New Job Is Pushing My Buttons

[sweetsleep28]

So I'm two weeks into my new job at LTC facility. I got about a solid 5 days of orientation, which is good considering most LTC orientations before I was thrown to the wolves. But alas that's how it goes most of time.

Anyways:

Tonight I was floated to the Alzheimers Unit, no biggie. BUT I never had any orientation at all on this unit. I had no idea who any of the residents were, and most of them wouldn't have been able to tell me if I had asked. I will wager a guess that at least 75% of them did not have an ID braclet on. The pictures in the e-mar were so distorted and fuzzy that I couldn't decipher who was who that way either. On top of that a resident came back from the hospital. I was never shown how to do re-admission paper work. I asked the RN supervisor multiple times just to give me at least a little direction. After about the 4th time of asking and being ignored I dove in head first and tried to figure it out myself. Today they started a new policy that everyone is to be open to air at night, and only resident who are care planned for it can wear any type of incontience product at night. My old facility did this so this wasn't a huge issue for me. There was one CNA assigned to this unit that had approx 25 residents, most of which were total care and incontient. She was literally drowning in complete bed changes by the end of the night because she was the only one on the unit. LPNs aren't allowed to leave at night untill they have rounded and checked each and everyone room for multiple things. I told the CNA that was working the hall that if she went and started her last round, I would come and help her and after I had given report to the oncoming shift. I did go help her after I had counted and have report, I figured I would have to make rounds at the end anyways so I why not kill two birds with one stone. We went around the unit changing everyone, cleaning off bedside tables and emptying trash cans. When I get back to the station the RN supervisor who had been MIA outside smoking all shift long, tells me that I'm not to do rounds for the CNAs! What?!?! And that if I'm found doing it again she will write me up? I tried explaining to her that I was not doing her rounds for her, but helping her so both she and I could get what needed to be done, finished so that maybe we might actually get out the building at a relatively decent time. I'm perplexed. I thought I was doing a good thing, by making sure both of work is done. Is that not what I am suppose to do? I always make my best attempt to be a team player. I will help anyone do anything. I'm not sure how I feel about working at a facility that doesn't promote a work environment where people help each other. And where I get threatend with write ups for helping out the CNA staff. It makes me sad because I do genuinely like the facility and the majority of people that I have met there. I do however fear for my license because of the horrible staff to patient ratios. Also that there are some supervisors who just don't want to be bothered with the new nurse who doesn't know how to do everything. There are ALOT of new grads working at this facility. I'm not a new grad but if I were I probably would be running for the hills if this were my first job. I've been around the nursing homeblock so I know what it's like, but this seems a little extreme to me.

I'm sorry about the length and my ranting but it's all I could think of on my drive home. Any advice, words of wisdom would be greatly appreciated.

[brandy1017, ASN, RN]

It' team work and protects the CNA's back and allows you to do an assessment of the patients, not to mention if you aren't watching the CNA do her job and then she is a slacker and the patients aren't cared for, its your license and responsibility. In NY the AG put spy cams in NH and found records were falsified re turning and cleaning, but it was the nurses not the CNA's that were charged. So you are responsible for making sure the patients actually received the care that is being charted! Am I wrong! I don't think so.

I have to say 25 total care patients for one CNA seems excessive to me but NH are all about cutting corners to save money! It's really sad if you ask me. These poor patients deserve better and God knows they are paying thru the nose for the substandard care in so many nursing homes. Most end up losing their house to NH bills and then being trapped there till they die! I think they deserve good care!

[newnurse012]

So I'm two weeks into my new job at LTC facility. I got about a solid 5 days of orientation, which is good considering most LTC orientations before I was thrown to the wolves. But alas that's how it goes most of time.

Anyways:

Tonight I was floated to the Alzheimers Unit, no biggie. BUT I never had any orientation at all on this unit. I had no idea who any of the residents were, and most of them wouldn't have been able to tell me if I had asked. I will wager a guess that at least 75% of them did not have an ID braclet on. The pictures in the e-mar were so distorted and fuzzy that I couldn't decipher who was who that way either. On top of that a resident came back from the hospital. I was never shown how to do re-admission paper work. I asked the RN supervisor multiple times just to give me at least a little direction. After about the 4th time of asking and being ignored I dove in head first and tried to figure it out myself. Today they started a new policy that everyone is to be open to air at night, and only resident who are care planned for it can wear any type of incontience product at night. My old facility did this so this wasn't a huge issue for me. There was one CNA assigned to this unit that had approx 25 residents, most of which were total care and incontient. She was literally drowning in complete bed changes by the end of the night because she was the only one on the unit. LPNs aren't allowed to leave at night untill they have rounded and checked each and everyone room for multiple things. I told the CNA that was working the hall that if she went and started her last round, I would come and help her and after I had given report to the oncoming shift. I did go help her after I had counted and have report, I figured I would have to make rounds at the end anyways so I why not kill two birds with one stone. We went around the unit changing everyone, cleaning off bedside tables and emptying trash cans. When I get back to the station the RN supervisor who had been MIA outside smoking all shift long, tells me that I'm not to do rounds for the CNAs! What?!?! And that if I'm found doing it again she will write me up? I tried explaining to her that I was not doing her rounds for her, but helping her so both she and I could get what needed to be done, finished so that maybe we might actually get out the building at a relatively decent time. I'm perplexed. I thought I was doing a good thing, by making sure both of work is done. Is that not what I am suppose to do? I always make my best attempt to be a team player. I will help anyone do anything. I'm not sure how I feel about working at a facility that doesn't promote a work environment where people help each other. And where I get threatend with write ups for helping out the CNA staff. It makes me sad because I do genuinely like the facility and the majority of people that I have met there. I do however fear for my license because of the horrible staff to patient ratios. Also that there are some supervisors who just don't want to be bothered with the new nurse who doesn't know how to do everything. There are ALOT of new grads working at this facility. I'm not a new grad but if I were I probably would be running for the hills if this were my first job. I've been around the nursing homeblock so I know what it's like, but this seems a little extreme to me.

I'm sorry about the length and my ranting but it's all I could think of on my drive home. Any advice, words of wisdom would be greatly appreciated.

Sorry to hear that things are bothering you tonight. I know the feeling. Thankfully it does get better after a good night's sleep! :)

As nurses, we are to provide whatever care necessary to make sure our patients are safe, well taken care of, and satisfied. I have functioned at every level, CNA, LPN, and now RN. If I'm not too bogged down with other work... you bet I help give baths, empty bedpans, answer call lights etc. All levels of nursing are working together for the good of the patient.

You are absolutely correct with your mindset, as long as you also use your delegation skills when necessary. I work w/ some nurses that seem to think they are "above" these tasks and it sounds like your supervisor might be of this mindset. After all, the first think a nurse is taught in school is patient care..because it's the most important aspect of the job. The CNAs are there to help the nurses. If they can help us, then we should be able to help them. And certainly without worrying about petty write ups.

You are the kind of team-worker that I hope to have if I ever find myself in a hospital or LTC facility. Forget what they said... you did the right thing.

[xtxrn, ASN, RN]

It' team work and protects the CNA's back and allows you to do an assessment of the patients, not to mention if you aren't watching the CNA do her job and then she is a slacker and the patients aren't cared for, its your license and responsibility. In NY the AG put spy cams in NH and found records were falsified re turning and cleaning, but it was the nurses not the CNA's that were charged. So you are responsible for making sure the patients actually received the care that is being charted! Am I wrong! I don't think so.

I have to say 25 total care patients for one CNA seems excessive to me but NH are all about cutting corners to save money! It's really sad if you ask me. These poor patients deserve better and God knows they are paying thru the nose for the substandard care in so many nursing homes. Most end up losing their house to NH bills and then being trapped there till they die! I think they deserve good care!

A lot of LTC budgets stem from Medicare and Medicaid funding. Very few "make" money. :) When Medicare went to the PPS system in the late 90s, many facilities/corporations either went bankrupt or had to merge just to make enough to keep the lights on. Medicaid resident's pay whatever their Soc Sec is (minus a small amount for personal use)...usually that is a fraction of the actual bill. Please don't knock ALL nursing homes. Of course there are duds everywhere (hospitals, LTACs, LTC, MH/MR, etc) but they're not all bad or stiffing the residents- most do the best they can.

OP- it sounds like you did an awesome job in the middle of a bunch of b.s. from the supervisor. When I was a LTC sup, I would have loved to see everyone working together.

:)

[Davey Do]

Tonight I was floated to the Alzheimers Unit, no biggie. BUT I never had any orientation at all on this unit. I had no idea who any of the residents were, and most of them wouldn't have been able to tell me if I had asked.

I told the CNA that was working the hall that if she went and started her last round, I would come and help her and after I had given report to the oncoming shift. I did go help her after I had counted and have report, I figured I would have to make rounds at the end anyways so I why not kill two birds with one stone. We went around the unit changing everyone, cleaning off bedside tables and emptying trash cans. When I get back to the station the RN supervisor who had been MIA outside smoking all shift long, tells me that I'm not to do rounds for the CNAs! What?!?! And that if I'm found doing it again she will write me up?

I thought I was doing a good thing, by making sure both of work is done. Is that not what I am suppose to do?

Any advice, words of wisdom would be greatly appreciated.

I wanted to copy the first quote, just because it amused me so. And to be able to find a little humor in your situation is a good thing.

First, I must tell you how much I admire your actions on all accounts, sweetsleep. From accepting your assignment without criticism, to the job you did, and going beyond to be Team Player. Kudos to you.

Now I have to say that if a PEER threatened to write me up for being conscientious, I'd have to challenge that Peer to do so...

Nevermind, I just thought of a situation where an incompetent Peer threatened to write me up for doing my job and I challenged her. It never happened. Oops! I just remembered another situation where a Member of Administration threatened to write me up for doing my job on another occasion. That too, never happened.

I try to avoid conflict and power plays, but what is just and righteous is just and righteous. It should NEVER be a point of contention to provide caring, direct care to a Patient.

My advice to you, sweetsleep: Keep on keeping on.

The best to you.

Dave

[Marshall1]

Wow - I wouldn't want to work in a place like this nor would I want a family member as a resident there. YOU obviously care as does the CNA but to be left like you both were..not acceptable..shame on the supervisor.

[EmergencyNrse]

"I had no idea who any of the residents were, and most of them wouldn't have been able to tell me if I had asked"

Now that's some funny stuff right there I don't care who you are...

Welcome to the asylum.

[NRSKarenRN, BSN, RN]

moved to our geriatric nurses and ltc nursing forum for advice.

[Yiggs]

It is unfortunate that this is the reality in most long term care facilities. The unfortunate thing is that the people who get the brunt of the neglect are the residents who happen to be someone's mother, father, sister, brother, child etc. None of the residents I am sure, asked to be in the position they are in. I am proud that you saw the need to assist the aide ensuring the clients were well cared for. Who can tell if one of us or one of our family member won't end up in a facility like this one in the future. Like Dave said, keep on doing what you are doing. The Bible teaches us to do unto others what we would want others to do for us.

I hope you made a note of all the things you encountered that were courting medical errors like residents with no "name band." That is what the supervisor needs to concern herself with - using her energy and initiative to make rounds, checking to ensure client safety and that her staff has the support they need.

From personal experience, most supervisors who avoid staff and stuff like this actually feels inadequate and are afraid they'll be asked questions they have no answer to, or they may be asked to help with a procedure that they have no clue about.

Miss Tang, you did the right thang. As long as you are not neglecting your duties at the expense of helping someone else - keep up the good works. Many of us would love to work with you!