dinkymouse

The people who were questioned didn't bad mouth the facility, they just answered the questions truthfully that they were asked. One was how long of an orientation did you receive? 2 days was about the norm for everyone. How often do you work with less than this amount of staff? The investigation did help in that now any new employee who is hired gets 2 weeks of orientation and just not on days, but on all shifts. An LPN that was hired at the same time of as this nurse quit because she received a whole of 2 days of orientation and was left as charge on 11-7 shift. Unfortunately, as is with a lot of nurses, few of our staff accepted that since she was a new grad it would take her a while to get the routine and because she seldom had her meds all passed they harrassed her. There is a mandatory meeting today about this attitude and the backstabbing that goes on here. It is the worst of any place I have ever worked. Now of course they are all complaining because we are working extra hours to fill the spots left by these two nurses and 1 who is off because of his gall bladder.

Our Cna's are required to attend report and before they leave I make sure they know what to watch for and what I need to know asap.

Not excusing her actions, but during orientation we were told to send someone to check the chart for code status. That has changed to have someone bring you the chart. The investigators were both state and federal and all those interviewed were told it was confidential and that the facility wouldn't know who or what was said.

I have been writing up by 2 different nurses, once for not checking that what the previous nurse told me was true and once for not passing something on in report. The last one I refused to sign because I had witnesses that I had passed it on and the nurse who gave report is notorious for "forgetting" to pass things on. We have had 2 nurse managers who have used the "disciplanary action" statement for things such as cna's not taking vitals for them when it is their shifts responsibility to do them, forgetting to call a family for a tylenol order etc. Unfortunately they ignore the things that actually affect the patients. Like leaving them on the bedpan for hours, leaving them unattended with out a call light, disrespect to residents from staff and not doing treatments. Our don has gotten good at determining what is done for spite and what is a real problem. I will write another employee up if it directly affects a patients safety, health or mental well-being and I let them know at the time instead of writing them up and leaving it attached to the time clock for everyone to see.

LTC-Iowa 70-80 residents-days 2 nurse managers, 1-2 nurses and 7 aides plus 2 rehab aides evenings-1 nurse, 2 med techs ( on a good day) 5-6 aides nights-1 nurse, 1 med tech, 3-4 aides I am usually the evening nurse and it can be overwhelming at times especially when I also have to pass pills.

An RN in our facility had 2 days of orientation and was then put on the floor as a charge 3-11. A patient died and she did not start CPR. An aide had accidently told her the patient was a dnr. The RN quit and the family called the State agency, who called in the Feds. They interviewed all the employees who were there that night, telling them that anything they said was entirely confidential and no one would know who they were. Yesterday there was a list of people who HAD to see the admin or don by friday. 2 of my cna's were on the list and went in. The admin showed them their "confidential" answers to questions asked by the feds. While it said employee A, B, etc. He had also gotten a list and by each entry the name of the employee was written. He asked the cna's to verify that what they said was true. These 2 had kept their answers short and simple but others had told them about the lack of orientation, short staffing and other concerns. Is this acceptable? If they are fired in the future will they be able to say that is why? I was not interviewed but in the future I would not say anything that would be construed as "bad for the image". I thought confidential was confidential unless it went to court. Does anyone know what options these people have.

I am generally charge, 3-11, of 70 residents. We do have 6 aides most of the time and I have at least med tech to pass 1/2 the pills. On a good day I have 2 so I only have to do the tube feedings, insulins, orders, charting, assessments etc. This last weekend staffing was awful, "Superbowl Flu". The on call RN wanted an LPN to be responsible for all 70 patients without a med tech. I told her no and that it wouldn't be safe. She said she thought a lot of facilities had 70 patients and only 1 nurse. I told her that if they asked me to do that Iwould refuse. The LPN did have to be alone for 2 hours.

When I started this post it was just a hypothetical question but in the past few weeks it has become a reality. I was the only nurse on one night when a patient went into cardiac arrest in the dining room. His chart was clear down on the other end of the building and I had to send someone down there to check. Luckily I didn't start start CPR and he started breathing after we threw him to the floor and I did a sternal rub. I then found out he was a no code. Even doing the sternal rub was apparently against our dnr policy. A few days ago a new RN had a patient die, she sent someone down to find out if she was dnr and the aide came back and said yes she was dnr. Unfortunately she looked in the wrong chart and this woman was a code. They didn't realize the mistake until after they had called the family. This was an unexpected death so none of us were prepared for it and she was a wonderful lady. The RN quit over this and so I am again the only non management RN.

I agree that a good assessment is necessary and charting must be detailed. What I find so awful is that many of our forms have the same redundent questions. On a typical 3-11 shift as the only nurse I estimated that I signed my name or initials over 500 times and that didn't include my nurses notes. It seems that all these initials are more important than my spending time assessing for skin breakdown.

I am a 3-11 RN charge at my ltc facility. Generally I have one med tech and we each take a wing to pass meds. We have 21 diabetics, many of whom get insulin twice during this shift. Of course I have to do that. I have to supervise the dining room, I generally try to pass meds during this time. I do any dressing changes in the building and other treatments on my wing. Any situations that arise like falls, acute illnesses, transfers to hospitals, new orders and family or resident complaints are my responsability. We have no one to answer the phone after 4p and I generally have to chart on 30+ patients a shift. If someone calls in I have to find a replacement. I am never done at 11p unless I have 2 med techs. Sometimes not even then. Last night I had 2 acutely ill patients that I had to send to the hosp. (Both at the same time) A fall, a resident who purposely pulled out her cath and 2 residents who yell the entire shift and anger the other residents. Any res. on ATB's need assessed and charted on. There are urine dips, residual caths. I am sure u get the idea. I had all of this last night and also had a g-ttube pump that wouldn't run. The 11-7 lpn sat and watched me do the residual cath, dressing change and a + ua dip which meant calling doctor. I asked her to get the ATB out of the ER kit and she didn't. :angryfire At 3am she started screaming at me, "This is ridiculous. There is no reason you should be so late." IN front of cna's. She wanted a chart I was working on. I told her that I needed to finish it and she kept screaming. I finished the chart, told her would discuss this when she was calmer and went home. Still had stuff to do but I just couldn't deal with her. So tell me am I too slow or take too much time assessing things and such, and should I have walked out.

Our facility has the 2 hour before shift policy and if you are gone 3 days or more you have to have a doctor's excuse before you can come back. No one has to make up the shift but we are "highlighted" and have to stay until they find someone else or end up doubling. When the new admin. came a note went up saying that this was going to be enforced along with the showing up late problems. That was 2 months ago and none of the "chronics" have gotten canned.

Update-the first cna is still too slow and the other aides are starting to stop helping her. If it didn't affect patient care I wouldn't mind it. Luckily most of the CNA's I work with know that if I ask them to do something it is the resident who will benefit and that if I had time I would pitch in and help. The 2nd CNA is still a problem. I have written her up once and I was sure she would be fired the other night. Didn't happen. :angryfire She had asked a supervisor the day before if she could work the next evening so that there would be 2 med techs. She was told yes. I was there when this conversation took place so I know exactly what was said. She worked 7-3 when I was working and then during 3-11 was told that she was moving to a different hall. This is generally what she wants but not that evening. Told the nurse that staying on the same hall was the only reason she agreed to work. I told the other nurse that she had asked to work. The CNA said if I can't stay where I am at then I'm leaving and she did. She was written up and I was surprized when I came the next time and she was working. We have been having problems with other cna's who see her getting away with this attitude starting it and even had a meeting about it, I feel that unless it is a totally unreasonable request the cna must do what the nurse says.

I have to say that when I am about to lose it and can take no more I sneak away outside to have a cigarette (yes a nurse who smokes) and if I had a pc I would probably I written a short note to a friend and posted it because I needed to vent to someone who really cared about me. This is only after residents are safe and the immediate situation is manageable. As to the original poster I feel for you and can say I have been there, done that and come home exhausted. Not so much from the physical part but from the trying to mentally deal with all the crisis situations, making sure I charted it all and still deal with the residents needs. I am the only nurse on the 3-11 shift with 75 patients and often have to pass meds for 1/2 of those. I am never out of there on time and have to deal with a 11-7 lpn who can't understand why. So just keep trudging along on nights like that, the dawn does come.

Unless it is a specially ordered tx that we don't have stock supplies for the price of tx's are billed to medicare. What medicare won't pay for the corporation eats. Some of our residents are private pay and they are billed separately with the costs paid by them. We have nothing to do with this and our billing dept. takes care of all the financial things. We do have to call on any type of order including applying a bandaid, prn orders for asap and other things the families always wonder why we bother them with.

"I sympathize with you... when *any* part of your team is not doing their job, it disrupts the whole unit. I am the type of person who will go out of my way to make my people happy...because I feel like a positive work environment is important. But some people you can't please... That is so true. Aides work every other weekends and since I work weekends I have one weekend where things run smoothly and the other is like all i want to do is go home or send them home.:chuckle