What Is the Problem???

Long Term Care Columnist / Guide · Apr 11, 2017

Wow. Where I come from, the nurse does all the meds and treatments, all the diabetic cares, all the orders, all the doctor calls, all the family contacts, all the supervision of the CNAs, all the lab draws/UAs and follow-ups, and all the assessments. Can I come work with you?

TheCommuter, BSN, RN · Apr 11, 2017

When I started in long term care in 2006, I had 30 residents on day shift and 68 on night shift.

There was no unit clerk to answer the phones. There was no unit manager to address orders, labs, or physician phone calls. The floor nurses did it all.

caliotter3 · Apr 12, 2017

If you are the boss nurse, I know what I would do if in your position. Bet you can read my mind too.

allnurses Guide · Apr 12, 2017

Cape Cod, I've read your posts for years, so I know your motivation is the highest standard of care. It saddens this old dino to know that very often these days any expression along those lines is likely to result in the "bully" fingerpointing exercise.

I'm not one to regard newer nurses as entitled princesses, either. I try to be fair. Wish I had the answer, but I'm pretty sure the general direction in nursing culture is weighted toward the feelings of less experienced nurses interpreting your message as your problem that needs to be fixed.

The whole thing reminds me of the adage of parents getting much smarter between the ages of 18 and 21, when it's the child who matured and gained perspective.

CapeCodMermaid, RN · Apr 12, 2017

No one on this unit is a new grad. I fully support new people and have mentored many nurses. It's a case, I think, of expectations. No one has expected them to do it- except the DON who has come to the unit twice in two weeks- but she doesn't tell them anything. I'm only there as an interim so I can't really make any changes. It's just surprising to me that they can't get more done.

CoffeeRTC, BSN, RN · Apr 12, 2017

Wow. I would love to work with those ratios. A secretary and unit manager? Sign me up.

We max out at 48 residents and normally hang out around 46. They just took the unit manager position away from days and have one floating between 7-3 and 3-11. They only want to staff with 2 nurses each of those shifts with the floater. CNAs...varies should have 5 on 7-3 and 4 on 3-11 but we've been at 3-4 and 3. I'm a well seasoned RN and things of leaving if this keeps up. Way too many geri psych and clinially complex residents.

djh123 · Apr 12, 2017

Wow. I (usually) have 20 people, have to pass meds, check several diabetics 2x per shift, multiple wound cares, have to enter orders, order meds, f/u w/pharmacy sometimes, call doctors, do the occasional quarterly assessment, occasional new admits (w/other assessments, fix or clarify orders, order meds), and more... falls, adjust pillows 1mm up or down :^), patient/family questions/wants/?, and did I say more?

nurseburst, ASN, BSN · Apr 13, 2017

That would be a walk in the park. I have 18+ patients. Half skilled. Usually 1 to 3 admissions a shift. Several IVs, wound care, accuchecks twice a shift for several patients, multiple fall risks and frequent fallers, pass all medications, do all treatments, usually have 7 or more evaluations to complete (yay daily skilled note), TPN patient now, lots of family with questions, phone ringing off the hook.

No supervisor. I put in all orders. Do all assessments on my patients. Call M.D.. Everything.

Tell the DON she needs to tell the nurses the actual expectations. They will continue to abuse you if you let them.

tmaca · Apr 13, 2017

Don't quit without notice, it could bite you in the butt later in your career.

Actually, I think you ought to start looking for a new job. You might try to get prospective employers to agree not to call your current workplace unless they've really decided they want to hire you, pending that call. Or maybe your current employer finding out you're job hunting might get them to make some changes. You'd probably have a decent read on how they'd likely react.

And by ther way, is your HR still in the dark ages? Why can't they just email your paystubs?

CapeCodMermaid, RN · Apr 13, 2017

I don't think you're replying to me but NO ONE around here emails pay stubs.

I was hired as an interim.

tmaca · Apr 13, 2017

Yes, I was talking to the OP, but all businesses of any kind have access to the internet nowadays, as do all employees, and paystubs (more accurately pay statements if you don't receive a paper check) can easily be sent in PDF form. I do know a lot of places don't do it for no better reason than not wanting to change, even though it'd save them money. And I suppose some state or other might have some law forbidding it, but I haven't actually heard of one yet. Try making a suggestion. Of course, many facilities, of all sizes, outsource their payrolls nowadays, so it might not be up to the hospital, care facility, whatever.