What do you do when......

Specialties Geriatric

Published

You run out of time at the end of the day and your work is not done? I will work a 12 hour shift, and stay an hour late and things are still not finished (mostly the little treatments, like creams and skin preps).

I don't want to falsify documentation, but I know the bosses will be mad if I leave it blank or circle it. If you do circle it, what do you write on the back as a reason? "Ran out of time, too much work, too little staff" seems inappropriate! LOL

So what do you do?

I run my butt off the whole time I am at work.... no smoke breaks, no personal calls, no sitting idle at the nurses station. I take a 30 minute lunch because it is required by corporate and my sanity.

Seems like every new admit we get is another AC/HS blood sugar check with QID neb tx.

I have tried talking to my supervisors about this, but I am always brushed off. They always respond that I just need to "improve my skills". And no, I am not the only nurse who struggles with this at our facility. Actually, I am pretty much the only nurse who even looks at/signs the tx book. Sometimes I will give a treatment to a patient and they tell me that I am the only one who ever does it (not surprising). And everybody else skips doing things like changing foley catheters, so I have to catch up on that during my shift.

I just dont know what to do. Its the classic LTC situation of having too much work for too few staff. I feel so bad when I am rushing through my blood sugars, and the residents want me to chat or help them with a little chore or give a PRN med. I am just frantic to get out of the room and onto the next person because its pretty much impossible to finish 22 blood sugars in 1 hour (especially when half the people are across the building at bingo)

GRRRRRRR!!!!! SO frustrated!! I am really ready to get out of LTC and into a better work situation.

Help me!

Specializes in LTC, Hospice, Case Management.
It is shocking how stupid some nurse managers can be! They act like they don't understand the stresses of being a floor nurse. They're just so out of touch with reality.

First let me admit that I am responding before reading the entire thread but I just gotta say something.

1. Yes there really are "stupid nurse managers". Have seen plenty of them to know there is some truth to this.

2. Even the "smart" nurse managers do really understand the stresses of being a floor nurse. What the "some stupid floor nurses" don't understand is the nurse manager rarely to never gets to determine the staffing ratio. This is determined by the stupid corporate bean counter in a land far far away. We are not always pleased with what we have to work with either, but it is a sad fact of life in LTC. The other sad reality in LTC is if the stupid nurse manager doesn't stay within the corporate assigned staffing ratio the suits come in from that land far far away and escort us out the door!

3. My last point is sometimes (and I don't mean ALL the time & I don't mean ALL nurses) but I have seen the times when I get "whiny" nurse about how "can't possibly get done, too much work, you have NOOOOOO idea, and I bet you couldn't do it". Always makes me chuckle when I grab the keys, march my butt down the hall and prove them wrong (and trust me, I have proved them wrong more than once!). I recently had a load of whiny nurses about one particular hall. The stomach flu then went rampant thru the facility with many nurse call offs & I was the nurse on call. I worked that hallway on both Saturday and Sunday & it was just plain EASY! No one has had the nerve to whine since. Now, I have been around a long time & I know ALL assignments aren't easy...but geesh, I can't believe anyone ever complained about that work load. Spoiled I tell you!

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Some LTC's require that you do false documentation in order to keep your job. I knew a nurse who said he wasn't going to lie and sign off any treatments that he hadn't actually done. The supervisors got angry and warned him that he had better sign them off no matter what. He didn't do it and he was fired for refusing to lie.:mad:

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Specializes in Rehab/LTC.

I remember the days of 2 hour med passes, an admission, no unit clerk to enter all the medications into the MAR and the orders into the chart, doing all the blood sugar checks because the CNAs are not allowed, and the CNAs are short a staff member - so can we RNs please help get people in bed and on/off the toilet and assist the CNAs with 2-person transfers. You tell management and they sympathize but do nothing. I will pursue another career before I go back to LTC.

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Specializes in LTC.
The CNA where I work at don't do vitals or accuchecks. I'm not sure why, they just don't. Once in a while I will ask a CNA to check a residents temp if we are keeps a close watch on the temps. We don't have a unit secretary either so the nurse are responsible for answering the phones (even during med pass). I don't feel like I'm too good to do any of the above things but it is almost impossible with 25+ residents to pass meds to. No wonder there is such a high turnover rate!

We must work at the same place. CNAs are only allowed to get temps at my facility. I found it ridiculous. We don't even abide by it. They make up these rules and policies and half of the time they get ignored. Because they are ridiculous and don't make any sense.

They keep adding more and more things for us to do and they think it only takes 2 minutes. Yet you are doing this additional work and 1, 2, even 3 hours go by faster than you say say boo.

As for staying late, I finish what I need to finish. I sign out when I have my coat on, purse in hand and ready to walk out the door. I write the time I leave. If its a ridiculous hour and staffing was short, or the workload was horrendous, I circle the time. I haven't been told I'm not allowed to stay past my time but if they have a problem, they can come help out on the floor.

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Specializes in Geriatrics, Transplant, Education.

CNA's get temps at my facility. Those that work on my rehab unit also get fingersticks. Long term nurses at my facility do their own fingersticks, however from overhearing things on the other floors, it seems as though once fingersticks are stable, they get the frequency decreased (I've seen some as infrequently as fasting three times a week) If it were routine vitals, I certainly wouldn't mind the CNAs taking them, however if I'm giving cardiac meds (which is usually the case on my unit) you bet your hiney I'm taking the VS myself.

As my post was somewhat OT, just wanted to address the OP. Those of us in LTC do feel your pain. See if you can talk to your MD/NP about decreasing fingerstick frequency on those that have been stable for some time. Are some residents on short acting versions of meds that could perhaps be changed to once daily long acting versions? (Toprol XL once per day, instead of Lopressor sev'l times per day, for example?) Do you have a consultant pharmacist? Perhaps they could make med reccomendations to make med pass more manageable.

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It helps if you move to night shift. There is less to do. Usually no treatments except for the very necessary will be scheduled at night. You can deal with time management skills in a less hectic atmosphere. Once you have it down on night shift, move to PM shift, then work your way back to day shift as your skills progress. If your DON agrees with this plan of action, it could really help your sanity.

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Some LTC's require that you do false documentation in order to keep your job. I knew a nurse who said he wasn't going to lie and sign off any treatments that he hadn't actually done. The supervisors got angry and warned him that he had better sign them off no matter what. He didn't do it and he was fired for refusing to lie.:mad:

Nurses at the facilities where I worked did not need to be encouraged to lie. It came naturally and most had no qualms about it.

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Specializes in Hospice.

Can the cna's but the creams on? we let most of our cnas put on medicated creams and then they sign it off. They are already their getting them ready ect....so it time efficient as well.

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Specializes in Vents.
Some LTC's require that you do false documentation in order to keep your job. I knew a nurse who said he wasn't going to lie and sign off any treatments that he hadn't actually done. The supervisors got angry and warned him that he had better sign them off no matter what. He didn't do it and he was fired for refusing to lie.:mad:

I can't imagine being put in this position where the NMs encourage you to lie. I would tell them that if they want to put THEIR license on the line like that then go right ahead. But when it comes down to it, it is ultimately YOU who is the only 1 protecting YOUR license. You worked waaaaay to hard earning it to have anyone offer to put YOUR license on the line.

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This is the problem with LTC. They are too cheap to hire enough nurses and expect that nurses can somehow be in millions of places at one time. It is shocking how stupid some nurse managers can be! They act like they don't understand the stresses of being a floor nurse. They're just so out of touch with reality. I am sorry you have this experience. Management should realize that when people don't have time to CHANGE A FOLEY, there is something seriously wrong. The longer you have a foley, the higher the chance for an infection, requiring more meds, which requires more expenditures to pay for the meds. It would be a much cheaper option to just hire more staff.

Hope you find a better job. This is why I am determined to stay away from LTC (unless of course, I'm fired and the only people who will have me is LTC).

Best wishes,

JE

I don't think it's necessarily cheaper to hire more staff than treat a CIUTI (cath induced UTI). But I hear what you're saying.

For OP:, just do as much work as you can. Continue to take your mandated and needed break, even you should be taking an extra 15 minute break, I think.

No easy answers from me, just work from your conscience and you will do the right thing. Any possibility someone could be a treatment nurse and do just the creams, dressings, and other treatments? If not enough work for a full time job doing that, what could it be combined with at your facility?

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Specializes in LTC/Skilled Care/Rehab.

3. My last point is sometimes (and I don't mean ALL the time & I don't mean ALL nurses) but I have seen the times when I get "whiny" nurse about how "can't possibly get done, too much work, you have NOOOOOO idea, and I bet you couldn't do it". Always makes me chuckle when I grab the keys, march my butt down the hall and prove them wrong (and trust me, I have proved them wrong more than once!). I recently had a load of whiny nurses about one particular hall. The stomach flu then went rampant thru the facility with many nurse call offs & I was the nurse on call. I worked that hallway on both Saturday and Sunday & it was just plain EASY! No one has had the nerve to whine since. Now, I have been around a long time & I know ALL assignments aren't easy...but geesh, I can't believe anyone ever complained about that work load. Spoiled I tell you!

Not at my facility. When our managers "work the cart" they always tell us "I don't know how you do this". They aren't happy with our work load either but can't do much about it.

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Specializes in Home Health/Hospice.

I would go apply to a better LTC where they are appropiately staffed, what you're doing is wayyy too much and it seems aparant the managers don't care.

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