Purpsfrog

I am having problems with the nurse that I follow. She is covering my hall while another nurse is on maternity leave. There are 26 residents on this hall, and it is challenging. Every day when I come in, 2 feeding tubes are clogged. I always check them when I arrive, before I even accept report. She knows what I am doing but she sits at the nurse's station. Yesterday when I arrived, she was flirting with an ancillary service provider while I checked the tubes. I managed to unclog one of them, but I couldn't get the other one. I approached her to get report, but she dismissed me and proceeded to flirt for 5 more minutes while I was waiting to receive report. I received report and told her that one of the tubes was clogged. I asked if she could work on it after we counted narcs, because she'd have a little time left. She told me no because she isn't "allowed to have overtime and that would cause overtime". We counted narcs and she left. Most of our medications are packaged for the day in little pockets inside the cart. I noticed that all of the am medications were untouched for every resident who has a feeding tube, as they are every day when I follow her. I discussed this with my supervisor, who told me to go to the DON if I want to. There are other problems, such as BID dressings that I am the only one who changes. I am conscientious and always flush the G-tubes one last time before I leave. Even if my medications are passed late, they are always passed. I always change dressings. And I own my mistakes. I am tired to walking into a mess every night. This nurse is sometimes a supervisor, which makes me more hesitant to turn her in, but I can't see another solution. Anyone have some advice?

I used to work agency, went to 40something facilities over 8 years. Yes this does happen at some places. Call the state. You can report anonymously, at least in PA. They have 3 days to show up here, and they will. If you can't find the # look at cms.gov website or ask local Area Agency on Aging for it. Assisted Living falls under Department of Public Welfare. Nurses are mandatory reporters so you are as guilty if you don't report!

First of all, good luck! It's a ridiculously difficult environment. Yes, you are going to need to learn to manage your time. I only graduated a couple months ago and had 8 days of orientation before assuming an assignment. The first two weeks were hell, all I wanted to do was run at the end of the shift but I had to stay an extra hour to finish documentation. I'm now able to leave on time, mostly. I worked agency as a CNA and med aide in LTC for 13 years prior to this though, and it's helped immensely. Get yourself organized right after getting report. Don't count on your cart being stocked. Gather IV antibiotics from the fridge. Look at what your charting requirements are for the night and be aware of them. Try to get a sense of who will require Medicare notes, who needs a skin check, etc. Catch up with the aides as soon as you can to tell them about urine/stool, vitals you need, etc. Cluster activities; e.g., when you go to deliver meds, flush PICC lines and change dressings. The rest is really trial and error; what works on 1 unit doesn't necesarily work on another. I worked on 3 different units last week, 1 skilled, 1 intermediate (still 2 PICCs, 3 tube feeds, 9 accuchecks), and 1 dementia. Anything out of the ordinary needs to be passed on in report, such as change of status, hallucinations, fights between residents, vomiting, falls, new orders. Pass on info about PICCs and antibiotics, specimens that are needed, time of last PRN meds, blood glucoses, Foley changes, new or worsening wounds. Anything else that seems significant; nobody gets mad about getting too much info! You will find your way but it's going to take time. I'm starting to get some respect but I'm still proving myself.