nancyjean68

Just wanted to add I was the ADON here also.

Oh Yes!! We had a facility like that. It did take a long time but good things come to those who wait. I can give some hints. The DON got out on the floors, toileted, fed, assisted ambulating, knew all the resident's names, and no bragging. Staff sees that and hmmmm, gets them talking. Families I've found that the most important thing to them was communication!!!! Tell them when an antibiotic starts, how their family member did last night sleeping, a funny short story that their family member did or said. They appreciate when they walk in the building that people smile at them and say hi, acknowledgement that they exist. (BIG DEAL!!!) Our CNAs had to change their whole way of thinking, working, and it worked BUT took a lot of hard work on the administrations part. The community needs to be able to trust you. We had monthly meetings with the community, a breakfast. They got to eat our awesome food and listen to a short lecture/education from one of our experienced nurses. We even did a breakfast meeting topic of sexual activity....AND it was a hit! You never know! You have to work hard to reap the rewards, and believe me it is worth it. The talk about town about us was incredible. It got to the point that when you mentioned where you worked people miles away would say "oh, ya, I heard about that place, I've heard great things." Our Administrator was very involved and active with the community. It wasn't something that he had to do forever but the expression of compassion lasted a long time, and it was real. The facility was homelike not stuffy, no chandeliers, no fancy rugs. Just real folks that cared, really cared. It was a long process to find the right mix, but it can be done. I'm talking years but don't be discouraged. Your heart should keep you alive and excited to see your dream come true! A lot of the CNAs stayed and it had a lot to do with education and more education. I think when someone (CNA) knows that someone else (boss) has put trust and faith in them, they give their best AND express that to other co-workers that they all should do their best because not only is it the right thing to do but they see they are counted as a worthy employee. Giving incentives to the staff, housekeeping, aids, nurse, etc. Winning over that one person you know is the "respected employee" by other employees can be your best move, not giving in to them but highlighting their best features, it will empower them the right way. Others will listen and follow. One moto we had was... Yes is the answer. Then we would figure it out later. "Can I put a flat screen tv in my mother's room? Yes. "Can my wife be up at 7:15 in the mornings so I can have breakfast with her daily?" Yes. This may not seem to be a big deal to some but the husband only had a small window every morning to be with his wife and we made sure it happened....every day. It's the little things to us that are such a big thing to others. It makes you feel good. The people talk and before you know it....your reputation is out there and it's GREAT! Take a deep Breath and it will come!

That's right. When you first received the wound vac, the company should have done an inservice to show you how the machine operates AND they show you how to place the dressing properly, if it is not a nurse showing you the dressing - one of your nurses would do it - that way they learn hands on and can show others. The inservice should include: plugged in, setting, drainage canister changing schedule, the tubing would be changed with each dressing change, also noting how many dressing are left so you know when to reorder them. If they are used more often as PRN then you need to make adjustments and that's when your med/treatment nurse will need to be on top of that ordering process. Depending on the wound, most dressings can be changed twice a week with maybe 1 PRN for soiling. The dressing should always appear tight, that way you know if the suction is working. The machine should have an alarm that sounds if the seal is broken. Again, I am probably telling you tings you already know, but the wound vac company can inservice you and they would love to because it's good customer service and PR. Just FYI, a wound vac works best after debridement and/or very little to no slough. I do not work for any company but coloplast wound gel....a little dab'll do ya!

In Mass. you have to have a scheduled antipsychotic before you can have a PRN, also make sure you medically clear them of UTI or any other labs, elevated BUN etc. THEN you can send them out for psyche eval, and only then. It may appear as a long process but if it were your loved one you would want everything done before they were committed. Many people act out with a UTI.

I think it all depends on how good your rehab dept and nursing relationship is. Is there a way to speak with the director of nurses and voice your concerns, or are they going to poo-poo you and sweep it under the rug? I worked in a wonderful SNF where the rehab and nursing had a great relationship and all concerns were addressed immediately that day and the administrator followed up that day or the next at morning meeting. I know a lot of these issues MUST be followed up on, that is the only way things will get better. People have to be held accountable for their lazy work ethics, we all know this, but you have to act on it. If you feel that this place is too far gone and your rehab/nursing relationship is in the toilet, then report straight to the DPH. But you must know that if you still work there....watch out. I hate to say it but unfortunately that's the world today. Express your concerns for the resident's health and safety, ALWAYS make it about the residents! Because it really is, right? If they weren't there, we wouldn't have a job, correct? So I think you know what you need to do, however, I feel for the administrator.....maybe,maybe not.....does he know what really goes on?