mander

I parked my fat behind here and I’m going for my adult geriatric np. It’s up to you whether you reach a dead end or not.

Can I ask how you are reimbursed for calls and texts? Or is it like on call hours for that?

I got a $2 raise... mind you I was already making below what other charge nurses were making at the time... and when we are short staffed I was always coming in and I work well with my DON. You should really be getting a raise if you have this on call responsibility. I personally could never take another job with my position, charge nurse or ADON. You could apply and let them know you expect a raise or negotiate on in 90 days or something. But if it's more of a headache and not worth it to get M-F then maybe it's not for you.

Do you have a ward clerk that fills out lab slips for blood draws and appointments etc? All of our units have a falls binder (where we pretty much just write the date of the resident's name and date of the fall as everything else is in the incident report or PCC), a coumadin binder (we missed those a loooooong time ago and got a deficiency on a survey probably more years ago than I've been alive), we used to have a wound binder but now most just keep a running list of current wounds, and the kardex is all on a kiosk so no papers around the unit. If a change is updated then it's there in the kiosk. Everyone has a separate gradual dose reduction binder for their units to track when changes are made. As for interventions, those just go along with the A & I process of ours which involves updating the care plan in PCC anyways so there's no need to track that. We do have someone responsible for tracking falls, date, times, injuries etc but we don't need to as unit managers. Much of this will depend on your facility policies.

Honestly, working 7 years n the ICU was probably the best thing you could have done.

That sounds asinine to me. I think we only report falls or incidents with injuries ONLY if there is a break in care plan or if it results in a death. Or if it's a burn. I don't think anyone wants to sit there and read all of that. What a waste of your time too! I wonder if your predecessor had some trust issues with someone and reported everything as no one could make a decision?

Yikes, we have at least 4 CNAs on days for 40ish residents, 3 on evenings, and 1 on nights. That's minimum before the DON and I are called in...

Smile... attempt to help... politely tell her she needs to calm down and tell her about discharging AMA. ?

Yikes. We have unit clerks that do that! I can’t imagine how stressful your place of work is. We are low on census as well so of course that’s all we hear. We’re still busy!!! We couldn’t get things done before and now we are just barely keeping up. What an ***. It doesn’t help anything trying to insult people. Go team!

They are nurses. I know they did more than study the art of medication passing in school. They need to practice to the fullest extent of their licenses. Yes, they need to report things to the charge nurse but they also need to do their best to take care of situations within the scope of their practice. The charge nurses need to empower their staff and hold them accountable. End of story. We are all busy but if they weren’t needed to practice as nurses we could just be using medication aides.

I hate the damn white pants. We all have color coded name tags already anyways. But our LPNs/med cart RNs have white pants, other RNs scrubs and white lab coats. Admin RNs can wear dress clothes but I've been wearing scrubs because it's easier. CNAs can wear anything but white pants. I think the white is bs because I always manage to get blood or treatment creams and ointments or dirt on my lab coat. The temps around the building are always messed up so wearing a long sleeve coat is annoying. It's not the worst but not the best...

We put up a Christmas tree in our lobby. Activities goes to every long term resident and asks them what they want for Christmas. If they can't speal for themselves we usually see if they need slippers or socks or some supply/clothes or a gift certificate to the beauty shop. We keep it around $10-20. We hang their lists on a tree and it's anonymous. Everyone is welcome to pick a tag. Leftovers go to a volunteer group to finish up what staff doesn't pick. Then each unit gets their gift at their unit Christmas parties.

We have a house supervisor at all times. We have a specific list of "When to notify DON and administrator". If you call for something dumb you better go find some lube for the ass reaming you're gonna get!

And their argument would be that they are paying you to be a nurse AND answer the phone. I would add that family members are unhappy you have to suddenly step out or you are being interrupted during assessments and this poses a risk to make an error. What if you were trying to start an IV and the phone rang? Does it ring overhead and bother the residents and interrupt their home-like setting?

ADON here. My DON and I area often coming in when staffing is critical. We've taken carts and done CNA shifts. Of course we're not going to be as fast and as organized but you gotta do what you gotta do. As long as it's not a weekly occurrence and you're not working 40+ as DON and shifts on top of that. Then I would have a discussion with your admin.

Our CNAs document foley output q shift. Nurses document exactly what they put into a tube feed, be it water or feed. So I never thought about it much but I guess we technically record everythiiiiing.

We just have a form that asks for vitals, grip strength, pupil reaction, and whether the resident is alert, responds to stimuli or unresponsive etc. You do it every 2 hrs x4 then every 4 hrs x4 then every 8 hrs times 3 or 4.

I hear it all of the time from family. "That's why you're making the big bucks! I know you RNs make $40 an hour!" I want to know where I can find a job like that in my area. People often say it to imply we aren't doing enough or don't deserve what we make.

We just switched from Sigma to PCC. We did it in sections (which we didn't agree with because we went from paper to Sigma a few years go and it was easier just to do the whole damn thing at once!) We entered in waves (general orders, then treatments, then meds). I think it would have been easier to do this all at once by resident. Have your order templates sorted out beforehand. Decide if you are changing any policies or ways of doing anything beforehand. For instance, we switched from exact times to "AM" "PM". Make sure once you put a resident in people are updating orders on paper and the eMAR. Plan a few days of reconciliation and run the building like you would a weekend, with all "extra" nurses checking orders and care plans. If you have one, have staff play around in the "sandbox" (we had a fake account with fake resident names and orders). When we went from paper to eMAR it was a LOT more difficult than going from one eMAR to another. I had 50 year olds crying. It was awful. Just make them practice! If you can, have extra staff to make the first day easier. We went live at 7 am. We had the third shift pass a couple of meds for 7 am so they can get the hang of it before we got phone calls at 4 am.

I mean, that depends on your position. My DON is on call 24/7 and comes in when needed. But so do I. We just get the next day off.

We have 2 hours to begin an investigation of abuse. We would right that person up for taking so long to report.

ADON here- We have issued out the McGeer criteria a billion times. We rely heavily on our nurses to not run to the MD about every little burning with urination. We make them document vital signs, all possible s/s UTI and if they are NOT present, and tell them to push fluids. We don't let them do in house UAs anymore. Families are not to dictate us to get urine samples because their mom's urine "smells funny" or "looks funny". We have long talks with the doctor. ...It worked for a while, but we have to keep at it. We have one PA that gets mad and is rude to us (us jerks in the lab coats are "the man" and he's against "the man). Our medical director seems to get it sometimes, but other times he caves when families approach him. We have an Optum NP that seems to not care. It's rough! But I think not having your staff report every little possible maybe almost sign of a UTI helps. It's difficult to get the nurses to steer away from this thought though. Even in nursing school we were taught about UTIs and how common they were and oh, must be the cause of an elderly person's problems when it's most likely respiratory or some other condition. Then there's the fabulous "UTI and dehydration" dx from hospitals.

My DON is barely in her office. Maybe half the day on a "good" day where she can get work done. Other than that a lot of time is spent in the administrative area discussing things, or searching for pharm recs and other auditing fun. We've been in a lot of meetings and conferences lately (I'm one of two ADONs). She also has a lot of incident reports to review and sign after we get through with them. We have a 200+ bed facility so she doesn't get out on the floors as much as she'd like anymore. We spend anywhere from 45 min - 1 1/2 hours in morning meeting. If her door is shut it means she's doing something serious. But everyone knocks on her door every 5 seconds anyways. It's ridiculous. I understand that they don't see our side to running the facility but people have offices with doors for a reason.

By law in my state, you are on call 24/7 technically. Our facility has a "when to notify administrator or DON" list. On top of that, she is available for anyone in the building. She comes in when people lose keys etc as she is the only one with spares. We try to rotate on call (I am an ADON). Our unit managers alternate on call and we are above and beyond that. That being said, she still gets a lot of phone calls. It's a 200+ bed facility. You can eliminate some calls by maybe making essentially an algorithm of what to do in certain situations, but for the most part you need great availability where we work. You need to set clear expectations when to be called and for what.

They got us on a dirty shower chair this year, and then were upset about the location of our sinks and dirty utility rooms (that have been that way for 30 years!). Our CNA didn't wash her hands for a long enough time, and another one put a dirty brief on the bedside table. And our poor infection prevention nurse is going nuts about the antibiotic stewardship program we have to implement. They came the very last week "possible" where they would be out of compliance- due at the end of June and came in September. They also did a thing where they would send someone in the week before to take care of minor incidents to investigate to make survey shorter. Glad it's over! Good luck!