Published Mar 28, 2004
I am the charge nurse for a 70+ resident facility in Wi. I do all the MD calls, admissions eg; orders, discharges, assess residents that are ill, many of our nurses are LPN's (They are very good at there assessment, but if I have to report to the MD I want to at least do a mini assessment of my own.) My duty's are many, as a LTC nurse for 20+ yrs, we know everyone is required to answer call lights, buzzers, bells and alarms. The interruptions are unreal, with residents and family, other nursing staff, social services, MDS nurse, PT, OT, ST, DON, Adminstrator all have issues/ questions that are directed to me. Now if and when the MD calls back, I have orders to write, NN (everyting needs to be documented) these all have to be put in there charts (if you can find them) meds ordered, family and careplans updated. I could go on and on.
Then when I go home at night (HOPE THAT I DID EVERY CORRECTLY). I usually put in a 10+ hour day 5 days/week. My administrator doesn't like all the overtime. Does anyone out there have a simular problem, or have any suggestions how I can accomplish all this in 8 hrs.
Delegate, delegate, delegate. I found if you do this effectively and fairly your life will be much easier. Why do you have to call the MD's? Why can't the LPN's do this? Look at specific jobs that you do during the day and ask yourself do I need to be the person who has to do this? Also look at how much time you are spending on things that have to be done by you specifically, keep track. Go to the higher ups and discuss the amount of time needed to do your job and to do it safely. Do you need an assistant manager? I know you are probably laughing at this but you never know until you ask. I did and my co. hired an assistant. Turns out that yes this is a two man job.
I agree about delegating some of your work. If LPN's in your state can't take verbal orders, then you write the order, document the phone call, and let the LPN's take off the orders. When you do admits, fill out the paperwork and get the orders verified, and have the LPN's fill out the MAR/TAR. Regarding the interruptions from other staff and admin., do you have a daily morning meeting? If not, see if you can set one up, that way questions can be handled all at once and plans can be made early in the day to tackle certain issues. Then, hopefully you won't have people coming at you all day long.
As far as the floor issues go, take a day to observe the staff. Maybe they need help with time management also. When bells are going off, make sure the nurses are helping to answer them as well, esp during patient care time when the aides are busy? A lot of paperwork can be delegated, too. There are a lot of things that LPN's can do, they just might not be used to doing them.
Also, you may want to consider having weekly or bi-weekly staff meetings with the CNA's and nurses on the floor. That way you can delegate responsibilites, do some inservicing, and make plans for any changes. It's hard to do all those things when you're all on the floor, it's just too hectic.
Finally, I would suggest meeting with the DON and administrator and telling them what you told us. Come up with solutions and present them to them. Ask them if they have any ideas. Try to work together to come up with solutions to your problems.
I know I sound like an idealist, and I know how admin works. But at least if you give it a shot, they can't blame you for not trying.
Good luck, and let us know how you are doing!
Definitely delegate...if it gets too hectic request help if there are ancillary staff available...is your MDS nurse an RN? Call for assistance if it gets too hectic...she can call a doctor or write some orders for you as well as your DON/ADON. No one likes to feel burn out...and that is what happens after too long. I have worked LTC for 9 years....charge nurse(for 7 of those years) and it can be very hectic...organization, multi tasking are a must! But even with these things there can be many days that are frazzling! I am the MDS coordinator at present and when I see the charge nurses looking a bit frazzled...I remember what that felt like (not to say I am not frazzled myself on many days being pulled away from my own job to work the floor or do an admission, etc.) I offer to do what I can to help (if able to)...write orders, hang an IV or three, hold down the fort while she goes and takes a much needed break. I also will call the doctors and do what I can for myself without having to bother them with any more things to do....(after consulting with her for her opinion of course)...and then update the other staff that need notified. It is a hard road to travel sometimes but definitely worth it and definitely rewarding (eventually..lol!) Hang in there!! :)
Thanks everyone for your input, you are right to delegate, but there are times when there is no one to delegate to. The nurses working the floor are overloaded to. I'm fairly new at this charge nurse position, now full time (I use to just fill in) it will just take some time to reorganize my responsibilities. This came up yesterday, I have the Feb & March MAR's in my office, I told the DON they need to be checked for initials she said "well, that has to get done as soon as possible", but did not say how or who should do it. I think she should delegate some of my unnecessary task to others, it would be more accepted.
Thanks again for your help, Im hanging in!!
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