Nancy1

After reading the posts tonight, I have know I work in a great place, thanks.

I have been away from the boards for a while, but from what I read there is no change in tone. I guess I must live and work in the most wonderful facility in the country because the mamnagement, of which I am a part, does not walk over people. For a LTC facity with a total of 111 beds, we are only looking for 1 night nurse position. And we don't have an attendance problem and would never aloow the words that I read in one of the posts about the woman who wanted to leave because her husband was sick. I guess I won't look for another job, I will stay in my piece of heaven NA

I understand where you are coming from, and I agree that not everyone reads care plans. However, residents need summaries. We made it part of our weekly summary that the nurse needs to review 2 problems on the POC when doing the summary. We also have the floor nurse update assessments and review the entire POC for the quarterly reviews. I have a form that I use to make sure all the nurses are doing this as it is on the nurse job standards. We use the American Data Electronic Chart System and I have found it to be good. I admit that I have worked to make it more facility friendly, but they have to make them more generic. I would be happy to enter into a dialogue. E-mail me. nancy1

After reading all of these negative remarks, I am almost afraid to be positive. I personally feel the reason many crash and burn may because there is no support within the organization. Many times nurses take a DON position without having any training. A good nurse manager moves up in an organization without having a strong knowledge base for the job. I would recommend asking for a copy of the job standards, if your organization has them. Look at the job description. Is there a LTC DON group in your community? Do you feel that you have strong personal and professional backers? I am currently an ADON, and I am very much looking forward to moving up to DON within my current organization as we build another facility. I have been getting strong support and leadership opportunities from my current DON because she know I want her job, and I feel that she is helping me reach that goal. We make a good team. If you have a good solid team you can be successful. I truly believe that you will get more ngative replies simply because it is our nature to report bad experiences than it is to report positive ones. Good luck with your decision, I know the decision you make with the information you have will be the correct one for you, Nancy

Roach, so you don't want to work for me, that's ok. I just thought I would clarify that if my CNA has 10 residents there are usually only 5 that would be a high care level. We have a fair number who are able to do many things for themselves. And from what I hear about this area 10 residents per CNA is not bad at all. And as far as the nurses go we have probably 1 treatment per nurse, because our CNAs give such good care and it is a true team effort. I hope that you will be able to find someplace you are happy, Roach, Good Luck NA

Lee, Thanks for your comments. I admit I tell my staff they cannot use the phrase "We are working short today." This is because we do not believe in staffing at minimums. For 40 ICF residents I have 2 nurses and 4CNAs, I admit there are days when I have call-ins that cannot be replaced so there may be 1 less person on the floor which may take the to minimum, but not short. Missing 2 people would make it short by the numbers. I realize that people do not want to hear that, but I find that the staff has plenty of down time, and as management I resent the saying we are short, but we have time to sit and do nothing. It is easy for someone to use the phrase, we are short, but somehow everyone gets their cigarette breaks and lunch breaks. My daughter who is a waitress tells me she puts up a sign when she is working that says 'If you have time to lean, you have time to clean." I think of that when I hear staff complain. I am very forward and remind them if they did not complain so much, they would have more time to do the work. I personally feel that there are people out there that are using this shortage to their own advantage. NA

One of the things that I have started doing and my staff seem to really like: When I see something special that an employee has done, I pull the person into my office and let the person chose something from a bag of goodies I get when I go to conferences. They really seem to like the pens for some reason. NA

Meg, I am an ADON in LTC and when I want to show the team they have done a great job, I bring in treats. Usuallysomething from the bakery as this crew I have now is not into hard rolls or bagels. Depending on the cash flow, we have done pizza for the staff. I also keep a bag of freebies that I get at conferences and give a person a choice to recognize the person right away. Hope this helps, NA

I work in LTC and we have a pharmacist that brings drug reps in once a month for an inservice and they provide lunch. Most of the nurses on at that time come, some from other shifts show up occasionally. We decided that if we wanted our nurses to get inservice time, we had to take it to them. We find articles that are pertinent and if they are from a journal we hope they have there own questions, we just check the answers and that way the nurse gets credit for inservice. It is not perfect, but it works. NA

After reading the most recent posts, I had to chuckle. When I worked in a hospital I had a pt who expected me to be his handmaiden. I was CNA at the time, but in nursing school. We had our class that I remember well: The nurses' job is to get the patient so he/she no longer needs a nurse. (I know I probably don't recall it as the instructor said it, but I am sure you all get the idea.) Maybe we should have that printed on the admission papers they sign. LOL, just a comment. NA

Unfortunately Maeve is right. I realize my nurses do not have time to follow up on what the CNAs do, just like I do not have time to follow the nurses around to make sure that they have done the B/Ps, tx, whatever. I know that there are lazy people on every level of health care. What has helped me is to do spot checks. I admit I do hone in on the residents that my lazier peiple have. I believe this has helped. I stay in the dining room to help feed, which I noticed has spurred on more attention at mealtime. There is less chatter between staff, and more staff to resident. (My pet peeve is they talk to each other while scooping in the food, and not saying: here's your oatmeal, now some juice, something to help the resident focus on meals.) When I walk down the halls, I do room checks, are the beds down, call lights where a resident can reach it. These are little things, but they have helped me to direct my staff to follow up and make sure things are done right. NA

In LTC there may only be an LPN working the floor while there is an RN available at all times. The most important thing we all need to remember is it is the patient, resident, client (whatever term your organization chooses to use) is the reason we are here in the first place. So the one who does the care and has first hand knowledge should be giving report to the next shift. To my way of thinking if A is reporting to B who then reports to C, there is too much room for error. NA

I checked my files, I am not sure if this will solve the problem, but it does give you a tool to help defuse anger, whether your own or a family member. The title is 21 Ways to Defuse Anger, there are audio tapes as well as a type of work book. I think CareerTrack puts it out. I hope this is helpful NA

This is a touchy issue no matter which area of nursing you are in. I work in long term care and have had a family member say "I don't want to hear you have 25 other patients, when I,(notice I) put on my husband'd call light I expect you to drop everything and answer it." This was to the nurse, she did not consider a nursing assistant answering the light. The management gave us some tools to use: 1) Say: "In order to provide care to all our residents on an equal basis, I needed to finish what I was doing, what can I do for you, now?" 2) Always ask if there is anything else the patient needs? Again focusing on the patient and that we are not here to care for others. 3) If it was too unbearable the manager would step in. I think that some family members are so fixated or perhaps guilty about this person needing nursing care that that they lash out at the nearest and most visible person "THE NURSE." Now that I am in management I have given these tools to my staff along with one more, ask "Would you like to speak to Nancy?" I am not saying this is any magic formula, because I still have family members telling my boss that I was rude, but I am woring on those relationships. The issue about asking the nurse to change an infant's diaper has me puzzled. I wonder why the family would expect that, unless some other nurse saw the child fussing and offered to help with the child. The coffee issue again, if the patient is very ill, my staff will offer coffee or to have a meal sent up, but again this is a kindness at usually an end of life issue. I am not sure if this helps. But ask your management for an In-service on dealing with difficult people. If you like, I will check my files at work, I think I have something that may help. I will be back with it, if I find it. Good Luck. NA

I admit that telling a nurse that she has to accept an assignment is rough, but as nursing administration it is my job to work out with the staff why the nurse is refusing to do something. In the case where the nurse had a previous incident occur with someone, I would expect the staff to work together and exchange a part of the assignment. That is where the TEAMWORK piece fits in. Our work is never just black and white. There are so many shades in between that we need to cooperate. Giving the person who floated over to help you should not be given all the heavy duty people, so that he or she is in over his/her head. Sometimes management needs to step in and help out, it is a quick fix, not a solution to the problem of why aren't there enough nurses. My cousin who is an RN left a hospital position because she felt her license was in jeopardy. I make sure that my staff realize that I am accountable for everything that goes on in the course of the day, I have 24 hour accountability, would I leave them in an unsafe situation. No, because I am ultimately responsible. Do others in management look at it this way? NA

I have never refused an assignment, but I will tell you that at my LTC facility if someone walks off (refuses an assignment) I would ask are you refusing to do as you are asked? And are you aware that you could lose your job? I hope that my staff can work together so one person does not feel that refusing is his/her only option. I would like to think that the team members could work it out. Hope that helps. NA

SSUleader, I read your posting about docs being on call and not returning calls. In our facility if we don't get a return call and we feel it is emergent, we call our medical director and cover ourselves that way. We have a great medical director. I hope this will help.NA

Hi, I am sure that any place in the world has the same issue. I am in LTC management and I hear my nurses make snide remarks on how the shift that the particular nurse works in always the worse. As manager I have tried to divide some of the work loads, but there is always something that keeps a nurse from finishing his/her tasks. The only way I see this problem coming close to being resolved is for all nurses to switch shifts and see what the other does. But I know that won't happen. I believe that we need to remember that as a team we can produce results as antagonists we will not accomplish anything. Good Luck with your situation NA

I stayed with my first facility for 4.5 years. I was in 2 different positions. The first was an internal float nurse in LTC. I was hanging in because instructors and other nurses said I should have 1 year in my first job. I didn't like it. I got lucky when they opened an Alzheimer's Unit. I had a permanent position there and loved the reisdents. It was the politics that ran me out. I offered suggestions and upper management did not take me seriously. So I started sending out resumes. I have been at my second LTC facility nearly 3 years, and as long as there is no shake up in administration I will be with this company a long time. I will not stay in the same position, but there is plenty of room to grow. Nancy

I feel that my work place has a very special relationship with our docs. I manage a 47 bed skilled unit. The residents for the most part are Lifecare, which means they gave us what they had and we agree to care for them till the end. Because of this unique situation my nurses and I deal with 3 MDs and we have a great working relationship. My nurses do not complain of having to call a doc, because they know the doc will listen. I hope that this is a norm, but then I know that I am very fortunate. NA

I accidentally cut myself off. I work in LTC and have been out of nursing school since Dec. 1993. In March, 1994 I became a Unit Manager. Stayed there for 3 years before decidng to leave for all the reasons others have listed. But the job I took after the poor experience is great. There is a true collaborative feeling throughout the entire facility. We are a team and we are aware that we all need each other to succeed. My immediate supervisor, the DON, is giving me opportunities to grow because she knows someday I want her job. She is not threatened, which I think is a problem with a lot of people, not just nurses. They are afraid someone will take something away from them, and we need to realize that we will need someone to take our place eventually as we will all move on at some point in our life. We need to work toward making transitions better for our clients and their families. I hope that there are others out there like me who are able to enjoy and grow in the field of nursing NA

Dear Naomi, It was very distressing for me to read all the negative responses that were in this listing. It makes me realize that my employer is WONDERFUL.