ecb

I was just interviewed for a job that offered 20-23 an hour, should I worry?

In our facility, and organisation, we have and create CNA Specialists, who have more education in Geriatrics and dignity, and residents rights and the stuff that is not touched on when they are in their 78 hour classes. Another thing we/they do is have PreNursing exams, so that CNAs will know what, if anything they need to brush up on before they take the LPN or the RN classes. They are starting a deal where the Facility will pay for a class, and then deduct the cost from the paychecks leading up to completion of the class. When you take in proof of an acceptable grade you get a check for the entire class cost. that goes for CNAs, LPNs, RNs, BSNs, MSNs without limits as long as you are emplyee in good standing. ------------------ *** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***

I am a BRAND NEW Unit Manager, I interviewed for a supervisors position, and got hired as a Unit Manager (big raise, and better hours, very supportive DON and ADONs) but very little in the way of orientation (more like try this, if you get it right I do not have to teach you anymore) and NO inhouse, mandatory inservice type orientation. MDS are totally alien to me. I get told I need to have my staff document on this or that, but one week a really good note a week is ok, and others everyday is required. My RNAC is fairly petty and spiteful (by her own admission she holds a grudge forever) and after 2 months I only just translated her system for "on time" accuracy, before this as long as it was done by care conference it was good enough, and now I am putting the MDSes on the chart myself because she is not getting them there by the day they must be compleated, not even by the day of referance. She has told me all medicares are 10 page ones until quarterlies. at least I will not be missing anything using that rule. for the most part I am consistant with the scaling, and it seems I am more accurate than my predecessor, but the RNAC is still totally dissatisfied with my work performance. I am frustrated, ad would love advice! ------------------ *** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***

this is nice, but where I work the DON is willing to have 1 RN and 1 LPN cover the entire house of 119 residents on night shift, they "compensate" by allowing us to sometimes have 6 CNAs (noramly 3-4, SOMETIMES 5) other times we have had 2 CNAs and 2 LPNs and 1 RN and she still expects us to get up 10-12 people because DAYSHIFT is running short. She has ONCE come in on nights, she came in to do turnover on the first of the month, because there were only 2 Lic in house that night (she came in at 3 with both unit managers, and we were still finding med errors 3 days later) she has never come in on nights to work that I have seen. The administrator is willing to pass trays, but the manager on the medicare floor, and the DON just walk around telling people what they are not getting done on days (yes I have seen it) I am pleased to see a administrator who is interested in getting thisngs working well, but it is a rarety, I have worked in 4 places, and find the $$$ pinches to be the most dangerus aspect of Nursing in general I consider the DON in this catagory, not in the catagory of nursing Sad but true sorry if I offended, but this is my impression from having worked all shifts in different facilities over the past few years. ------------------ *** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***

I have informed my employer I will not accept a tripple assignment, the position I hold entails taking 2 assignments, a short floor and cover the house, but they have begun adding on the second half of the whole floor (60 residents total) and I have done it 4 times, and so far nothing major has gone wrong, but a lot got missed. I have told them I will not do it, IF somting major happens elsewhere on the facility while I am supposed to be doing something on one of the wings of the floor, I would have to choose between basic care, and the chrisis and peoples FBSs and early am meds would be given significantly later. I am not willing to be in that possition again, and have put it in writting and my DON is not pleased oh well ------------------ *** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***

Sorry, never seen a GREAT flowsheet, but I have made spread sheets to be used as report sheets that are very helpful to float personel, and agency nurses, in my NH we have to document pain and relief in MAR, Narc book, and chart, unless we ALSO have to put it on the 24 hour report sheet, then we have to explain the whole change in condition in the note. GRRRRRRRRRRRR IVs are on the room to room I&O the I&O book, the MAR, and the IV record sheet, as well as the chart, unless we have to document a site change, then its on the 24 also, usually with an incident for why it needed to be changed (unless it was actualy scheduled to be changed then which rarely occurs in the elderly) AND don't even got me started on drs apointments, transfers, or 911 outs I agree there has GOT to be a better way, I find that more places to document gets us (LTC, not hospitals) in BIG trouble with the state inspectors, because if there is ANY discrepancy it is false documentation, and god forbid you leave a BLANK nuff said ------------------ *** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***

I once was asked to come up with better staffing ratios for actuall patient care, and came up with 2 possition/timed changes for a nurse to do, one was a 6a-6p and the other was a 12 nn-12mn BOTH to work in conjunction with the normal 8 hour all day long staffing. These possitions took up the slack of those heavy shift change times, provided for better overall coverage in the even of something untoward occurring at shift change when they did the end of beging of shift rounds to be sure floor care was COMPLEATED, but the administration did not thing increasing 2 positions to 12 hours was cost effective, even if they were charge/supervisory positions but I thought it was a good use of ressourses (I wish I coud spell that word right) just a thought, basically I think that they are BOTH good if used apropriatly, but I find if all #e!! is going to break loose, it happens most at 5-7a, 2:30-3:30p, or between 11p-12:30a and we all have seen that ------------------ *** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***

Does your facility/institution/corporation have an EAP (Employee Assistance Program)? They can help by getting the COMPANY to pay for some of this just a thought (My Xh used to be one) ------------------ *** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***

When I graduated an ADN program in 1990 from Comunity College of Philadelphia, I was also an Exter nurse in a SMALL hospital, and my boyfriend/fiance was working a=i another hospital as a tech and had nurses calling me all hours of the day and night with drug math quetions and problem solving vignetts {sp?}. The Head nurse on the floor I was on addored me UNTIL I GRADUATED then I could do NOTHING right, I was transfered to another shift and I was the head nurse for eveing shift, and WOW was I scared, i had an EXCELENT team of Philipino nursing assistants who were related to each other or neighbors, so THEY were a team, and instead of saying "I am the RN" I asked, "how can I make this floor work best" One of them (her name was Lucy) used to be an EKG RN in the philipines, I learned more from her about getting the equiptment to work, and she always told me if a non stat EKG needed to be called in NOW rather than later. If I had not had these benefits i would probably have quit and gone into computers like my mother wanted me to (stupid me) ;-) In a nutshell, it was NOT the nursing program that had me ready for the real world of nursing, it was the support network I had to help me get through the initial "there is NO WAY I can do this" phase. ------------------ *** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***

I have removed penrose drains, and 1 JP, but if I were requested to do it again I might want to review a procedure book, it has been about 7 years. I go to a procedure book when I question a procedure or an order to do a procedure, that is how i found out I am not allowed to do things I used to think were basic nursing care (just NOT in the long term care setting) I am being sent to certification class so I can maintain IVs again, seems odd because I have been starting them and drawing labs for 9+ years, but I cannot even flush a Heplock right now, in my facility. ------------------ *** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***

Suctioning is (IMHO) a comfort measure, even as uncomfortable as it can be. I have watched a patient suffocate to near passing out (due to a growth pressing on his airway, even a trach would not have helped him) I was horrified at how absolutlely terrifed he was. The swelling went down, and he told me it was the worst feeling he had ever had in his life, and he had NO bad feelings for me, (I had called for help, but it was not a siruation we could fix, and he did not want to be moved) Enough rambling on and on Suctioning is not rescusitation, it is maintanence of an airway. ------------------ *** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***

I am in my 3rd job in 16 months, and it is the best facility I have worked in in al of that time, BUT (you knew there was one) we have a fairly new DON {more new than I} and she is horrible for moral, she writes up people for calling out with a Drs note, and for being sent home for being ill. We have lost 3 licences nurses and more than 1/2 a dozen CNAs in the time she has been "cracking down" Needless to say i had a friday night where I was not covered for the next shift, the CNAs asked the supervisor how she could be so calm in that they had stuck HER like this, I had to explain she was not the one stuck. We all know she is not required to take on 2 assignments, but I am legally required to stay and care for the assignment until my relief arives, even if they are 8 hours late. We also know that in most facileties that administration is "required" to cover shortages like this, but the DON just happened to forget her beeper when she left her home(she knew about the shortage before she left work) and the ADON had no one to watch her kids. the supervisor did end up covering the house AND a floor, and another supervisor came in to take 2 sides to the skilled floor, and the sceduled nurse covered her regular floor, {this was a night with NO call outs} pretty bad huh? the kicker is without her there tightening the staffing ratio to 11:1 for CNAs up from 10:1, life there is doable, and the people she is driving out are the thorough, caring, compassionate ones who do not cut corners. It makes for real problems, and she ONLY sees the botom line, she tells others, that this is out of her control, but she has ^ our paperwork by 5 documents a shift/day, per patient. Sorry to vent, but her way of doing things scares me. I have been in a facility reviewed by the state, and it is the extra documentation, double {triple} documentation that gets a facility in the most trouble. no-one wants to put problems in writting, because the one nurse who went to corprate was fired within 3 days of the complaint (yes she was written up to justify it, and she is disputing it, but still) I am not liking this situation, but as my sig says "patients above personaleties" ------------------ ecb . @}--->-->- remember: Patients above personalities