ComicRN

Thanks to everyone who has replied. This has been a big issue in our facility. Last month we had 10 outside appointments which left us short staffed 10 days. Granted, it wasn't for the whole day, but it does put a burden on the staff left behind. Our policy says that a staff member (usually a CNA; NEVER have I seen a social worker or therapeutic rec person go!!) has to go with the resident. Anyway - thanks again all of you for your replies. Jan

Another thought about writing up or discipling folks. Keep personal issues out of it. Make sure the person knows it is about their BEHAVIOR, not about them personally. In your case, it should be easy. "Here is the task I delegated to you. It did not get done. Is there a reason it didn't get done? No? Ok, I have to write up the fact that you did not complete this task I asked you to complete." Blah, blah, blah, or words to that effect!!! Usually it's all about tasks not getting completed.

I've been in LTC (employed, not living!!) for almost 10 years. I still love it. I am an RN, a nurse manager (for the past 1 1/2 years and currently a BSN student). I've learned a couple of things along the way. Treat others as you would like to be treated and it will eventually come back to you. How are we treating our CNAs? How are we treating or LPNs and RNs? How are we treating the folks who bring the clean resident laundry back to the floor? Hopefully with respect. I tend to be a little bit of a Pollyanna and think the best about everyone before I think the worse. Is the CNA on her cell phone because she has to call her pediatrician's office when they open and she is not allowed to use the phone at the nurse's station, or not allowed to make personal calls until her break (at perhaps 10:00 am when it's harder to get a good appointment her your her sick child after work because all the good appointments are taken by then?) And, yes.....I know that everyone's response will be that the CNA is on the phone with her friends, etc. But, please take into account that it just MIGHT be for another reason. As a manger, I try to say, "Thanks, that was a really good job" more often than, "Can I see you in my office for a minute?" I make sure I praise the staff (EVERYONE) in front of their colleagues so that everyone knows what the other person has done that is GOOD. Yes, that person may have just been doing their job but, so what? What's wrong with thanking someone for that? How many times do we go to the grocery store, or the bank, or a clothing store and thank the clerk when we are leaving? Why do we thank them........they are just doing their job. That's what they get paid for, isn't it?!!!!! And remember, we can all thank our colleagues, you don't have to be in management to appreciate when someone has done something. Another thought.......if I have an employee with an "attitude" who suggests that perhaps I should be out on the floor helping them more, I ask them to come to my office and pick one of my tasks to do. They usually look at me funny. Then they realize that, yes, I may be able to do the work that they do (I also was a CNA once) but they are not able to accomplish my work for me. If I spent my entire day helping to pass meds, toilet and feed people, I would have to work an entire extra shift just getting MY work done! This usually gets the point across, and I try not to do it an "holier than thou" attitude. It just depends on the attitude I am approached with. Hope this has helped. :) Jan

Hello, it's me again........with another "how do you do this in your facility" question!!! We're having problems in our facility with residents going out for outside appointments: cardiologist, their own eye doctor, f/u after surgery, etc. We do have some clinics in our facility, but not enough. Our policy is that if a capable/willing family member (i.e., strong enough to transfer from w/c to exam table or from w/c to toilet) is not with the resident, one of our staff members muct accompany the resident. Of course, this usually means a CNA. This, in turn, puts our CNA:resident ratio off while the CNA and resident are out of the building. Just as a point of reference, my facility has approximately 350 beds and my unit has 46 beds. We've brainstormed our little hearts out and can't seem to come up with an answer. Of course, we've talked about having more clinics right in our facility, but that takes time. This is a real problem RIGHT NOW!! Does anyone have any words of wisdom? Thanks - Jan

Thank you so much to everyone who has replied!! Great ideas so far and I will take them all into consideration. If anyone has anything more to add, I'd love to hear it. Thanks again - Jan

Has anyone checked to see if the child has a megacolon? This could also be causing her problem.

Greetings! I am a returning member, last here in 9/14/02, according to the little thingee that popped up when I logged back in!! I am now the nurse manager on a 46-bed LTC unit. I am also a returning nursing student. I am in the midst of getting my BS and will be finished in May. The big project that I have been working on is to initiate an ambulation program on my unit. We seem to have a real problem getting residents ambulated as often as they should be. Therefore, their transfer and ambulation status declines more quickly (among other things!!). What I am wondering is this: what things have you tried in your facilities to get your CNAs and/or nurses to complete the required ambulation? I know it seems like a simple thing, but there are all kinds of obstacles that seem to get in the way.......not enough staff, too busy, etc. Does anyone have any words of wisdom for a tired old nurse manager and nursing student?!! Thanks - Jan

I think Aimee and kd said most of what there is to say. I would also add that in you "spare time" familiarize yourself with your facilitiy's policy and procedure book. I'm sure it's about 3 million pages long (as most of them are). But, even just skimming through it and getting a general idea of how your facility likes things done is a good idea. I've been an RN for 10 years, but there are many procedures I haven't done in a while. If I had to change a trach, for instance, I would have to call in someone to help me. No one knows EVERYTHING (although I'm sure there is at least one nurse in each facility who thinks he/she does!!) and there is no shame in asking for help. Good luck and welcome back to LTC. :roll

Ok............at the risk of starting "something" here, I'm going to put my two cents in! I've worked on a med/surg floor, in rehab and currently work as a clinical coordinator in a LTC facility. Know what my pet peeve is? When we call to get report (or the hospital calls US with report) on an incoming admission and the nurse says, "well, I don't know, this is my first day with this patient." OK...I understand THAT part of it, but I think the next line should be, "but I'll find out the answer to that question and get back to you." Would that same nurse say that to a doctor, or a family member? I don't think so. So, why can't we give our fellow nurses the same courtesy?

OK......here's something sort of off base, but thought I'd mention it. I was having ear pain and a weird itching sensation in my ears. Especially my left ear. At times it felt as though there was a cool liquid coming out of my ear.....but there was nothing there. I saw my doctor (twice in 4 days because of the pain) and she could find nothing wrong. I happened to mention it to my dentist about 7-10 days later when I went to see him. I have been having some extensive dental work done. I recently had 4 extractions done in preparation for a lower partial. He feels that all of my problems (including the incessant itching) are probably caused by TMJ, which has probably temporarily been caused by the lack of 4 teeth in my mouth!! Therefore, I've been chewing differently, etc. It makes sense to me. I don't know if you're having any dental problems, but it might be worth checking out! Good luck....I know how annoying it can be.

Kona - oh....your post really hit home for me! Two years ago I was asked to become Assistant Nurse Manager on the 28 bed rehab unit I worked on (in a LTC facility). It was a VERY busy unit. Our nurse manager was being pulled from our unit to help another unit get their feet on the ground and we were told that it would probably be for 2-4 weeks. It ended up to be over 9 months! I thought - "cool, I've always wanted to try management, this will be great!" At then end of those 9 months I was a wreck!! I actually ended up in the ER with incredibly high blood pressure, elevated pulse and a depression to beat the band. Granted, we may be two very different indivuals and handle things differently. I guess what I'm trying to say is.......listen to your head and your heart. You might end up loving the job and being very good at it, but do it for your own reasons, not because everyone is telling you what a great job you would do. I don't mean to sound negative, but some of those people telling you that may have their own best interests in mind. One of the hardest things for me (after I got my health straightened out) was to go back to work as a staff nurse again on the same floor. Everone kept coming to me with "manager type" problems if they couldn't find the manager. I eventually left that job. But, you might want to try it for a while. Can you tell the "powers that be" that you will give it a trial of 6 weeks (or something like that)? And, if it doesn't work out that you could go back on the floor. I know I just said above that that didn't work out well for me, but it might work for you. Well, I've probably confused you even more and made the situation worse, but I thought I would just share my experience. Good luck with your decision.