TooBusyRN

Reply to NursesRmofFun/RN - Girlfriend, I didn't mean that I used to work as a CNA and then an LPN...I meant as the DON I find myself having to fill in when needed on the floor just to meet staffing sometimes, and others just when my staff is feeling overwhelmed and they need the extra encouragement of seeing me out there busting tail WITH them and not railing AT them to get their work done. I have always maintained an open door policy and it's true that you have to find a balance and get your paperwork done. My staff and other department heads know that if my door is shut, it means I'm either trying desperately to catch up on paperwork, counsel with someone, or meet with a resident or family member and they'll usually slip a note under my door and know that I'll get to them as soon as I can. But, more often than not, I find myself doing my paperwork on my "off" time - whatever that is. To any of you out there who have husbands and younger children, I have to applaud you because I don't think I could do it all and have any time left over. I've worked hard the last year to find that balance, still have time for myself, encourage and educate my staff and not burn out. We have to hold each other up. That's one reason I'm so glad I found this BB! :balloons:

I just have to say that I've watched this thread closely and love so many of the comments everyone has made. In LTC we are multi-talented, multi-tasking, autonomous, well-rounded nurses who should have no fear of losing anything while working in long term care. I do have to agree that there are some poorly run facilities, but I disagree with the solution offered of just leaving and going to a better-run facility. Then who cares and advocates for those residents in the 'poorly-run' facility??? You have to be proactive as a nurse. If changes need to be made, let it begin with you! It's not always easy rocking the boat, but if the boat is sinking and folks are drowning, someone has to throw out the life-line and get them back onboard. Start with talking to supervisory nursing staff about some of the problems you're having on the floor. If they don't listen when you talk to them, write them a memo, if they don't respond, then write another one and give a copy to the administrator. If you don't get any response there, then request a meeting with both the Director and the Administrator to discuss problems. And it helps if the LPN staff is united and wants a 'group session' instead of just one or two lone nurses who might appear to be griping. You can make a change. You just have to care enough to want to. As a Director, I've had to work the floor as an LPN, I've gone in at 3 in the morning to work as a CNA, and had days where I've worked around the clock and then some. It's frustrating for the floor staff, I know. But if your nursing supervisors/administrators have never 'walked a mile in your shoes' then they may not have a clue what's really going on. THEY have to care, too! We may not have the respect of the rest of the nursing community because we're "just" LTC nurses, but we don't lose a darn thing. We gain knowledge, compassion, integrity, love, and the respect of the people who matter - our residents, their families, and our staff - when we do a great job.

I absolutely agree with Shezam...NEVER go onto the floor without some kind of report. The off-going aides should care enough to let their relief know if a resident is having some kind of problem or special care needs - even if they are short-staffed. The LPN's should be giving each other shift report and counting narcs before they hand-off as well, so if your LPN doesn't voluntarily give you any information, then ASK her/him if anything out of the ordinary is going on with any of your residents. If you consistently ask every shift that you work, then perhaps the LPN will get the message that you care and begin to give her team a report without having to be asked. One more suggestion...if your facility doesn't have a CNA council, at your next inservice or staff meeting, suggest that they start one. Talk with your DON or ADON (whomever directly supervises the CNA staff and LPN's) about the things that you are concerned with like not getting reports. They are ultimately responsible for making sure you have the knowledge, skills, and resources to do your job correctly.

Tammy, Here in Arkansas you will find that there is a great disparity in salaries across the state for the any position in the nursing home field. The pay in rural areas is a lot less than that in the metro areas like Little Rock. An ADON can make as much as 65k a year in LR, but in a rural area might not even make 40k a year. MDS coordinators are the same way. It all kind of depends on the ownership of the facility and how attentive they are to keeping their salaries/wages competitive in their market. Good Luck! Hope your interview went well.:balloons:

Care Planning and MDS completion should go hand in hand. Our facility has care plan conferences on Wednesdays with families, residents (if they are cognitively able to provide input), and the entire interdisciplinary team (social, activities, dietary, DON or ADON, and MDS/Care Plan Coordinator. Often there are things that the members of the team come to the table with that haven't triggered on the previous MDS that still need to be care-planned and possibly added to the quarterly/annual MDS that will be due the next week. (our residents are care-plan/MDS conferenced the week before the MDS is due) Also, we have quarterly assessments that are required to be completed that aide in completion of the MDS/CP. Most are Briggs forms and include Fall Risk, Dietary Assmt, Elopement, B/B function, Skin Assmt, etc. It is vital information that the MDS coordinator needs to have to completely submit a correct MDS for that resident. In some facilities, the charge nurses complete the quarterly assessments, and in others the MDS/CPC does them. But the MDS coordinator must have a good working knowledge of each resident and their particular condition(s) in order to complete all the assessments, or he/she must be able to go into the chart and get this information from the most recent documentation by ALL departments. If all the team members aren't completing their documentation, it isn't possible to get a completely accurate assessment. I personally feel that the charge nurses don't have time to complete these assessments, but if they are doing their bi-weekly/monthly summaries accurately, then all the info the MDS/CPC needs will be there for nursing. A state surveyor told me something when I was a new DON and she was in her 'teaching mode.' I have remembered it and preached it to all my MDS/CPC's since then. You should be able to take a stack of care plans for your facility WITHOUT ANY NAMES ON THEM, throw them out on the table and pick each one up, read the problems, and recognize what resident that care plan pertains to. That is truly individualized care-planning. And when you think about it, think about your residents and realize that every single one of them has some certain thing about them that makes them an individual. Capitalize on that when you are care-planning and you'll never go wrong. Cookie cutter care plans don't do nurses, CNA's or residents any good at all.

Anyone who feels that nurses in LTC are in danger of 'losing their nursing skills' has not worked in LTC. If anything, the LTC nurses have a more well-rounded practice than nurses working in other sub-specialties. Think about it...we have cardiac, pulmonary, renal, GI, oncology, psych, etc., etc, all under one roof. We have to multi-task like no other 'specialty' does. We have to have an all-around knowledge base to deal with any potential problem that these residents could possibly present. LTC IS 'acute' care nursing if it is anything else. As for the comment someone made in one of the earlier replies that 'these folks are dying,' I have to disagree. Some LTC residents may live 10-15 years in a nursing facility and this is their HOME. As a DON, I encourage my charge nurses to feel empowered to not only make suggestions, but to present me with solutions for how to implement any improvements they think will improve work performance or patient care. It is vitally important that the charge nurses feel that they are exactly that....in charge. LPN's have much more freedom to act autonomously in the LTC setting as well. They shouldn't have to feel that every decision to be made has to be run through the nursing administration. Suggest that your facility have standing orders if it doesn't have them already. Request a meeting or inservice with your DON and Medical Director, if possible, to open a discussion about how the LPN's can be given more decision making abilities. The physicians are funny about some things. Some get perturbed with every phone call you make to them, no matter how serious the situation. Others want to be called for the slightest thing. Determine what your MD's want and set into motion a program for what your docs want. They would love for you to make their life a little easier too.

I don't know what state you are working in or whether your state Office of Long Term Care sets staffing ratios, but here in Arkansas if our LTC nurses had only 8-12 patients to care for they would think they had died and gone to nursing heaven! In my 115 bed facility with a current census of 93, we have three LPNS on day and evening shifts and 2 on night shift. That's a considerably greater ratio than you are talking about. I know it's hard on a new grad, but you can do it!! First, you need to assert yourself to the off-going nurse that you want a complete report on ALL of your residents that will be under your care. Then take a few minutes after you've gotten report to organize your thoughts and get yourself prepared for what you have to accomplish on your shift. With all the demands placed on us to give the best care AND get all the required paperwork done, supervise CNA's, pass meds, etc ORGANIZATION is the key. If you don't get yourself in the right mind set and get organized at the beginning of the shift then you can't accomplish what you have to do. Second, make sure your CNA's know exactly what you expect of them and enlist their help as much as possible within their scope. Your CNA's are the backbone of your team and if you don't establish good rapport with them, you might as well throw in the towel. Good luck and keep your head up!