Smarteena

My facility went "paperless" about 6 months ago, with one exception -- we still print out Kardex-type information as we always did. Each unit of about 25 residents has a form which lists the care basics for all 25, how they transfer, toilet, eat, special equipment, etc. This is stored in a Word document and is updated and reprinted every time there is a change, new admit or discharge. A little stack of each unit's current forms is kept at the corresponding nurses station. Every CNA is expected to have the form in their pocket, available. It would be nice if they would/could stop and go look information up on a careplan, but we all know that is unlikely to happen. We have had this form in place for years with much sucess.

When I was new, I remember having the same thoughts and feeling so incompentent, slow and frustrated.... I can't begin to tell you how many days I would punch out on the clock and then stay for a couple of hours to complete my work (illegal to do with labor laws, I know) It was probably 2 years before I started to feel confident and up to speed. Other than time, the one thing that really helped me was finding someone to act as my sort of unofficial mentor. I was lucky to find a nurse that was very near retirment, and literally had "been there, done that" and was delighted to teach me all of her little "tricks" and secrets. She was a lifesaver and helped boost my confidence 1000%. 25+ years later I can still hear her voice in my head when I run up against a problem!

I guess it depends on what the expectation is re the management where you work. At my facility (and throughout the company), it is expected that the DNS or RCM steps up and helps if they are unable to find replacement nursing staff. Over the years, I have seen more than a few Administrators making rounds and (literally) wiping butts when we're missing a CNA. I am the Asst. DNS in a large facility and I have stepped in more than a few times over the years to pass meds, do admissions, charting, treatments - you name it. Charge nurses become (understandably) upset when management staff doesn't pitch in and help -- which then causes further staffing problems when unhappy nurses move on because of problems like this. In order to have good staff morale, I think it is really important for all mangagement staff to be ready, willing and able to give a hand when needed. I wouldn't want to work where managers either say they will help and then don't, or where they think they are "above" working on the floor. Teamwork, you know??

The goal for the (LTC) company I work for is to catch changes of condition *early* so they can be treated in the facililty. It is incredibly stressful on both residents and their families to send them to the hospital, and better for all (resident/family/facililty staff/the bottom line) if we can avoid transfers. We have focused on teaching nursing staff how to recognize early symptoms of dx like UTI and pneumonia and how crucial it is for the nurse to act as soon as the beginnings of a problem are noticed. Although it has taken a lot of time and training (we have more new grad nurses than most) we have been able to significantly reduce our rehospitalizations and ER visits. This also fosters better relationships with the local hospitals. Money is always going to be an issue -- but we need to remember, that medicare money coming in is what allows us more staff and better pay. New Medicare rules for LTC will be in effect soon -- which will levy hefty financial penalties on facilities whose resident are re-hospitalized for these "preventable" diagnosises (i.e. pneumonia and UTI). ' This also includes residents that return to the hospital any time within 30 days of their discharge from the LTC facility. If nothing else, this will force us to step up our recognition of emerging medical problems and turn discharge criteria/planning a notch -- again a win-win for our patients. At the end of the day, preventing that re-hospitalization or er visit is universally what is best for the resident -- its not always all about the money......