we_rn

Would I work ot at straight time...no.

I have worked in long term care most of my nursing career. It can be rewarding just as any other type of nursing can be. My advice it to try it before you buy it. Which means go in as pool or agency first before you take a full time job. Long term care is not for every one. You must work with impaired residents, their families and nursing assistants. The documentation is much different than in the acute care setting and staffing can be a challenge. The most important thing to know is that not all long term care facilities are created equal. A few are great, to many are dumps and the rest fall somewhere in between. The quality and commitement of the administration and staff is key and all to often this is lacking. The financial situation of the facility is also important to look at. Hate to say it but the more full fee residents a facility has the better the care and resourses. Things go down hill once a facility has to depend on medicaid for most of their funding. This is not the fault of the residents covered by medicaid. Medicaid does not reimberse well and you get what you pay for.

I have posted on the subject before. Much of the problems with bad CNAs are that they are bad employees. Unfortunately it is to often the case that the administration of the facilities we work for does nothing to get rid of bad employees. Further licensed nurses do not know what to do when faced with a bad employee. Union or not one does not have to tolerate substandard job performance. Training of the care staff is key but training of the licensed staff on how to deal with bad employees is also important. Nurses are not trained to handle staff issues. We are trained to care for patients and residents. Staff discipline is often done in a trial and error fashion. This is not good for all concerned and adds to the stress of working. Licensed nurses need to be proactive with this issue. I would like to see this issue tied to retention of licensed staff. There is a shortage of LPNs and RNs. If a facility wants to keep their licensed staff they should be willing to back them up when it comes to CNAs who under perform. This would greatly improve working conditions for licensed staff. I work in a facility where the CNAs are under control and do their jobs. The bad ones do not last long in this facility. It is a pleasure to work here. Less stress, less complaints from residents and their families. No nasty attitude from staff. The facility I work for wants to keep staff turn over low. It is expensive to hire and train new staff. The more education an employee has the more money spent. No need to say who cost more to hire and train. This is something that should be brought up at your next meeting with administration. If the licensed staff at your facility does not meet with administration you should start. Start on your units. Meet with your nurse manager and as a group unite to push for better care on your floor. This includes all shifts. In nursing homes where the licensed staff does not stick together the CNAs take advantage of this lack of unity by playing one nurse against the other. It does not have to be this way. Licensed nurse should be fair and consistent with staff. One set of guidelines should be used and used consistently for every on, every time every shift. Know what is in your job description ant that of the care nurses. Keep it on hand to refer to should a problem come up. You should ask for training in employee relations. We get in serviced on everything else why not this. If you have a human resources department where you work they have a great deal of information on this subject since this is what they do. Know your chain of command; know what to do and who to report to when a problem arises before the problem arises.

All due respects most CNAs do not act this way. I was a aide and I certainly did not act the way this person is acting. I know first hand how difficult the job of an aide is. The person in question is just a bad employee. There is no need to undergo self analysis to figure out this aide's problem. The aide is responsible for her own job and how she conducts herself on the job. I hold aides to a high standard since they have to most impact on the quality of life for the residents they care for. Aides also have to accept the fact that they have the least training and skills and are thus low man on the totum poll and has to follow a chain of command which includes the licenced nurses she workes directly with. To bad if she has a problem with this. When I have a problem with an aide like this I tell them to earn their credentials just like I did. Only when we are carrying the same level of responsibility can we address each others as equals. What this aide is doing is trying to control the unit to her advantage. She is showing a lack of respect to the licences nurse who is responisble for the conduct of the unit during her shift. This cannot continue and should be addressed sooner rather than later.

I have worked many years in long-term care as staff and as a supervisor and have run into my share of trolls. Do your self a favor. When interviewing for a job in long-term care ask about the staff and how disciplinary problems are handled. Know up front if a disruptive employee can be escorted out to the building by security or the police if they will not leave voluntarily. I have done both. Know who to call off shift should a problem arise. If you don't like the answers you get at interview don't take the job. You do not have to work with lazy aides with bad attitudes. It is not impossible to fire a union employee. Know what is in the union contract or how to proceed if there is a problem. Know upfront if you will be backed up by administration. You will find out very quickly during orientation if that is the case. If you are not backed up then you will have a hard time getting rid of a bad employee. If you are backed up then most of the time you will be asked to send the person home pending investigation. Learn the correct way to document disciplinary problems. Most nurses do not know how and when to do this right and end up making matters worse. If it is a union matter then a shop steward must be present. You have to have the correct documentation and a strong gut because you are in for a long fight. Bad employees will fight for their jobs and will sue for unemployment benefits so your documentation has to be good enough to stand up in court. Bad employees will play every card imaginable to keep their job. I have been accused of sexism, ageism and racism during discipline sessions. Have a second licensed nurse with you when you discipline an employee. If no other licensed nurse is available then a manager from another department will do. You need a witness for support and to back up your version of events. However if you handle the situation right you will get a reputation for someone not to be messed with and your staff will fall in line. There is always a leader and that is the person you want to identify and go after. The rest will fold after the leader is put in their place or fired. Remember aides do not make much money and need their jobs. Most live from paycheck to pay check and cannot afford a protracted job search once they are fired. Quite a few work more than one job as well as overtime and thus are trying to pace themselves by not working any harder than they have to. That is not your problem. If bad aides can intimidate a charge nurse into letting them slide then so much the better. You do not get paid to do their work; you have enough of your own. You are also there to care for the residents and not act a social service agency for aides with problems. Remember if an aide is verbally abusive to you just imagine what they are doing behind close doors with the residents.

I work the 7p-7a shifts every Saturday and Sunday in long term care. You could not pay me any amount of money to work any other shift. I have not had problems with mixing up words. But then I am only up over night two days per week. Regardless, some one has to be there for the patients. If nights are not your thing don't work them. If you have no choice then try to work with your nursing administration to make this an easier experience. They may have to rethink how schedules are arranged or pay a staff dedicated to working nights more money. That is what my facility does. Further, getting good sleep during the day is key and suggestions about how to do this have been posted on this board in the past. It is up to you to control your environment at home. While working nights can be difficult for some it is not impossible to adjust. You just have to be proactive about it.

Wow thanks for the offer I may take you up on that when we are closer to making the move. I will check on the net for imfo on the two cities you mentioned and maybe arrange for a visit. Again thanks much.

Thanks for all of the information on Canada. I will contact the nursing board re. taking the licencing exams needed to practice. Husband and I plan a visit to Toronto this summer. Moving to a new country is a challenge but we are looking forward to it. Thanks again.

Husband and I are interested in living somewhere near a large university. Husband is a retired academic. We both love the stimulation of being near an academic setting. We also are interested in living in as diverse a location as possible. We love the arts and culture and are very much a couple of book worms.

Husband and I are interested in moving to Canada. Any nurses on the Board who live there and could tell me what nursing in like in Canada and what if any opportunities are available? I am an RN with over twenty years of experience. Prefer Long Term care but am experienced in many areas.

This falls in the catagory of, "Ya gotta do what Ya gotta do" If this is what ya gotta do to acheive your goal then do it. Will it be easy? No. If you do not have early classes on Monday then I would suggest working 3p to 7am, the work loads are not as bad and you may be able to get a little school work done. I worked my way through nursing school by working 16 hour weekends and working as many shifts as I could get during the summer and breaks. You can get through it. Good luck.

I have already posted several times about the advantages of working the Baylor System. I love it. Just a word of caution, a 12-hour shift is a long one so do not expect to get much else done during the weekends that you are working them. It should be a work and rest time, that way you can perform well on the job. Get your supports in place to help with the kids on the weekend; housework, errands et al should get done during the week when your off if not delegate!!!!. That is key. You can get your uniforms and work supplies ready during the week also. If you are working 7a-7p chill out Friday evening before you start have your work stuff assembled and ready to go and then do something nice for you. Rest. That Saturday evening after your shift is a great time to go to a movie or do something low stress with the family then get to bed. Your Sunday's will go a lot better If you work 7p-7a like I do then chill out Saturday AM and try to catch a nap before you go to work. Again having your work stuff together makes getting ready a lot easier. After your shift in the AM, go to bed and sleep as long as you can, I generally get 6 to7 1/2 hours. My family is supportive so all I have to do is sleep in on the weekends that I work. When I get up I chill out and pamper myself with a long hot bath, facial and time on the couch in front of the TV or on the phone with my girlfriends. I return to work refreshed knowing that half of my workweek is behind me and the other half is just about to be completed. Monday morning I go home, go to bed and then like to go out to a movie or something with my husband. By Tuesday I am ready to enjoy my week off. I would also advise against working too many extra shifts during the week, as many Baylor nurses tend to do. One shift only is what I would recommend and I would work it as agency and not as pool since the rate of pay is higher and worth the time that you are giving up. Working at your own facility to cover call outs and vacations may not be worth your while either even though supervisors and staffing coordinators will beg and beg. Remember they are trying to staff the place as cheaply as possible, you on the other hand should be trying to get the highest rate of compensation for the time that you are taking away from your family.

My attitude is this; you walk into a hospital or nursing home you deal with the staff there. As nurse I have had to switch assignments with male nurses because some woman, usually old, or her family did not want a male nurse taking care of her. It was a pain in the neck every time I had to do this. You would be in the middle of your assignment and have to switch because some one was uncomfortable with a man. Please. Now it was OK for the old girl to have a male doctor all up under her clothes to examine her but not a nurse caring for her. Personal care was being delivered by nursing assistants so a male was not likely to be bathing the patient in question. The patient and their family would always explain that they were just uncomfortable having a man caring for them or their mother and I would say something to the effect that the nurse was more that competent to do their job and would not be working here if they weren't. That would usually result in a response such as "Oh I guess the two of you are friends?" To which I would reply yes and I am proud to be working with him, we're a team. As far as the racist in question how far do we go giving in to this nonsense? The fool does not see who is cooking the meals in the facility, processing the billing, cleaning the equipment or the thousand of other jobs that go into delivering health care. This insult was directed at the staff he could see the most highly trained staff by the way. The hospital knows this which is why they are doing what they are doing to make things right. These doctors and nurses can get jobs elsewhere. Racism is a business liability no one needs.

Not all LTC facilities are like the one you visited. Before walk into a interview at a LTC you should do a little research at the place. Much like a family would who is about to place their family member. There is a great deal of information on the Internet about each facilities current and past survey results. I think you did the smart thing by spending a day shadowing a nurse to see what it is like at "ground zero". A try it before you buy it approach to a job search is smart and may improve retention. I have found that most corporate owned and family owned facilities are not very good to work for and the staff is exploited. Those run by religious or fraternal organizations and the like are much better. Also because many of theses facilities are small benefits and compensation are not as good as that you would receive at a larger company. It is all a trade off. The problem with ancillary staff, and by this I mean nursing assistants, is that they have to be well screened before hire and closely supervised after. If licensed nursing is swamped with work this cannot happen. If nursing administration fails to back up a licensed nurse who reports sub-standard care by an aid and fails to take disciplinary action then the aids get the attitude that substandard care is acceptable and get the attitude that nothing will happen to them. This makes for a very difficult working situation on the floor. I learned a lot of this stuff through trial and error but did succeed in finding a job in long term care that I like and hope to continue at.

Now that is what I call team work. For those nurses who do not want nursing assistants looking at the patient chart give them report. They have just as much right to know what they are walking into as you do and want to be informed of any exposure risk just as you would want to. Why does nursing always have to pull against each other.