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Editorial Team / Admin · Sep 24, 2005

I'm a DON-LTC in WI. I am looking forward to finding out the many issues that other DON's face in their facilities through reading items on this site. We have just been through a particularily poor survey and the staff(union) are the ones causing the problems, and this is what we are being told by the surveyors, that the staff are trying to get us in more trouble.

:balloons: Hello and Welcome to Allnurses.com:balloons:

You will get great support here. Good luck with this issue.

Nurse_Smith · Sep 24, 2005

I'm a DON-LTC in WI. I am looking forward to finding out the many issues that other DON's face in their facilities through reading items on this site. We have just been through a particularily poor survey and the staff(union) are the ones causing the problems, and this is what we are being told by the surveyors, that the staff are trying to get us in more trouble.

First off welcome to Allnurses, I too am a new member but have been using this site for a long time. I have worked in Racine, WI briefly as a traveler, and found the moral generally low. Could you point out where the problems arise from and how the staff(union) is trying to get you in trouble.

noc4senuf · Sep 25, 2005

First off welcome to Allnurses, I too am a new member but have been using this site for a long time. I have worked in Racine, WI briefly as a traveler, and found the moral generally low. Could you point out where the problems arise from and how the staff(union) is trying to get you in trouble.

THe union staff are not at all happy, since we acquired a new owner a few months ago, due to the fact that hours were cut. We have a facility of 65 beds and are only running at 35-38 of them full. There are the same amount of people on the floor but, the shifts were all cut back since realistically, it would take an 8 hour shift to care for a full house, and less time to take care of fewer beds. Less hours means less money... so they are not happy and the union is involved now.

The surveyors have told us(management) that our staff are telling residents that they don't have time to do things for them in return the residents complain to the surveyors, staff also tell the surveyors they have not been told how to do things or what is going on when everybody in the entire building has had to attend mandatory meetings for exactly that purpose.

THere is also one nurse (a union steward) that writes down everything she tells ANYONE, and if she doesn't see proof in writing SOMEWHERE that the issue was addressed to her liking, calls the state. Get rid of her? Can't, protected by the union and the whistleblower law.

Also, in our deficiencies, none of the statements that the NHA or myself stated to the surveyors was listed, only things the union staff stated and it looks bad.

Jubei · Sep 25, 2005

I'm a DON-LTC in WI. I am looking forward to finding out the many issues that other DON's face in their facilities through reading items on this site. We have just been through a particularily poor survey and the staff(union) are the ones causing the problems, and this is what we are being told by the surveyors, that the staff are trying to get us in more trouble.

Are you treating your LVN's nice? :madface:

DutchgirlRN, ASN, RN · Sep 25, 2005

Are you treating your LVN's nice?

Oh please! Let it go......From your other posts it seems as though you are an LVN who wants to be an RN although you say you "hate" RN's. I used to be an LPN and I was just as respected as I am now. The difference is the diploma, the actually piece of paper which raises our hourly wage and allows us the opportunity to do charge and eligible for administrative positions. I chose to go back to school after 26 years as an LPN. I admit I was always an RN wanna be..... not because of respect but because of the difference in salary. I do the exact same job now but get paid $12 an hour more for it. I knew I was worth the extra money and I had to make it happen myself. The LPN's I work with are awesome and also worth the extra money but you have to have that piece of paper on the wall.

CoffeeRTC, BSN, RN · Sep 26, 2005

Hey...lets be nice!

Are they working at boosting the admissions/ marketing the facility?

I'm confused. What exactly is the union reporting to the state? Staffing issues or resident care issues? When we staff down because of census (only happens rarely maybe 3 times a year), they can refuse it or its in their contract that they still have to get paid, so why send them home?

Keep good documentation of those inservices that you give when training. Remind staff that it will come back in thier face. What about performance evals? Do you do them? We don't, but I think its an excellent way to see just were the staff are in terms of need for more training/ re education and shows the state that you do teach staff the correct way. Hold them accountable.

Try and be pro active with the staff.

DusktilDawn · Sep 26, 2005

the union staff are not at all happy, since we acquired a new owner a few months ago, due to the fact that hours were cut. we have a facility of 65 beds and are only running at 35-38 of them full. there are the same amount of people on the floor but, the shifts were all cut back since realistically, it would take an 8 hour shift to care for a full house, and less time to take care of fewer beds. less hours means less money... so they are not happy and the union is involved now.
the surveyors have told us(management) that our staff are telling residents that they don't have time to do things for them in return the residents complain to the surveyors, staff also tell the surveyors they have not been told how to do things or what is going on when everybody in the entire building has had to attend mandatory meetings for exactly that purpose.
there is also one nurse (a union steward) that writes down everything she tells anyone, and if she doesn't see proof in writing somewhere that the issue was addressed to her liking, calls the state. get rid of her? can't, protected by the union and the whistleblower law.
also, in our deficiencies, none of the statements that the nha or myself stated to the surveyors was listed, only things the union staff stated and it looks bad.

welcome to allnurses noc4senuf :balloons: :smiley_aa :balloons: :smiley_aa

also, in our deficiencies, none of the statements that the nha or myself stated to the surveyors was listed, only things the union staff stated and it looks bad.

you may have to follow any verbal statements with a formal written one, it is more concrete than a verbal statement. michelle126 brings up some good points about documentation of inservices.

any inservice i have to attend, i have to sign an attendance sheet; new equipment, new procedure, etc, we have to sign that we attended the inservice. we are having a "skills fair" the first week of october, i will have to sign an attendance record and each skill (ie: mediports, lab draws, ng tubes, restraints, etc) reviewed at this fair has to be signed off individually by a nurse educator to verify that i know the policies and procedures at the facility and demonstrate competency with the skills reviewed.

we also have a "net learning" where we have to review things like "erogonomics", "infection control", "restraints", etc. we have to review the material and pass a test with each topic listed on the "net learning." we have to print a certifictate to submit to our um for their records. believe me they do get on our case if these topics are not done.

have an attendance record and minutes for all mandatory meeting you are having with staff.

definately acquaint yourself with the collective agreement in regards to the union in your facility, especially when it comes to implementing time off in regards to low census. keep a formal record of how this is done.

the surveyors have told us(management) that our staff are telling residents that they don't have time to do things for them in return the residents complain to the surveyors, staff also tell the surveyors they have not been told how to do things or what is going on when everybody in the entire building has had to attend mandatory meetings for exactly that purpose.

you need verification as to whether the staff are accurate in their assessment as to whether they "have time" or not to do things for their residents. this is another area where resident complaints need to be investigated in house and followed through on. again documentation in regards to the complaint, statements by staff & residents, findings, and actions taken are extremely important. any facility where staff are routinely not getting breaks/lunches or leaving on time are clear indicators of valid staffing issues!! (can you tell that i frequently do not get lunches/breaks or leave on time :angryfire :angryfire ).

if there is validity in the complaints, they need to be addressed, if it can be shown that there isn't that also needs to be documented on. also having a commitee with both administrators and staff that actually listen to each other can go a long way.

bear in mind that there is always more than one view on any given situation.

i do wish you the best of luck noc4senuf

CoffeeRTC, BSN, RN · Sep 26, 2005

Dusk.....I know this is OT from the OP question, but could you tell us more about your skills fair or net learning programs. We soooo need a refresher for some staff.

DusktilDawn · Sep 26, 2005

Dusk.....I know this is OT from the OP question, but could you tell us more about your skills fair or net learning programs. We soooo need a refresher for some staff.

Hi Michelle,

We were having the same problems with staff soooo in need of a refresher.

In regards to Skill Fair:

Last year the facility I work at started these "Skill Fairs," there was alot of positive feedback from the staff on this, so again this year they are having another one.

We are provided a booklet with the skills that will be "validated" at this fair. The booklet wil contain:

1. Key important points on the skill being reviewed (ie: mediports, CTs, NGs).

2. Procedures involved (ie: for mediports; accessing an implanting port, blood draws from ports, flushing the ports, drsg changes (when, how often)), included are the facilities policies and procedures.

3. Study questions:

ex: The correct flushing protocol of an accessed implanted port is:

A. 3ml normal saline followed by: IV therapy or 3ml of 10 unit/ml heparin

B. 3ml normal saline followed by: IV therapy or 5ml or 100 unit/ml heparin

C. 5ml normal saline followed by: IV therapy or 5ml of 100 unit/ml heparin (this is the correct answer for our facility BTW)

D. 5ml normal saline followed by: IV therapy or 10ml of 100 unit/ml heparin

We are to review this booklet prior to attending this fair. It is scheduled for 4 hours (depending on how many people are attending that day, it varies, less people=less time).

"Stations" are setup for each skill with "Nurse educators." They will ask you questions (ie: What would you assess on a patient with a CT? Who can co-sign when you send a specimen for T&C?). You will have to demonstrate that skill (ie: proper application of wrist restraint, changing central line drsg, programing the IV pump for heparin gtts, programing a PCA). You had a form you brought to each station to be signed by the educator that was submitted for your records. The attendance for this was mandatory and we are paid for this. This year we do have the option of choosing the time we attend by signing up for the dates available.

We were using the same equipment that we have on the floors (ie: IV pumps, PCA, wrist restraints, pleura-vac system, etc). For instance with our IV pumps, even though we did receive an inservice, there is a "Guardian" feature for programing medications such as insulin, heparin, dopamine, etc that will give you a warning if it is an unusual dose for that medication (for example if you program in 10,000 units of heparin by mistake instead of 1000 units/hr) and a "Label" line for common IVF or for TPN & Lipids.

I kept the booklet they gave us last year, and will keep this years booklet also, I find they are a quick reference source if needed.

Last year the skills they reviewed were:

1. Mediports

2. NG tubes

2 LifePak AED & noninvasive pacing

3. Chest Tube setup

4. Restraints & application

5. PCA & pain

6. Heparin

These were areas that it had been noted that errors/lack of understanding by staff had demonstrated a need for improved education.

This year the skills being reviewed will be:

1. Blood product identification

2. Blue Alert (for either GPU or ICU)

3. Neuromuscular blockade

4. Respiratory Treatments

5. Glycemic control.

Skill reviews for:

1. Doumentation on Blue alert form & restraint form.

2. Equipment: bladder scanner, CASP tube

3. IVs: Power PICC, mediport, discontinuing CVP lines (ICU staff)

4. Heparin

5. Stroke

6. Pain Management (Adult)

7. Pyxis med station

8. Order of lab draws.

I hope this gives a good idea of what the "Skill Fair" is all about. It seems like a lot, but I feel that this saves time in the long run for both staff and educators. Also it is not being done in the middle of your shift for example when you are trying to take care of your patients. Personally I find it very hard to do inservices when I have patients to take care of.

In regards to Net learning:

Our facility has a website where when can access a program from that site that provides continued learning in areas such as employee safety (fire codes, ergonomics, MSDS, infection control, TB, etc). We can access this from our home computers (I don't know how, a little technically challenged here) if we want to do them on our own time. Basically you review the material provided on each topic and then do a test at the end. When you pass the test, you can then print a certificate verifying that you achieved this competency, I usually print up 2 copies, one for me and one for the UM. These go in your employee files as does the form from the skill fair.

I'm not sure how better to explain the "Net Learning" we do.

Feel free to ask any questions, I'll do my best to answer.

Best to ya