thenursebabe25

Alright everyone, I need some advice. I work at a small long term care/assisted living facility. Small as in my floor literally always under 10 patients. Our ratios are unheard of. On my shift, we always have 2 nurses, and every now and then 2 CNAs. That's amazing for such a small group of patients. They are trying to get away from having 2 CNAs, and just have 1. Here's where the issue comes in. Although it's not a lot of patients (currently 9), they are total care but 1. Even though our CNAs are amazing and will work alone, I don't let them on my watch. I help with checks and changes (q2 hours), answer call lights, do my own vitals, etc. My nurse partner on my shift NEVER helps out. She does her meds, and that's about it. Again, we each literally have 4 and 5 patients. It's ridiculous. She will come get us while we're changing someone about another call light going off and all. It's not fair that on top of my meds, assessments, and other nursing duties, that I'm the ONLY one EVERY shift helping with patient care. I don't know what to do. Telling management will be obvious that it was either myself or my CNA which will make for an uncomfortable work environment. I do have a great relationship with my DON and have known her for like 5 years, so I've thought about asking her for advice and asking her not to say anything. She's super understanding and will hear you out, especially when she knows you're a great worker. I love my job and my patients, and its literally a dream to have such few patients especially in long term care. I do agency work on the side, and it's not abnormal to have 20-40 patients alone! This work is a breeze compared to the norm! It's nothing personal to my partner, as a person she's actually really sweet. I hate confrontation, and I'm not comfortable saying anything. Technically she's a "charge" nurse. But I do all the work, as well as her judgment not being the best which is also concerning (she's been a long term care nurse for 20 plus years). Example: not knowing that a med being pulled from an ekit has to be accounted for. Another one of the nurses at my facility has a similar issue with her partner, and brought up how she asked her to just take both med carts, and pass all meds, while she works the floor with the aid and does patient care. This seems like a good possible idea as well. I just feel like patient care shouldn't be on me every shift. Please please help!

Before anyone gets upset, please understand the whole story. I'm the nurse that absolute adores and appreciates CNAs. I'm the nurse who has no problem making check and change rounds with the aids even when not needed just to lighten the load. I'm the nurse who will stop what I'm doing and answer call lights myself when the aids are busy. I'm not going to go pull you away from your work. I'm the nurse who has no issues with assisting patients with ADLs, and doesn't think wiping bottoms is below me because I'm a nurse. I'm a team player, and I speak to all my team mates with respect, kindness, and compassion. So for the life of me, I don't understand why I encounter so many CNAs who refuse to take simple delegation. I know that CNAs endure so much from patients, we as nurses, families and so on, but we all have a job. When delegating simple tasks, I often experience CNAs tell me no and refuse to comply. I ask in respect, and never at a time where someone is busy. I never delegate something that I can't or wouldn't do myself. The only time I do even delegate is if I'm tied up and can't get to it, or when it's something that needs to be done later that the aid could do with no issue. Then it's the same ones who don't comply that have no issues pulling me away from my work to assist them. I experience so much laziness as well especially in long term care. At my full time job, our aids are great and perform check and changes every two hours. Every since I became an agency nurse, I continuously witness CNAs who literally don't round on patients all night, and don't change them until morning. It's getting ridiculous. I think my may kindness may come across as weakness because I'm so nice and such a team player. How can I as the nurse become more firm, but still kind? If you're an aid reading this, please don't take it as my accusing the entire profession. I've had great aids during my career. I know that you all aren't like this. But this needs to be addressed. Ultimately, our patients' care comes first, and I want to know how best to achieve that.

Hi, I really appreciate your feedback! All very true. As far as agency; I've been a nurse for 2 years now and in healthcare for about 5. I would say my lack of confidence at times comes from paranoia with everything going on in healthcare on the legal side. Hearing about all the cases that end up being blamed on nurses really gets in my head. My background in healthcare and foundation in nursing was in ALF (assisted living) which is super low acuity, so everything I know really came from on the job experiences at other places. We all know nursing school doesn't really prepare you for the real world. So sometimes, I feel like I just don't know enough in certain situations. Again, thank you!

So I work for one of those online agencies that are really just more of a third party than an actually agency. They wouldn't really be able to do anything.

OK everyone! How do you handle working behind a lazy coworker? For example. I'm an agency nurse, and there's one (LTC) facility I work at frequently. Just about every week. There's one particular nurse where every time I come on night shift to work after her, things are left undone. Admissions from day shift that she claims "just got here" who were actually there for hours, things like that. She also never does wound care.... She'll chart off that she did, then when I check, the dressings are soiled and dated from days ago. This is constantly. Then, patients and families question me on when it should be changed, so I just go ahead and do it. They have every right to complain. Sometimes during report, she even skips entire patients!! It's getting ridiculous. This facility is so nice and easy, but she is making me not want to come. I have enough of my own work, hers shouldn't fall on me too. I hate confrontation, and I know how some staff nurses already feel about agency. Management and administration here have complimented me numerous times on my work ethic, and how they appreciate how I get things done. Should I discuss this with them? How would you guys handle this? I don't want to "snitch" or get anyone in trouble, but I do feel like management would hear me out. This isn't fair to me, and most importantly, our patients.

So I worked at a LTC facility (memory care unit) for the first time with one of my agencies. I had a patient complaining of pain to her side. After assessing patient, my CNA let me know that her son told staff that she had a fall a day or two ago which was not reported to me during shift change. Patient didn't remember if she fell or not. I didn't think much of it, and figured she was experiencing some soreness from the fall. She had no other complaints and refuse pain meds. I also did not think to check if neuro checks were done.... Shame on me, I know. I passed along the info of the alleged fall to day shift, and the day shift nurse then said she would start the patient on neuro checks. I don't know why I didn't think to start them myself. God forbid if the patient was to sustain a serious injury from the fall, could I face any repercussions for not initiating neuro checks? Im sure it would fall more so on the shift in which she allegedly fell, but still. So tired of working in a field where I'm constantly paranoid about losing my license or worse. I try to give the absolute best care to my patients, but I'm still learning and don't always remember every single thing.

Thank you for this, I said the same exact thing when the nurse gave me report!! It was the MDs responsibility to order any appropriate testing! Again, I appreciate this feedback.

With everything going on in the nursing world as far as the legal aspects, I'm constantly paranoid about losing my license. Especially working in a long term care facility. As most nurses do, I still feel like I often don't know enough to perform my job as an nurse, although I continue to prove myself wrong. Recently, I had a patient who was taking Keppra. I was preparing to give it to her one night, but when I opened the EMR, I saw that it was not showing to be given. I then opened up the order, and saw that she was only receiving it for 30 days, and that the last dose had been given that morning. After that, I didn't think anything of it. A week later, I just found out that she's in the hospital and had a grand mal seizure. The nurse also said the patient had been behaving peculiarly. The scary thing about being an agency nurse and going to different facilities is that we don't know patients baselines and normal behaviors. The nurse who gave me report said that she declined quickly & that she's heard the family might sue. also, the hospital is blaming our facility for this. The nurse let me know that the person who d/c'd the order should have ensured some sort of test was ordered for the patient after completing the keppra. Please don't judge me, but I honestly didn't know this, and didn't even think to look for an order for some type of test. Could we get in trouble for this? Could I somehow be responsible although I didn't give the last dose or d/c the order?

I worked at a long term care facility as an agency nurse. It was a crazy night, I sent several patients to the hospital and so forth. A high fall risk patient managed to get out of bed into her wheelchair. She's pretty heavy and hard to transfer. I go into the room to give meds, and the CNA is frustrated due to her having had gotten out of bed alone. She was literally almost in tears from being in physical pain from the workload that night, and I felt so bad because she's an awesome worker. I of course jump in and help. During us transferring the patient, I remember thinking to myself that she could be a bit more gentle with the patient. However, I didn't deem her actions in my mind as abusive or anything, otherwise I would have said stopped her, and reported the behavior. So after this, I didn't really think much else of it. A few days later, I get a call from the DON asking about said patient. Immediately in my head I thought the patient had complained about some meds that were out of stock that she was upset with me about that night, so I explained this to the DON. The DON then goes on to ask me if I witnessed the CNA being rough with the patient. I stated that both the CNA and the patient were frustrated about the difficult transfer, but that I don't remember the CNA being rough. It is the honest to God truth. Again, it was such a hectic night, I can't even remember what exactly the CNA did that made me feel she could be more gentle. I just remember us both having a tough time with transferring the patient. The DON let me know that I had not done anything wrong, but the patient had complained that the CNA was rough with her. I take my job and my duty to protect my patients very seriously. I know that I would have intervened in and reported any behavior from the CNA that I felt was abusive or aggressive. The last thing I want to do is make a comment insinuating that the CNA was abusive when I don't even remember the entire encounter. My main priority is to be an advocate for my patients, but I also don't want to potentially cost someone their license, and possibly even their freedom over a speculation. Did I handle this situation right? Nurses, would you do anything differently? If so, what? I just don't want to feel like I failed my patient.