cinnybug

I was with my previous employer for 5 years. During that time I consistently received the highest pay increases that the company would allow. I know this because part of my responsibility was to do evaluations and suggest the percentage of pay increase for my CNA's. I was told that the company would not allow more than 1.6%. I was never late and never called off. I worked extra hours when needed (which was frequently due to staffing challenges). During those 5 years, the company increased the pay for the CNA's by $1 an hour twice and the RN's by $1 an hour twice. The LPN's received nothing. In fact, at one point the LPN's were told that the company would be phasing us out and only hiring RN's (that lasted about 1 year and they went back to hiring LPN's). The new RN's that were hired had to be trained by the LPN's to perform everything from glucochecks to straight caths. I found this amazing as my school had trained me to do everything including IV's (we had to train on dummy arms and had to pass starting and discontinuing IV's as part of our clinicals). In my state the only things LPN's can't do that RN's do is pronounce and push IV meds. I worked at a skilled facility so I received plenty of experience with all manner of sub acute processes. After 5 years, I was making about $1 more an hour than when I started but my responsibilities had increased at least tenfold. I heard through the grapevine that the CNA's were possibly going to get another $1 an hour raise so I began applying at other facilities to check my worth. My present employer offered me $3 more per hour to start as a Personal Care nurse. I went to HR and tried to negotiate a raise with them. They offered me all sorts of non-monetary incentives to stay but stated that corporate would not allow them to match my offer. I am much happier in my new position and the saying that you have to leave a position to get a decent raise is very true. My previous employer still calls me and tries to offer me to come back ( at a higher starting rate of course) but I know where I will be with them 5 years from now so no thanks.

The Mr/Ms was in relation to the patient not the aides. My aides and I do call each other by our first names. Sharing meals or celebrations as a group is acceptable. What i was referring to is spending time alone with a singular aide. As to the witness issue well you may do as you like but it has been my experience that when administration starts asking who is responsible for something the lowest members on the totem pole will throw their supervisors under the bus. People as a rule hear what they want to hear and it is not uncommon for words to be misunderstood. Then HR simply has your word against the oher persons to go by.

I was fortunate to have decades of management experience prior to becoming a nurse. So I came into the situation with the foreknowledge that employees listed as my responsibility (Aides) are members of my team. I treat them with respect and dignity as they are grown adults performing a specific and well defined job function. I immediately familiarized myself with their job requirements and worked alongside of them to gain a full understanding of their stresses and needs. As a Nurse, I am well aware that making their job easier in turn makes my job easier. I assist my aides whenever possible in order to maintain a smooth functioning shift. A couple of rules that I personally follow are: 1. The Aides are my fellow employees/team members. They are not my friends. My relationship with them is friendly at work but I do not have personal relationships with them outside of the workplace. This keeps the accusation of favoritism/bias out of the picture. It also helps to maintain a professional relationship wherein my position as a manager/supervisor with the right to discipline is respected and acknowledged. 2. I never speak to anyone in a tone or manner that I would not want to be spoken to. I do not yell, sneer, demean, order or call anyone "girl" or "kid". I am polite and I ASK for assistance politely. If I need to let an Aide know that a patient needs assistance I do so with the caveat "When you have a moment ( or chance) Mr/Ms So and SO would like....I told them someone would be in to assist them in a couple of moments". If I am able to assist the patient I do so. 3. NEVER speak to an Aide ( or really anyone) alone. Always have a witness to the conversation. This goes double for any disciplinary conversations. If I am having issues with the floor I will organize a meeting with all Aides and other nurses on the floor. I usually will have an outline of the meeting in written form with expectations fully defined. Best not to list any criticisms. And particularly do not to point out anyone in specific. I usually will go over this agenda with my supervisor prior to calling the meeting so that they are aware and approve of the meeting. 4. Be the model for what you expect. Set the example. I am never late. I have never called off. I do not indulge in gossip about other employees or patients. I maintain a positive professional attitude. I do NOT have my cell phone on the floor. I always let my aides and other nurses know when I am leaving the floor. I give report to my aides every morning. I praise my aides for a job well done most everyday. One of my favorite sayings is "You get what you advertise for" If you wish to receive respect then you must act as someone who deserves and expects respect. Always remember that respect is definitely a 2 way street and most times we give more than we receive.

Lol.you're right! We do use EMAR and PCC. Even so management still dictates that we have to do additional charting in our progress notes on what we charted in EMAR or PCC so that they can see it during their morning meetings. So even though we document VS for instance in EMAR we still have to include those signs in our alert charting via a progress note in PCC.

At the facility that I work at we chart all of the aforementioned as well as weight increases/decreases of 5lbs or more. We also have to notify the MD and RP and chart that as well. We also chart any dietary changes or therapy orders ( new or d/c'd). And let's not forget meal completions and hydration notes. We also have to document at least three different methods of alternative resolution before we administer a PRN Narc along with the effectiveness after administration. We have to chart mood/behavior for 72 hours when any psych or depression med is started, decreased or increased. Thank goodness I type very fast!

Many, many meetings and many, many care plans lol. And you are right...she continues with her manipulations at the new facility. Her PCP told me that she was telling all of the nursing staff in the new facility that she had no earthly idea why we transferred her there. The PCP spoke with the new administrator that very instant and advised that they would no longer treat this patient. It is sad because the facility that she went to is not as "concerned" with providing optimum quality care so she will be able to do as she pleases and most likely will decline to the point where she will never be able to go back home or even to the point of death. I was more concerned with my own thoughts and feelings regarding this patient. Not so much the legal ramifications as my supervisors removed me from the responsibility of searches. I documented everything I said and did with this resident. And I never searched her room without her being in it (gaining her permission first) and a witness being with me. I did manage to work out my stress and also alleviate my feelings of guilt. I just needed to stop trying to be superhuman! I am an excellent nurse and I will always go above and beyond to help those in my care whether they work with me or not.

Thank you so much. I was seriously considering therapy for myself! Lol...but instead I joined a gym so I swim laps and take Body Bootcamp classes to work off the stress. I am trying to give myself a break. I kn ow that I am not superhuman. I can now understand why therapists only deal with patients for an hour at a time!:)

Thank you. Today I am trying to deal with some guilty feelings as I truly believe a good nurse is patient, empathetic and compassionate. What I wrote above is only a small portion of what I have had to deal with. I also had to deal with the frustration and anger from my aides as she was constantly demanding that they tailor their work schedule to her desires. The thing that angered me the most was her disregard for the needs and safety of other patients and staff. Just yesterday while one of my patients who has severe dementia and a broken arm (from a recent fall) was having a sever anxiety attack (resp 36, pulse 122, grinding teeth) in the bed next to her she was constantly interrupting me asking "when is my therapy? Can I have a fresh cup of ice water? Am I allowed to go outside with my family?" I was ASTOUNDED! It took al my strength not to yell at her to shut up and let me help someone who truly needed help!

For the past year I have been taking care of a patient who is a paraplegic due to spinal stroke resulting from pain injections to the lower spine. To list all of the diagnoses she has would take more space in this forum than is possible. She is 59 years old and for the majority of her life she has been in and out of medical facilities for various ailments. She also has a history of alcohol abuse. The over arching issue with this patient is that she is highly manipulative and completely non-compliant with all of her care and medications. The PCP has even refused to issue any orders or changes to her med regimen (she frequently would request different meds be added to her regimen). They would tell me that she is a huge liability and needs to be removed from the facility. She has a wound vac, has been treated for C-diff 3 times in the last 6 months and sepsis d/t UTI twice in the last 6 months. She is a diabetic who refuses to eat on a regular schedule and supplements her meals with items she buys online such as candy, cookies, marshmallow peeps, peanut butter, etc. Her glucochecks were typically 400 to 600 every morning. She insists on drinking large amounts of cranberry juice ad orange juice. She self caths but frequently refuses to cath on a given shift and will wait until she produces over 1000cc's (usually 1500 plus) despite education re: autonomic dysreflexia. She also orders online OTC meds such as sudafed (she says to pick her up), Benadryl and Nasal sprays (for her deviated septum) Immodium to harden her stools, Fiber Laxative pills. She also orders cigarettes, E-cigarettes, chargers and has been caught numerous times smoking in the facility ( she is on a nicotine patch) Literally everyday for months I was responsible for searching her room for contraband and documenting all non-compliance. Everyday I had to argue with this patient over her request for Xanax when she had just awoken (usually at noon). I found myself becoming extremely frustrated. When she was confronted with the contraband found she would lie and we would find new"stashes" hidden in evermore insidious places (most recently the false bottom of a drawer that she kept her cath kits in) Yesterday, after I caught her for the 3rd time in two days smoking in her room (in front of her family who then lied to my face about it) she was issued a 24 hour emergency eviction notice. I am trying to deal with my emotions regarding this patient as I went from being extremely empathetic and caring to feeling extremely frustrated and angry over her manipulation attempts and lying. I know she has a mental disorder, Definitely an addictive personality ( I also suspect Narcissistic Sociopath tendencies). I also felt angry over the danger she frequently placed staff and other patients, in as well as the amount of time that she took from the other 29 patients I am responsible for with her demands on my time. And, of course, since I was the main person finding all of her contraband and reporting her she went so far as to tell my supervisor that she did not want me around her anymore. Fortunately, I am off today and she will be removed from the facility this afternoon. I feel emotionally and mentally beat up. Has anyone else had to deal with this type of situation? Am I wrong to feel angry and frustrated?

I will be 56 in January and I am a day shift charge nurse at a SNF. I frequently do 12 hour shifts and rarely do I have a "regular" 8 hour shift. In fact, I just did a double yesterday. Granted, I am home today recuperating from that shift lol. However, I do not consider myself "aging" or "old". In fact, I run circles around a lot of the younger nurses at my facility. Age is a state of mind. I keep myself in good health. No, I am not at an ideal weight but I am in the process of losing that last 20 lbs that I have put on since becoming a nurse. I eat good clean food and have given up sodas, fast food and sugar. I get 7-8 hours of sleep nightly. I take care of "me" first in order to take care of others. By the way, my mother, also a nurse, recently slowed down to a PRN position. She now only works 3-4 days per week at a SNF. But then she is going on 75!