Working in Nursing home is all the same?

benegesserit · Sep 17, 2016

Definitely not all facilities are the same. I worked at one where staying several hours late to finish charting was not unusual. At the other, even 15 minutes late was uncommon, and tended to indicate that something requiring a lot of paperwork had happened late in the shift.

I will say that one hint about a facility: if they are using agency/hiring through agency this often (not always) indicates that there is a problem. If you do decide to find a different job, you might want to consider not going through an agency.

Agreed. Agency nurses are expensive - you're paying both the nurse (who may be making more than the facility normally pays nurses) and the agency. They're not going to go through an agency unless absolutely necessary, and they'll often utilize as few agency nurses as they can - in other words, not enough to actually fix the staffing problem.

And staffing problems are a red flag for other issues at the facility. Maybe it's an area where nurses have their choice of jobs, and are simply choosing not to work in SNF/LTC. Or maybe the facility itself is an undesirable place to work.

I've also heard of agency nurses getting stuck with the heaviest/least desirable workloads because the facility is not concerned about their retention and long-term happiness.

bigorange123 · Sep 25, 2016

Just an update. I finally decided to quit after two weeks working there. I am planning to quit this Tuesday . Would that be an issue if I don't give them two weeks notice?

caffeinatednurse, BSN, RN · Sep 26, 2016

Yes. As someone who has quit without giving a notice, I can tell you that it can make your future job search much more frustrating than it needs to be. Nobody likes to hire an RN who will jump ship without giving warning.

Give your 2 weeks notice and stick it out for that length of time. If at all possible, stick it out until you have another job lined up.

Neats, BSN · Sep 26, 2016

As a Registered Nurse AND Licensed Nursing Home Administrator I can say same stuff different faces. Most posted there are differences in SNF in that if you have good management that is great it means the place is running good. It does not matter what SNF you go to we still have the state and federal regulations that we must adhere to. RN's who make geriatrics their specialty are great nurses with well rounded assessment skills and like the autonomy this environment brings. Moving for 4 dollars more an hour may not bring what you are looking for other than a long commute and a little bigger paycheck, you have to weigh your quality of life for that.

Bridging respectful workplace boundaries with your NC-A staff and LPN's will assist you. I "chunk up" their assignments into 2-3 hour increments with first always get vital signs because I need them for my med passes. Some medication I do my own vitals. It is imperative you follow through with each individual NA-C at the agreed upon hours to check their work otherwise what you are doing does not mean anything. Most aides know when I am working the floor they need to get their work completed in a timely fashion. It takes some time, some staff whine and say I am mean, others like my work saying it is fair for all. It seems to me that when I hold people accountable then the place runs smoother.

Good/Bad running SNF exhibit the following traits:

1. Most Management staff has been there for a long time (greater than 2 years). Look for the Administrator/DON/MDS Coordinator and Activity director and a some NA-C's to be there for over two years(for every 100 beds I would think there should be at least 8 NA-C who have been their greater than 2 years) (I think these positions carry the most influence of making residents and staff happy-please know I think we all play a huge part in the success of a SNF). If they have, it is not by chance they are working together-they are working hard together, doing the right thing and this results in making people are happy.

2. Observe how they treat an incident report. If the nurses are playing rock, paper, scissors about who is gong to write up the incident report then it shows they do not really care about change as the solution to the incident report must be made on the spot (in most instances, this shows the effectiveness of the staff). Look for who completes the new admission, does the facility management allow for multiple nurses to complete this over several shifts, if so I would be worried, this admission exam shows the acuity of the resident and will follow that resident throughout their stay. IT MUST BE COMPLETED IN A TIMELY MANNER AND SHOULD BE COMPLETED AT TIME OF ADMIT. Look for dining in the evening, how does this experience unfold? Is it pleasant for the residents? If not then you have a facility problem. Does management recognize this evening problem or do they brush it aside and make excuses?

3. You will always have CNA turnover, you will always have licensed nursing staff turn over and other operational turnover. Look at the way they train new employees. Do they only allow one week? Can you extend the time for training? Is your training beneficial to you? Do they go over forms, scenarios that happen? Avoid training that turns into a situation of we do it this way and then a session of examples from prior employment scenarios form anyone who wants to speak up RED FLAG of training issues that spill over into the work environment!! If you are able to look for other employment I would suggest to shadow the activity director for an afternoon, you will find out quickly how the facility operates and who really works and who does not.

4. Lastly a good running facility will have staff that do not call in all the time, that say to the new shift change person....I was not able to complete this and not get negative feedback, that show residents and their family smiling and bringing in treats for the staff even though it is not a holiday and everyone is approachable not waiting for so and so to finish before I go down to that area.

The above are concerns that show how a facility is really run from an operation standpoint. These examples are easily identified and hard to fix but once they are able to improve then the residents, the staff environment is so much better.