same station burnout?

I work in a LTC facility that has 2 nurses stations with approx 35 residents each and and an alz. unit. We have had looong discussions on the topic of keeping staff in one area or having everyone rotate to each station. I see the advantages of having the same staff at each station, but is it worth the burnout and disadvantages? Currently most of the cna's and nurses are comfortable being able to work any area with the exception of 3 or 4 cna's and one day nurse that absoultely refuses to work another unit. I would like to hear from others out there and what is being done elsewhere.

We have a couple of "inflexibles" who insist upon working in one place. I rotate all of the CNAs because I told them they should be able to care for all of the residents. Ours is a relatively small facility so the residents know most of the staff well. New staff is oriented to all sections; I work where I am needed. The ones who refuse to work other sections have been there for a long time and have been permitted to get comfortable. We have a new DON, however, and I think it's about to change. I feel that staying in one area does increase chances of burnout, complacency. Stepping out of the comfort zone is a good thing.

We have permanent assignments for our nursing assistants. We feel that having the same care giver is an enormous benefit to the resident, especially folks with dementia. This is substantiated with research, facility studies, best practices and current literature. Our part timers need to float and fill in for fulltimers on their days off. Our staff likes knowing their residents well and take pride in the care they give ~ they can really take credit for the good care if they are the primary care giver! :) All staff get to know all the residents because our facility is small and the aides are always helping each other.

Floating around may seem like a good idea in theory, but where I work it doesn't work. Not everyone is cut out for the fast paced world of the sub-acute unit any more than everyone can work on an Alzheimer's unit. We try to keep our staff on "their" unit and match their strengths with the unit's needs. Of course, on a day like today when we got 12 inches of snow...who ever showed up got sent to the unit with the least staff people.

I work in a LTC facility that has 2 nurses stations with approx 35 residents each and and an alz. unit. We have had looong discussions on the topic of keeping staff in one area or having everyone rotate to each station. I see the advantages of having the same staff at each station, but is it worth the burnout and disadvantages? Currently most of the cna's and nurses are comfortable being able to work any area with the exception of 3 or 4 cna's and one day nurse that absoultely refuses to work another unit. I would like to hear from others out there and what is being done elsewhere.

I too, see the advantage of having the same staff on each unit, but......for me, I have been going through this and I am getting burnt out being on the same unit. One particular night, I had it. I went to supervisor and begged her to please not put me on that unit the next day. I work 16 hrs shifts, several times a week and after a while, I feel that I just need a break. They are pretty good about switching assignments but sometimes we have those who will not give up "their unit" and they refuse to work on another unit. That means that we have to work where assigned if others won't work elsewhere. Right now, we have a nsg shortage and are using alot of agency. That is when we can ask for certain assignments. With our Cna's, most have regular assignments and I think that is good for our residents since most have dementia/alzh. The families really are happy to see the same faces everyday, it makes them feel better. That is all and well, but what about us nurses? Bottom line, when a nurse feels that she is becoming burnt out, they should have the facilities support and be rotated for a while.

JUDE

I am currently working as DON in a facility similiar to the one you are working in. We keep the same staff on our dementia/alzheimers unit to help reduce confusion for our residents.

Out on the other 2 halls- the C.N.As rotate every two weeks (on payday). We provide C.N.A assignment sheets that are kept very detailed about resident care. Every aide is expected to have a current care sheet in their pocket at all times for the area they are working. By rotating; everyone gets the chance to "enjoy" those residents that are more demanding and who has family that are VERY involved!!

This also prevents aides from not being able to come in when there are call-ins because they "have never worked on ____hall" and "I don't know the residents."

I tell all applicants during the interviewing process that they will be expected to work all sections. If any of them try to pull any crap later- I just tell them that "hall ____" doesn't issue their paycheck- the facility does.

All jokes aside- most of the aides want to rotate to prevent any of their co-workers from having to deal with difficult people very long. I am very fortunate that my aides really do care about each other for the most part.

I do keep the same licensed staff on the same sections. I think that the residents in long term care can have a change in condition slowly and a nurse that has not worked with that resident may have a hard time pinpointing what the issue is.

All facilities are different though. But- this rotation of the C.N.As works best for us. Good Luck

Jude, I m not trying to be smart, but don't you think that your burnt out feeling is more from working sixteen hour shifts? I could never do that on ANY assignment. I give you a lot of credit!:)

All the units where I work are full of dementia pts. Sometimes CNAs have to work another unit. Some of them throw a God awful fit about it though. I find it very ironic that the same aides who flat refuse to care for people they don't know keep saying they want to work at the hospital where they will ALWAYS be caring for people they don't know. Asking some people to float is like asking them to harvest an organ for crying out loud.

Jude, I m not trying to be smart, but don't you think that your burnt out feeling is more from working sixteen hour shifts? I could never do that on ANY assignment. I give you a lot of credit!:)

Yeah, you have a point there. It is a long shift and sometimes knowing that you have 2 double shifts to get through gets to ya. It's alot different than being asked to pull a double now and then. The other thing that is burning me out, is that at night the assignment they always put me on is one which you have 2 units(60pts). The other 3 assignments are 30 pts each. Why is this one 60?? It is the unit that shares a nsg station and splits off into 2 units. Other than that, there is no difference. It is not an "easier assignment", as all units have the same type of pts etc... During day and evening shift, each unit has a nurse with 30 pts, then on the 11-7a shift, the "middle" gets the 60 pts. Several of us have complained over and over again that we need 2 nurses at night and we get the same answer, "it's not in the budget"....To make matters worse, they are giving night shift more and more duties. Most of which we just don't have the time to do. Just lastnight, I had 3 residents who were climbing out of bed, 4 pts with diarrhea, 2 falls from previous shift who are on neuros, 4 with g-tubes and 3 who are comfort care. Oh yeah, then there's the one who can ambulate and is always trying to get out. And the one who atleast once a night pulls off her colostomy bag off. It is also drug-pull night, lab night and wander-guard checks. On thursdays, we have to defrost medication fridge out. Then we have our charting to do, plus medicare charting, signing off on the cna books. The lab slips have to be filled in everytime with pt name, dob, ss#, insurance#'s, diagnosis, codes. Some places have pre-printed labels, not us. You can count on a few UA C&S's to obtain. Now, they are having nights do the monthly summaries. I didn't do them, I just didn't have the time. Before ya know it, it's time to do your med pass, blood sugars. We were told that nights now has to check each room with a printed checklist for each pt. I can't even understand how this falls under nursing. Shouldn't housekeeping be doing this??? We don't have a DON right now, the ADON has her hands full right now, so what can we do? I am seriousely thinking of telling them that I refuse to take those 2 units at night because I don't feel it's safe and I am not going to risk not only my patients well-being but my license too.

Sorry so long, but this is why I'm burning out along with doing these doubles. I need to make a decision about my hours or I need to stop complaining. LOL, I still think that with 2 nurses, it wouldn't be too bad.

JUDE