DusktilDawn

In reading Ruby's post it's also obvious that the nurse did not notice for approximately 6 hours that the patient was dead. Without knowing all the circumstances involved, 6 hours for a nurse not to notice a patient has died seems like a long stretch. For falsifiying VS the CNA should have been fired. There is no reason that someone trained to do a job should not be expected to perform that job properly.

Actually I think if a question like this comes up in an interview, they are not looking for "inform the nurse" as the only answer. Interview questions like this are designed to see what kind of thought process and initiative a prospective employee has as it pertains to their job. They are not looking for "answer the call light and tell the nurse the patient is in pain." Let's look at the scenario not as an RN but as a CNA: Mrs. Jones is in the facility for a fractured hip. She constantly likes attn. by putting on the call light pretending to be in pain. Everyone on the hall is ignoring her. You pass by the room and hear her crying what is your response? What does a prospective employer want? What can a CNA do? Acknowledge and TALK to the patient. LISTEN to what their telling you. Pass that info to the nurse. Make a point of introducing yourself and explaining what your there for. So many times staff forget to do this. Recognize that when someone is constantly seeking attention it is often a sign. Mrs. Jones have any visitors? Perhaps she is lonely. Has she been hospitalized much? Perhaps she's scared and overwhelmed by all of this. Recognize that maybe this person is lonely and scared and that may exacerbate her pain. Taking the time to talk to the patient, even if it's about their garden or whatnot. Even if it's a few minutes. It's diversional and puts their focus on something other than their pain. Providing information about what's going on, for example what time is breakfast, when are your going to wash her, if your going to reposition her tell her about before you start doing it. Patients can be overwhelmed when hospitalized and it's worse if they feel no one is keeping them informed. It's even worse when staff walk in and just start doing things to them. Gather information about her pain, where it is, what's the score, does anything help make it better or worse? These are things you should report to the nurse. Offer to reposition the patient. Hourly rounds, they do make a difference. Reassuring the patient, letting the patient know you won't forget them. Statements like: "Mrs. Jones I'll be back in about an hour to check up on you." Ensuring things the patient may need/want and placed where they can be reached. Following up with the nurse. "Hey, did Mrs. Jones get her pain medication?" Collaborate with the nurse. Is it ok to offer a massage, hot or cold compresses. I think you get the point. A perspective employer is trying to gage the person they're interviewing. Good luck Flordagirl, let us know how it goes.

First off I would check what your facility's policy is regarding schedule changes once the schedule is posted. Second I would discuss with HR what constitutes your agreeing/accepting a change in your schedule, and I doubt simply leaving a message INFORMING/DEMANDING that your schedule has changed counts, get the name and extension of whom you spoke with. Any facility I have worked at has guidelines regarding how schedule changes are to be handled, there are limitations on management regarding schedule changes once the schedule is posted, and I've yet to work anyplace where leaving a message constitutes an agreement on the employee's part to a schedule change. WTH is this supervisor thinking having other employees call to leave a message to verify that a message was left??!! Means absolutely nothing in regards to schedule changes, however the repeated messages, repeated texting, and recruitment of co-workers leaving messages could be considered harrassment. Unless your supervisor gets confirmation from YOU that YOU are agreeable to the change, she cannot assume that ANY message left by her or anybody else is proof of any kind agreement on your part. While it is not unreasonable for any supervisor to request an employee to make a last minute change regarding their schedule, it is unreasonable for that supervisor to demand it and you have the right to say no. We all have responsibilities outside of work, we cannot always accommodate last minute schedule changes. What your supervisor is essentially doing IS placing you on-call and denying you on-call pay. You can try discussing this situation with your supervisor, this is not how she should be treating you or any other employee. Have a copy of the policy, labor laws, or whatever else you need that validates your position. As I posted earlier, check out what HR has to say regarding the matter and refer her to that person if she is still unreasonable.

I tend to question the motives of people that provide "gossipy" information. I have had the misfortune to work with a few people that would relay comments taken out of context in order to spread discontentment. What may have been said may be totally different than how it was relayed.

Almost sounds like we work at the same place!! We just replaced paper charting with the most user unfriendly computer charting possible! It takes 2-3 times longer to chart the most simple of things via computer than it did to write it out. Oh and the added bonus of being unable to "lock" other users out, meaning we have to log off and on everytime we leave the computer unattended, that's if we can find one (that properly works half the time). WOW, so much for making our job easier, love how they tell us that. When you hear the words "It will make your job so much easier" be afraid, very afraid.:stone Usually that translates to 2-3 times harder.

What the nurses on this board see is that there is NO BENEFIT for the patient to have to unnecessarily wait for someone else to provide proper skin care to incontinent patients. What you don't seem to grasp, mirgadia05, is that the majority of our patients were once fully functional and as independent as we are. Regardless of what circumstance has robbed them of that ability, or whether it is temporary or permant, part of our job is to maintain their dignity as human beings. If that person was your family member, HOW WOULD YOU WANT THEM TO BE TREATED when they are at their most helpless and vulnerable? Frankly, as a nurse, sometimes you wish some of the issues you come across were as easy to deal with as wiping a bottom.

They'd probably be referred back to the NURSE:banghead:

Well, what I'd like to know is how unfair the housekeeping supervisor would think it is for someone in respiratory distress to die because the nurse is playing pedicurist? The sad part is you're right, she doesn't get it. But again why would anyone put on shoes that they know will cause them pain? The resident is only going to be uncomfortable through their own action. Their pain is avoidable. Makes me wonder if they actually expected the toenails to be done first since if the resident in respiratory distress died they couldn't complain. The ONLY solution in their scenario is to take care if the patient in respiratory distress, than deal with the toenails. You apologize for making the patient and explain that you had an emergent situation that had to be dealt with. If a resident is so self-absorbed that they cannot understand that and complains, the PTB SHOULD BACK UP THEIR STAFF. The issue in their scenario isn't about the nurse "making" one wait before being "willing" to do a task, unfortunately they don't understand that either. Regardless of whether one has to wait because of an emergent situation, or whether one has to wait simply because the nurse can't do two tasks at the same time, it boils down to the fact that one person will have to wait. In essence, the SSD is THREATENING disciplinary action towards nurses for the inability to be able to be in two places at the same time. Regardless of whether the SSD has any authority to discipline nurses, I would view her remark as a threat, which constitutes workplace harassment. I think you should discuss this "inservice" with your superior and outline your concerns. I think the SSD and Housekeeping supervisor need their own educational inservice on what truly violates a patients rights.

I think you've missed the point of the OP. In fact the OP stated that their understanding was that making a resident wait an UNREASONABLE AMOUNT OF TIME FOR NO REASON for something was a violation. Her/his issue was the example provided during the inservice by SS Director and Housekeeping Supervisor that argued that making a resident wait to have toenails trimmed while the nurse is tied up with a resident in respiratory distress is a violation of resident's rights. They actually argued with the OP and stated that this could be grounds for legal or disciplinary action despite acknowledging that life threats come first. In essence they're saying nurses should be disciplined for not being able to be in two places at the same time. Rather disheartening for the nurses. The sad part is that nurses have been disciplined over nonsense like this. Someone complained because they had to wait for a coke because the nurse was busy with a patient whose wound dehisced, or someone complained because they had to wait to have soup warmed up because the nurse was tending a post-op patient who was bleeding. Both of these examples have been posted here by other members and in both instances those nurses were reprimanded. It's gotten ridiculous. I really don't think you believe that nurses should be disciplined for dealing with an emergent situation first before things that are not. Toenails, coke, and soup can wait. Respiratory distress, wound dehiscence, and hemorraging can't. Nurses understand this, unfortunately a lot of those that want to dictate how nurses do their job don't. That is the issue that responders on this thread are indignant about. Another thing not really brought up on this thread is how other disciplines want to dictate to nurses on how to do their job in order to make THEIR job more easier or convenient at the ultimate expense of the patient. From housekeeping, dietary, PT/OT, RT, XR, Social workers, etc, etc, pretty much every department wants to dictate to nursing staff how to do their job. It usually involves them wanting nurses to do part of their job. It's not about any interest these departments have regarding patient's rights. When hasn't patient advocacy been part of the cirriculum taught to nurses??? BTW patient advocacy groups didn't come along just to tell nurses how to do their job because nurses were the only ones violating patient rights. They came along to educate and inform ALL health practitioners that patient's HAD RIGHTS AND WERE ENTITLED TO THOSE RIGHTS. It's also amazing what state inspectors and hospital accreditors fail to see and continue to do nothing about that adversely affect patients and their rights. BTW not intended to be flammable towards you Atheos, just my on the issue.

Your statement that she feels like she is firmly in charge of the unit and that she basically tells the other CNAs what to do etc. sums up the big issue you have with the CNA. She appears to be unchallenged in this belief and is in effect firmly running the unit. When she "loudly informs" you of her decisions, she is, in fact CHALLENGING YOU, in fact almost daring you, to go against what she believes is within her authority to do. Right now she does not feel nor believe that you have any authority over her. Guess what? She wins each and everytime no one says anything. She has effectively usurped supervisory authority away from the CN. What she cannot usurp is the responsiblity. YOU ARE RESPONSIBLE because you are the one that is supposed to hold supervisory authority over her. Also bear in mind that YOU, as her supervisor, can be subject to disciplinary action from your superiors and the SBON if/when the crap ever hits the fan because YOU have allowed her to make decisions she is not qualified to make. Regarding her abuse towards patients, as Valerie put it, write it down, factually without your opinions and submit it to you manager. Also bear in mind, her abuse towards patients may also be part of her belief that she is running the show. She may think she's untouchable. Perhaps this person is still there because no has started a paper trail. Also keep a copy for yourself and include details such as the date you submitted it and to whom. The problem is that this was a situation that has been allowed to develop over time, probably long before you ever set foot there. Realize that she has become embolden over time, she will become even more so as long as this situation continues. Recognize that she is not going to like it if ANYONE tries to change the status quo. Realize that if you takes a stand and refuse to her allow her behavior to continue, it will get worse. She will up the ante in challenging your authority. She will see you as some snot-nosed newbie that knows crap trying to tell her what to do. Realize that if you stay firm and hold to your ground, she will eventually back down and back off. Before you do anything, you need to sit and discuss this situation with your manager. It may help to write things down, what you believe the issues are, and if possible provide specific examples with dates and details before you have a meeting. If management refuses to support you, than you may want to consider looking elsewhere. This CNA is not worth YOU LOSING your license.

I agree with Leslie, you should talk to your manager about what has been going on along with documentation. I think your manager needs to go higher than the DON at this facility. Obviously the Social worker and DON do not understand the purpose of having a hospice nurse come in and that ignorance is passed down to the staff. Obviously some things need to be clarified regarding orders. I'm not sure why you would tape physician orders on a chart, wouldn't they be placed with the other physican orders on the chart. I'm just unclear on this point. The rest of the behavior you describe is deplorable and inexcusable, but I do think it stems from the leadership on that unit and is based on their own ignorance about hospice itself and the purpose that you as a hospice nurse are there to provide. They fail to see the necessity and have turned the situation into an adversarial battle. They fail to realize how this compromises the patients. This is why I think your manager needs to go above the DON since the DON is probably a bigger part of the problem than the social worker and the staff.

Wooh was reprimanded because somehow (telepathy, astral projection, global warming??) she gave the impression she wasn't there to a family member that wasn't there, despite the facts to the contrary (use of interpreters, charting, presence of other family members). I just don't get how any manager can summon up any sort of justifiable conviction within themselves to even contemplate reprimanding another person for this kind of nonsense.

SBONs tend to stay away from employee/employer or work place issue type conflicts. Even if this wack job filed a complaint with the SBON, I doubt you'll hear from them regarding this matter. Basically I think she was trying to threaten and intimidate you because you had the audacity to expect her to do her job. I also wonder if she wasn't "asked" to resign, I doubt your the first nurse who's had issues with her.

I think contacting the BON is the right thing to do. This person equates her limited training to that of a licensed nurse,has too high of an elevated opinion of her medical knowledge and "nurse" training and enough cockey confidence in that elevated disortion that she thinks nothing about dispensing inappropriate medical advice and dismissing legitimate, sound advice from an educated licensed professional. This is exactly what makes her a dangerous menace. I think you should also have a conversation with the MD that employs this persons. God only knows what she may be saying/advising his own patients about.

You're sister's friend is a dangerous menace.

Wow, good point. I would estimate that they could hire 3-4 more people to work in dietary doing the jobs he wants to pawn off for what he gets paid.

Basically this dietary manager is trying to save money on their budget at the EXPENSE OF the CNAs, the patients, and somebody ELSE'S budget. This manager wants to eliminate employees or shifts in his own department at another departments expense. This is exactly the approach the nurses and CNAs should use when discussing the issue with their manager. I'm also in agreement that this could be a health issue since the CNAs would be going INTO the kitchen area. Many organisms survive as spores and even effective handwashing doesn't eliminate them (C-diff is one, also considered part of medicare's "never" event, facility won't be reimbursed for treating those infected). Definately another issue to bring up. Also I would contact the State Health unit and ask them a few questions regarding this situation. CNAs aren't trained to be food handlers/preparers. What would be their position on the situation. Reminds me of the time I worked at a facility where dietary management decided that the nurses had time to toast bread products brought up with breakfast, despite the fact that there were thirty patients on the unit and most units had only toasters that could toast 2 or 4 pieces of bread. That lasted all of 2 seconds. It's amazing how other departments try to eliminate from their budget at the expense of those caring for the patients and by extension the patients.

As long as there is SBONs and state legislation that continues to put nurses between a rock and a hard place, health care facilities will continue to pay big bucks to follow the folly and doctrine of groups like Studor and Press-Ganey. They will never be named in a lawsuit involving a bad pt outcome. Only recently have health care facilities been recognized and named in lawsuits for their staffing practices that lead to bad pt outcomes, as a rule it has always been as long as the nurse "accepts" an assignment the nurse is held accountable. The only type of lawsuit I see coming for any groups like Press-Ganey or Studor would be a suit brought about by nurses naming them as contributors towards creating a hostile work environment. Rewarding outrageous and bad behavior is so common in the health care industry that people now know they can manipulate any facility they walk into and intimidate/threaten any staff (usually nurses) they encounter because a facility wants to retain them as "customers." That's why we get insane write-ups or reprimands for not giving family members a coke in the middle of a code. That's why management will threaten people, like in Southernbee's situation, without ascertaining the validity of the complaint, they've been convinced by these groups that all complaints are valid and have merit.

The situation isn't against a specific union, it is against a specific group of employees. It doesn't have to be intentional and it doesn't have to be against a specific union to be discriminatory. It may not have been intentional towards a specific group of employees when dietary enacted this change. However those that supervise the Practical nurses and Care aides are aware of this situation affecting this group specifically: So yes, the TPTB are aware and have chosen not to address issue. If these break times were negotiated by the union, they were negotiated in good faith, meaning that these employees had the same options as ALL employees. Management of the Dietary department made changes that affected 2 groups of employees. Whether they intended to or not they disallowed the same choice of these 2 groups that other staff has. Regardless of Dietary's intent or motivation, the Director of Nursing IS aware that it is the Practical nurses and Care aides that have been affected, according to the OP. In regards to this issue they are not being treated the same as other employees, management is aware, and yes that can be a basis for filing a grievance against discriminatory treatment.

I think most of you are missing the point here. It's not about shut-up, quit whinning, and be grateful they even provide anything. Although few places provide meals, the facility that the OP works in does. The issue isn't about the OP being grateful for what is provided. The issue is the Practical nurses and Care aides are being treated differently than other staff. Everybody else but them gets a full hot meal provided. Yes, in a union shop this could be seen as discrimination towards a certain group of employees. BTW my place dosen't provide meals.

Sorry this happened to you Zacarias. I agree about reporting this to you coordinator and to the manager of that ER department. This isn't about developing a thick skin, it's about common decency and respect towards staff that are sent to that area to HELP ensure that they are adequately staffed. No unit manager worth their salt is going to be pleased to hear about agency, or for that matter, any staff sent to their unit being treated this way. Just to add to Leslie's comment, it may also give them insight as to why they have staffing problems period. Wonder how many new nurses get run out of this ER with this behavior?

Can you not understand why her coworkers are disgruntled about this? As a CN you cannot arbitrarily grant exceptions (ie: leaving early) to one and not expect others to have some sort of negative reaction to this. You've put yourself and others that rotate into the CN role into a bad position. If they refuse the request are they now the bad guys in this employee's mind and how would/could that affect the care their patients receive from this NA? The role of the CN is one of increased responsibility and accountability without the autonomy. I think it's great that you understand why this person makes the request, however this is something SHE should discuss with the unit manager. That is the one she needs to discuss and possibly come up with a solution/compromise with. Nothing wrong with providing suggestions to another employee on how to handle a situation like this instead of usurping authority that you don't have. Missed breaks and lunches have no bearing on this, it's a whole different issue. Any employee is entitled to compensation for this. Actually I can count on one hand the number of times an NA missed a break or lunch in all the years I've worked with them. Not saying it doesn't happen elsewhere, it's just rare in my personal experience. Consider this, when do nurses get to leave early if they miss a break or lunch? We don't.

I think it's a little hard not to come across as confrontational and even accusatory when you are basically asking a co-worker if they spoke to the manager and complained about you. Unless one has a real gift with words, that's how it comes across. I've been in situations where co-workers have gone around essentially asking if they were the one who "reported," "wrote up," "spoke to" the manager about them. Regardless of having not done anything, it does leave one feeling like they've been accused and defensive, wondering if they've been labeled guilty. It's aggressive and may come across as hostile. Chances are this complaint started with one person. Chances also are that one person who complained isn't going to admit it when confronted. Why alienate everyone on the off chance that one person will actually admit it. I think in this instance what kharing suggested about writing down a written response to the manager about this meeting is a much better course of action. As oramar noted, most of us when confronted by managers by these situations are unprepared for it. I like how in the end she handled it.

Klaatu barada nikto?

Excellent post Vito. Let's face it, the public in general has no concept of what nurses really do. What's surprising about a 17 year old displaying that same lack of concept.