MrsStraty

Oh Thank you thank you! My shoulders have instantly stopped hurting. I feel it was the right decision, although I feel bad for my residents, all of whom I know adore me and think I am the best thing that has happened to the unit.......BUT......you all know the real deal. Need I say that this facility has been through 6 administrators in 3 years......2 since I've been there....9 months! They need to revamp the DON and ADON but why don't they see that? Nurse Managers.......they can't keep them either, or the staff nurses. Yup I'm out! MrsStraty

and boy do I feel 100% relieved! I have been toying with the idea for a few months now. I have been a Clinical Nurse Manager for 9 months now at a LTC and boy does it suck! I am responsible for everything the nurses DONT DO! I have been a nurse for 2 years now and I am going to be doing agency work for acute care for now. I work already with an agency every other w/e to keep up with the acute care skills. The hours I work at this LTC are endless, 12, 14, 16 hour days and only get paid for 75 hours q2 weeks. You never see the ADON or the DON out of their office, all they do is DELEGATE EVERYTHING to the clinicals! I&A's never get put to rest, I give them to the ADON and she just hands them back with sticky notes on who to track down for statements, instead of her doing it, like at my old facility. EVERY single investigation the clinicals have to do and bring back a report so the ADON can type it. Every res. who is on report in the AM, the clinicals have to bring chart to AM report. The clinicals have to interview new hires, the clinicals have to make sure all MARS and TARS are signed, and the list is ENDLESS! I don't dare delegate to my nurses because they are so taxed already! I am in endless meetings and the only time I can do care plans are on my time in the evening. I just want 3 12 hour shifts, go home and not have to be responsible for a unit 24/7. Sorry for rant, but I am relieved! We have 35 nursing vacancies at my facility, and everyone is sick to death about being mandated and everyone wants to quit! Sorry but LTC sucks for these residents and it isnt fair! MrsStraty

We use Resident information sheets, which the CNA's get a sheet for their group everyday. They are updated by myself, the unit manager a few times a week. Also on the assignments sheet they jot down the vitals, sign for their showers and weights. Their accountability books have the BM and adl info they sign for. Carlissa

There is nursing shortages EVERYWHERE, including the hospital setting. Still, nurses need to be held accountable for not signing their MARS and TARS! I just found one med error where a resident did not receive DILANTIN for a whole month, because it was not transcibed onto the turn over. Am I supposed to just cough that up to understaffed? Sorry, that is just plain slackfullness, not double checking your work. Thank God my resident didnt have any seizures. Also I had a nurse tell me, "Oh I was giving it to him anyways because I usually give it to him in the am." She didnt even notice it was not on the MAR! SCARY! Nurses and CNAs fail to realize that the Nurse Managers are responsible for their units 24/7. The DON and state are going to come to me, and make sure I am being proactive about things. Will I get in trouble for someone else, NO, but they will look to me to see what I have done to make sure it does not happen again. I love LONG TERM CARE! I am there to make sure they get the proper care and respect that they deserve. Afterall, we are in their home, we go home, they do not. They are there to die, most of them. We need to remember that more often. It is NOT about us! We have a job as nurses, to ensure their saftey! NUR 101, is for ALL nurses! MrsStraty

It is not the multiple documentations.......It is signing for meds that you give that I am having the biggest issue with. There are far too many gaps on the MARs and that should not be. If you give the med sign for it. I have worked several different places where the documentation is getting redundant....even in the hospital setting.....but that is no excuse NOT to do your documentation. And the other nurse manager was signing the nurses initials because she said that is easier than chasing around the nurses to sign on the MARS. It is my job as the nurse manager to see that all the MARS are signed correctly. I am not feeling ok about just initialing someone elses name and this seems to be common practice.

Thank you. That sounds great, maybe I'll try that.

Don't laugh....what is micromanagement?

I really want to implement a way to make sure that everyone signs their mars and tars but I'm afraid it will be like stepping on toes of people who have been there for years. I might have to resort to writing people up for med errors, which people will hate, but you know it is a med error because if it was not documented then you did not do it. And the PRN is horrible. The last place I worked if you gave a PRN there needed to be a nurses note to go along with that PRN, and here they don't do that. I am still in the sitting back and observing phase before I jump in and make changes. There is so much paper work. The last nurse manager would just fill in the gaps, forging the signatures, and they think that is FINE. I am NOT OK with that kind of practice. I hope I don't get fired for doing the right thing......because this seems to be the norm. :blushkiss MrsStraty PRN= patient receives none.

Alwats flush PICC lines with 20cc of NS. You flush 10cc with regular central lines. MrsStraty

how the heck do you do it? As you know I am on day 5 of my new job as a new unit manager at a LTC facility/Sub Acute Rehab and the biggest issue I see are the gaps. How do you get the nurses who give meds and do treatments and the CNA's to make sure the accountability sheets are signed? This is very frustrating. Of course this is a new month and I am sure that the nurse manager who was there before me did not do EVERYTHING because she couldn't of. How do you not get behind in ALL of the rudundant paper work? How do you deal with CNA attitudes? :uhoh21: I have tons of questions but this is all I feel like typing now. LOL:nurse: MrsStraty

WOW! Thank you Daytonite, what a post, you summed it all up for me and it was great. I have my job description now and you were right on point. Where do I find these seminars for 1st time managers? On how to supervise? MrsStraty

I have worked LTC almost my whole career, which began when I was 18 and I am now 35! I know ALL about LTC and their troubles and how desperate they are, but I also KNOW that LTC facilities need people like myself who actually care about their residents and respect them and I want others to follow my attitude and if I can make a difference that way, then I am happy. MrsStraty

That is exactly how I am coming into the job, thinking I can make changes, we will see. I am truely excited and I can't wait to start on Tuesday. I hated the acute care setting and I am just so thrilled to go back to LTC, that is where I belong! Although it was hard to find a staff RN position, every place I interviewed for suggested RN Unit Manager to me and I thought why not? If they feel I am ready then I must be. I'll keep you all posted on how I do! MrsStraty

Yes I heard about the paperowrk thing.....and guess what I LOVE paperwork, I know I'm an oddball! I have worked LTC throughout my whole life, much of it as a CNA, and I left the acute setting to return to my roots, geriatrics. I absolutely LOVE geriatrics. I can't even begin to tell you the reasoning, it is just something my heart desires, to see that our elderly get the care that they deserve. After all, we wouldn't be here without them and second of all people need to understand that when we are in the LTC facility, we are in the resident's HOME, they are there, most of them until they die. Anyhows I feel a rant coming on, so I'll just go and clean my house now..... MrsStraty

I just accepted a position as an RN Unit Manager in a LTC/Sub Acute Rehab unit. I start next week. I am very excited as this is my 1st management job. I have worked acute care for 3 months and for the first 5 months I have had my license at a LTC facility. I have only had my license since Sept. 05. Wow how the heck did I land this job? I got skills.....baby. I love geriatrics and want to make sure they get the best care possible, they deserve it. Want to know if anyone knows EXACTLY what my work will entail? There is a MDS Coordinator there, so I wont be doing those, maybe alittle, but not my job description. What will I be doing? Thank you, MrsStraty