inaniel88

Thanks you guys, Yeah this was pretty much my opinion from the start. I guess I'll just resume signing it for hours actually worked. And keep reporting it to their agency and the scheduler whether they actually worked or not. MY only hang-up was that these CNAs along with my own scheduler and THEIR schedulers and some staff management were telling me they got paid either way, whether they worked or not. Like, if someone was scheduled, and (miraculously we were overstaffed) management would tell us to send our actual staff employees home first because "agency is paid either way" (whether they work or not). Which was the cause of my confusion. And the drama when I correct their (self)-filled-out time sheet to reflect actual hours worked. Crazy. I guess I'll just do my part. I just don't know where this thinking comes from? Do they ACTUALLY get paid for time not worked - everyone in my facility seems to think so..I don't really know who to ask, unless I called their corporate office or something to ask them.

Question - (especially to anyone in DON/HR roles)... So, at my my LTC/rehab facility, we're kind of imploding and having a lot/majority of agency staff from multiple agencies on all shifts... They all have their own time sheets, and being charge, I sign them at the end of the shift, or their last day if working consecutive days. Bottom line question - isn't it "fraud" if you sign a time sheet that says 6-2, 2-10, 10-6...if they actually show up 45mins-2hrs late? The reason I'm asking is I've gotten very different responses from everyone involved and can't seem to find a straight answer....CNAs themselves, DON/ADON, scheduler, HR, friends in the business, whoever answers the phone when I call the agency to see if this person is actually COMING or if we have to rezone 30-60m into the shift... I guess, posing this question right now, I should probably just call up the administrator if I'm THAT concerned/upset about it, but he's very shady as well and he probably doesn't know what he's talking about anyways ....I'm not really worried about being in trouble personally - I don't think anything would come of it (unless I make a big deal of it of course....) I USED to make a big deal of it - If someone showed up 1 hr late and tried to write on their time sheet for me to sign that they showed up at START of shift, I'd either correct it (which they would AGGRESSIVLY confront me about and say they got paid for the time they were SCHEDULED either way) or sign it to avoid the hostility and then call their managers at the end of MY shift (30-60m after THEY'VE gone; to say NO, they came it at THIS time, THIS is the time they worked , and relay that to my scheduler)...it caused some drama... But the majority response from everyone involved, in MY experience, is that if an agency aide or nurse is scheduled to work 6-2 and they show up at 6:45 and leave at 1:30, they STILL get paid for 6-2. And if our scheduler makes a mistake and someone shows that isn't supposed to be there and they get sent home without working, they STILL get paid because they were scheduled in the first place? ?!?*****!? So I guess my question is, if anyone has any experience with this and anything factual they can lay upon me, because I'm getting kind re-fed-up with people getting paid to do work they're not present for, and how to handle this in general?,..I'd very much appreciate the advice.

"Am I the only one who's amused by the idea of starting a thread to complain about nurses who complain?" Well, how do you deal with people who complain day in and day out that they do too much and their jobs are too hard, when in actuality you do way more then them but just don't complain about it as much and they don't take kindly to being called out on it? Just put up with it? For how long? Until it becomes passive-aggressive and toxic? Maybe OP just doesn't want to contribute to the negative/whiny environment at work. How to deal with negative/whiny people....I usually commiserate at first, but if I'm actually doing more than another person who is constantly negative and complaining about everything every single day, then I try to be annoyingly positive to get the point across that I'm annoyed by their negativity - it sometimes works.

"What do you MEAN I have this many patients?!" (Um, were you not present on your orientations days?!?)

This woman died a few days later after being re-admitted from hospice -house, she was there for awhile, went out for a week or so, then came back to us to die. Getting MS ATC and drowned in her own secretions. Died on my shift in front of me, I was very torn up and affected by this for awhile, seeing her like that.... Commentors said it didn't add up, and it didn't. "Hospice" for years, COPD on RA and 2L PRN, with pulse ox in the 90s still her first day back...Crisis care for some reason, and the nurse asking for MS q2. Readmitted multiple times from hospital for falls at home/UTI, probably on her opioids she didn't (IMO) really need. Multiple narcotics for neuro/DM pain. All communicated to MD/palliative on my part. She was young, early 60s, and fun/young at heart, independent, ambulatory, but narc-seeking unfortunately. I remember a few days before she was sent out she had me cracking up talking about finding a boyfriend and showing me her new Victoria Secret bra she ordered on her laptop.. POA, who never visited/didn't have a relationship with, wanted her medicated, and medicated she was. She went out ok, SOB with anxiety, came back not herself, and overmedicated (IMO) and died a couple days later. She would come, go, come back on medicare for falls at home/UTIs, go hospice, then go home because she missed being independent, then come back and repeat. I don't know if she was a "hospice" patient when she was at home living with family but she was ambulatory and pretty independent whenever I had her as my pt. No edema, not overweight, no circulation problems,.. I don't know what qualified her for hospice exactly and that was my concern in the first place. That's not my expertise, but her only DX was COPD, Afib, DM. Her pain c/o to me were neuro. She had no reason IMO to have dilaudid and MS. She had no ortho DX, she was up and walking around. I feel like if I had more experience at the time I could have advocated for her more.

Hi all, little info - 120 bed facility, usually 100-110 occupied, I'm NOC charge RN for 4 yrs, shift runs with 3 nurses, 6 CNAs (that's if we're lucky - usually 5, sometimes 4, a couple times I remember with 3!) with two 15-bed medicare/rehab halls, one of which is mine, plus my LTC halls... My assignment is always the fullest, usually 40+ residents. I actually enjoy my job, my residents, and being busy, and working as a team with my CNAs and other nurses.... so I'm not complaining about the LTC environment...I like the nursing part of being an LTC nurse. But lately my facility is very short-staffed, my shift especially. It's become the norm for 4-5 of our CNAs to be staffed by an agency, or new hires, with major attitudes who hide/don't want to work. I'm having some major issues the past few months that I've never encountered before and I really don't know how to deal with it lately. Generic example...agency aid or new hire, I give them their assignment/report. I tell them to pass waters/towels, check alarms are on, O2 tanks that need to be filled, do rounds, who they need to get up before they leave, who needs to be turned/offloaded, when they can go on break and to let me know when they go. I always give them their assignment/report/acclimate them to the facility and codes for med and stock room before getting my own report from 3 other nurses, or counting my own narc drawers (2) from PM shift that's waiting to go home, and by the time I do it's almost time for my midnight meds/txs/start checking my orders/do paperwork... ....And I'll see them on their butts. Or not see them at all, no carts outside the room they're supposedly in. This infuriates me, especially if they are blatantly lazy and just sitting out in the open or on their phones - I'll ask if they did rounds and they usually lie and say yeah, (I have my eyes on my halls and lights at all times so I CAN see if they are actually going room to room and doing their jobs and am very aware of my surroundings). Also get infuriated (is a strong word but true) when agency comes in and says "I have THIS many people?!, Oh no, that's too many, uh-uh"....or something to that effect ... No, that's the assignment, welcome to blahblah-facility, if you don't like it then at least do your job tonight and then don't come back! - is what I want to say... They are getting paid double what our employed CNAs are, they should be working twice as hard, if at least not AS hard. If they ARE blatantly lazy then I have to spend my time micromanaging them and that's BS. We are all adults, we know what our job is...why should I have to micromanage someone who is 10-20+years older than me. I don't get paid extra for being "charge" (babysitter/receptionist/scheduler/moderator) nurse; that is the spot that was open when I was hired and it stuck. In the past couple months I've had CNAs that have outright refused their assignment, have refused to go home when I got fed up and told them to go home (we've worked short before, it's nothing new, would rather work short then let our resident's sit in their waste and develop bedsores and most of our regular staff shares my sentiment), I've had CNA's claim I was being racist or being a bully or being a b*tch, I've had a CNA threaten to beat me up/have her bf beeat me up, I've had a CNA I had to write up every single day for consecutive days before she was terminated, I've had CNAs outright lie to my face and then try to lie their way out of lying when I point out that they're lying in the first place...And this really hasn't been a problem before the past few months. We used to have really amazing CNAs who have all left recently for one reason or another... So problem #1 - how do you deal with this kind of person who doesn't want to do their job? (In the case of the agency CNA - they are getting paid well, if they're resolute in being lazy or insubordinate I report them to their agency and my DON/scheduler and ask that they not return. If it's a new CNA, and I really wish we COULD retain staff lately but it seems we're hitting the bottom of the barrel and just cycling through ab bunch of new faces who quit or are fired pretty quickly..., I try to be open/welcoming/understanding/establish a relationship. I try to be helpful and available, especially if they're brand new. I try to give explanations. I try to be they're partner when they need help with problem pts. I give them written AND verbal report so they can't say they didn't know something. I was a CNA not long ago so I know how hard it can be. And problem #2, which is greatly contributing to problem #1, is another particular nurse. Been there a long time. Is very negative, dramatic, insecure, cliquey and talkative...talks excessively to the CNAs, tells them her whole life story. Want's them all to be her best friend. And gives them the impression that it's ok to sit on their butts and that work is the Oprah show for the next 4 hours. That they don't have to do rounds or chart. That they can chit-chat, they can go on break for their 45mins, then come back and chit-chat more and then get busy 2 hrs before shift ends so that everything is set for the morning shift. And her hall is always empty and she complains about how busy she is, complains about everything. And I work side by side with her, I see how busy she is NOT. Constantly complaing about how much she hates her job, dislikes the residents, talks down to the demented and sometimes annoying residents. But she makes problems patients worse by getting them worked up. I f she was a little more, idk, "therapeutic" in the way she talked to them, she wouldn't have to deal with so many behaviors. She should know better. We'll have people new to the facility, whether they're new hires or new agency staff, and as soon as they have her as their nurse they get this impression that they can sit on their butts and talk all night and not work that hard. And I try to correct it when she's not there, it's like night and day. I've addressed this with her in the past in what I thought was a respectful way, but nothing changed and now she's suspicious of me and talks about me behind my back to the CNAs. I don't know, I feel like this is an uphill battle, I don't really want to wait it out but I don't want to find a new job either. I've gone to my DON with my concerns, and she wants a meeting with our shift where she'll moderate us hashing it out but I really think that'll only add fuel to the fire. Suggestions? Besides brushing up my resume?

1. Maximum capacity - 120 beds, census today 112 2. nursing ratio? - 5 nurses AM/PM (20+: 1) 3nurses NOC (35+ :1) 3. CNA ratio? - 8-10CNAs AM/PM (10-15:1) 4-6 NOC (18-30:1) 4. able to provide quality nursing care? - rarely, especially when constantly short-staffed 5. computer charting? - yes 6. mandated overtime? - not technically, but it works out that way when no one can come in to cover call-offs 7. How long in the LTC setting? 2 years fresh out of school 8. able to keep residents safe? - for the most part 9. mixture of residents? - rehab, LTC, psych 10. wage? underpaid? -24$/hr ..... underpaid some days, overpaid others. 11. state? - IL

So. Just bouncing off ideas here....? Resident is hospice. Independent. Main problem is COPD and diabetic neuropathy.. On 2 L. (WHY she is/has been "hospice" the past 3 years on 2L PRN is a mystery to me. Most of my (40+ ) residents are COPD/CHf and on O2. And she's only on 2L PRN and usually doesn't wear it - though I encourage her to, esp. @ NOC) Sent out last week for increased anxiety/SOB by a nurse who had been on leave for 3 months and it was her first day back ( so basically, she didn't reaslly know her........) Went to a "hospice house". She told her MD there she wasn't getting "medicated for pain." She had scheuled pain meds before + scheduled gababpentin + is very drug-seeking/exagerates. She will ask for her "dilotto" because her legs hurt....Really?? I give her a hot pack + extra gabapentin or tylenol... and she's good 6+ hrs. Other nurses give her her "dilotto" , Norco 10mg q4PRN, her PRN ativan/klonopin.. and she's a nut-job ?for the next couple days. Really? The opiods make her super-goofy. and DO NOT help with her pain b/c she keeps asking for more, and even forgets she got dosed.... Really? She IS drug-seeking. I tell her "all that extra stuff makes you goofy." She hallucinates, talks to people that aren't there, falls a lot. She is 100% awesome when I have her and she verbally tells me she is not " in pain"......And I chart it. I CARE about this lady, and have communicated to her MD she deosn't NEED all this crap. She has told me specifiacally she wants to live a long time and (basically) doesnt wan't to be "killed off" by her family. She's told me multiple times that all the extras make her goofy and she's not herslef (norco, dilaudid, tramadol, ativan, klonopin). And now MS Contin BID?!? all because she "wasn't being medicated for pain". But she has like 3+ PRNs at the time and can/does ask for them/DOES get them when asked..... I've found (in the 2yrs [off and on, medicare-frequent-readmit]) taking care of this woman, (5 nocs/wk so i know what im talking about) that gabapentin is what works for her for pain. I;ve told that to the day nurse (who talks to the ?MD who can only be reached during the day or else I would take it upon myself to call him). I've talked to the DON. Nobody seems to care. I've talked to the family. I am kinda of holding mylself back from FB'ng a family member I'm friend with to tell them what's goin on...I really don't want to kill this lady with scheduled narcotics she DOES NOT need but I don't know what else to do. I've called/can'treach/charted/passed to Day shift. to calll about this lady asnd they don'.t I want to call state but don't want to lose my job, obviously. So here she is. POA who says "give it to her, she needs it". COPD main/only porblem and sat 97/98% on room air with 4+scheduled pain meds with DM pain that is under control ( & always 95+% in the AM) And now she is crisis care and I have a new crisis care nurse every night who doesn't know ANYthing about this ladY and they are sleeping/asking for MS and atropine q2 AND SHE DOESN'T EVEN NEED IT!!!! And I have to do that whole thing. ... So basically.....I kind of feel like this is worth throwing my job away over at this moment..... I've alreaedy done the "chain-of-command" BS. Nobody cares. I have a relationship with this lady and feel like, responsible>? Do I just keep going along with all this pish-posh? What can I do (besides what I've already done and voiced/documented my opinion)? I really want to .... tell her grandson (who i'm FB friends with) what is going on. (HIPPA)....like i understand /Md is just trying to cover his butt.. Butt this lady does NEVER c/o pain.... So what do I do??? I've already involved MD/DON/ADON/POA. She's told me before she deosn't want to be "thrown away" by family. I reallly think she could "live forever" 10-20rs snd I feel like we're just goin to kill her on PRNs she soesn't need and they'll chart shes "confused" re:"snowed" and give her more crap she doesn't need. She has not eaten in 3 days becuase she's too "confused" but sPO299% on 2L, 96/97 RA. Really nothing is wrong with her....COPD, scheduled nebs...She had SOME on day shift for an unfamilair nurse who just wanted her out of her hair.... What should I do? + Love this lady. Just go with it?

So I know this has been posted about may times before....and I know it exists almost EVERYwhere no matter the setting......But I am REALLY getting tired of the animosity b/w shifts.... Any advice about dealing with next-shift CNAs that want to complain about MY shift when MY cnas are gone and clocked out and already home.... and I'M still trying to sign out my book/chart/answer alarms and avoid a "fall event" and everything that goes with it /answer the phone (chrage is basically responsible for playing secretary and answering (lab-family-calloff calls) til secretary comes in at 8a) /give report to 3 other "zone" nurses/do MY job (medicare charting/vitals on 5-10/night ...depending on zoning) + trach/IV care (other zones at other ends of the builing and I have to stop what I'm doing and go to do LPN trach-care/IVs/blood-draws/sign out MARs/TARs)?......Keep in kmind I am only making 23$/h with NO noc shift or charge nurse differential. and getting threatened with write-up for o.8/FT overtime) ......Do I need to just call it quits and start taking my job-search seriously? Try to go to med-surg in a hospital w/ I've been on nights 4 years now. 2 years CNA. 2 years charge night nurse. There are 3 nursing "zones" on NOC, and 5 zones for AM/PM. And I'm reposnible for 1 of 2 medicare/post-op/PT-OT-ST, and overall AOX3 needy-complaining/short-term "zones") It's never been a problem before now, and don't get me wrong I pretty much love/enjoy my reisdnts whether they're short/ong-term,.... but lately (d/t poor NOC-shift staffing, poor staffing across ALL shifts really...) I constantly get interrupted in report w/day-shift CNAs questioning NOC shift. There is SO MUCH chatter/whining/complaining at the nurse's station for 30 mins of 6a-2p before the CNAs actually get to work. I can't even hear MYSELF when giving report..........They (day CNAs) come up to me "you need to tell YOUR cnas to do , - blah-blah-blah" "why isn't so-and-so's O2 filled?" "Mrs. X's TED hose aren't on!" "they have a dry brief/pad over a piss-stained shee!t" "why isn't THIS PERSON up!"....."I;m going to tell [DON}".....really? !? .....If I had TIME to follow around ALL my CNAs and make sure EVERYthing was being done, then I could just go do their job AND mine (and I usually DO -- changing people, answering alarms, gettting water/cookies, stocking, spotting people w/ 2-assists, quick-risers and hoyers, switching out empty O2 concentrators, listeing to the neeey people10-15mins.night) AND playing "hospice nurse" (when our hospice doesn't provide critical/continuous cae - when someone is dying and 3+ famliy members are there overnight demadning MS/Ativan/Atropine/vitals evry 2-4-6hrs).... Being a CNA before at the same facilty I am definitely willing to help out my CNAs and have relationships w/them across all shifts.... But it's just like generally day shift just thinks all we do is sit on our butts all night. Night shift is BUSY (not EVERYwhere apparently, according to posts I've read - but definitely at MY facility). We usuallly have 100-120 beds. Supposed to have 9 CNAs for AM/PM and 6 for NOC when fully-staffed (if such a thing ever exists?). I don't have time to do all that. I fell like if they have a problem with NOC shift cnas the they need to come in early/give report to their oncoming shift.....I've brought this up to my DON but even though she's empathatically on board, she can't do anyhting to about it to make this madatory...... We've been consistently running either 4-5 CNAs at NOC (usually 4), so that's at LEAST 20-30 residents per CNA and they're supposed to change incontinents q2hrs AND take 30-45 min break, AND fill O2s, wash W/Cs, and have AT LEAST 6 get-ups UPs up (each) before day-shoft comes on at 6a, AND chart, AND filll out toileting sheets, .AND do inventory & weights admissions.,..............AND cover the other hall who's on break for 30-45mins, so at that it time it's 40+ that they have eyes/ears on..... As charge nurse I come on at 10, have to get report from3 nurses, count 2 narc boxes, print and check my orders from the day (NOC responsibiliyt), check BGM machines, check fridge temps (daily), check crash cart (daily), check and call on labs, check/fix admission orders (I ama perfectionist when it comes to orders), send people out, re-admits (latest was 12am), midnight meds, solving other peoples probems, making sure the phone system is working in the secretray's office and switched to NOC-shift setting, locking and un-locking the front door (at the other end of the building), locking and unlocking the BACK door (at a FURTHER end of the building where CNAs take out their garbage 2x/NOC and I have to make sure they're lockig te door behing them 3x/NOC ), treatments (now 2-3 nightly, but at max has been 11 every night), gtube-dressing changes, foley changes/straight-cath UAs for daily labs, Gtupe-lopez valve changes monthly, O2 bottle-tubing-neb changes weekly, book change at the end of the month (HUGE pain in the azz, at least 3 hours of my 8 hour shift, MARS and TARs that I usualy come in a m hr early and late for), I have to clock out for 30 mins (even though I work THROUGH my break b/c if I don't I WILL be written up - and the 1 time clock is also at the far end of the building...plus we have like 10+ surveillance cameras thst can prove we're acutally WORKing though our clocked-out break but yet we're threatened with "corrective action" if we fail to clock out)....), time spent chit-chatting w/residents b/c they find me 'nice' and 'approachable' vs other shift nurses,.... helping older PM/NOC nurses who aren't as savvy when it comes to entering orders into the computer,.... dealing with CNA's personal problems ('can i hav some tylenol, i have some tylenol, i have a headache?' 'my back hurts i think i'm going to go home early and go to the ER', 'I can't work on THIS hall b/c MRs. X doesn't want a male CNA',.... having to call everyone on the 'call-list' to find covers for AM shift if there's morning call-offs, callling maintanence/admin if there's a structural issue or power-outtage/security/workmans-comp issues ..... I feel like the list goes on and on. days/pms has TWICE as many nurses AND cnas PLUS 10-20 ancillary staff (maintanence, office/secretarial, dietary, MDS, OT/PT/OT, lab, podiatrists, MDs, RTs, vistors/family, volunteers, CNA/RN students) Well basically the point of my post is not MY noc-shift responsibillity, but is actually re: the HAASSMENT I get from day-shift CNAs (used to get flack from the day-shift nurses too, but after 2 yrs they kinda know im 'on top of my s**t".....They (mostly AM CNAs)... think we don't do ANYthing all night, and tattle-taling to my DON.... I am constantly moving. When I have my trusted/good/regular CNAs then they are constantly moving too. I like to have a good relaionship with my (and all-shift) CNAs. They do the hard crap, work hard (for the most part), but they are always blamed for a job poorly done (d/t poor staffing IMO) And their animosity towars eachother bleeds thorugh into ME doing MY job....And they are always the least "heard" when it comes to employee complaints, unless it's the majority/joint-shift effort....if it's one person complaining/standing upf or their "rights' (?)...then they are usually targeted by admin and quit/are let-go. So how do you calm the shift-chaos? Should I just ignore it, or re-direct it to my DON? ( who will re-driect it back to ME, eventually saying it's MY problem to solve"....i really love my job/location/schedule/pay/ and co-workers (for the most part) but feel like I am feeling the flack and taking the blame for alot of other people..... Sorry this was long. Any advice -big thanks, I want to make it work but realize this is idealistic,..My DO N told me to advise CNAs to report off to one another, (but there's no way of enforcing it) or to talk to the probldm-person specifically and privately (but like I have ntime to track them down and do thst) My DON told me"you need tobe a bi**h to get things done -- her advice to me"... IF I was DON/admin, I would require ALL shift staff to report to oncoming (CNAs/nurses). I would hold monthly meetings ("bit*h sessions" with regular shift nurse + FT shift CNAs, so theyy can all be heard/addressed) I'd assigns CNAS as "shift leaders" to address shift issues. I'd pay shift diff. I've stood up for myself. My shift. Individuals (across all shifts). I play "get along"....but I am really fed up with getting blamed for other people's percieved/exagerrated short-comings. We are in the 24/7 business. If you have a problem then bring it up with the indiviual/admin, and not me, I have enough to do. In the time it takes for someone to b*tch about something, they could could've adressed the problem + another. Ho do you encourage shift-friedliness and NOT shift warfare?