It's not independent living........and it's not a nursing home. It's not a secured Alzheimer's facility.........yet it does house some Alzheimer's patients. It's definitely NOT a 'retirement community'..........but some tenants who still drive, live active lives, and manage their own affairs come here for the meals and housekeeping service.
What is it? Why, assisted living, of course!
And as anyone who works in this relatively new field knows, ALF nursing has its own unique challenges. We care for residents with a wide range of conditions and abilities, from the independent 65-year-old retiree who does his or her own thing to the blind 95-year-old diabetic who needs daily glucose monitoring insulin injections. We serve as supervisors, administrators, confessors, staff developers, mentors, companions, receptionists, marketers, counselors, even chief cooks and bottle washers from time to time. And we are guided in our practices by a set of regulations that vary by state, are often muddled and contradictory, and WIDE open to interpretation by state and federal surveyors.
This thread, then, is for us---the bold, the brave, the confused---who go to our "cushy 9-5 desk jobs" every day (any of you fill in as NOC shift med aide lately? I have;) ) and put our careers on the line to assure quality care for each and every resident in our communities. Please feel free to ask for or offer support; share ideas that have (or have NOT) worked in your community; or even just vent!
I started working in AL about 2 years ago. I graduated from LPN school at that time, so this is my first nursing job. I am in my last semester of RN school.
I love my job in many ways, also dislike it in many ways. We have a Wellness Director, a nurse on duty all the time, and about 4 resident care assistants. Our total # of residents is about 60. Our administrator is a RN. The Wellness Director is wonderful, but sees her position (she's said) as getting ready for retirement. I go to her with any problems, but most don't get acted on. Personally, she's great to work with, but professionally, the nurse on duty does EVERYTHING. The administrator I thought was interested in resident care issues, but it turns out marketing and sales are her thing. She takes care of scheduling and essentially running the building business-wise. The RCAs are mostly assistants who are not certified. This is an area of stress for me, as the acuity of our residents is pretty much that of a nursing home (I do clinicals in a nursing home currently), but standards of care are not the same. The RCAs are taught that Management are their supervisors, and nurses are not management, so they run all over us. It's the worst part of the job, as if a nurse tries to tell them how or what to do, they go straight to management, and the truth of the story seems to get totally distorted. It's a family-run place, and the daughter of the Administrator is an RCA. I'm sure she earns more than nurses, and has a lot more "say" in everything, and she has told me what to do a few times recently, nursing-related. The other day, she yelled at me "it's not a nurses job to..." She's not a nurse, but hoping to go to nursing school. She has a LOT to learn, yet thinks she knows everything. Again, very stressful.
The reason I love my job is the residents. They are so special to me, and I've taken my role as nurse to be advocate for the residents. Every once in a while I get called into the office for losing my cool (the days of stress add up), as I let someone who is not providing care or respecting expectations know it. Inevitably they go to the Administrator, and I get in trouble. But 75% of my time is with residents, so 75% of my time provides me the job I've dreamed of as nurse. I get to be the kind of holistic-type nurse I want to be.
My goal is to be a geriatric nurse practitioner. I'm continuing with my BSN, then will either get my FNP or DNP. I will probably stay where I am until I earn my BSN. At that time, I'll probably want to get some hospital experience. A nurse I work with is going to help me get a contingent job at a nursing home in January. I want to work there a few days a month so that I can practice more skills like IV administration, etc.
It's the worst part of the job, as if a nurse tries to tell them how or what to do, they go straight to management, and the truth of the story seems to get totally distorted. It's a family-run place, and the daughter of the Administrator is an RCA. I'm sure she earns more than nurses, and has a lot more "say" in everything, and she has told me what to do a few times recently, nursing-related. The other day, she yelled at me "it's not a nurses job to..."
Don't envy your situation, Fav. Not sure I could tolerate the scenarion you described for long.
Kellyma- Regarding the A&D ointment: on one hand, I would permit families to bring in the ointment for the resident to use since it has no medication in it. But on the other hand, in assisted living, the residents should be able to move and care for themselves quite a bit so you should not have rashes you know where. Just my 2 cents worth. And catheters are permitted in AL if the resident cares for it independently or with some guidance. I have a resident that is about 90% independent with a suprapubic catheter. Home health care visits monthly to change the catheter. My staff assists with education, hygiene, and reminding to empty the bag. Hope this helps.
I had asked because of one Res. Who had a rash after she got back from the hospital actually. now that I've been there for a couple weeks, I see rashes aren't common. but as far as getting around ok...well most of them do but there are a few that have gone to the point where the could be in skilled and on section is for memory care, most of them let you know when they did to be changed even if not in words. I was just so used to skilled some stuff really bothered me at first, but I'm adjusting.
In skilled I put it on every Res. I changed every time, because they all had it on their bed side. It wasn't a rule to use it every time, i just did it, because a lot of times they'd sit for a while in their wheel chairs and it just seemed like a good idea.....old habit are just hard to brake sometimes, it was part of my routine.
but yeah I chart every thing that happens that might mean they need to change the care plan.
I have recently been hired as an LPN in an ALF. I have minimal clinical experience. Any suggestions on sites/skills/texts that would assist me in this position to "catch" up.
Specializes in Telemetry, Orthop/Surg, ER,StepDown.
Hi There!
I'm a new Dir of Residential Services (thats what we call it here) and still work part time as an instructor. I do have some questions from all you seasoned ALF nurses, what type of inservices do you perform? When I took my DSD class, they focused on furthering CNA skills for inservice. i was told that one of the major focuses for the facility is to get their training program up and running for the PCA. Should I teach the things i taught hopeful nursing assistant students during their training? What is the curriculum for the attendants in Assisted Living? HHA? Any information would be great and I think we should have our own little piece of the pie on the specialty ladder here!
Specializes in LTC, assisted living, med-surg, psych.
Hi There!
I'm a new Dir of Residential Services (thats what we call it here) and still work part time as an instructor. I do have some questions from all you seasoned ALF nurses, what type of inservices do you perform? When I took my DSD class, they focused on furthering CNA skills for inservice. i was told that one of the major focuses for the facility is to get their training program up and running for the PCA. Should I teach the things i taught hopeful nursing assistant students during their training? What is the curriculum for the attendants in Assisted Living? HHA? Any information would be great and I think we should have our own little piece of the pie on the specialty ladder here!
I think it varies from state to state, and corporation to corporation.....sometimes even from building to building! Your facility should already have a training manual for the resident care aides; if not, you can ask your administrator or your regional nurse consultant to supply you with one.
However, if you have to build a program from the ground up, the staff needs to know Nursing Assistant 101. Start with handwashing and go from there---bed-making, ADLs, transfers, vital signs etc. There may also be delegated tasks of nursing care that require more specialized and individualized training; these differ from state to state and you'll need to become VERY familiar with your state's Nurse Practice Act in order to know what you may and may not delegate.
In my state, for example, ALF staff may be trained to perform FSBS, prepare and administer insulin, do some wound care, give SQ injections and more; in any case, the delegation must be reviewed periodically to ensure that the caregiver remains competent to do so, and it has to be specific to the individual resident. Sometimes it's a real pain in the posterior because there's so much paperwork involved; but it does make it possible for ALFs to admit and retain residents who would otherwise be forced into nursing homes just for diabetic management or because they have an indwelling catheter.
And most caregivers absolutely relish the learning opportunities! A lot of them are pre-nursing students or young moms trying out a career in health care before committing to a college program; these caregivers love being able to do things their counterparts in the nursing facilities aren't allowed to do, and they take their responsibilities very seriously. In fact, some of my medication assistants are even more anal-retentive than I am, and they'll even throw ME out of the med room for distracting them while they're counting narcotics.
Wishing you the best of luck in your new job. I hope you love it as much as I do!
Specializes in Telemetry, Orthop/Surg, ER,StepDown.
I think it varies from state to state, and corporation to corporation.....sometimes even from building to building! Your facility should already have a training manual for the resident care aides; if not, you can ask your administrator or your regional nurse consultant to supply you with one.
However, if you have to build a program from the ground up, the staff needs to know Nursing Assistant 101. Start with handwashing and go from there---bed-making, ADLs, transfers, vital signs etc. There may also be delegated tasks of nursing care that require more specialized and individualized training; these differ from state to state and you'll need to become VERY familiar with your state's Nurse Practice Act in order to know what you may and may not delegate.
In my state, for example, ALF staff may be trained to perform FSBS, prepare and administer insulin, do some wound care, give SQ injections and more; in any case, the delegation must be reviewed periodically to ensure that the caregiver remains competent to do so, and it has to be specific to the individual resident. Sometimes it's a real pain in the posterior because there's so much paperwork involved; but it does make it possible for ALFs to admit and retain residents who would otherwise be forced into nursing homes just for diabetic management or because they have an indwelling catheter.
And most caregivers absolutely relish the learning opportunities! A lot of them are pre-nursing students or young moms trying out a career in health care before committing to a college program; these caregivers love being able to do things their counterparts in the nursing facilities aren't allowed to do, and they take their responsibilities very seriously. In fact, some of my medication assistants are even more anal-retentive than I am, and they'll even throw ME out of the med room for distracting them while they're counting narcotics.
Wishing you the best of luck in your new job. I hope you love it as much as I do!
Thank you so much!!!!! I'm going to just go ahead and bring my lesson plans from when i taught CNA classes and see what they have..better overprepared than looking like an idiot ( and let me tell you, I can already accomplish that without any extra help). If you don't mind, i'll be stalking you for answers to any questions. I think I'll really like this since it incorporates all the things I love, especially the teaching aspect.
Wow. Wish that I had read this thread before taking what I thought was the job of my dreams. Today, I finally ran screaming from a job that defeated me.
Should have been two nurses, but they fired one, leaving me to work 70 hour weeks for months. On call 24/7. Constant pharmacy issues? Oh, you betcha.
The day my daughter graduated from high school, the corporate nurse did me a favor and actually allowed me to have my scheduled day off...off.
One of the biggest problems with Assisted Living is that "Protective Oversight" can mean so very many things. Acuity is going up, up, up...and the large ALF corporations do not want to lay out the money to staff appropriately.
But if they can find a nurse with a stubborn streak and bad boundaries (like me) they can use her up and burn her out for the price of one nurse.
Wow. Wish that I had read this thread before taking what I thought was the job of my dreams. Today, I finally ran screaming from a job that defeated me.
Should have been two nurses, but they fired one, leaving me to work 70 hour weeks for months. On call 24/7. Constant pharmacy issues? Oh, you betcha.
The day my daughter graduated from high school, the corporate nurse did me a favor and actually allowed me to have my scheduled day off...off.
One of the biggest problems with Assisted Living is that "Protective Oversight" can mean so very many things. Acuity is going up, up, up...and the large ALF corporations do not want to lay out the money to staff appropriately.
But if they can find a nurse with a stubborn streak and bad boundaries (like me) they can use her up and burn her out for the price of one nurse.
ditto,work in a different aspect of health care, but you said it so well. I'm depressed and hanging in by the skin of my teeth. I've been promised it will get better so often, I don't believe them. All the people who told me they'd be there for me, somehow "forget" to call me back...for hours if they call at all. I'm feeling bitter and I've only been there a month! Thinking if the next 2 weeks don't show a real improvement, then I'm history.
favthing, APRN
87 Posts
I started working in AL about 2 years ago. I graduated from LPN school at that time, so this is my first nursing job. I am in my last semester of RN school.
I love my job in many ways, also dislike it in many ways. We have a Wellness Director, a nurse on duty all the time, and about 4 resident care assistants. Our total # of residents is about 60. Our administrator is a RN. The Wellness Director is wonderful, but sees her position (she's said) as getting ready for retirement. I go to her with any problems, but most don't get acted on. Personally, she's great to work with, but professionally, the nurse on duty does EVERYTHING. The administrator I thought was interested in resident care issues, but it turns out marketing and sales are her thing. She takes care of scheduling and essentially running the building business-wise. The RCAs are mostly assistants who are not certified. This is an area of stress for me, as the acuity of our residents is pretty much that of a nursing home (I do clinicals in a nursing home currently), but standards of care are not the same. The RCAs are taught that Management are their supervisors, and nurses are not management, so they run all over us. It's the worst part of the job, as if a nurse tries to tell them how or what to do, they go straight to management, and the truth of the story seems to get totally distorted. It's a family-run place, and the daughter of the Administrator is an RCA. I'm sure she earns more than nurses, and has a lot more "say" in everything, and she has told me what to do a few times recently, nursing-related. The other day, she yelled at me "it's not a nurses job to..." She's not a nurse, but hoping to go to nursing school. She has a LOT to learn, yet thinks she knows everything. Again, very stressful.
The reason I love my job is the residents. They are so special to me, and I've taken my role as nurse to be advocate for the residents. Every once in a while I get called into the office for losing my cool (the days of stress add up), as I let someone who is not providing care or respecting expectations know it. Inevitably they go to the Administrator, and I get in trouble. But 75% of my time is with residents, so 75% of my time provides me the job I've dreamed of as nurse. I get to be the kind of holistic-type nurse I want to be.
My goal is to be a geriatric nurse practitioner. I'm continuing with my BSN, then will either get my FNP or DNP. I will probably stay where I am until I earn my BSN. At that time, I'll probably want to get some hospital experience. A nurse I work with is going to help me get a contingent job at a nursing home in January. I want to work there a few days a month so that I can practice more skills like IV administration, etc.