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achot chavi

achot chavi

acute care and geriatric
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achot chavi has 20 years experience and specializes in acute care and geriatric.

achot chavi's Latest Activity

  1. achot chavi

    Cruel Summer

    My thoughts and prayers are with you and your family during these trying times, You are truly an inspiration to all around you. I am proud of what you are doing, I cant imagine how much strength it must take for you to do all you do.. Please try to reduce interruptions during med pass by gently refusing to be distracted and say, we will talk after I finish this. Good luck and I hope you, your sister and your husband all feel better and improve.
  2. achot chavi

    Doesn't It Make You Want To Scream, part two

    On our Alzheimers unit we had a sweet but disturbed Holocaust survivor. I was called one evening to his room as he tried to slit his wrists on the shards of a broken mirror. As I took care of the patient, (the unit nurse and 2 other CNA's were freaking out and had to be sent on a time out)- I sent the CNA to check the room for left over shards and anything dangerous. The psychiatrist was in the building by chance so he was in the picture. After the room was checked I went in to double check. The patient has 2 thin paperback books under his pillow and I found more shards carefully hidden between the pages. I showed this to the CNA who answered, "Oh, I didnt think to check there" , she also didnt think to remove the glass framed picture from the wall. Sometimes I feel so alone. Story number two, I caught a nurse who neglected to change a dressing. She admited it but then asked, "maybe I just added saline to the dressing and didnt change it, that would be ok, wouldnt it?" They obviously didnt hire me for my pretty face.
  3. http://www.medscape.com/viewarticle/776075 According to this article, it is mostly in LTC where med aides are used and apparently abused by being asked to perform tasks that are beyond the scope of their practice. Is this what is really going on? Maybe we have to be as careful with our support staff's ethics as with our own. I would like to imagine that we all would refuse when asked to perform outside of our permitted scope, and that we would be annoyed if pressured to do so.
  4. achot chavi

    Is this abuse? Emotional blackmail?

    I would make sure that the residents know that she was just kidding and of course they should feel free to speak their minds at all times, they should be assured that even if they give "bad reviews" to anyone - it is OK. Criticism is fine and we always want to hear what they have to say - the good , the bad and the indifferent. I would even go so far as to tell some of the more sensitive patients individually that they should know that she didnt mean it, and if anyone asks her anything, they can always tell the truth without fear. I would also give this Rec Director tips on what she CAN say and what her limits are. I have found that negative comments ("Dont do this, dont say that") rebound, but steering her in what she CAN say works better. Together build a repertoire of cheerleader type comments like "Who's your favorite Activities Director?" and " I just love spending time with you, you are the greatest!", even "Dont I plan the most exciting and fun activities for my favorite residents?" Its ok to toot your own horn as long as its within good taste and stresses the positive. Mentioning state survey to a patient is a real no-no!
  5. achot chavi

    New On Call procedure. Need ideas, suggestions

    When staff work short, they must be made to feel appreciated, and compensated for the extra miles they have to go that day, Compensation need not be monetary, although some nice extra to the unit like a pizza or ice cream for the staff would go a long way. Letter of appreciation, or some other prize. You have to know your staff and what makes them tick, what approach to take to make them feel like going the extra mile is to their advantage and at the end of the day they get something for it. Activities that make the staff bond and care for each other will also help. Celebrating birthdays together or the like so that when one calls in, they dont see it as a burden but as helping him out and he will help you out when you have to call out... Keeping the positive atmosphere is the best thing you can do for your patients, your staff and the facility. Anyone grumbling should be asked to take a short 5 minute break, do some deep breathing and relax and come back to work, as complaining wont help and besides together the work will get done. Administration should see that it is hard and takes longer (I would ask for overtime if the staff just cant manage to get it all done on time) and shouldnt get the idea that the unit can manage short....or they might get ideas.
  6. achot chavi

    New On Call procedure. Need ideas, suggestions

    Strategies I have seen work: 1) On every unit have a nurse who really wants work full time but tell her you can only give 75% hours for now and will build up but you will consider her for every call out so that hopefully she will end up with 100% hours..... I am not endorsing this, just passing on an idea that I see works successfully 2) If there is too many call outs on one unit, call a meeting explain that because of the call-out problem you will have to hire another nurse who will have to be given an equal slice of the pie so that there will be less for everyone, you wish you didnt have to do this, but your responsibilities lie with consistent patient care and if the present staff cant cover their units shift responsibilities, you have to bring in more staffing. Unfortunately seniority wont mean better shifts, everyone will be given fair shares of hours - even the new staff. (it goes without saying that staff that dont welcome new staff will be dealt with on an individual basis). 3) Overtime is usually according to whatever is the norm in the state/region (according to location), Find out what other facilities or hospitals in your area are paying for overtime. 4) Often we allow the nurse who is forced to work an extra shift to take off a future shift and ask the call-out nurse to take it. This doesnt always work but is an option. 5) We have sometimes called back the call-out nurse and said, we called everyone and no one is available, you will have to come in anyway (unless she is sick herself) and find someone else to (watch your dtr, stay with Mom at the hospital, or whatever) However we can give you tomorrow off and "Betsy" can cover if that helps.... OR if the call out is because of an unexpected funeral or event, we will find a way to give her two hours to attend and return, and find someone who is close by and can cover for the two hours, of course we do full shift handover with each coming and going of nurse, we dont like it but in an emergency situation we allow it, and it goes without saying that no one gives meds that someone else prepared. 6) Every so often I will ask a nurse from one unit to cover another unit just so she be familiar with the unit, in case of call-out she can cover the unit and it wont be foreign to her. Also if there is a unit nurse on vacation, the nurse from another unit who is now familiar with two units can help cover during her unit nurses vacation. This is not a new problem, it is great that we share ideas on this, Anyone with other ideas, Please share!
  7. achot chavi

    New On Call procedure. Need ideas, suggestions

    Inkydorei, et al, with all due respect, what profession did you sign up for?, Guess what- we are not working in a clothing store, a museum or NASA, in our business the show must go on, 24/7 NO MATTER WHAT, we dont close our doors because one of our nurses is sick, we have a professional responsibility to stay and take care of our patients when the oncoming nurse is late or cant come. We have a moral responsibility to honor our work schedule, to come on time or early and to help when there is a call-out. I know you "signed on for 40 hours a week" so did we all, but it doesnt always work out that way. Who told you that it is management's problem if there is a call out - its EVERYONE'S problem and you have to work together to shoulder the burden. Management is responsible for so much, staffing is a small percentage of it. Strong nursing management is in your favor and it is to your benefit to support your nursing management if you want to work in that facility. I am so glad I work with nsg staff that totally understand this and there is such a sense of camaraderie when there is a call out. In fact I hear the nurses caring about the nurse who called out ("Oh,her daughter is sick again, OMG she had a car accident? With her new car? poor thing, let me also call her and see if she needs help"or," Wow, her dtrs boyfriend just proposed?, so exciting, sure I'll help cover her shift tonight so they can celebrate") . Just my 2 cents..
  8. achot chavi

    Med Pass

    I dunno, We had a pharmacy that filled a month worth of pills on cards- a different card for each medication so that if the pt had 10 dif meds, they sent 10 cards for the month etc. How many times did I find the cards filled with the WRONG pill? Loads of times, and each time it was Ooops , sorry ! If we had given the wrong pill and there had been an adverse reaction, who would be to blame, you got it. Its not being old fashioned, its being responsible and preventing errors. BTW we were told, even though pharmacy filled the order, nurses are responsible to give the right pill and pharmacies errors are our responsiblities! I would not feel comfortable with baggies of pills, and the surveyors wouldnt either. My take? the adm are always trying to balance their budget on nurses backs, the problem is , when they look at the budget, they mistakenly think that nsg is getting too big a peice of the pie and forget that its called "Nursing" home for a reason, we are responsible for the majority of the work and without nsg there is no home. The problems begin when one DNS / DON is willing to lower her standards (her risk) and the Administrators who talk to each other then pressure their DNS's to follow suit. You have to have a real command of the accepted standards of care for your state in order to stand up to the administrators and protect the professionalism in your facility. OTOH, we do have to respect the budget and show that we are making the most of it. With your experience you must have lots of great ideas and instead of telling the administrator "NO" divert his attention to your ideas on making the most of the nsg budget and show that you are on board with his goals of running a fiscally responsible business that is also professional, passes surveys and progressive. Good Luck!
  9. achot chavi

    ADON interview help

    Not knowing the DON and what she is looking for that is hard. I can only tell you that an ADON plays an important part in implementing and assisting the DON in her duties and responsibilities. You have to be totally on board, you might have to let her get credit for your work, you might have to lower your ego, you have to be supportive, responsible, always follow the rules etc, no exceptions unless she approves it. You can talk against her behind her back, you cant join groups that do, better to walk away when they start bashing her etc. You will be thrown a ton of work, mostly the stuff the ADON doesnt want to do or is tedious. Find out what responsibilities it entails - QA, UR, Inservices, MDS+? Clarify hours, responsibilities, being on call, etc You might not be able to take vacation when your DON is taking vacation.. Hope this helps, but it may not apply to your facility..
  10. achot chavi

    New nurse in ADON position. Advice needed.

    CCM I can agree with you, but know that logistics play a certain amount in the structure of each facility. I think it is a miserable idea to send the ADON to eat in her car. When you make managerial choices that are unpopular is exactly when you have to take your breaks with the staff, as CCM wrote, "to foster teamwork". I know my staff will see things on their level, and I want them to see things on my level. BTW GerRN23, you wrote "I never realized how mean and malicious staff were to their bosses until I became one. Before this job I would have never spoke to any of my bosses the way some of my staff do me" ......Perhaps that is the reason you rose above the rest and are sitting pretty in your position. Perhaps it is a positive reflection on you that has put you in the quandry you have presented and perhaps you need to stop seeing yourself through their eyes and expect them to see you (and the work you all do) through YOUR eyes!!
  11. achot chavi

    New nurse in ADON position. Advice needed.

    Personally I think it was poor judgement on the DON to make you ADON, but I have to believe that she had her reasons. You got some good advice on previous posts, criticize in private etc. As ADON you will have to develop thicker skin and dont depend on ur coworkers for social or emotional support. You are there to do your job and it sounds like the DON is happy with you. Regarding the CNA's - it is understandable that they are jealous and instead of looking to you as a role model, they prefer to take the lower road. You worked hard for your RN and your position and you deserve it, but not everyone will see it that way and that is their problem. If you show that it means nothing to you, it will stop. When I took over ADON, I was brought it from the outside and had the opposite problem. The staff had banked on one of the head nurses becoming ADON and were disappointed that their friend didnt get the position. Like I wrote, develop a thick skin and remember the only approval at work you need is from the DON.
  12. achot chavi

    Coworker nurse trying to ruin my reputation...

    How do you know the rumors you are hearing are even true? How do you know she went to the DON? If multiple sources are telling you this, and there is strong evidence of " where there is smoke, there might be fire". I would approach the DON with proof that this nurse is spreading rumors that might be construed as defamation of character and certainly unprofessional. Tell the DON that these rumors are a distraction and they are ruining the productive work environment on the units, other nurses are also afraid that this nurse will start rumors on them as well. If you are afraid that you cant do this in person, write it as a letter to the DON stating that you are aware that some nurse(s) have been spreading unsubstantiated rumors which might be construed as defamation of character and certainly unprofessional and you want a positive, rumor-free work environment. If you can, have others sign on it as well. Obviously follow all the previous good advice on good documentation for every PRN pill you give. Never skip this step no matter how busy you are. I dont think I would run to another job,
  13. achot chavi

    Some days I just wanna bang my head against a wall

    I blame Dr House!! I've been told that when kidney and liver failure kick in that is when the miracle cure is found !!
  14. achot chavi

    What NOT to say during an interview

    Well I am glad you did not hire her, not because she insulted you, your skin is thicker than that and your ego more secure. But because if she lacks tact on a job interview can you imagine the crazy stuff that will be coming from her unsupervised mouth during a stressful shift...and you will be stuck dealing with it (as if you dont have enuf)..... I love new nurses who dont know to keep their eyes and ears open and mouths shut until they have some experience under their belts. A new nurse in my family started telling my brother that the medications his cardiologist prescribed were inappropriate for the diagnosis. I shut her up and told her I would email her references to the contrary (which I did). Do you think this taught her? She is still passing judgment on every treatment from other doctors, nurses and health care professionals! Then she complains to me that all her coworkers complain about her.....
  15. You sound so much better, I am glad that you put your time to good use. Your success reflects on all of us!! We are all behind you. Somewhere out there, Florence Nightingale is clapping her hands.
  16. You need to set a management policy for correcting professional behavior. For example, in our facility, if something was not done or done not according to policy or good nursing practice, first they get an oral inservice and explanation of how we want the nurse or CNA to do whatever it is. Usually this is backed up with a written memo in the staffs file. If the problem persists, it is a written letter to the staff also cc'ed to the personal file. Usually if we have a written in-house policy on the problem then we attach a copy of the written policy and the original signature of the staff when she or he was oriented and signed on the policy. If the behavior re-occurs (a third time) the file with a brief letter of explanation goes to the Director. The Director tells the staff that this is a last chance and if it happens again, he or she will be fired. Of course if the infraction is serious enough, either I or my boss will fire the staff on the spot. You will then in the position of training new staff. This is a key to obtaining cooperation and improving standards. I put a lot of my energies in training new staff and it usually pays off. What I cant stand is if old staff (devils) try to curropt them. I take that seriously and then am all over the devil like a wet blanket, writing up all her infractions no matter how slight. The devils out there get the message real quick. I would also suggest you praise staff when you see them doing the right thing, dont take things for granted. If you want to make a staff of the month award, with a picture and posting at the entrance, a letter to their file and a symbolic present , that might be good motivation. Every once in a while, have a staff meeting to explain policy, what needs to be improved (DONT embarass one by pointing out a specific persons problems, but talk in general and explain, "I dont want to point fingers so I am telling everyone...". Bring a (chocolate) cake or cookies or the like to these meetings to create a positive environment. Never criticize in public, I am sure that was said before, but it is an important point, as it just puts people on the defensive and as we know a good offense is the best defense- the staff will start attacking YOU! Good luck, keep taking deep breathes and remember you are not alone.
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