flashpoint

I think there is a big difference in a resident referring to us as the "girls" and a coworker asking the charge nurse if I can have a "girl" take Mildred to the bathroom. I don't call them the "cleaning girls" or the "dish washing girl." I just feel like the CNAs on my team also deserve the respect of either their name or title. I am pretty tolerant of whatever the residents call us.

I initially posted this in LTC: Directors/Assistants...not paying attention like I should have been! I think I will get better response here. I was a dietary aide when I was in high school...way back in the late 80s. The facility I worked at had a lot of issues with various departments not getting along. The administrator had a "teambuilding expert" do an inservice on teamwork and respect. On of the things the expert said stuck with me and still bothers me. She said that no one on the staff should be referred to merely by their gender. She strongly suggested that we not refer to the maintenance staff as "the guys" or the nursing staff as "the girls." It honestly drives me crazy when someone approaches me and asks something like, "Where are your girls?" or "Can you get a girl to take Mildred potty (you probably don't want me to talk about how much I HATE the word "potty!"). Does it bother anyone else when CNAs and nurses are referred to as "girls" rather than by their name or title? I honestly don't ever remember anyone asking the housekeeping supervisor if one of her "girls" can mop a room after a spill. No one asks the dietary supervisor if her "girl" can take a coffee cart to a room for a family. Why do people think it is alright to call the nurses and CNAs "girls?"

I was a dietary aide when I was in high school...way back in the late 80s. The facility I worked at had a lot of issues with various departments not getting along. The administrator had a "teambuilding expert" do an inservice on teamwork and respect. On of the things the expert said stuck with me and still bothers me. She said that no one on the staff should be referred to merely by their gender. She strongly suggested that we not refer to the maintenance staff as "the guys" or the nursing staff as "the girls." It honestly drives me crazy when someone approaches me and asks something like, "Where are your girls?" or "Can you get a girl to take Mildred potty (you probably don't want me to talk about how much I HATE the word "potty!"). Does it bother anyone else when CNAs and nurses are referred to as "girls" rather than by their name or title? I honestly don't ever remember anyone asking the housekeeping supervisor if one of her "girls" can mop a room after a spill. No one asks the dietary supervisor if her "girl" can take a coffee cart to a room for a family. Why do people think it is alright to call the nurses and CNAs "girls?"

I have worked in several facilities and there is almost always a battle between housekeeping and nursing. I am always a little shocked when a housekeeper starts barking at me about which pain medication I need to give a resident or how they will try to stop a CNA in the hall to tell them that a resident has their call light on (as the CNA is walking toward that resident's room). The thing that gripes me the most right now is our recent organizational chart. The administrator is ranked at the top, then all department heads, then the charge nurses and every staff member except CNAs, and the CNAs are at the very bottom. So a charge nurse and a dietary aide have the same rank? A housekeeper and a charge nurse have the same authority? And EVERYONE outranks the CNAs? It wouldn't bother me if people didn't actually believe it. A few days ago, I asked a housekeeper to stop swearing in the dining room. She pulled a copy of the organizational chart off the wall and told me we are on the same level and that I had no right to tell her what to do. Our administrator just shrugged and went about his day.

We don't use because they are apparently too confusing. We specifically write "Hold for systolic blood pressure less than 100". It is a pain and takes up an incredible amount of space, but it is quite clear. Hope things improve for you soon! I admire anyone who can handle being a DON.

Just because something has already been discussed doesn't mean that there is nothing new to say or nothing new to add to the discussion. I can see the point about the PVT, but a lot of other topics can certainly be discussed more. I always find it odd that people will complain about an old thread being resurrected by someone adding their thoughts or questions, but the same people (not the OP here) will complains about a new post about something that has already been discussed. AN is HUGE and there is no way to make everyone happy. Just ignore the posts that don't interest you.

We had a survey team in our facility yesterday. They were there on a complaint that was unfounded (yay!). One of the people on the survey team looked awful. She admitted that she was not feeling well and wore a mask. She wore her mask just below her nose, so it just covered her mouth. Every time she talked to someone, she lowered the mask and when she went into resident rooms, she took it off completely. A part of me wanted to ask her to wear the mask properly. The DON also considered asking her about it, but the administrator told her not to, so the DON told me to leave it alone. Seems crazy that we would allow someone to potentially infect our residents because she is a state surveyor.

It really isn't a picnic for me either. When I was hired, I was told it would be temporary...only a few weeks. The few weeks turned in to more than eight months, but I did it because I had the least seniority and the hours needed filled. The new nurse agrees to it when she was hired, did it a few times, and decided it was too hard.

I am always a bit confused when anyone went through a nursing program and seems to think they won't end up working weekends and holidays. Really? Do they think the residents are only there Monday through Friday? I have to admit, I am seeing similar trends in several new employees, not just new grads. When I was hired, I was told that I would be doing day shift, every other weekend, an occasional evening or night, and a "fair" amount of holidays. I have worked every other weekend on the evening shift for eight months. The new nurse they hired was supposed to take over my evenings and I was supposed to do the day shift on the same weekend. She decided it is too hard to flip from days to evenings and complained to the right people, so I am back on the evenings. She has been a nurse since before I was born, so she certainly isn't newly licensed. I think the people who are willing to do whatever is needed to maintain their hours and safe and adequate staffing are becoming more few and far between. I sit in on interviews and am often surprised at the people who have to work a certain weekend, can't stay past their shift ever for any reason, or who are demanding wages far beyond their experience.

We do the Date Time # on hand # removed-route # left on hand Signature thing every time a med is removed. That isn't what I am talking about. Our consultant wants us to do Date Time # left on hand Signature / SIgnature at the end of every shift to verify count. Both nurses will have to sign to verify that the count is correct. I have done this in another facility and it takes so much time. I would like to see an actual regulation or evidence based practice that says this is the best way to do it.

I am my facility's infection control and prevention nurse. During our recent corporate survey, we got nailed for poor compliance with hand washing and use of gloves. My DON and administrator want me to come up with some ideas to increase compliance. My first thought is simply to try to put the "fear of God" in everyone. A few years ago, a friend of mine spent over 100 days in the hospital after she got an infection when a nurse scratched her while helping her move up in bed. She ended up with a surgical debridement, a wound vac, and weeks of IV antibiotics. She has gross, ugly, and painful scars on her upper arm. She would love to tell her story to our staff. I hate the idea of "Ask Me if I Washed My Hands" buttons. I dread the idea of scripting. I don't want to burden anyone by asking them to be a "Secret Shopper" hand washing compliance monitor. I know from experience that the people I work with would make a mockery and cheat if we did something like rewarding staff that wash their hands with candy or whatever. I know the issue certainly isn't limited to my facility. Hand washing compliance is poor in many LTCs, hospitals, and clinics.

We don't get gifts, but they do a lunch. Instead of gifts, they give us a bonus at the end of the year. I had been there for two months when the bonuses were given last year and it was over $100. People who had been there for several years got way more than that!

We don't have a paper MAR, just a paper narcotic sign-out and count book. The last place I worked had us sign each page at the end of the shift. We were supposed to do it with the oncoming nurse and both of us sign as we counted. It didn't work because it took more than forty minutes and that was on a good day. I really hope the DON stands up to the consultant and we keep doing what we are doing. I think she will. It is frustrating that we deal with a problem or potential problem by taking extreme measures. It reminds me of the meme where someone burns down a house to kill a spider. :-)

It is a nurse consultant. Our pharmacy consultant says that our current policy is fine. I am pretty big on asking to see the regulation when there is a change in policy that causes more work. The DON asked to see the regulation and the consultant just looked at her the way I look at my kids when they asked questions like why dogs bark instead of mooing or meowing. I do know that a lot of facilities in my area do the sign every page thing. I want to know why and I want to see the documentation that says we have to.

I am on call for disasters. However, short staffing is not a disaster. They ended up with three CNAs showing up at 0400. I am a bit speechless at the charge nurse's tactics to ensure staffing. I feel bad for the people who didn't know that she really can't get someone in trouble for not coming in on a day off. The DON was mad, especially since no one was sent home when three people showed up to cover for one.

Currently, my facility has one page for each bubble pack. When we give a narcotic, we sign our name, date, time, the current number of tablets (patches, vials, etc.), the number we are taking, and the number remaining. At shift change we sign one for saying that we counted all of the controlled substances and that the count is correct. In the few months I have been there, there has not been a discrepancy. Policy states that if there is a discrepancy, we don't sign, notify the DON, and she investigates. In the six years that she has been the DON, she has always found a logical explanation for each discrepancy. Our nurse consultant wants us to sign each individual page at every shift change to verify that the count is correct. We would also need to write in the date, time, and correct number of tablets or whatever. I tried it today and it took over 20 minutes. When they are concerned about overtime and the system we are currently using works, making a lot of changes doesn't seem to make sense. How do you do it?

I work at a small LTC. We have exactly enough staff to get the job done...when we are short staffed, things can get pretty stressful. Last night one of the CNAs on duty got a phone call saying her father was being taken to the hospital and was in critical condition. She needed to leave right away. The night charge nurse made phone calls trying to find a replacement. The first call on my voice mail simply explained the situation and asked if I could come in to cover. The second phone call informed me that "If I don't hear from you, I will see you at 4:00. If I don't see you at 4:00, we will consider it an unexcused absence." I know things are pretty desperate when they are calling nurses to cover a CNA position, but wow! I just ignored it...especially since I didn't even wake up until 8:00 AM. I have had four calls from CNAs asking if she was going to get away with her threats and if I knew what they needed to do. I told them to enjoy their day off and that I would talk to the DON on Monday. I have a feeling that the DON is going to have a line of people waiting to talk to her when she arrives Monday morning!

LOL...I was once written up for buttering a patient's toast wrong. I didn't spread the butter clear to the edge of the bread. She felt that I was "juvenilizing" by leaving a dry edge. She cried that I didn't think she could eat without having sticky and greasy fingers. I had to go in and demonstrate for the DON that I could spread butter to the edge of the toast. I had to repeat the process six months later to show that I still knew how to butter toast. It is sometimes hard to know what to document in LTC. If you hadn't documented about the nightmare and the resident talked about it hte next day, you might have been in trouble for not documenting. Hang in there!

We color code our cards according to which med pass we are giving them. We use one card per drug no matter how many times it is given during the day. We pull ours our completely. our drawers are so long that I don't think most of us could reach clear to the back to pop the pill while leaving the card in place. The color coding speeds things up quite a bit.

The things the OP listed make sense. They are not allergies, but might be reasons patients don't want to take the drug. I am not allergic to Cipro. But, Cipro causes severe abdominal pain. I throw up and have diarrhea to the point that I am just expelling mucus. My temperature goes up and I get extremely dizzy, to the point that I cannot walk. I also hallucinate. It is not an allergy, but I would not take Cipro unless it was a life or death situation. The last time I took Cipro was at work. Everyone who took care of a certain patient got a prescription because of whatever he had. My reaction was witnessed by coworkers and a doctor. The doctor turned it in to MedWatch.

We had a resident who seemed as nice as anyone could be. She was patient and kind. She would try to help other residents by pushing their wheelchairs, getting them coffee, and other things like that. No one could understand why her daughter never came to visit. I met her daughter after I left the facility and when she heard that I had worked there, she told me the reason she never visited. Her mother never married. She was a single mom at a time when it was very unacceptable to be a single mom. Her mother liked to go out for supper and then to the bar. She brought different men home from the bar and when she was not in the mood for sex, she allowed the men to have sex with her daughter. The daughter said she was forced to have sex and lost her virginity at age 13. She was "an expert at oral sex" by age 14. She claims that she had gonorrhea when she was a freshman in high school. I don't know if what she says is true, but if it is, I can see why she never visits.

I work with a CNA that thinks everyone should make the same wage, have the same size home, wear the same clothing, eat the same food, etc. She read Agenda 21 by Glenn Beck and thinks it is a good idea. She even wrote a letter to corporate asking that they revise the wage scale so that everyone makes the same money. Another CNA draws out her vowels when she speaks. "Flaaashpooooiiiint, Maaary waaaants graaaaape juuuice." She also checks the placement sheet fifteen or twenty times during a shift. When she gets bored with something, she just stops. She will call for help when getting someone dressed and just leave when help arrives. She will pass water to half of her hall and then just stop and move on to something like checking the placement sheet. :-) The most crazy that I can remember was a CNA named David. He was an awesome CNA. One day he didn't show up for work. He had been pulled over for speeding or something like that and they found that he had escaped from prison in Arizona (I think it was Arizona).

Things like television, Internet, and food are important. If I am already stressed, television or Facebook might be a good distraction. But, we need to find a way for nursing staff not to take a hit when things like cable television are not up to par. Nurses are not responsible when patients don't like their clear liquid diet. Nurses should not take the blame when a patient gets tortilla soup instead of the chicken breast that they requested. The last HCAHPS survey I saw didn't even address food, which is one of the biggest complaints that I remember when I was in charge of tracking survey results. In LTC, we get very similar complaints. We recently had a resident complain to management because it was too cloudy for her to see the "pink moon" and the nures would not help her. Another resident was mad because the vending machine was out of Milky Ways and no one could leave to go get her one (not that there is anything open at 0200). We got complaints about the fireworks being cheap and boring last night. Things above and beyond actual nursing care are important, but nurses cannot take responsibility for everything. Blame should fall where blame lies.

I survived Statistics only because I took it online. Our instructor encouraged us to "use technology" to pass the class. I built an Excel program to solve the problems. All I had to do was plug the numbers into the formulas that I wrote and Excel did the work for me. My instructor asked me for a copy of my Excel program and told me it was "brilliant." I lost some points for not showing my work, but I passed overall.

Double masks because of an odor? Seems kind of mean to me. I don't like the smells either, but I don't think I would humiliate a resident by masking because of it. But I am old and still remember when we were told it was humiliating to wear gloves when changing a colostomy.