SpookyRN764

Hi there! I'm a resident care director in an ALF. We have a licensed nurse in the building from 8a-8p and my RN designee and I rotate on-call responsibilities after hours. I've written a "fall policy" which includes the basics about how to immediately respond to falls both when a nurse is in the building and when not, including documentation and making the appropriate notifications. Also the QI process including RCA. I also included interventions for fall prevention and mitigation prior to resident move-in, following a fall, and ongoing. They are asking me to create a "workflow" for the policy including specific actions and responsible person. I thought I laid it out the procedure pretty succinctly in my policy, but they are still asking for this separately and I'm brain stuck on what they are looking for and how to lay it out. Does anyone have any guidance, suggestions or even a template? Thank you!

I’m sure it’s been said, the only issue I would have is that you are held ACCOUNTABLE to the highest level of license you possess. CNAs don’t have as much to risk as you do liability-wise. Good luck. And relocate. The east coast has plenty of RN positions available

Hi there! I'm about to turn 45 yrs old. I currently work as a DHS in Assisted Living. I have never had a more stressful job. I've been handling everything up until recently (finally have a day nurse who's not me, a scheduler starts today and we finally hired a 16 h/week SDC). We have recert sometime in October. My staff issues are out of control. My resident population is high acuity (for ALF) and extremely demanding. They complain about bedmaking and I'm just trying to make sure the RAs can give med cues without killing someone (figuratively not literally). I feel frustrated that my value and effectiveness is based on "employee satisfaction surveys". I don't know, I think if I'm doing my job mostly right with the motley crew of staff I have to work with, they probably WON'T rate me very highly. I'm in a no-win situation. My ED is overly involved in my department issues which compounds my stress. Not only do I have to fix the issues but now I have to fix them the way the ED wants me to. Personally, my life is a mess. My relationship is abusive and ending but not well. He's still living with me. He's been unemployed and I've been carrying the financial alone. My credit is shot, my savings depleted. I was on the verge of being evicted and dodged that but at the cost of literally not having money for anything but rent, utilities and car expenses so I can GET to work. My kids are either in college or high school and can live full time with my ex if needed. I cannot resist the desire to jump in my car and drive away from all of this. I want to see if I can buy (finance with my crappy credit, I don't know) and park it somewhere in the woods or near the beach. I want to find a nursing job I can do from home (harder to find than I thought) and just have some quality of life. I have Crohns Disease as well and while I've managed to stay in remission, I don't want to keep pushing. My diet stinks, I'm too tired to exercise (and I know, too tired not to) but I'm just feeling like I'm failing at life right now. There has to be MORE to this than what I'm living. And looking forward seems so dismal because I will be living hand to landlord until July. How do people do it? What is wrong with me that I can't seem to manage average levels of stress? I swear, my patience and tolerance is wearing thin and every day I feel like I'll snap and quit but I really don't want to do that. But it's a struggle to fight that everyday. Thoughts?

I am the Director of Health Services at an 80-ish bed building with 20 special care residents. When I first started, we were 13 below budget. Now we are at budget. It took a long time but we are there. Mostly because we offer more services than a typical ALF in our region. The main aim issue is this, I am a WORKING director. As in, I am the full time day nurse on our SCU. Plus, I do all the scheduling and day to day management stuff. Wasn't QUITE as hectic when we weren't at budget, but the types of residents we accepted to GET us there means more issues that need to be handled. (Care issues, staffing issues, family issues, med management issues) and since we are a new building, this is the FIRST time since opening that we've had this many residents. So there are logistical issues as well that we are trying to deal with. I consider myself to be a great manager. However right now, everything is falling apart because I'm not able to be the manager I need to be. As the full time day nurse, I barely know anything about my SCU residents. Which is unacceptable. Basically, I run their meds out and handle emergencies but most of the day to day falls to my full time evening nurse. We have one full time wellness nurse on day shift and only that one full time evening nurse and no licensed staff overnight. This is the first position I've had being the head, 2nd in charge, of a building. And I'm about to throw in the towel out of frustration. It is simply too much for one person to manage well. I'm a half-butted director and a half-butted floor nurse. My ED is wonderful and gives me great feedback but is reluctant to add another full time day nurse so I can focus 100% on my DHS duties. The reason is that we've "been in the red for so long it will take some time at or above budget to warrant more staff". The issues is, we will lose residents because of this and I will lose staff because of this. Running a building at nearly capacity with the same staff we had at half capacity is not possible. And it's showing. Im the ONLY working director in our company. What metrics or other evidence can I collect to bring to the table when I request another nurse that will justify the need? I am a steward of our company and wouldn't ask if it weren't impossible for me to do it alone, but it's impossible for me to do it alone. Ideas? Thank you for reading and please redirect me if I'm in the wrong area.

Thank you for your thoughts. The good news is that I have the full backing of the COO. They are currently a 1-star home. The only way is up and they all know it. Anything is better than what they have in place right now. I'll keep you posted on how it goes. And I hope that things start to look up for you as well.

For the entirety of the shifts, 5 RNs/LPNs and approximately 10 CNAs (rough estimate) and I do plan to meet with each person individually and/or in groups. I will also be attending their reports/meetings and work on improving the flow of information between management, staff nurses and CNAs. I'm very much a "transformational" type leader. I want to educate and enroll everyone in the changes that may need to be made and why. I want their valuable feedback about what is currently working for them and what they feel ISN'T working. Then I can go from there. I'm not about reinventing the wheel. If it isn't broken, we don't fix it. I'm about eliminating unnecessary and cumbersome redundancy and inefficient processes in order to allow nurses to focus more effectively on patient care and thus improve patient and staff satisfaction. I'll be getting my Clinical Nurse Liaison salary, plus mileage (since I will have to be on campus daily and it's 140 miles round trip each day ) plus a yet unknown "stipend" for my help in this particular area. I don't know if I'll be getting paid enough quite yet but we will soon see. I start on the 5th.

Hi there! I'm about to start a new, ill-defined, position in a SNF. The home is in transition and exhibiting all the signs of such! Management is in upheaval. Key positions are vacant. Senior staff are resistant to change. It's frankly, a hot mess. I was originally hired to be the Clinical Nurse Liaison, however after realizing the experience I had (22 years of LTC/Sub-acute/MDS/PPS/Supervisor) the COO decided I might be able to help establish processes and systems that are apparently not currently in place. It's all sorts of anarchy and chaos. I will be the "RN Unit Manager" of the 44 bed Sub-Acute unit for now, since they don't really know what to call me. I don't own a set a scrubs so it should be interesting when I show up in my corporate gear to be on the unit. I should probably get at least a lab coat I suppose. Sorry, I digress. Essentially, I've got to go in and assess the current status of the unit. Audit charts for accuracy and complete documentation. Review the processes they have in place. Review nursing staff performance and flow (they don't have an SDC). Review acute transfer logs. Review Infection Tracking procedures. Basically, the whole "flow" of the unit. After assessing the damage, I will be recommending a plan of action and assisting with the implementation of that plan. I'm OCD and all about walking into a mess, sorting it out and organizing the heck out of it (I have five children), but I also have ADD and have no idea where to START with doing all of this! I'm going to guess that almost every process is either going to have to be reworked because it's ineffective or established because there never has been a process. So, where do I start?!

I PASSED!!!!!!!!!! :woot:

UPDATE: My quick results are still not available! My test time was 2p. I finished around 3p. I'm DYING!!!!

AWESOME! Congratulations!!! I have to run errands today and will likely be out and about when my 48 hours is up! Were the results available right at 8a?

Fayassin, Did you get results yet?!?!

Just to update. I tried the PVT a few times yesterday and was unable to register for another exam date. I'm hoping my QR will be ready around 2p today!

Good morning! I just wanted to share my experience with the NCLEX-RN and the PVT so far. I have been an LPN for 22 years. I took boards the first year of CAT for my PN. I graduated the program with As. I didn't study at all for the NCLEX-PN and took no prep course. It shut off at the minimum questions (85) within an hour. I waited 6 weeks to get my results and passed. I bridged last year and just completed my ADN in May. I completed the program with As/Bs. We were required to take the ATI Live Review prior to graduation. The professors recommended we take the ATI comprehensive exam "cold turkey" without studying to get a better idea of the areas we needed to focus on. ATI predicted a 99% chance that I would pass the NCLEX-RN on the first try. I have half-heartedly studied the ATI review guide and did most of the tests but none of the focused study they recommended. I used the RN Mentor app (free) which was just questions with rationales. I took the NCLEX-RN yesterday at 2p. It shut off at 75 questions around 2:50p. It was mostly SATA and priority questions (I'd like to say about 40 out of the 75 questions). One order question. There were a couple medication questions. As well as several OB, Pedi, and therapeutic response questions. There were no audio or hot spot questions. There were no EKG strips. I did not need to use my wipe board at all. I felt through the entire exam that there were only a few questions that I felt confident with. The rest of them, I felt like I was guessing. I was not ready to be done when the computer shut off. I received the email from PV that my test was completed and info on getting my Quick Results about 1/2 hour after I left. I checked the PVT with a valid card and got the "good popup". I had read that it likely wasn't valid before 2 hours, so I tried again later with the same card and got the same "good popup". I further read it can take up to 4 hours, so I tried it again at 4 hours, same card, same popup. As I kept reading, I read different times of "validity" for the PVT. I tried several times throughout the evening with the same card and same result. I also checked Nursys and they have no record for me. I checked my CT BoN account and they listed me as "pending". I did a license search and there were no results. At 11:15p last night I checked BoN again. Still listed me as pending on my account. I did a license search and now I show up but there is no license number and my status is "pending". Status reason is "pending". Licensure actions or charges is "none". BoN says I am missing my exam results. As of 9a this morning, I am still unable to register for a new test date and my BoN status remains the same. In terms of the validity of results, I have a theory about the test shutting off at 75 questions. Either the computer determined that I passed with flying colors or failed miserably and should quit nursing. That said, I doubt that if the computer shuts off at 75 questions, there would be any real possibility that the outcome would change based on the second scoring. Likely, if it shut off at 75 questions, the results were not "borderline". So even if a correct answer or two are invalidated, it's unlikely to greatly affect the outcome. At this point, there has been zero risk to me financially by trying the PVT. The site is not allowing me to pay for the test and I have tried at least 5 times with two different, valid cards. Hopefully my QR will be available around 3p tomorrow. And I do plan to pay the $8 for it! It's worth every penny to retain whatever sanity I have remaining. In the meantime, I will continue to check the BoN, and attempt to register for the test. I'll update as results become available (both PVT and BoN).