violetrose

Thanks to all who replied to my issue, update: I'm retiring - I'll work part-time but not in the same position. I'll be looking for something less stressfull. Thanks again, for all your replies it really help me make my decision what to do.

"]I've worked at this facility for 13 + years, been ADON/Charge Nurse for 5 years. I do 80% of all MD calls, orders, admissions, resident concerns, staff concerns, end of the month MARS/TARS prepare for MD rounds and what ever else the DON wants me to do. Usually work a 10-12o day 5 days/week of course I'm salaried. The DON is very particular and wants everything perfect, so if she finds an error she writes me up. Very little ever gets by her, shes at the facility all the time it's her life. This week I was suspended because of an error, 3rd non were life threatening. The she informed me one more means termination. I'm tired of this job, tired of her on my back all the time. I'm 65 yr old looking to retire next year, hope to work a little PT, to supplement my income. I don't want my nursing record to show I was terminated. I feel like I'm sitting on a time bomb, I can retire now, but it would be a problem financially. Does anyone have advise to give me?? Do you think they are seeing something I'm not, why am I feeling so violated? [/size]

As RN, chg nurse I do much of the reporting to the MD's on the day shift I generally fax the chg of condition or updates to the MD, and wait for his response, if no response by the end of my shift I call the MD. I always call on anything I need an immediate response to, and then have to wait for him to call back, sometimes hours. My concern is our nurse consultant have informed us we are not to fax to the MD anything that needs a response. Basically NO FAXING, apparently a NH got into trouble when a faxed COC was sent and the MD didn't respond. The COC was considered not reported (did the MD recieve the fax? or maybe he didn't feel it was important to call back.) Apparently there was no follow up charting that the MD called back, only charting that the report was faxed. We don't have a NP or PA we can call for orders eg: laxatives, report non critical things, wound care chg's and day to day updates. Does anyone have a simular concern with faxing?

I am a RN nurse manager/ADON I have been informed that LPNs can not assess a resident condition or change of condition, it must be done by an RN. However, if the lpn does assess a chg of condition and if the RN agree's with the assessment and willing to co-sign that is satisfactory. This can be risky for the RN, if she doesn't reassess the resident. So, the point is what can an LPN do these days. We have some great LPN'S do good assessments, we have RN's that do terrible assessment. 50% of our nurses are LPN's, only LPN's on the dementia unit. This seems like another responsibilty for the RNs, to cover. We always have a RN and LPN working each shift except noc's. Is charting, wound care an assessment? What about lung sounds etc? Does anyone have the same concerns?? I have learned the the state surveyers are handing out (IJ's) like candy and this is one of the things they are looking at, so god help us if they find an issue where an lpn assessed and not an RN. Your thoughts, maybe i'm getting paranoid or reading into this;

So,so, True, I Work In Ltc, Frequently Get An Order For W-d Drsng. I Have To Call The Md To Clarify And Explain. A Wet To Moist Drsng Is An Exceptable Treatment.

i'M A ADON, I'M SALARIED. I DO ALL MD CALLS UPDATES, ADMISSIONS, FAMILY CONCERNS, PT/OT/ST ORDERS/RECOMMENDATIONS/DIETARY RECOMMENDATIONS, ASSIST ON THE FLOOR AS NEEDED. ++++ WORK APPROX 50-60HRS A WEEK. DON IS CONSTANTLY ASKING ME TO DO THIS, DO THAT, DID YOU DO THAT YET!! DRIVES ME CRAZY. I'M 63YRS OLD CAN'T WAIT FOR RETIREMENT, I'D RETIRE TODAY IF IT WEREN'T FOR HEALTH INSURANCE. NEEDED TO VENT!! THANKS FOR LISTENING:angryfire :trout:

We get lots of heat when we work overtime, frequently admissions come in after lunch it is difficult for that shift nurse to even start the assessment. A quick admission note is all they can do,sometimes. Our day to day work load is terrible and our aquity is so high, now we have a new admisson or someone becomes acutely ill this throws a wrench in getting out on time. So, we have been told to give to the next shift, but depending on who on, it just comes back the next day. We also have a lot of part time day/pm nurses, they come in 1-2 days then off for 4-5 days. When they come in it takes a while for them to get organized, takes longer to pass there meds and little follow through. We have 60 resident two nurses and the ADON which helps us alot, but she has her own responsibilitys.

I agree, catch-all job. My job title was charge nurse, I do all MD calls, orders, charting, family updates, admissions, discharges etc, etc. It involved working 10 - 12o/day. The admin, didn't like paying me the overtime but no matter what I tried to do to cut down my overtime it didn't work. Multi phone calls, MD's, families and interruption continued. The admin decided to salary me and give me the title of ADON. Now I can work 60 hrs/week and get paid the same amt, which stinks. I just can't leave my work for the next day, orders have to be written etc. I love my job, but resent the fact I am not paid for the overtime I put in. I get very little help or sympathy from the DON or admin, all day long it's do this, did you do this do, do, do!!!. Just venting, anyone have the same situation.

We have a shower aid, she gives the showers starts at 5:30am, does weekly BP, weights, nails, monitors changes in skin condition. Documents all the above. Helps with bkft and feeding. Usually done with this by 11:00AM, then helps in the dining room. This position is very valuable, I've worked at places where the CNA did the showers, no consistancy, sometimes the showers were missed for weeks at a time, nails not done etc. As far as getting a resident up in the middle of the night that is a terrible practice, should be stopped.

I'm a charge nurse in LTC, I make most of the MD calls and orders, do MD rounds monthly plus many other tasks. I have an issue with interrupting the nurses while doing there med pass, so when I have to put these orders in the MAR it is very difficult to do without interruping them. I sometimes delegate the orders for the nurse to put in, but consequently if they don't do it or if it isn't put in correctly, (the old card not pulled, marked changed, ordered from the pharm etc.), the DON tells me it's my fault, my error because I am responsible to put all orders I write in the MAR including all the above. I work anywhere from 10 - 12+ hrs/day (I'm salaried) don't get paid overtime:angryfire I feel I should be able to delegate this to the unit nurse or other misc. tasks, it should not be my error if not done right. Any comments about interuptions during med pass. Our AM med pass takes at least 2 hrs PM med pass about 1 1/2 hrs. less staff and lots of behaviors due to sundowning.

In our facility propective residents are screened very carefully, we don't accept them if they have combative or disruptive behavior. We were sited big time by the state when we had a resident transfered from our Alzheimers Unit to the SNF because he was nolonger appropriate for that unit due to his decline. He became disruptive, threatened other residents and staff, actually didn't hit anyone, but did shake his fists made foul sexual comments. So we are very careful now!! These people with alzheimers/dementia/mental illness fall through the cracks, no one wants them, we can't find placement in LTC geriactic Psych units. We have had residents that when there disease advanced and developed inappropriate behaviors, there is no place to transfer them to, so now what do we do with them??? The bottom line is we have to train front line staff as how to deal with difficult behaviors, psych evals, medicate appropriately, offer deversional activity, get family involved if they will and document. It's a problem we need more advanced LTC alzheimers/mental Ilness units that aren't so restricted by the states/feds and trained appropriately. These are human beings with a a terrible disease and no one seems to want them or care for them.

After you have exhausted all suggestions and you still have problems. This is dementia care, sundowning is symtom of the disease. 1:1, oh sure on LTC staffing, interventions, activities helpful but lasts only a little while do to the poor attenion span/short term memory. We try to keep the worst of them on the unit to keep tabs on them, some motor around and get into trouble with other residents. We have a resident that after 4:00pm she starts to chant "vita, vita over and over, another paces, another wants to go home and trys to leave, setting the alarms off it's a zoo!! It's like night and day between the AM and PM shift. My advise is have lots of patience, keep your cool. Suggest a inservice or class on dementia care may be helpful. Hang in there!!

Monica::rotfl: I am having the same problem with NO OVERTIME!! I'm a chg nurse in a 78 bed facility. I do all the MD calls, updates ect. I try to get my faxes out if the fax machine works or calls by 10AM. Invarabily the Docs don't call back until 4:00pm or later. Now I take the orders, have to chart and do them put everything were it belongs and order the meds. I'm overtime!! What to I do?? My DON says to pass it along to the next shift, but I took the orders, some nurses will not do them or will they do them correctly. Either they don't get done until the next day which is not legal, I'm stuck!! Besides it the trickle down effect, then they are overtime doing my work. I don't have a lot of control over my day, it's never the same. I also do admissions, most of the time they come late afternoon. Now what, no overtime, an admission from start to finish takes about 3-4hrs if I do the Care Plan and orders are correct on the PPOC, I don't have to clarify to many of them with the MD. My day is so stressfull, I have families, residents in my office to chat or address concerns, answer call lights, do all the MD rounds usually the first two weeks of the month. Help the other nurses with assessments and the DON with all her overwhelming jobs. She is excellent willing to help where ever she can if able. I'm an older nurse, not quite retirement but close, I would hate to end my career by my licence being suspended or taken away for failure to be a my work properly and correctly eg: Negligence I would even work off the clock but our administrator says that would be deciplinary action. I don't know what they expect, do 12hrs work in 8hrs but don't make a mistake!! Hurry, Hurry, Hurry I've worked in LTC for 25yrs, this is the worse it's been, the resident are sicker, we have many difficult dementia residents with behaviors. I'm just rambling now. These are my thoughts, NO OVERTIME!!! Gail: angryfire

I agree don't wake resident up at night except for repostioning and incont care which are essential. Treatments a NO,NO!! If I have a TID treatment we do the night treatment at the time of repositioning. ***I have a concern related to starting med pass at 6:00am, our pharm mandated that we give everyone on Prilosec or Thyroid medications before meals and on empty stomach. Our bkft meal is served at 7:00AM. In order to comply we felt it better to start at 6:00am and TRY to administer just these meds. We looked at other times but most of our resident don't have an *empty stomach because of the supplements and snacks given throughout the day and evening. WE HAVE GIVEN THESE MEDICATIONS FOR YEARS AT MEALTIMES WITH OUR GENERAL MED PASSES, WHAT IS THIS!! ARE WE GOING TO HAVE TO PASS MEDICATION ALL DAY LONG, WHAT ABOUT TREATMENTS, CHARTING ETC. THIS IS GETTING CRAZY!!

I have your sympathy, I'm also a "Charge Nurse, Unit coordinator, Patient care coordinator, babysitter, ADON (don't have the title). My day starts at 8:00AM-4:30-5:30-6:30 sometimes 7:30PM. I am so so tired of being dumped on, by all the other nurses, administrator, DON, SS, therapies and dietary. It seems everything comes to my little office (closet) is what it use to be. Family and friends of resident expect me to give them all the answers as well as other staff. I reluctantly took on this job after the previous "charge nurse" burned out and went to acute care after 25 yrs of service she was charge for 10 of those years. Here I am in the same boat as she except we lost a excellant RN, and have not replaced her, so I have no backup. I do it all. We have usually a LPN & Med Tech or Nurse Tech on the day shift and me the only RN. Have average of 60-65 residents plus 6-10 on the special care unit Alizhemiers, which has either an LPN, or part-time RN. Neither know how to put an admission it the computer and are always looking to me for answers. I don't know how long I can hang in either. I have 5 yrs til retirement, I hope I can make to then, I really don't want to start over somewhere else. Just to let you know YOUR NOT ALONE!!