blue280

I am the manager of a Memory Care facility. I think I am burnt out. I have been on call 24/7 for the past 3 years. I have to cover night shifts if someone call off and its getting to the point that my health is suffering. We recently have had a change in leadership and I'm having a hard time supporting the new regime. I don't feel effective as a nurse and I'm sick of hearing all about what a "good leader" does. I'm nor sure if I even like nursing I want to find a way to get my passion back for patient care but I feel lost. Any suggestions

Wow, that's a new one that I haven't heard yet. Breaking down silos is big by me. Also the superlatives make me sick. Everyone is doing an AWESOME job

We have that problem by us also. Its ok to chart the residents actions as long as you chart what interventions that you put in place to try to reduce the behavior. If there are no interventions besides prn given, it may look like there was nothing done. Also, I'm not sure if I would chart any "possible" behaviors, only chart what actually happened

I agree, when I signed on to my management job, it was explainedthat I would be salaried. I carry a pager 24/7 and many times work weekends. Granted, I love what I do but the responsibility can be overwhelming at times

Hi Lexibear99, I find my residents LOVE to reminisce! Talk about anything from the past. Having babies and talks of weddings are popular. We have an activity dept that does alot with our residents. Many different kinds of crafts, knitting, ect. They also love to listen to music, we have muscians from the community come in and play. And every Saturday, they love to watch Lawrence Welk. As far as med lock up, I am in a large CBRF (114 residents) and we keep all the medication that we give in a locked room. Our state regs require any Scheduled II meds also be locked in a cabinet or a lock box that is permanently affiixed to a wall. Some of our residents keep control of their own medications and keep them in their room. I am the RN clinical health services coordinator (fancy name for nurse manager but nurse manager is too clinical sounding) I oversee a staff of about 45 people, nurses, caregivers ect. I wear a pager 24/7 and I absolutely love what I do! If I can help with any of your questions, just let me know

Hi, I am a nurse manager in a CBRF and we have approx 120 residents. during the week each nurse has about 30-35 residents to pass meds to but on the weekend they are responsible for around 60-70 BUT they have a med aide working with them. 60 by yourself seems like an awful lot!

Hi, asking the question to find out in your facilties, when a resident is on aricept and/or namenda and it is no longer giving the resident any benefit, do you taper the resident off or just quit cold turkey? Its a bif issue for us right now. One of our MD likes to pull both drugs and we see a HUGE difference in mental status/ physical decline. Any imput would be helpful! thanks

Congrats on sticking it out! I work in an ALF and I basically do the same thing, I never ask my staff to do anything I myself won't do. I have a wonderful boss and he is very supportive of the decisions I make. I think healthcare is a very hard field to be a manager in. You are dealing with staff and with the residents, family, doctors ect. Before I was a nurse, I worked as a group leader in a factory and I thought THAT was difficult! I really love what I do and your passion for what you do comes across well. Keep up the good work

Hi everyone! HAve not been onsite for quite a while but thats because I took a job as a clinical health services coordinator in a ALF!!! As you know, it can be very busy in these types of positions but I wouldn't trade it for the world. I manage 2 facilities, one is 16 beds and the other is >120. I would love to be able to talk with nurses in my situation. Most of my friends who are nurses just don't understand what I go thru. Regulation for ALF is SOOOOO murky. Well, hope to talk to some more of ya soon!

I used to work in a chemical factory and would get siver nitrate stains on my fingers and hands frequently. They usually wore off in a few days

Gosh, I feel bad. It's only taken me 5 years. My last 1.5 has been in hospice and it real just sucked the life out of me. Will take a job now with less pt care to see if that helps

Good timing on this thread! I had a pt yesterday with compartment syndrome of both calves. She was in the unit for a week, dx with rhabdo, 3bouts of dialysis. Labs are looking much better now. Big pain control issues! She has 2 facsiotomies on both legs, I never saw wounds like that! problem is, she has been in for opiate toxcitity in June and now her MD's are leery of prescribing too much for pain. Even with the facsiotomies she has, her legs are still very edamatous and she cries during dressing changes (which are Q4hrs) She has a fentynyl patch 75mcg and get oxycontin SR 20mg Q12hr. Any suggestions?

Is this strange! Just today I fanally told a co-worker that while I understand the stredd on the unit, whining and complaining about it just makes me feel worse. I told her from now on, if I can fix it then I'll try. otherwise all the bellyachin' in the world won't help and I know I can find more productive use of my time.

Today my homework from rounds was to find out from the MD why he did not order a psych consult on a ETOH withdrawal pt. MD was firm in his belief that the pt did not need a psych consult. My manager wanted me to report the conversation in writing (I guess she is following up on all the requests made in rounds) I suggested that she tells the docs that they should come to rounds. She said it wouldn't be convient for them! I told her that its not convienent for me to call them for things that could wait and I think it is irritating to them to get these kinds of calls. It definately is not fostering good MD/RN relations at this point. Now they are getting a new work group in to teach MD's how to write progress notes so they fit a pt's DRG. Guess who these docs are going to take their frustrations out on?

Just sat on a commitee at work cuz they want us to start this. None of us are comfortable but interventional radiology is always on hand to help. Its not a chest tube per se that we irrigate, there is a small catheter that is put in the pleural space with a stop cock attaches. You put in a small amt of saline and GENTLY aspirate out. If I have ANY questions, I'm on the phone with IR and they come up to do it.

In my hospital, we have OFT's (I'm not sure what that stands for) that RN's need to attend daily. The nurse manager, CNS, social worker, utilization review, PT/OT and dietary usually attends and sometimes other disciplines will be there too. We are to give a report on our pts, why they are there and what we can do to get them out the door. Sometimes it turns into an inquisition and it can really put the RN on the spot. These are held each day at 9am and if it is a pt you never had seen before its hard to answer the questionsif yu haven't had time to read the whole chart. Also it is held during our major 9:00 med pass. We've tried to get the timing changed but it doesn't work well for the other people who have to attend. Now to make matters worse, our manager gives us an assignment after rounds that needs to be done and verified by her before we leave for the day! Most of these are call the MD and find out why the patient is still here, or Call and find out why he did not order labs, consult ect. Our MD's are not pleased with being questioned and take their frustrations out on us and if we do not come back with the answer NM wants, she makes us call again. Does anyone else have systems like this and how are they handled? Any advice is greatly appreciated!

In our hospital we have a report line that the ER uses. When the ED RN finishes her report, she call the floor and lets the unit secretary knoe the report is on the line. The floor RN has 20-30 minutes to listen to report and get the room ready. ED is usually good about waiting until shift change is over but when a patien t does come up at shift change, the outgoing RN settles the patient, makes sure the patient is stable then leaves he rest for the next RN.

We do a written report but its not very consistent. Some RN's write sown all vital signs and labs even if they're normal. Others write sown social issues that aren't addressed in chart {pt is whiny and complaining about temp in room} but miss major medical issues. I try to write any abnormals, things that still need to be done, ect. I always will do a verbal on a new admit or a very involed pt.

The nasal vaccine is a LIVE virus and can live in your nasal passages for up to 2 weeks. Where I work, if you got this vaccine you couldn't come to work for three weeks and there was disciplinary action taken against you. The flu is going to spread faster this year because of this vaccine

I know I go against the majority, but most people in the hospital would like an easy way to identify the people taking care of them and color seems to be the easiest. Elderly people have poor eyesight and sometimes their memory is not so good. we have the NOD system where we work (Name, Occupation and what am i going to DO for you) and we are supposed to do this each and every time we have a patient encounter. It can be useful if everyone uses it but so far taht has not been the case

I'm soo excited! I'm going tomorrow for an interview at a hospital within walking distance of my house and it for FIRST SHIFT!!! I hope I remenber what its like to have a schedule like normal people! No more every weekend! I am keeping my fingers crossed that this comes thru for me, cuz I really need to leave all the politicall BS behind me. I know I'll run into it anywhere but mt manager seems to continually look in the other direction with this. I recently floated to another floor in the hospital and found their staffing matrix was very different than ours. He says he has no controll but the manager in the other dept says that she determines staffing needs. Hopefully the new facility I go to is more consistent. Thanks to all for all the support you've shown me, y'all rock!

this is why I love this bb, you guys are sooo wonderful. I couldn't ask for better support than what I received here. Thanks and much gratitude!

thanks, you know who I feel bad for? The 92 y/o crawling on the floor. I can't get her out of my mind. I just feel like I let her down. I really love my patients and this was one time I feel they didn't get what they deserved. I know I can't beat myself up about it but it really scares me how wrong things went and I had no control over it. I just want to be able to take good care of my pts and I feel that they didn't receive that last night. How do you get over that?

thanks for the hug! I actually have a transfer in the works. Should hear if it goes thru tomorrow and if it don't, I will look else where. Remember those signon bonuses that were offered? Still working mine off and if there is ANY advice I'd offer to new grads, it would be careful, they offer those bonuses for a reason! Also told my manager this morning that I had my liscense for 9 months and I WILL NOT lose it because of such poor staffing. There is an incident report on this also. He told me I was worried over nothing and I told him I hope I can take his reassurances to court with me. The RN who worked with me last night told me I was too sensitive and everyone has nights like this. I for one hope to never have one like that again and it worris me that she was so flip about it.

I just had the shift from hell! Worked 7p to 7:30a on Sunday to Monday. 14 pts on the floor, 2RNs 1 aide so we take 2 pts as total cares. Not to bad, right? pts with total hips replacements, both are 92 and confused as all heck. Can't get orders for restraints but the doctor will order haldol prn of course so its up to my dicrection and Lord knows, I better not overmedicate! Both are pulling at their IVs and foleys and when I call for mitts I'm told not to restrain at all just give more Haldol. My admit is a man who speaks only Spanish and the interpeter wnats to assess over the phone so she doesn't have to come in. My trach pt is spikiing a temp and needs suctioning every 1-2 hrs. Thank God for my total knee pt that only woke up once thru the night for pain meds! The pt next to her is a woman who found out her remission from CA is over and wants to talk. Last but not least is the pt who had "stomach pain" who is a frequent visitor to our floor. OK, I'm working my butt off but around 4am I think I just might gret out with only 1 hr of OT when "stomach pain" lady does her famous trick of "falling" I unfortunately was with one of the hip pt convincing her to leave her foley alone when I got called into her room. Shes on the floor and states she can't get up. Weighs around 300lbs so I call security for help. Guy comes up and states he won't help "with all these people sitting around on their a** eS. aides hear this and cop an attitude. All I want is t get her back to bed! While helping lift, somehow the patient turns, I twist my back and the pt pins me under her on the bed. While this is going on, my confused hip pt got out of bed, and attempted to go sit on a chair in her room. She was found crawling on the floor. Filled out incident reports for 2 hours after my shift ended. I hope this is as bad as it gets! Sorry so long but I just had to vent. Thanks for listening