The DPH/Corporate Blues

Nascar nurse, ASN, RN · Dec 22, 2005

I feel your pain - everyday, I feel that pain too. Not sure who is worse DPH or corporate - (least DPH is usually only once a year!). Our facility double documents or more - per corporate mandate - and it is just asking for trouble every time. Just take pride in the residents like the one you sent home today. It's easy to forget, but that is why we walk thru the door everyday.

CapeCodMermaid, RN · Dec 31, 2005

This week we've had scads of the corporate biggies in the building constantly telling us we are not doing things the right(their) way. I don't mind help but wouldn't it have made more sense to send all this help BEFORE survey? I think they like to puff themselves up to justify their jobs. Yesterday during a 40 minute conference call with one of the biggest of the biggies, we were discussing staffing levels. The woman on the other end of the phone actually asked: "Have you advertised for staff?".... :idea: :idea: :idea: wow what a concept!!! DUH!! Does she think we live in a cave? Her answer was to send another corporate person, one from HR, to give pep talks. This is the world they live in. I told her that of the last 10 people who applied for a CNA job, we kept 1. 5 flunked the drug test (one of those people went to work for an agency and she works in our building sometimes and she's very good), and 4 said it was too hard for them. Why work LTC when you can go to the hospital and make more money for far less work? The other issue...why do we miss things on admission? They had the luxury of sitting in an empty room behind closed doors and looking at one chart at a time. My nurses have 3 or 4 admissions at a time, the longest, most redundant admission packet I've ever seen, and 15-20 patients to take care of at the same time they are doing the admission. That is the trouble with working for a corporation. Some center got tagged somewhere so they come up with 6 new forms and ALL the centers have to comply. Sorry for the long rant. Happy New Year to us all!!

Bird2 · Dec 31, 2005

I feel you pain. Corporate has been making us very long, detailed policies that are going to hang us with DPH. Some are 10 pages long. How can a floor nurses absorb and remember all the details?! I'm one on the managers and I have trouble keeping up with all of them.

cantoo · Dec 31, 2005

I also work for a corporation that's unrealistic. I recently went to a meeting with the big wigs where one idiot suggested that my nurses should be doing skin sweeps every day for at least a week on any new admission. Her reasoning is that boggy heels on recent hospital stays don't show up for several days. This may be true, but try taking care of 20 plus patients and doing skin sweeps every day for a week. Geeze, I'm lucky if they do the first skin sweep!! Our admit packets are way too long, redundant and plain silly.

I'm expecting state in our building any day now. Although I was the ADNS at this facility for several years, this will be my first state inspection as the DNS and I have to tell ya, I'm a bit nervous. Our quality monitor was there on Thursday and she didn't have too many concerns.....but then she wasn't looking too hard! Wish me luck!

Bird2 · Jan 1, 2006

I also work for a corporation that's unrealistic. I recently went to a meeting with the big wigs where one idiot suggested that my nurses should be doing skin sweeps every day for at least a week on any new admission. Her reasoning is that boggy heels on recent hospital stays don't show up for several days. This may be true, but try taking care of 20 plus patients and doing skin sweeps every day for a week. Geeze, I'm lucky if they do the first skin sweep!! Our admit packets are way too long, redundant and plain silly.
I'm expecting state in our building any day now. Although I was the ADNS at this facility for several years, this will be my first state inspection as the DNS and I have to tell ya, I'm a bit nervous. Our quality monitor was there on Thursday and she didn't have too many concerns.....but then she wasn't looking too hard! Wish me luck!

The floor nurses just do not have time to do complete skin checks on all of the residents. But, the CNA's are trained to report any deviations from the norm and they can report a problem to the nurse who would then go in to assess the residents skin. At the beginning of the shift the nurse just needs to say to the C.N.A that they want all problems with skin reported. This process works wonderfully. It is important that all understand that the aide is doing a skin check and the nurse will assess. Good luck on your survey. In my area they were concentrating on Infection Control, and pressure ulcers.

CapeCodMermaid, RN · Jan 1, 2006

We had a wound/skin consultant come in once. She said we should have 2 nurses check skin on admission....yeah right! But one thing she said made sense. If your admission has pink or boggy heels or a questionable butt...document "Skin intact at present, but probable deep tissue trauma from prolonged immobility or being found on the floor at home after 4 hours" or what ever it is. That was the pressure ulcer that shows up in a few days has already been documented as starting before admission. Of course it's still up to you to prevent any further ones or heal ones they already have.

The surveyors here were really keyed in to the new 314 pressure ulcer regs and infection control and grievance reporting....yikes!!! do we really do this for a living?

Bird2 · Jan 1, 2006

We had a wound/skin consultant come in once. She said we should have 2 nurses check skin on admission....yeah right! But one thing she said made sense. If your admission has pink or boggy heels or a questionable butt...document "Skin intact at present, but probable deep tissue trauma from prolonged immobility or being found on the floor at home after 4 hours" or what ever it is. That was the pressure ulcer that shows up in a few days has already been documented as starting before admission. Of course it's still up to you to prevent any further ones or heal ones they already have.
The surveyors here were really keyed in to the new 314 pressure ulcer regs and infection control and grievance reporting....yikes!!! do we really do this for a living?

I almost forgot that they were also very keyed into the grievance reports and the post fall investigations. They want full investigations on pressure ulcers, incidents, and infections. Can you spell OVER WORKED!