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.

You know something we all go around and around with this C.N.A issue and it never seems to be solved. Having been a C.N.A. myself I have a little more sympathy for their job and see things from both side. The rift between the nursing assistant and the licensed nurse if born of both parties not understanding the other's job. Neither one can care for residents in Long Term Care with out the other. Nursing assistants are not indentured servants who are there to serve at the pleasure of licensed nurses; they are there to care for the residents who live at the facility. Nursing assistants have the closest contact with the residents on a given unit and are expected to report changes in the resident's condition to licensed nurses. Good nursing assistants take ownership of their unit and their job and to a certain extent the residents they care for. There are many things a nursing assistant can tell a licensed nurse about a resident because they are there to see it. We often fail to listen to them and discount their opinions because they do not have the same level of education that licensed nurses do. This has always struck me as strange since the same observations coming from the resident's family would elicit a much different response. Licensed nurses are all too often guilty of elitism when it comes to their relationship with nursing assistants. True the nursing assistant is the least educated and lowest paid of the staff caring for our elders but that is a function of how the health care industry is set up. Ask your self this question. Would you, with the amount of training that you have invested in your self, work for what nursing assistants are paid? I didn't think so. While each of us can do the job of a nursing assistant would we want to in addition to everything else we do to care for our residents? I didn't think so. So it is in the best interest of licensed nurses to work with nursing assistants instead of looking down our collective noses at them because they have less training and all to often come from a different socio-economic group that most licensed nurses come from. On the other side, nursing assistants have to understand that licensed are responsible for the action of the nursing assistant and for the overall planning and implementation of care for every resident living on the units licensed cover. Much of what we do is governed by our nurse practice acts, standards of practice and State and Federal regulation. They cannot do our jobs and most know that but nursing assistants also know that we licensed nurses look down our noses at their job while preaching how important they are to the quality of life for each person we care for. Nursing assistants are not stupid and can see the disconnect. I see nothing wrong with nursing assistants sitting on report. What is wrong with this opportunity for dialogue and coordination of the shift's work? As far as the resident's record is concerned HIPPA is clear about this and in servicing of the law and facility policy should have stressed what the nursing assistants responsibility is. I have very little problems with the nursing assistants I work with; they know who I am and what my responsibilities on the unit are. When they are asked to do something I take the time to explain why. Most adults expect this. When they have something to report to me I take it seriously enough to listen to them and assess the situation. I then give them feed back of my assessment. Most adults expect that also. This is the same as I would do if a resident's family came to me with a problem. You know something the nursing assistants appreciate this.

I would take a try it before you buy it approach. Go in as an agency nurse to see how the facility is. In general I have found that the "chains" are not really that good to work for. The pay and benifits are better with a larger company but the work loads and paperwork are heavy and there is a lot of turn over.and staff shortages as a result.

I work every weekend 7p-7a (hence my screen name) and love it. I pick up an agency shift on day per week and stay home the other four. For me this schdule is perfection, I could not be happier.

I also saw this in the papers and have to say that I have a lot of respect for Abington Hospital for trying to make things right. In the end bigots are more trouble that their worth. By the way the supervisors involved have been disciplined for not following policy.

The only time I wore my nurse cap to work was as a joke. My nurse manager was going on leave for a few months to complete her degree and the staff wanted to come in on her last day looking like "real" nurses. We came in that day in starched whites and caps. Dammed uncomfortable. Well the reaction we got. The patients loved it, the other department loved it, the DON was so happy she was in tears and the entire administrative staff came to the floor to see us. Same nurses. Same level of care. Diffrent package. Would I wear on on a regular basis. No way. People are paying for the knowledge in my head not what sitting on top if it.

teeituptom, I am currently a nursing supervisor and have been for 15 of my 21 years of nursing. I make it a point to know facility policy and to follow it. That keeps me from being called on the carpet.....most of the times. In this case I would have "spread the wealth" and discusses the matter with administration. A situation like this one is, thankfully, rare and needs to be handled carefully. Bringing administration in may have prevented some of the problems Abington is now having and would have given the supervisor backup for what is a difficult situation. Many times problems must be handled on a level higher than that of a shift supervisor in order for a solution to be found and to contain any potential dammage to the facility. Decisions that may have prevented the current bad publicity and hurt feelings need to be made at a level hire than that of a shift supervisor. In my 15 years as a supervisor I have never once had a superior upset that I consulted them on a matter that was potentialy dammaging to the facility. Administrators want to be kept informed and expect me to recognize situations that warrent their intervention. Following the chain of command I would have brought others in to help solve the problem. Remember the supervisor now has to go back and live with the decision he or she made, meaning having to deal with the co-workers affected and the fallout that has resulted. Abington Administration appears to be reasonable and will not terminate the supervisors in question. That tells me that they are supportive, maybe calling on that support would have resulted in a better outcome.

Theses are truly interesting posts and as a woman of color I am gratified that they are overwhelming running against the behavior of the racist and how this situation was handled. The supervisors dropped the ball on this one and should be reprimanded. There was a written policy and they did not follow it. A more that gentle reminder is in order. In their defense they may have seen accommodating the racist demand as the way of least resistance but it was wrong. If the supervisors were not sure about what to do or what administration expects then a call to Administration should have been made. Believe me the administrators would have rather handled this problem on the front end and not have to deal with the damage control that is now going on. Abington has a good reputation and that is gold in a competitive heath care market. . The supervisors owe a duty to their co-workers and subordinates. The employees at Abington should have been backed up in this situation. White staff should not have to be burdened with accommodating racist's demands. Judging from the response on this board White staff would not have been to comfortable dealing with this situation. The professionalism of the minority staff was called into question by the request and was given tacit agreement when the supervisors agreed to accommodate the request. The racist comes and goes leaving a path of destruction in his wake, a mess for some one else to clean up. Abington administration is trying to make it right. I applaud them in their efforts. There is no place for racist behavior in the work place (or any where else.) The cost in productivity, job satisfaction and efficiency and again the reputation of the business are just too high to tolerate it.

The next step is to have a chest x-ray to see if you indeed have an active case of TB. There are several reasons why you man have tested positive. You may have been exposed but not infected and that is why you are testing positive. A cxr will let you know for sure. Don't worry. If you are infected tb is easily cured but it is very important that you complete the treatmet.:)

Have to agree with the rest of the replys. Ya got to pay your dues before you can move on to another type of nursing job. I always tell new nurses that the only thing good about that first year as a new nurse is that you only go through it once. Hang in there you will get through it:)