and oh, they will!)

NO NEED to elaborate this - be ready to respond to any narcotic issue. NO NURSE leaves until the issue is resolved with a written report as nec.

If you feel you need to touch base with your DON, then give a call if nec. But that is WHY you've been hired to handle the regular things, so think about it & PRIORTORIZE. Don't ever let her be the last to know something critical, like no heat in a blizzard and the maint man is there and can't fix it. Or the FIRE ALARM/security system is down. Or a real fire or an elopement. I figure I've gone up my chain of command for liability issues. I'll make an isolation room decision and I'll move around pts as nec for broken air conditions.

Hope this helps! If I think of something more, I'll come back!

This is an amazing answer, I don't have much I could add to it. As a nurse in ltc I depend on my house sup for anything that happens that I am not sure how to handle. Get to know your nurses. When I was new I was calling the sup all the time with questions that now seem silly. Now my sups know I can handle most anything and they are able to spend more time helping on other units.

When you come on shift and make rounds to each unit check for orders that need to be 2nd checked or processed because I frequently see orders written at the end of shift and I don't have time to process them and the on coming nurse can't deal with it immediately.

Make rounds a couple times a shift and check in with each nurse in each unit, staff will feel like you are really there to support them if they see you a couple times a shift, even if they don't need you. The most frequent comment I see about some sups is nurses complaining they never see them all shift.

Good luck, it's a hard job and you will wear many different hats.

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misstrinad has 1+ years experience and works as a RN.

1,725 Visitors; 84 Posts

Oh, get to know who the Coumadin patients are so you can make sure new orders on INR day are followed up on. I don't know about other facilities but we do our INRs in house on a portable then fax to Coumadin clinic then they fax us back with new orders and sometimes they come in late and if the nurse working isn't watching for it and gets it faxed to the pharmacy right away we don't get the new dosage delivered until after 8pm or not at all.

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Wow thanks! All extremely helpful answers. I'm copying and pasting to my to do lost lol ;-) I got the "it doesn't happen often but you may have to work a med cart" so now I just have to wait and see. They use medication aides too so expecting to "occasionally take a team"... Want to be truly available to staff and pts so hope its infrequent. Thanks for reminders of areas to be proactive! Truly grateful for the advice :-)

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Did think of few things more - SUPERVISOR KEYS. Sometimes there's just one set that you pass from supervisor-to-supervisor. Or you may have your own set. Be sure you can get to where you have to. Not saying you'll ever need to get into everyplace but...

Like central supply so you can pull out emerg equp like a replacement GT pump/pole or O2 concentrator, VARIOUS COLOSTOMY equip, Ensure/Glucerna supplies, correct foley & GT sizes when needed, etc.

Will you have access to the kitchen? Esp for late/after hours admissions who need a meal (kitchen staff usually leave by 7p). Or for a diabetic who needs FOOD.

Can you access medical records? Physical therapy? The laundry? The nursing office, which is nice to know in case you need another emergency med cart replacement key. but I have in the past. And you may need to know how to get in for some bizarre reason. Esp when I've located missing pts in therapy. I've also needed access for FIRE DEPT when the enunciator panel identifies the 'kitchen zone' and the firemen have to kick in the door.

Will you have a security guard. They can usually get into any office, but otherwise YOU may be it. Learn as much as poss about any security alarms or wanderguard systems.

Union? You'll need to be aware of their disciplinary process. When are they due for renegotiations?

You will be wearing many other hats esp after all the other dept heads go home. You might have to do 'tours' for prospective admissions.

You may have to complete some forms if you do.

*****In LTC, the goal is to keep pts in house as long as poss before you have to send them out. What can the hosp do that we can't? But there are some things that we just can't manage and if we must send them out, then out they go to be safe. That decision will most likely fall to you.

And in LTC, always remember the FAMILY. For ANY change of status, call them. They get REALLY PO'D if you don't. I'd give them heads-up for just about anything and everything. I don't want them upset!!! You'll be dealing with lots of families. They tend to form very close 'clique' bonds with each other. Like neighbors. I could be FRIENDLY, but they were NOT my FRIENDS. Just be aware.

*****In LTC, we have a different mind-set than acute care. When I switched, it took me a while to tone myself down as I was always in a' do, do, do something' mode. It's just a slower pace, but we have to always be thinking ahead.

Know all the protocols and paperwork that your staff must know, esp ADMISSION stuff, FALLS/INCIDENT REPORTS (for wounds and bruises of unknown origin), transfer forms, change in status, house wound protocols.

When are you due for your next survey? A well-run facility is ready for them anytime. But when that window of potential arrival comes around, some places get NUTS. And YOU and your staff may have some readiness projects to do.

Just for my own use, I kept a supply of a few facility forms that I knew staff or I may need in case we ran out. I also kept disciplinary writeup forms avail.

Might you need to come in for nsg management meetings? I also kept inservice forms avail. My staff knew how to put together a green O2 tank without blinking an eye; same to setting up suction. They knew all the items on the floor crash carts. I would accompany them for med passes/wound treatments. The CNAs are required to have 12 hours of inservice, so if I had to pull them together, I'd keep inservice attendance on them with an outline for whatever (always under the 'hot topics' - pt rights, inf control, safety, etc).

In a small facility, you may get involved in QA activities, like falls & safety, inf control, psychoactive meds, wounds, pain control, etc. You may be involved in meeting or maintaining logs, etc. Like I said, lots of hats!

Lastly, is your place religious-affiliated? They tend to utilize their ministers and the Catholic places are last-rites sensitive.

It will take time for you to settle into you new place and new role. And it takes time to absorb all this info. Good luck.

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The thing I should have said FIRST in my first post was to know how to use the facility telephone and intercom. 'Nuff said. You may need your own password.

Know where they keep replacement batteries for the glucometer, flashlight, etc!!!!

If a crash cart gets used, it needs to be restocked ASAP. It should not be left for the next shift. Crash carts in LTC facilities usually don't hold lots of fancy stuff. When I hit a floor, that's usually the first thing I eyeball. Carts are also freq cannibalized. Even though the floor nurses are supp to check it q shift, I sometimes check the cart myself (esp the O2 tank & O2 equip). The carts sometimes lose the key to crack open the O2 - maint can string a chain sometimes to the cart.

Another poster commented about labs - sometimes that falls to 3-11 super to retrieve the labs off the lab printer, spot check them, then distribute them to the floors.

Check with your nurses to ensure that they know something special has to be done at an atypical time. They prob already know as they got report too, but I like to make sure everybody's on the same page. I'm a worry wart, so I check back just to make sure it was done. I don't want to know that a surgery or other procedure had to be cancelled because of an omission (and I would have an incident report done for that).

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At my LTC, the 3-11 shift supervisor spends most of her time doing admissions. If there are any nurse call offs, the supervisor then has to take over a med cart too.

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