rnto?

I also think there is no such thing as low stress-it's just a trade of stressors when you're in healthcare.

I am a director of nursing in LTC, it is very low stress. Ha ha! Obviously don't recommend management if you're looking for low stress. I've heard that case management is getting more and more pressure to cut costs, etc. I think that is still one of the lower stress positions, relatively speaking. Also, working for an insurance company being the nurse line contact doesn't seem bad.

Whats mandated is direct care nursing hours per patient day, or the total amount of nurse and CNA hours divided by the number of patients over a 24 hour period. It doesn't matter how that is divided, so you can theoretically have 1cna for 150 residents on one shift if the other shifts balance out the number. (obviously not a good idea!)

As far as changing the patterns, we need to utilize our collective power. The public and those in office need to know what is truly going on. The Medicare and Medicaid cutbacks have HURT our industry, as we are being expected to do more with less. Those facilities who provide good care have good outcomes and usually have good profit margins to match! It starts with investing in bedside care.

Not all LTC facilities are this bad. I have 2 units, a LTC unit and a subacute/rehab unit. My LTC unit runs with 1nurse and 2aides for 25 patients, but my Adon handles dr calls and labs, department heads take turns helping in the dining room for lunch, and I always jump in if there are change in condition. On the skilled/rehab unit i have 2 nurses for a MAX of 30 patients, and 3 aides if we are full. I bump down to 1 nurse and 1.5 aides overnight, but I make sure there are no treatments on 11-7 and few Meds to pass. ADON handles dr calls, writing orders, labs, etc, and I often get behind on my responsibilities because I'm helping out on the floor. (then I stay late and fight with my husband over the time I spend at work). I work for a really good corporate entity that values direct bedside care.

Ditto what kitty said about having your ducks in. Row before you call! You will make the call and your life so much easier! You will learn to use your judgement about when to call. If you are working overnight, you don't really need to call about a skin tear at 1am. But a temp of 104 and low bp? Heck yah! I always try to think about what the doctor will do about the change in condition, and if their possiblebinterventions warrant a call immediately or the next time you talk to them. Most LTC facilities have a plan to make a phone call or fax to each md daily on all patient concerns. Also, if you are calling on a weekend or off shift, coordinate with your charge nurse or the other nurses so you can make one call and address all patient needs. And if you arebstill unsure, ask a senior nurse! I am a new DON and I still call my regional person to bounce stuff of her.

Ditto, suspension pending investigation. And if the nurse in question did not tell me about the suspended license, THAT would be immediate termination

Lvn2bsoon - I totally agree with you in theory. The thing is, though, that it doesn't seem to make a difference when I praise, give constructive advice, etc. That's where I get frustrated. I'm not talking about minimal errors here. I'm talking missing 2doses of phenobarbital because we didn't have a script for a pt admitted with seizures. It's patient's lives here, and staff have the same license I do. I'm frustrated, it's been a bad month.

I'd really like a discussion about how to make nurses think. I took over as don in a facility where it seems no one knows anything. I've educated, I've put processes in place to streamline their work, I've yelled. I have some good staff, but there are some who just don't seem to want to take responsibility for their care.

Sounds like you are the unofficial number two. I agree that it is not illegal to not be paid for being on call unless you work, but there are a lot of caveats to the on call laws and I think it depends on the state you live in as well.

Ditto what both previous posters said. I am curious where one would get a cd of lung sounds? I am a new DON and looking to improve the skill set of some of my staff.

How do you DONs at small facilities manage your restorative program? I am currently a new DON in a 55 bed facility which has two levels. The lower Level is my long term unit and has 25 beds. Upstairs is skilled with 30 beds. I am currently struggling with staffing patterns that were developed years ago. I have 2 CNAs on the LTC unit and a restorative aide who is supposed to help out on the floor until 11am then do restorative. However, he continuously struggles to complete his programs and document accurately, and the floor staff feels that he does not help them as much as he should in the am. He is not the strongest CNA. I also struggle to keep my staffing within budget. So my thought was if I could cross train the floor staff in the Restorative program I could run 3 floor staff by having the current restorative CNA take a section and expect each person to perform and document restorative in their section. Does anyone do something like this or have any better ideas? Thanks!!

OK, I really need follow up advice. About 2 weeks ago, the DON and administrator called me and said that since they didn't get what they wanted out of the last unit manager, they were going to downscale the position to a charge nurse helping at the desk in the am and then on the floor, and it wouldn't really be a promotion for me, since I was looking for advancement. They complimented me and said that night turn had never been better, yada yada yada. Yesterday I overheard the new nurse telling other coworkers that she is the new unit manager and she is now salaried, starting in January. I am not salary. If she has a title and a salary, how is that not a promotion/advancement? DH says I need to have a talk with the DON in person and tell her that I think it's not fair that I was not chosen for this promotion, I am far more qualified, etc. I am sick to my stomach thinking about it! I feel like they were just BSing me in the first place, so how do i know they won't just BS me again? EEk, I don't know what to do.

the DON is on a business trip until Thursday

thanks for the advice everyone. I will be calling the DON tomorrow. CapeCodMermaid-glad things worked out for you. I too am hoping for upward mobility. I can't afford not to have a job lined up before I resign. We're living paycheck to paycheck as it is! I have a few possibilities through networking already. I've often felt that as supervisor I had more responsibility than the unit manager position, but it is what it is. I'm not considered management, but the Unit manager position is, and is therefore salaried with all kinds of bonuses, etc.

I'm working M-F 11p-7a as RN supervisor in LTC/SubAcute, but I also have a 6month old that I'm breastfeeding. I have plenty of time to pump on this shift, whereas on daylight -ya right! I have a white noise CD for the baby that I use during the day, and an eye mask really does make a HUGE difference. I have to wake up to breastfeed. I occasionally do have trouble falling back to sleep. I feel like no matter how much sleep I get, I always feel tired. I've talked to other nurses who feel the same. As far as I know it is not illegal to pre-pour, as long as you can adequately maintain each individual patient's pills and not mix them up. When I worked for a special needs school that's the only way they did it to get the pills to the kids. However, at our facility each patient has their own individual slots, which makes it easier. Start at 5AM for your med pass-just be careful to stick to your hour window. Our facility changed the time of some meds so that our nurses could stay in compliance with the time frame. As far as calling families, generally I will wait until 7AM and call right before I leave unless I'm transferring someone to the ER or something.

I have a suspicion of this also. I never wanted to be night turn forever. If this is the case DH thinks I should tell the DON that I'm looking elsewhere. I will look elsewhere if I've been pigeon-holed into not receiving a promotion

I should add that the DON asked the other two girls on Monday, before I expressed interest.

i've been a supervisor at a snf/sub acute facility for a little over 2 years. Until May, when I left for mat. leave, I was whole-house supervisor on weekends. In July, while on mat. leave, I was asked to take a newly created night shift whole house supervisor position, which I did. I've always gotten excellent evals, and in my current position/shift, I've made positive changes. I have a Bachelor's degree. On Monday, the previous unit manager was fired. The Director of Nursing told me Tuesday morning, at which time I told her I was very interested in the position, that I wanted The Director of Nursing told me Tuesday morning, at which time I told her I was very interested in the position, that I wanted to get further involved with management. She said "interesting" multiple times, she thought I had to work night shift b/c of the baby and that I liked it, to which I responded that while that was the case in July, my schedule was wide open, since my DH is now a SAHD, and that while I liked my position, I did not enjoy the off-shift. The conversation ended with her telling me to sign up when the position was posted in the break room, which I did. Since then I am the only person who has signed up, but I have been told by the persons themselves that the DON has asked 2 people to take the position-a PT girl who has never worked on the unit in question, which is busier with a higher acuity w/ no supervisory experience, who's been a nurse for less than a year, and a woman who's been a nurse longer than me but who's only supervisory experience is since I left for mat. leave-she's who I trained to cover for me, she's been at the facility for less than a year and has a 2 year degree. I've also found the position posted on careerbuilder.com. i should also add that while the previous mgr was on fmla, i filled in for her for 6 weeks. the position is salary with better benefits than my current position. I have not heard anything one way or the other. My DH thinks I should call Mon. and ask whether I am being considered or not. what do you think? if i don'get this position i am leaving-why waste my time if i have no future? i've turned down other opportunities

I just wanted to vent. I've heard several people say, over the past few days, "Well, they're a DNR so why are we doing XYZ?" Um, because if their heart stops they don't want CPR, but the last time I checked treating Afib with coumadin was not CPR? Most recently I was giving report to the oncoming supervisor, and was telling her about a LTC patient who was being worked up for ca. She asked if the patient was a DNR, which she is, and then asked why we were doing a ca workup on a DNR patient-"they don't do chemo on DNRs" Oh really? This nurse was new to our facility-she's an ICU nurse who acted like LTC/SubAcute was beneath her and that she knew everything there was to know about geriatrics because "people in the hospital are old". (her words)

can cme for physicians count as our ceus for rns? sorry no punctuation-baby in other arm:)

I am currently a supervisor in sub acute/ltc facility. I supervise 160beds, and 20 nursing staff members during off shifts and have done so for 2 years, with excellent reviews. It is a national company w/ 3 local facilities. I would like to get my masters in management and work up the ranks in nurse management, hopefully to DON or something similar. I also have a job offer at an ICU at a VERY large teaching hospital, and through a friend who works on that unit, I know that one of the assistant unit managers there is considering retiring at the end of next year if someone can replace her. of course the friend thinks I would be great for it. (no one else has expressed interest) My question is, do I stay at my current position, or take the hospital position? Which would be more likely to be beneficial for a career in management? Or should I be doing something else entirely?

shadow some doctors and some nurses. having a family member who's a nurse does not mean you know what it's all about. at the most basic level nursing is caring for a patient by following physician orders, but we assess, intervene within our scope of practice, educate, comfort, and shovel poop. (it rolls downhill, remember?) a quick perusal on this forum should give you an idea. physicians are responsible for creating a plan of care for the patient-prescribing drugs or treatments. your day to day will be completely different with one or trhe other. crying baby-more later

I've been a supervisor at a SubAcute/LTC facility for the past 2 years. 2 months ago I became a night supervisor (after returning from maternity leave). Since I started as supervisor i've been told by the don/adon that non-emergent issues on off-shifts can wait until office hours to be handled by the physician. i've never had a problem determining what i needed to call on on an off shift vs what could be handled during office hours. recently one of the night turn nurses has been questioning this policy-specifically, she states I should call the MD for every single change in condition at 12am, even if the patient is stable and the change in condition is not emergent. i cannot find anything about the legal issues surrounding this. is it acceptable to wait until day turn to notify the md that, for example, mr. smith has increased edema but no other abnormal assessment findings. or jane doe has a cough but no fever, not in distress, etc? ADon told me yes, because the facility is 'thier home' and at home non-emergent issues would be handled during office hours. generally if the patient is stable w/ a minor issue and/or te appropriate treatment couldn't be started to daylight anyway, i defer.

@ 2shihtsus-I'd be happy to PM you. I don't feel right posting publicly. You never know