SYDNEY

]Cameron I just got home from work. Some time in the wee hours of the morning, I sat outside and cried. Like you, I have almost 50 patients and two aides. I had two patients last night, on opposite ends of the building, who were reported to me as "dying, checking out, on their way." Thats been my "report" all week. - and every night this week there has been one portion or another or several of their care not being done on the shift prior to mine. - Continuity of care, provision of comfort measures..I think administering meds and i.v. fluids per d/o's fall under that, doesn't it? Except I come in to find pain meds not given, pumps shut off or i.v.'s never started. Upon reporting this I have been informed that I LOOK too hard for something to complain about, always trying to get someone in trouble. - It really isn't that difficult to "look" to see an i.v. pole at a person's bedside and wonder a.) why its there, because you weren't told about it in report, and b.) if its there, why isn't it running, and c.) if it isn't running, why does the chart say it is and has been for sometime? - and if I don't report it, then doesn't that make me an accomplise after the fact? But if I do report it then I'm a trouble maker. THIS is the cause/affect relation to the nursing shortage, the decline of the nurse's stature, and the pathetic pay rate we receive. Suddenly the job requirement for caring for the elderly and infirm is no more than a warm body with licensure. No need to embelish on that one to answer the frequent question of "why are so many choosing to put away their nursing licenses?". As for my two patients, they were still alive when I left. For their sakes, I hope they don't wait for me to come in tonight.

I once heard it said that we should load all the elderly up on buses and send them to the white house lawn, where they could proclaim VERY loudly, 'NOW, what are you going to do for US?" At the time, I laughed at the bizzarre image of my people rolling up to Pennsylvania Ave. Now I don't laugh about it so much anymore. I printed and read the web report posted, and the future doesn't sound much better. They keep referring to nurses as aging at a quick rate, and at first I thought, "geesh, there's a nice thought." Then realized that, oh, yeah, I'm not in my 20's or 30's anymore, myself. So as the nurses get older along with the rest of the population and the $$ gains of being a nurse continue to be on the lower list of professional jobs..yup, I can see the shortage. The report acknowledged something that I try not to acknowledge myself very often; the low perception/opinion of nurses working in LT. In thought of going into LT, my own parents have said take us out and shoot us first. The report went on to identify cause and effect that I can't say I ever thought of. "We" always blame the facility for being cheap..we know the cost per resident to stay there, should be loads of cash floating around, right? - Except the report better explained that although, yes, the general fee for residents seems high, if they are medicaid/medicare recipients (which most are), the government decides how much they are going to pay for that stay (hmm..sounds like an hmo to me!) - and when the money runs out, I know my facility eats the cost and the resident stays. - I did laugh at the average pay for nurses in LTC; I'm no where close to that range. In any event, referring to residents as witches or ridiculing their appearance, particularly in the work setting, is not only distasteful, and unprofessional, I would think that it borders on verbal abuse. If you can't depend on your DON to take action, what about the adm.? Suggest an inservice on proper work behaviors and abuse..that way they've been warned and if they don't get the message, they can get out. Does it do any good to contact our representatives? I know some have - and I know this bill is going up before Congress again soon. The concept of 15 or 20 residents to care for rather than 40..what a dream. Oh, here's that website with the report; I warn you, its 48 pages long!!! http://www.ahca.org/news/staff-02-2001.pdf

[The only way they got rid of the ring leader cna was when she beamed the don in the back of the head with a coke can! NO DOUBT? Hmm, and I thought working nights with less than 10 employees in house was a hazardous job! We had problems for awhile with the "them that do's being tired of the them that don'ts"..it really hurt the team because those doing would finally adopt the attitude of why the heck should I when so and so isn't and gets the same pay as I do? Coaching wore thin after awhile..I think they reached a point where even if they COULD visualize the resident as their own parent, their morale was so low that they probably would have told Mama to go jump in the lake, too. - and when we did the official write ups we got a lot of backlash for it..suddenly doctor's orders would appear stating so and so was on restriction from such activities or had to take a medical leave..can't fire someone off on workman's comp. - or we'd be accused of one form of prejudice or another against that person, race, sex, sexual orientation, socio-economic status, personal differences, disliking them for wearing two different colored socks to work..you name it. It turned into quite a three ring circus there for awhile, but for now those issues have been settled. The thing that got me the most was that it seemed like adm. quivered and caved to such nonsense that it was suddenly OUR fault that these things were happening. But this isn't just a CNA problem. We have the same issues with nurses and even supervisors. We have a supervisor who gets handed a list of honey do's, doesn't do them, and then comes to nocs saying, "if YOU don't do these things, we're BOTH going to get written up." Hmm..now, if law says we can't get them up in the middle of the night to give them a shower, which might help them actually fall asleep, what do you suppose the law would say about getting people out of bed to WEIGH them in the middle of the night?! Sometimes I feel caught in a no win situation..by reporting failure in job performance, I'm told I'm a trouble maker. But if I don't report it and a supervisor catches it, then I'm an accomplise. A routine task for nocs is to change out supplies, i.e. O2 tubing, septo syringes, etc. Evening shift's task is to change the dressing on the peg site. Normally I take the new septo to the room with me and put it away, use the old one for my feeding and then throw it away. So, if I go into a room and find a peg that either has no dressing or the same one from yesterday on, and a septo unopened with its protective cap still on the tip, survey says that resident hasn't been fed since my last feeding, right? Well, now, I don't know what the circumstances were..so and so swears she did feed that resident, and since I wasn't there, how do I know.... But then at the beginning of the next month when that resident's weight has dropped, guess what..we're ALL in trouble because we OBVIOUSLY haven't been feeding her correctly. I guess the point to all of this rambling isn't that its necessarily a CNA problem so much as it is human character and how management deals with it. I suppose they too get tired of complaints and b*tching. I try to remember that anyway, that I get tired of hearing the cna's gripe about the previous shift and what they did or didn't do and repeating the same old mantra that if you didn't do walk through I don't want to hear it.

Well, some are good nurses without being good leaders. It accomplishes nothing to demoralize your staff or make yourself their enemy. If you get down to it, in long term care, we're all "butt wipers", but there's a whole lot more that both nurses AND CNA's do while on the job. I work nights, and have a great deal of respect for the CNA's that I work with. It may be because they're an extraordinary group, or it may be because I started off in LTC in the laundry dept., moved my way up to CNA, and then went to nursing school. So I can appreciate the aspects of everyone's participation in providing good care. I'm usually the first in battle to defend my staff from others who say that nightshift does nothing. In addition to keeping residents clean, dry, moisture barrier inplace, turned, hydrated, etc. they also take out the dirty dishes and trash that the other shifts left in residents' rooms, and clean up the facility from the daily grime. One time dietary was complaining about all the dirty dishes nightshift was bringing down and leaving to be washed, so the DON gave us a "chat"..um, excuse me...dietary is closed in the middle of the night. - My staff is just cleaning up other shifts messes, not making them. I've at times stood outside a resident's room listening while a cna does her job. A common misconception is that residents sleep at night (LOL). I think the reason I love nightshift so much (but can't get through to my hubby) is that because its night time and no one else is there, we actually have more time to provide one on one and listen to what the residents are saying, and that makes them feel cared for. And on that note, its time for me to go to work!

Due to the lack of time while in-facility to sit down and explain rationals, I use my hobby (the computer) to put together mini-inservices for the cna's that I work with. I type up whatever issue needs addressed, the "right way" to do it, and the rationale behind doing it the right way. Some roll their eyes at me, but most thank me for the gentle reminder that keeps all of us on our toes. - They may not get CE credit for it, but its better than being cited by a preceptor for doing something you knew better than to do in the first place but just kinda short-cutted along the way.