Shift Warfare BS - vent/advice? (long/sorry)

[inaniel88]

So I know this has been posted about may times before....and I know it exists almost EVERYwhere no matter the setting......But I am REALLY getting tired of the animosity b/w shifts.... Any advice about dealing with next-shift CNAs that want to complain about MY shift when MY cnas are gone and clocked out and already home.... and I'M still trying to sign out my book/chart/answer alarms and avoid a "fall event" and everything that goes with it /answer the phone (chrage is basically responsible for playing secretary and answering (lab-family-calloff calls) til secretary comes in at 8a) /give report to 3 other "zone" nurses/do MY job (medicare charting/vitals on 5-10/night ...depending on zoning) + trach/IV care (other zones at other ends of the builing and I have to stop what I'm doing and go to do LPN trach-care/IVs/blood-draws/sign out MARs/TARs)?......Keep in kmind I am only making 23$/h with NO noc shift or charge nurse differential. and getting threatened with write-up for

o.8/FT overtime) ......Do I need to just call it quits and start taking my job-search seriously? Try to go to med-surg in a hospital w/

I've been on nights 4 years now. 2 years CNA. 2 years charge night nurse. There are 3 nursing "zones" on NOC, and 5 zones for AM/PM. And I'm reposnible for 1 of 2 medicare/post-op/PT-OT-ST, and overall AOX3 needy-complaining/short-term "zones")

It's never been a problem before now, and don't get me wrong I pretty much love/enjoy my reisdnts whether they're short/ong-term,.... but lately (d/t poor NOC-shift staffing, poor staffing across ALL shifts really...) I constantly get interrupted in report w/day-shift CNAs questioning NOC shift. There is SO MUCH chatter/whining/complaining at the nurse's station for 30 mins of 6a-2p before the CNAs actually get to work. I can't even hear MYSELF when giving report..........They (day CNAs) come up to me "you need to tell YOUR cnas to do , - blah-blah-blah" "why isn't so-and-so's O2 filled?" "Mrs. X's TED hose aren't on!" "they have a dry brief/pad over a piss-stained shee!t" "why isn't THIS PERSON up!"....."I;m going to tell [DON}".....really? !? .....If I had TIME to follow around ALL my CNAs and make sure EVERYthing was being done, then I could just go do their job AND mine (and I usually DO -- changing people, answering alarms, gettting water/cookies, stocking, spotting people w/ 2-assists, quick-risers and hoyers, switching out empty O2 concentrators, listeing to the neeey people10-15mins.night) AND playing "hospice nurse" (when our hospice doesn't provide critical/continuous cae - when someone is dying and 3+ famliy members are there overnight demadning MS/Ativan/Atropine/vitals evry 2-4-6hrs)....

Being a CNA before at the same facilty I am definitely willing to help out my CNAs and have relationships w/them across all shifts.... But it's just like generally day shift just thinks all we do is sit on our butts all night. Night shift is BUSY (not EVERYwhere apparently, according to posts I've read - but definitely at MY facility). We usuallly have 100-120 beds. Supposed to have 9 CNAs for AM/PM and 6 for NOC when fully-staffed (if such a thing ever exists?). I don't have time to do all that. I fell like if they have a problem with NOC shift cnas the they need to come in early/give report to their oncoming shift.....I've brought this up to my DON but even though she's empathatically on board, she can't do anyhting to about it to make this madatory......

We've been consistently running either 4-5 CNAs at NOC (usually 4), so that's at LEAST 20-30 residents per CNA and they're supposed to change incontinents q2hrs AND take 30-45 min break, AND fill O2s, wash W/Cs, and have AT LEAST 6 get-ups UPs up (each) before day-shoft comes on at 6a, AND chart, AND filll out toileting sheets, .AND do inventory & weights admissions.,..............AND cover the other hall who's on break for 30-45mins, so at that it time it's 40+ that they have eyes/ears on.....

As charge nurse I come on at 10, have to get report from3 nurses, count 2 narc boxes, print and check my orders from the day (NOC responsibiliyt), check BGM machines, check fridge temps (daily), check crash cart (daily), check and call on labs, check/fix admission orders (I ama perfectionist when it comes to orders), send people out, re-admits (latest was 12am), midnight meds, solving other peoples probems, making sure the phone system is working in the secretray's office and switched to NOC-shift setting, locking and un-locking the front door (at the other end of the building), locking and unlocking the BACK door (at a FURTHER end of the building where CNAs take out their garbage 2x/NOC and I have to make sure they're lockig te door behing them 3x/NOC ), treatments (now 2-3 nightly, but at max has been 11 every night), gtube-dressing changes, foley changes/straight-cath UAs for daily labs, Gtupe-lopez valve changes monthly, O2 bottle-tubing-neb changes weekly, book change at the end of the month (HUGE pain in the azz, at least 3 hours of my 8 hour shift, MARS and TARs that I usualy come in a m hr early and late for), I have to clock out for 30 mins (even though I work THROUGH my break b/c if I don't I WILL be written up - and the 1 time clock is also at the far end of the building...plus we have like 10+ surveillance cameras thst can prove we're acutally WORKing though our clocked-out break but yet we're threatened with "corrective action" if we fail to clock out)....), time spent chit-chatting w/residents b/c they find me 'nice' and 'approachable' vs other shift nurses,.... helping older PM/NOC nurses who aren't as savvy when it comes to entering orders into the computer,.... dealing with CNA's personal problems ('can i hav some tylenol, i have some tylenol, i have a headache?' 'my back hurts i think i'm going to go home early and go to the ER', 'I can't work on THIS hall b/c MRs. X doesn't want a male CNA',.... having to call everyone on the 'call-list' to find covers for AM shift if there's morning call-offs, callling maintanence/admin if there's a structural issue or power-outtage/security/workmans-comp issues ..... I feel like the list goes on and on.

days/pms has TWICE as many nurses AND cnas PLUS 10-20 ancillary staff (maintanence, office/secretarial, dietary, MDS, OT/PT/OT, lab, podiatrists, MDs, RTs, vistors/family, volunteers, CNA/RN students)

Well basically the point of my post is not MY noc-shift responsibillity, but is actually re: the HAASSMENT I get from day-shift CNAs (used to get flack from the day-shift nurses too, but after 2 yrs they kinda know im 'on top of my s**t".....They (mostly AM CNAs)... think we don't do ANYthing all night, and tattle-taling to my DON.... I am constantly moving. When I have my trusted/good/regular CNAs then they are constantly moving too. I like to have a good relaionship with my (and all-shift) CNAs. They do the hard crap, work hard (for the most part), but they are always blamed for a job poorly done (d/t poor staffing IMO) And their animosity towars eachother bleeds thorugh into ME doing MY job....And they are always the least "heard" when it comes to employee complaints, unless it's the majority/joint-shift effort....if it's one person complaining/standing upf or their "rights' (?)...then they are usually targeted by admin and quit/are let-go.

So how do you calm the shift-chaos? Should I just ignore it, or re-direct it to my DON? ( who will re-driect it back to ME, eventually saying it's MY problem to solve"....i really love my job/location/schedule/pay/ and co-workers (for the most part) but feel like I am feeling the flack and taking the blame for alot of other people.....

Sorry this was long. Any advice -big thanks, I want to make it work but realize this is idealistic,..My DO N told me to advise CNAs to report off to one another, (but there's no way of enforcing it) or to talk to the probldm-person specifically and privately (but like I have ntime to track them down and do thst) My DON told me"you need tobe a bi**h to get things done -- her advice to me"...

IF I was DON/admin, I would require ALL shift staff to report to oncoming (CNAs/nurses). I would hold monthly meetings ("bit*h sessions" with regular shift nurse + FT shift CNAs, so theyy can all be heard/addressed) I'd assigns CNAS as "shift leaders" to address shift issues. I'd pay shift diff.

I've stood up for myself. My shift. Individuals (across all shifts). I play "get along"....but I am really fed up with getting blamed for other people's percieved/exagerrated short-comings. We are in the 24/7 business. If you have a problem then bring it up with the indiviual/admin, and not me, I have enough to do. In the time it takes for someone to b*tch about something, they could could've adressed the problem + another.

Ho do you encourage shift-friedliness and NOT shift warfare?

[ktwlpn, LPN]

Take a few minutes and round with one of your cna's every day prior to the end of your shift.Rotate the duty amongst them,have them fix the messes you are finding.You will soon see patterns emerge and will be able to follow up with the staff on your shift who are sloppy and cutting too many corners.After a few weeks you assign this task ,again on a rotating basis to the cna's and let them round without you.Clear it with your DON first and make it part of an assignment.You should be doing walking rounds with the oncoming nurse as well.Zero tolerance for the shenanigans at the desk,too.Make them back away,they can stock linens carts ...Tell them if they have an issue they need to report it to their charge nurse.Together you need to take control of this group.It sounds like you have let this behavior go on too long.You should also have implemented static assignments for them,makes it easy to check job performance.I get the frustration,I was an aide,too.Cursing and generally bytching and moaning on the floors where the residents can hear and feel it is abuse and needs to be handled firmly.

[ktwlpn, LPN]

I know you are thinking " ain't nobody got time for that!!!" But it truly does work and in the beginning it will really only take a few minutes of your time.Once you turn the task over to the cna's to perform it independently peer pressure comes into play.Your best ones will ride the slackers....The DON will think you are rock star....

[ponymom]

you could try printing out copies of your post and giving one to each nurse, cna, pt, rt, don, adon, etc., on each shift, particularly the bozo who would write you up for not clocking out on time. Then call off for a day or three, you need a break.

Gawd, I'm so glad I'm out of ltc,

[bluegeegoo2, LPN]

We have mandatory rounds with round sheets. On-coming shifts are required to show up on time to do walking rounds with the off-going shift. (The off-going shift is not allowed to leave until rounds are done.) When rounds are completed both parties sign the sheet and that goes into the "Shift Rounds" binder. The rounds include checking each resident, bed, room, as well as common areas (dining room, hydration room, shower rooms) and ensuring barrels and all trash cans have been emptied. That way, any issues that the on-coming shift might find are addressed by the off-going shift before they leave for the day. I rarely hear any complaints anymore about the condition of the unit before I leave. If I do hear a complaint, my first question is "Did you do rounds?" If they didn't, then it's on them.

[ktwlpn, LPN]

We have mandatory rounds with round sheets. On-coming shifts are required to show up on time to do walking rounds with the off-going shift. (The off-going shift is not allowed to leave until rounds are done.) When rounds are completed both parties sign the sheet and that goes into the "Shift Rounds" binder. The rounds include checking each resident, bed, room, as well as common areas (dining room, hydration room, shower rooms) and ensuring barrels and all trash cans have been emptied. That way, any issues that the on-coming shift might find are addressed by the off-going shift before they leave for the day. I rarely hear any complaints anymore about the condition of the unit before I leave. If I do hear a complaint, my first question is "Did you do rounds?" If they didn't, then it's on them.

But what happens when certain staff are chronically TARDY???

[bluegeegoo2, LPN]

But what happens when certain staff are chronically TARDY???

They get wrote up and referred to HR. If they continue, they are terminated. In the meantime, they have no valid argument regarding any conditions that they may find as they did not fulfill a requirement of their job duties.

[litbitblack, ASN, RN]

I agree with the rounding.we do shift rounds and if my aids on 6-2 find something after the other shift leaves then Oh well you should have caught it on rounds and I say that. Now they don't even say anything to me they take it the aids and if it continues to go on then I get aim on it and go from there. I take it to there charge nurse, it is still a chain of command

[HappyWife77, BSN, RN]

We do twelves as nurses and CNAs do 8's.... They do their rounding and it's between them... We have no issues, occasionally the previous shift is staying over to correct things. They get 1/2 hour together to do this, they work 7.5 hours a shift.

Definitely stand your ground about no interruptions during nurses report!

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