HARLEYDNS

LTC/SKILLED FACILITY QUESTION: So we have 3 units each unit is aprox. 26 patients for each nurse) Typically we have 1 nurse per unit. However, there are times when someone calls in last minute or we just can not find coverage. If we have the 2 nurses split the other unit (which would be up to 10 patients extra) how should I handle refusals by a nurse to take the additional patients?

Is there really a max hours for a nurse to work in michigan? If no one will work and someone says they will work 24 hours is the allowed or totally illegal? I can not find answers on LARA (if you know where I can locate this information let me know.

Hey Cape Cod Mermaid, Here we are 4 yrs later. Still have the job, just got thru a gurling survey escaped with 2 baby isolated tags. One on blowel care and one on hand hygine. I am so proud of my staff we have come a long way!! The job is a joy to my heart everyday!! Even being there 10-12 hrs per day (STILL) I am happy, it is a great facility, I am learning ever day! The staff turnover is rediculious to say the least!! Hope this message finds it's way to you! I am currently looking for duties for the managers (turn over here too) Just want to be sure we don't miss anything. Any input would be great!!! Thanks!! Harley

WOOHOO! I got the job after 4 grueling interviews (finally) and FYI, ?I got a 22% raise! I know it will be a challange, sounds like lots of systems are broke but I am willing to learn and do the best I can to get it into shape. The survey window isn't until July, so hopefully we can get it together by then. Harley

I'm sorry what is that?

An RCM is a resident care manager, you manage your unit and do all your reports and MDS....Good Luck in your new building, I got the scoop from several work friends and my personal references that they all got the call yesterday asking about me and my ability to do the DON position. I am going back today for the final time (interview) they told me that after todays interview they would either tell me I have the job or.... not. It sounds good so far, I think. I am being open and praying alot for guideance and wisdom and of course patience in this new position. I have set my mind on a goal salary of 75-80k. We shall see.

needshaldol, then you must love you job! Good for you, hard to find a balance btwn money, job and life. Glad you found yours.

Wow! No you would write in your journal things to remind you of the events that took place that day !!! Again you would never ever say you have a journal...As I said in my first post it is your PRIVATE journal. I totally agree with documenting EVERYTHING, but again in 5-10 yrs it all becomes a blur...so a journal is the way to go. As I said there are things you do not write in the chart but are things to help you recall the events. Ie... he was wonderful, his wife was a drunk and came in drunk....etc... as "[COLOR=#003366]Nurse_ " wrote it is to help you keep protected! After over 20 yrs as an RN, and 20 yrs as a NA and LPN (nursing assist. were not certified back in my day) so total 40 yrs in nursing, the journal is the way to protect yourself as employers no longer back their nurses. It's just about protecting your self and your family! It is not a legal document, and it has no names, its only your reference, call it what you want but again No one EVER knows about your journal. So, obviously when and if ever in court you never say you have a journal..... before getting into court you will have the opportunity to speak with an attorney and you will go over the patients chart with the attorney. You then go home and read your private notes for better recall and tell the attny. I have been thinking about this and I remember....xyz about the patient, it is not play by play of the day with each patient is just a recap of the days events. ie... very busy, guy in rm 2 coded, and went to ICU..etc.. I had 8 patients and 3 admits and 2 d/c's etc....just my own personal experience after many years of nursing. That is what makes us a diverse group of people, we all have ways of doing things. Just sharing mine.

Again thank you for your feedback. RCM is a Resident Care Manager, manage a unit and do the MDS for that unit. Thanks for the info on the pay. Today is the day I find out if I get the job or not. I do know that there is NO money worth this type of commitment. The facility is about average here, it also has apartments, and Home Care in the same building. Only a few others with more beds and a few with less.

Here's the real deal. Keeping your own records is your business. In my opinion a personal journal is better than keeping you work sheets and do not EVER tell anyone you have this. It is for your protection, and your eyes ONLY..... now, how to get around the HIPPA issues, (this is not a hippa violation) ... but for the ones who think it is.... you dont use names in your journal. Only room #'s and initials. The reason you do not tell ANYONE that you have this journal is because if an attny finds out you have it, it CAN be used in the court of law, and may be used against you. However, with employers not protecting their nurses any longer you MUST protect your self. Trust me, in 5 years from now are you going to remember the patient that was a diabetic and his blood sugar was 87 after breakfast? HELL, no! However, if you have a PRIVATE journal you will remember it once you get the chance to go home and pull out that SECRET journal and read it. The chart is public info. once it gets into the legal system. (Public as in the courts) They can use your chart notes however, when you go home and write your real thoughts like (he was a jerk, pervert, nice guy, bald....ect.. 10 attempts to get his IV going) you know that stuff, you will then be able to recall the patient better than what your quick note in the chart was. If you can not remember a patient you can just ask when was he a patient there? Then you go to your journal and look up that date or aprox date and you will find it. A court case may not even come up for a year or two, but getting to the official court day may take another year or two, so believe me you will not remember one patient from another a few years down the road unless you keep a journal. On a good note, you can keep your journal to use when raise time comes, you can flip thru it and remind youself of all the times you went above and beyond the call of duty. Then you remind your boss of those days when raise time comes. Good luck, and start you "PRIVATE" journal ASAP! Harley

Wide Awake, The interview went well. I have to tell you I was quite surprised to walk into the conference room and find 14 others there as well as the regional nurse consultant via phone. It was some what grueling, but I made it thru. The questions were very complex and mentally draining. I rec'd a call yesterday (the day after the 3rd interview) to let me know that I have a 4th interview, meeting tomorrow. (I can not believe it) however, the administrator told me that they would be telling me yes or no at the conclusion of that interview. So, I hope you come here often and you can answer my question about the pay. You mentioned you have friends in the director position. Can you give me an idea. I am wondering if I should expect or ask for like 10-20% above my prior RCM pay?? I really have no idea. I live in Oregon west coast area. 60 bed facility, 20 rehab and 20 long term is the avg. 2 RCM/MDS coordinators. Will be on call Monday thru Sunday every 3 weeks. Thanks for any help/advice you can provide. (Anyone with info. is welcome to reply to this as well.) Harley

[Thanks for the replys. I wanted to let you all know how the 3rd interview went. I walked in to this interview and found that I would be questioned by 14 other directors and managers in the facility as well as the regional nurse consultant via phone. Talk about intimidating. I feel pretty good about it but wow, some really complex questions as well as very mentally draining. Sooooo, did I get the job??? I got a call from the facility yesterday, (the day after the 3rd interview) Well, believe it or not I go back tomorrow for round 4. What the heck?? Has anyone ever heard of 4 interviews for a job?? In all my years as a nurse I have never gone thru more that 2 for a particular job. I was told that after this interview I would be told yah, or nah. I am still wondering what kind of money I should expect. As I said before I was told to anticipate at least 50 hrs in the building per week, on call Monday thru Sunday every 3 weeks. Aprox. 100 employees, and it is a 60 bed facility which averages 40 full beds. Aprox. 20 rehab beds and 20+ long term beds. Any advice would greatly help. I live on the west coast, Oregon. One more thing, I have checked all the salary.com, paycheck.com ...etc...and still not getting a clear picture. I am an RCM and wonder what percentage of a raise from RCM to DNS I should ask for. 15%-20%...or more than that?? I really dont know. Again thanks for all your comments! Harley

Thank you CapeCodMermaid for your answer. Yes, I know that salary is based on location. I am west coast Washington/Oregon area. I also have another question if you have the time. I was told there would be a competency verification test. I am a good nurse, and know that pretty much I can pass a "nursing" test but I am concerned if there will be test questions regarding DON issues that I many not know about. Can you give me some ideas or do you know of somewhere I can go to get information. Any assistance would be greatly appreciated. Thank you again for answering. Harley

Nurse Guy Bri, You seem to be on this site frequently. I would like to ask your opinion about taking the DON position. I am new to long term care and am going for my 3rd interview tomorrow for the DON position. I have no idea what kind of money to expect or to ask for. I have been an RN for over 20 years. Also I have to do a competency verification training test can you give me any ideas what that will be like. i anticipate about a 50 hour week. Oh, I should tell you it is a 60 bed facility. Aprox 20 of those are skilled rehab, the other are long term care. It is a large non-profit organization. There are 2 RCM's (resident care managers) one on each of the two units. Can you give me any advice as to things to say or ask at this 3rd interview. This one is the panel interview and the regional nurse consultant with be on a conference phone for the interview. Thanks in advance for any assistance you can give me. Harley

I took a $9.00 per hour pay cut a few years ago and in the long run it was worth it. Money isn't everything and being home on the weekends with kids and family makes it all worth while. Good luck in your new job if you get it.