signs of a bad unit

NOADLS · Oct 23, 2015

CNA's not taking orders from nurses. Red flag.

Another one is if nurses are doing CNA work (ie changing diapers, toileting patients)

You might think the second one is the product of the resources you are given, but I firmly believe that if a workplace isn't giving you CNA's, then it isn't worth the time or effort to stay there.

blondy2061h, MSN, RN · Oct 23, 2015

*High turn over

*Poor ratios that aren't adjusted for acuity

*Poorly visible management

*Poor communication between physicians/management/nursing/auxillary staff

*Either all new staff or all old staff

*Running out of basic supplies- linens, IV pumps, bandage supplies, etc

meanmaryjean, DNP, RN · Oct 23, 2015

Turnover is always a bad sign. Just listen to the nurses chit-chat on various units. You get a pretty good idea if they are happy or not.

johsonmichelle · Oct 23, 2015

CNA's not taking orders from nurses. Red flag.
Another one is if nurses are doing CNA work (ie changing diapers, toileting patients)
You might think the second one is the product of the resources you are given, but I firmly believe that if a workplace isn't giving you CNA's, then it isn't worth the time or effort to stay there.

Good advice, although it can go both ways, I believe the nurse and cna should work together. There are some lazy cna's but there also overtly demanding nurses. I believe in the ICU, the nurses do most of the basic care such as changing diapers, bathing patient etc. I guess it would depend on the type of unit as well.

johsonmichelle · Oct 23, 2015

Turnover is always a bad sign. Just listen to the nurses chit-chat on various units. You get a pretty good idea if they are happy or not.

I agree, one unit I floated too , has a very high turnover rate which is strange because thats a unit( ICU) where a lot of people want to work.

Dranger · Oct 23, 2015

Good advice, although it can go both ways, I believe the nurse and cna should work together. There are some lazy cna's but there also overtly demanding nurses. I believe in the ICU, the nurses do most of the basic care such as changing diapers, bathing patient etc. I guess it would depend on the type of unit as well.

Very rarely do ICUs get CNAs, so yes you will be doing all of the basic care. ICUs are also plagued with high turnover.

johsonmichelle · Oct 23, 2015

I'm also a bit concerned when I see a lot of new grad nurses in high acuity area. I wonder who they can get guidance from if a good portion of the staff is new themselves.

johsonmichelle · Oct 23, 2015

Very rarely do ICUs get CNAs, so yes you will be doing all of the basic care. ICUs are also plagued with high turnover.

I float a lot to the ICU and the duties are assisting the nurses with their patient, stocking supplies and getting the patient blood sugar.

KatieMI, BSN, MSN, RN · Oct 23, 2015

High turnover in ICU often caused by the fact that many new nurses only stay there for exactly as long as they need to go to CRNA school.

My own 0.02 to the list of red flags:

- core of "old" nurses who stay doesn't matter what, and high turnover of new hires

- hospital having "diversity statement" on its online site (it can be either imposed by EEOC as part of "solution" or put there as the facility expects trouble with this organization, in any case the fact of having this statement practically means "we've got discrimination problem here")

- drastic difference in between facility nursing workforce demographics and the one of the surrounding area, as well as yourself (you do not want to be a non-white nurse in a place where 90+% of other nurses are white, and in the nearby city 70% of population are non-white. Cafeteria is an excellent place to study the question)

- above average Press-Ganey surveys scores (available for public here: https://www.medicare.gov/hospitalcompare/search.html) and otherwise average clinical results, the reason being that you will be considered a waitress or handmaid of a sort and spend most of your time doing "customer service" instead of nursing. Characteristic for such places is starting every job application/description with something like "the employee provides excellent customer service..."

- orientation is shorter than usual

- preceptors changing daily in random order

- cross-training in other units during orientation

- too rare (once or twice during orientation, or no at all) or excessively frequent (daily) meetings/reports to "see orientee's progress)

- nurses oriented by non-nursing personnel beyond a couple of hours

- lack of resources and their sources, especially at night

- lack of cooperativeness and teamwork between everyone. Best observed during emergencies (are someone purposefully staying to answer the call lights while everyone is busy with the code?) or if some personnel has to leave the unit to transport the patient to a test, for example... what the nurse expects to be done with her other patients while she is out of there?

- lack of helping hands (do they have anyone who is particularly good in doing certain tasks, and if so, do people feel comfortable to ask this person to help?)

- and, of course, nurses hanging endlessly at the station and in breakroom playing their phones and chatting about ourselves with gossip and long dialogues about how their job sucks:nono:

RNperdiem, RN · Oct 23, 2015

A few overworked senior nurses who are always in charge or precepting,and a lot of new grads, floats and agency making up the bulk of the staff is a bad sign.

Understaffing of CNAs and clerical staff in areas that depend on them is another worry if it is frequent. A patient needs a sitter and you are left 2 CNAs short because another called in sick and replacing CNAs is treated as not that important.

Nobody seems to take lunch or leave on time.

Dranger · Oct 23, 2015

I float a lot to the ICU and the duties are assisting the nurses with their patient, stocking supplies and getting the patient blood sugar.

Your hospital is well-funded and staffed. Most places are not like that.