Protection for Wellness Directors and unsafe staffing

[RedRebelRN]

Hi all, I'm hoping to find some advice or referral to any resources I may not be aware of....

I'm a wellness director RN at a supportive living facility. I love the field I'm in and see much potential for growth, but the facility that I work at has some practices in place that I find to be extremely unsafe and unethical....

1. I am the only nurse for about 130 residents. That to me is fine if my level of care expectations were reasonable, but I am expected to handle all resident quarterly assessments and yearly reports alone, as well as managing all admissions, medications that come into the facility, managing over 15 CNAs, and coordinating resident care with physicians, staff infection control training and customer service oriented complaints, I am expected to always be on call, and to respond to emergencies as they occur. Once a resident's care has exceeded what I am able to do, they should then be referred to home health nursing, however, since our facility and state frowns upon use of home health, I am expected to pick up the slack. For direct care such as wounds and IV's, HH is allowed to come in, but when a resident needs individual care that is outside of this, such as teaching insulin administration, bp monitoring, COPD exacerbations and the like, I have to work to my wits end to try to make it happen on my own. I have happened to come across people who work in my field and am appalled at the fact that facilities with LESS residents have more nurses on the floor.

2. The admissions process. Other similar facilities have their wellness directors working with marketing to interview prospective residents to make sure the facility is able to their needs, as well as to have a good understanding of what needs to be coordinated prior to the resident's admission. There is also a preliminary assessment that is supposed to be signed by a nurse. Not only do I not get to meet with residents until I am admitting them, it is the marketing director herself that performs what is a NURSING ASSESSMENT, dates the application for the interview day, and I am expected to sign these several weeks old preliminaries that "I performed" on the day I admit a resident. This might seem minor, but our marketing director has brought people who should be in a nursing home, expected my department to meet unreasonable needs, and she collects a commission for all new residents.

3. Poorly trained CNAs/poor hiring practices - currently the CNA department is lead by a supervisor CNA that, first, does not take his responsibilities seriously (the state has been called in for him twice since I've started working there), and second, has to fill in as weekend manager all but one weekend of every month, so he isn't even available to do the job he was hired for for two days out of his week. Also, my executive director uses him as her personal assistant, she has him reporting to her, which erodes my credibility as his supervisor, and they get together and chat frequently when I need him to do his job. The CNAs are only provided *2* days of training (I have tried to suggest 3 days, but I really think they need at least a week) and are basically thrown on the floor to guess their way around situations. There is no procedure manual for my department, so there is no consistency in training, I, of course, am so over-extended that I do not have the time to develop one, lead CNA doesn't care to take initiative to create one, my executive director only care that the facility "appears" to be running and nothing more, and I am left to explain all the mishaps that occur due to this.

4. Medication deliveries that come in when I am not in the facility to review. I am responsible for most of the resident's medications. The CNAs provide medication reminders and I need to see what's coming into the facility and review what the CNAs will be giving to the residents under my license. This used to not be a problem because the clinic was only in TU and TH, but now since they have started coming in 5 days a week, not only am I now being inundated with more than twice the rx's I used to previously handle, but meds are now being delivered over the weekends when I am not there to receive them. I asked my director if friday clinic could stop due to the possible dangers of meds coming in when I'm not here, and she told me that clinic will continue 5days and to find another solution to my problem.

5. My department was designed to have an RN and LPN to handle resident care and nursing needs, then the LPN position was eliminated, a CNA was promoted to fill in for what the LPN used to do, and she is in charge of responsibilities that are direct nursing responsibilities. I don't think I need to explain the many things that are falling through the cracks because of an inadequate nurse staffing.

Anyways, I am wondering if there any resources out there, or if this can be reported to anyone because it is extremely unsafe. I want to stay at the facility because I enjoy working with the residents, but I feel that my license is being abused, and I feel the residents deserve FAR better than what is currently in place.

Any referrals to resources would be appreciated!

[hope3456, ASN, RN]

Your story is not uncommon in relation to LTC/assisted living nurses. It sounds like the state has already been contacted a couple times. From what I understand unless there is substantiated abuse there isn't much the state can do either. Unless you live in a state where there is staffing laws, the state surveyor cannot directly tell them to add staff. But just watch, when it comes time for the yearly survey all of a sudden they will add positions - for a couple months. Of course you can go up the chain of command but as youve already seen they usually only care about profits. Be warned, crap roals downhill. You are in a position where you will be blamed for alot when your facility gets 'called on the carpet' by the state, a lawsuit, ect because then they are just looking for someone to point the finger at. I recently experienced this being employed in a ltc. I wish there was a better way.

[richardgleaton]

Practice makes the man perfect...That's why practice is necessary in all field and so to you..That's really good that you love the field and see much potential for growth..All the best for future..

[Kooky Korky, BSN, RN]

I think you should find a new job - one that does not require you to be Super Woman.

After you find a new one, you might want to sit down with a copy of your post above describing all of your duties. Ask your boss for help with time planning. Expect to be asked to resign. If not, resign. Give notice, of course. No point in burning bridges.

Or tell them you'd like to demote to being a staff nurse. Oh, I forgot, there are no other nurses working there. They certainly have it made. You're their fall guy. Any problems, you get the blame. On call 24/7/365, probably low pay and poor benefits.

Don't give them a backward glance. Just realize you've been had and move on. But find a new job first - I think.

Or, write out a contract stating your responsibilities and the limits of what risks you can reasonably accept, given the current situation re: training and no other licensed personnel. Get them to sign it. When they won't, you'll need that new job.

You might want to notify authorities, but talk with a lawyer or 2 first to see if they are actually violating any laws or ethics. Anonymity is your friend, I think. Good luck.

[DixieRedHead, ASN, RN]

Find a job, and I mean quickly. Your license is in jeopardy every minute of every day. No human person could handle all that responsibility and trust me, you will be thrown under the bus first, not last, first.

Run, get out now.