Teamwork or not

[nurse4117]

I have been in LTC since July and it has very intersting and since I like challenges, also rewarding. I have learned about the MDS process and Resorative nursing. The facility has 150+ beds and three floors. I am one of three ADON's, each one of us has their own floor. I work on the long-term care floor, therefore, when the surveyors come, they focus on my floor. The other two floors are Transtional Care.

I have concern about staffing since it is not done by acuity but by numbers for each unit. This is a problem since many of the residents on my unit require total care, not so on the other units. The Administrator cannot see this difference.

I have a concern about supplies since we are many times lacking what we need near the weekend, but the administrator is prideful about being the 'best budgeter' within the company. So staff hoard during the week.

There is no lap time for report with the CNA's so they start at 7 and end at 3 one the nose.

I am a RN but am seriously considering leaving this place even though I have made several positive changes already and have had a previously earned skin tag removed by the surveyors. How does one last here in LTC? I think I should have just been a DON. By the way, she is new,too and does not know what I do about LTC.

[achot chavi]

They used to hoard by us too- we put a stop to it with surprise inspections all over the place. My boss is known to throw out expensive sneakers if they are left in a patients room ( some CNA's are too lazy to change in the designated locker rooms so they used to borrow space from pts closets- It was disgusting till we started throwing out their things- boy did that get them to stop - BTW there is an official policy regarding this. Supplies are distributed every other day but if a Head Nurse asks, she can get more. Pharmacy supplies are once a week and PRN for new orders, but we are allowed a certain amount of hoarding...

Regarding staffing- in principle you are right- and if you can get the support of the other units (doubtful) you can ask for a redivision of work force- it might also mean a monthly or weekly report of how many pts need full or partial assistance in all aspects of ADL. ( could mean more work for you.)

I succeeded in this - where I work one unit had 1 RN and 2 CNA's to moniter 22 ALF residents who got their meal served by kitchen staff. Ridiculous when the SNF units were bursting with 36 pts and at least 20 of em requiring assistance (mostly full) in eating. We all complained- except the ALF staff of course- but a policy was passed that during meals only one staff (usually the RN who is passing meds) stays with the ALF pts and the others go help feed pts on other units.

Re your knowing more that the DON- my DON is quite open about it and often says I know more that she... she openly asks me about medications, treatments, diagnoses etc. HOWEVER She is 17 years my senior, has lots of pull with the DOH (she used to work there...) taught nursing for years, knows everyone in the business and is better at recruiting staff, organizing major in-services (by bringing in nurses whoare experts in their field- usually from various schools).

I'm glad that you like it as much as we do- I lOVE LTC...its certainly arewarding place to ply our trade.

It does sound like if you keep on doing a good job- you might be able to pursue a DON job, if thats what you want- GOOD LUCK!!!