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

I quit, just like that because the place sucked. A big huge medical center and 2 weeks ago I had a patient nearly code and he really needed O2, and guess what no friggen O2 thingys to put in the wall and NO suctioning to be found and NO damned 100% non-rebreathers anywhere, even on the Resp. Care Unit.....what a scary ordeal. His SPO2 was in the 60's on RA and he needed a non-rebreather and we couldnt find one. Had to go to another floor, what a JOKE! They don't keep O2 cannisters or suctioning in the wall hook ups because it isnt "cost effective". You basically have to steal someone elses oxygen or run around like crazy looking for basic crap to maintain airways......none even on the code carts... Need a spot check for a pulse ox? Steal another patients.....LOL..what a joke. Anyhows I have only been there for 3 months and last week I decided I dont want to work there. This was only my 2nd job. I just graduated last May 2005. My 1st job was in a Sub-Acute rehab/LTC facility and they won't take me back, because I left them for acute care after only 5 months. So now I am back to interviewing.....and I left the Medical center w/o getting another job 1st because I thought it would be easy to land another job...the other 2 jobs I had first got, were hire on the spot jobs, same day thingys, now I am having a hard time landing a job. Been on several interviews, and I have several more to go on this and next week. I think I prefer LTC though, I am not sure. Any suugestions on to LTC or Acute care? Carlissa RN

I currently work in a hospital setting and have only been licensed a year now, but on Wednesday I am interviewing for a RN NUrse Manager job at a Sub Acute Rehab/ LTC facililty which will start me at $67,000 a year, which I have calculated at $34.89 an hour. I am making 62,000 a year now. I hope and pray I get this job, which will involve alot of MDS and PRI stuff, and they will train me. Carlissa RN I have been in the hospital for under a year and already feel burnt out. Dont wanna give up my 3 days though but hey I will have holidays and weekends off and be home evey evening.

I too work on BMT unit and we start Vanco and Fortaz at the 1st neutropenic fever, right after the blood cultures are drawn that is. We culture anything that can be cultured. We have the no fresh flowers rule, no flowers at all actually. No fresh fruit or salads either. Our patients wear masks while out of their room, visitors are limited, I have never seen a nurse be sent home because they were too sick to work on the BMT floor, they just are told to wear a mask in the patient rooms. We give Neupogen also, haven't seen a reaction with Neupogen, just with Leukine and we sometimes give that instead of Neupogen. We transfuse platelets under 10,000. Carlissa

NEVER inject air into a Tubex, which is how our Ativan, Demerol and most of our Morphine comes! I guess I had to learn the hard way. We have prefilled 10 cc syringes and I let out 3 cc's of NS then I put on a blunt fill needle and draw up the Ativan from the Tubex and push the whole 8 cc's SLOWLY! I work on an Oncology and BMT floor so almost ALL of my patients are accustomed to IV push meds. Carlissa

:lol2: It helped immensly. Thank you for your reply. I did cry infront of the family and they knew why I cried, I was sad for them and I missed my mother. The other night I found one of my mother's hats that she wore when she had no hair.....oh did I cry like a big baby! I am 35 years old. Abd then the next day at work someone dies and I lose it. How I love onc nursing though. I really do, not sure quite what it is but I truly feel that I belong there! I first worked somewhere else, and I hated it and I only worked there for 4 months and this is my 2nd job and I love it already. The whole time I was working at the sub-acute rehab I didn't feel like I belonged there, something was missing and I dreaded going to work. I actually LOVE going to work, to an extent, of course I am human! :lol2: Anyhows I am off today and I will enjoy my kids and tomorrow I will be back to work. Carlissa

Well thank you all for the replies. I have heard some nurses say that the docs DO tell some patients the truth but the pts are in denial and so is the family. Also in my original post I was talking about my 36 y/o patient, who is on the brink of death, well the nurse who is precepting me to the floor is soooooo damned mean. She is like 60 y/o and is ready to retire, trust me. She(my pt.) gets a world of visitors and she has young kids,......"Oh the young kids should not be here, we have pts. who have no immunity", my preceptor says. It gets my pt really upset for one, and for 2, for God's sake she IS dying! She should be able to have as much time with those precious kids and her family as they all need. And when I stand there to talk to the patients.....she hits my arm and pulls me out of the room.....you don't have time for this little chit chat. Oh she is so controlling. Yes I DID have time if I did not I would not have stayed for a few minutes. I am very good with time mgt. I was working at a sub-acute rehab wgere I was responsible for 43 residents PLUS supervising the whole house of 119. I can't wait to do my own thing. I am so tired of hearing the patients say how mean she is and she is. Thank God I am going to nights and I won't have to work with her. Also if I lay in my bed dying NO ONE ever better tell me who can come see me and when they can come see me. That is just plain heartless, if it were them, thats all I think. Anyhows, anyone out there ever lose a family memer to cancer and work on an oncology floor now? How do you cope? Does it get easier cuz I find myself CONSTANTLY thinking about my mother! All the bald ladies LOOK like my mother.....well make me think of my mother and when someone dies I lose it. Carlissa

Hello. I just started to work on an Oncology floor/BMT floor. I work at a VERY large teaching university/medical center. We take everything when no one else will. Anyhows, my mother died last year of IBC at the age of 52 so that is why I want to work in Oncology. I have had this patient for 2 days now, 36 y/o female with lung ca and mets to the liver and bone and she has ascities so bad she looks 12 months pregnant! She has a PCA pump and Methadone for pain and it is so sad to know that she has gone through all of these tx's and they have not doen any good. The doc's are going with her wishes to do more, but have the docs really told her the TRUTH about what happens once you mets to the LIVER!?! The doctors and residents and interns and sub-i's sit in the lounge and talk in front of the nurses about how so and so is NOT going to make it and their chances are grim and WE as the nurse know that once you mets to the liver it is NO good, but why can't the docs just tell them so they can get their affairs in order and be comfortable? I know once my mother mets to the liver it was very fast after that. The nurses tell me that at this med. center they take what every other place won't because it is the patients LAST resort cuz they have tried everything else and because we are a teaching hospital they experiment. But the nurses tell me who have been there for 15 years that they RARELY see anyone do "GOOD". They usually watch these patients deteriorate over a few months, if that then say good bye. Anyhows sorry for the rant but I have one more thing to say. A patient died tonight at the age of 52 and the family started to cry and I had to excuse myself and go cry my eyes out cuz all I could think about was last year losing my mother. How long will that go on for? I KNOW I am not the oncology nurse to have lost a loved one to cancer. How do you cope? Carlissa RN

I live in Dutchess County NY and my investigator was from the Port Chester office in Westchester, NY. The investigator had to clear me and all was well with the BON. I had felony charges of Grand Larceny stemming from when my father died when I was 21 and he was ONLY 42, from a massive MI. Well my father had his own business and when he died I was executor of it ALL and had NO value for the dollar and spent 20,000 in 3 months. After I learned I could not handle my dad's sprinkler company, I signed everything over to the public administrator, on my own to be liquidated, he had me arrested because he told me to stop spending money and I could not, I was like who are you this is MY father's money. That WAS my attitude then at the age of 21, I am now 35 and definitely value the dollar. Apparently when you own a business you cannot just spend money without receipts to show for what you have spent for tax reasons, this I had NO clue of! I never went to jail served probation, was supposed to be for 5 years but was off of it in 2 years. I now am an Oncology:nurse: nurse, which I love. I lost my mother last year during my last semester of nursing school from Inflammatory Breast Cancer at the age of 52, this March 30th will be a year since she has been gone and she inspired to go into Oncology Nursing. I HATE cancer and if I can't do anything about it I can help those and their families going through this awful disease! I work and a big todo University Hospital where we use experimental drugs and do BMT everyday, it is so exciting! Sad but I am proud to be a part of this team we have there. Sorry for the rant, Carlissa

Good Luck tomorrow. What state are you in? I had to go through a Moral Character review also and I live in NY. I never had to go meet the BON personally, and I just faxed them all the info they needed and dealt with the investigator over the telephone, which he was EXTREMELY nice! I just graduated in May 05 and have been working since Sept. They would not even start the MC investigation until after I passed the Nclex-RN. I now work at a University teaching hospital. Carlissa

I just graduated in May and for some reason was scared to go to the hospital but I have been working in a Sub Acute Rehab/LTC facility for the past 4 months and I have 40 res. to do med pass to plus txs and medicare charting and I am the ONLY RN for the 3-11 shift so I have to OVERSEE the LPNs and CNAs on the the other 2 units, we have 3 units there. I also am NOt the supervisor the supervisor is a LPN, so that is why I have to go and assess. Whenever something happens, ie: fall, skin tear, etc I have to stop what I am doing on my unit to go and assess and write a nurses note for the LPN, since they cannot assess. I said if I can handle ALL of this, I am ready for the Hospital setting. I interviewed this am and got hired right on the spot. I am so excited. I start Feb. 14th. But now I am worried how they will treat me on my present job for the next month because they are under pressure from the state to hire RN's because they got in trouble for LPN's assessing residents. They got a G-Tag which is a bad thing and I really fear for my license there. I feel bad for leaving them, but I need to do what is good for me. Plus I don't feel like I am utilizing my nursing skills that I learned in school at this place too. Oh and also they want to make me a RN supervisor. Hello I am a new grad in May 2005.....I have NO desire to supervise I want to work with patients! Sorry for the rant. Give me some pointers for dealing with my present job for the next month, I already gave them my notice today. I know they won't be happy cuz it is so hard to get RN for 3-11 shift. Thanks, Carlissa