Want to Change Locked Unit. What Do I Say?

[Newgurl17, CNA, LPN]

Hey all!

I work on a locked unit in ltc and have been for nine months on an on call basis. I worked last Saturday and was talking with my CNAs who had reported that a resident had a wound on her heel. They reported that this resident had this wound a week ago too!! Same wound, nothing done! I hadn't been on the unit a month prior to last saturday. I told them that I felt like this unit was the most under-served and understaffed unit in the whole facility. One of them told me to write a note to the RN who works on the unit to say exactly what I told them. She also wanted me to ask the RN why things are not being done, e.g., the dressing to the resident's heel.

This unit is split up into 2 sides, one has 17 residents and the other has 24. At one time, there were more CNAs working on he unit and 2 LPNs in the unit in the morning. My thought is that, "I get that there are less residents on the one side of the unit, but it's a locked unit." This is the unit where I feel everyone's safety is the most at risk compared to the rest of the units on the facility because the resident's on this unit have the most advanced dementia and there are more aggressive residents. In the morning, there is one nurse who starts at seven am and is there until 3pm. The RN helps with the morning meds on the side of the unit with the least amount of residents, then for lunch the LPN does the meds for the entire unit feom monday to friday. In the evening, there is an lpn that comes in from three pm to eleven pm, then another nurse who is there from four pm to eight pm. On thhe weekend, the lpn is by themselves until the other lpn comes in from 12pm to 8pm. I work on another unit in the facility where in the morning there are two nurses working eight hours in the morning, and one in the afternoon. He or she arrives at three pm and there is another nurse working from 3pm to 9:30 pm, sunday to saturday. This unit's wound care book usually says when to change a dressing for a resident whereas on the locked unit it says when the dressing was changed last and to change the dressing prn. This unit has 24 residents per hallway.

How do I start? What should I do? I'm working on the unit again this Saturday.

[Blackcat99]

My experience has been that nursing management doesn't care about our concerns. They will continue to do as they damn well please They don't care about the opinions of the nurses working the floors. The only thing that happens to nurses that try to improve things is that they get labeled as "trouble-makers" by nursing management.

[Newgurl17, CNA, LPN]

My experience has been that nursing management doesn't care about our concerns. They will continue to do as they damn well please They don't care about the opinions of the nurses working the floors. The only thing that happens to nurses that try to improve things is that they get labeled as "trouble-makers" by nursing management.

I'm still going to leave that note anyway. In the end, at least I tried to make a change. It's sad that your experience with management was not satisfactory. I applied at another facility and was thinking of getting oriented to another unit. The locked unit is unlucky to me.

[litbitblack, ASN, RN]

Why not try to look at the charting to see if it has even been addressed. Maybe there are behaviors that are preventing it. Change the dressing your self. Document what it looks like then write a note to the person in charge of the unit.

[Newgurl17, CNA, LPN]

Why not try to look at the charting to see if it has even been addressed. Maybe there are behaviors that are preventing it. Change the dressing your self. Document what it looks like then write a note to the person in charge of the unit.

When the cna's reported the wound , it was nearing the end of my shift so I left a note in our planner for it to be changed. Otherwise, I usually apply dressings right after they are reported to me.

[canoehead, BSN, RN]

Putting a dressing on a wound, and adding that to the care plan is within your scope. Do what you can, and if you initiate care others will be more likely to follow.

[Scorchednurse]

My experience has been that nursing management doesn't care about our concerns. They will continue to do as they damn well please They don't care about the opinions of the nurses working the floors. The only thing that happens to nurses that try to improve things is that they get labeled as "trouble-makers" by nursing management.

Yes! I have seen so many nurses get fired with good intentions but being perceived as trouble. I've done it myself. Sent a text to the DON about a serious neglect concern and she forwarded my text to all of the other administrators and said this ones going to be a nagging problem...take care of her? I was fired 3 days later with some loose explanation that staff complained I was difficult to work with, even though I worked there for a year with zero complaints. Fortunately I was really good friends with the case manager who showed me the text in confidence so I had some idea it was coming. Lesson learned that you don't always want to be "that nurse" who can find every error and flaw and show how wonderful you are to be able to fix it. Not saying you're wrong, just have come to find they'll just replace you with someone who keeps their head down and does their job.