Wound Nurse Workload in SNF's "We'll let the wound nurse know"

[wcextraordinaire]

Excuse me for expressing my curiosity in a "venting" type of way, I become passionate when I reflect on certain daily experiences. I'm wondering what is expected of WCN's in other SNF's. I am alone and don't know other WCN's who work in SNF's. I'm overwhelmed with responsibilities...to the point I fear failure. How many WCN's are required to do EVERY treatment (all wounds & all topicals) every day, generate & update every wound careplan, plan and write every treatment order, transcribe all the orders into computers & ADL books, do all planning, ordering and evaluating for wound PREVENTION, obtain measurements with thorough documentation initially, weekly, and per exception/exacerbation, call doctors& surgeons when there's complication or change in condition and calls to families r/t wounds (even if the problem occurred on your weekend/day off while the nurses would "keep an eye on it" until the wound nurse comes in), schedule appointments, write letters to Md's & families with each new pressure ulcer? Review and sign every shower sheet from every shift for every day...complete weekly monthly quarterly, annual, AND significant change braden AND foot observations, perform initial, daily, weekly body assessments, deliver all positioning devices to patients....while constantly being called to the desk when you are on the floor. And being called to the floor when you are at the desk, OR being called from one patient to another while you are holding up a leg trying to wrap it at the same time. Never being offered help, getting attitude or "you're gonna have to wait" when you ask for help. Frequently coming in to work to find new patients admitted with wounds FOR their wounds with NO wound orders established or ongoing patients with new wounds with NO orders in place (awaiting arrival for wcn to write). Meet with reps. Unpack and distribute supplies. Generate weekly wound reports. Being expected to feed two meals a day, answer phones and take orders when other nurses are away from the desk, get pulled to pass meds when there's a call off, being expected to stay the next shift for nurses who pass meds on the next shift when theres call offs....then get attitude and reported when you cant feed or help others because you can't even touch the surface of your own work. CNA's feel you should be helping them, LPNs feel you should be doing more for them, supervisors feel you should be doing more for them. Everything skin related...rashes, bruises, hang nails, even edema that needs managed is forwarded to you b/c ts easier for the other nurses to hand it to the WCN rather than to call the Md and have the underlying issues handled. Occasionally I hand non-wound issues back to them, but when I do the problems get ignored until edema BECOMES a wound. Then I feel guilty and HAVE to handle the underlying medical cause as an intervention for the new wound I have to care for...and staff knows it. Sometimes I have more wounds on one half of hall than some facilities have total...and each wound is a measurement, order, transcription x2, careplan, potential for complication requiring phone calls and more orders...I've had it up to HERE being chased down to handle rashes, bruises, and wounds that could have been prevented if all the orders I spent alot of time and effort writing and transcribing were followed. I understand every one at a SNF is super busy and overloaded, but somehow it seems like everyone gets ALL their breaks EVERY day when I may get two to three a week max, and only because I asserted them. If anything goes wrong....physicians and families are always directed to ME with the blame and anger. My work is scrutinized by the state, and no one understands how important it is that I have time to think about what I am doing and documenting. I can NOT get my work confused and I cannot be half-orificed, and it all must be consistent. Sometimes I feel like the worlds most hated for not doing enough when it seems like I spent more time serving the staff rather than the patients? Is there anyone who can identify with me? Anyone who can enlighten me on how work is distributed in their SNF? Am I being taken advantage of? All of this surely can't be on the shoulders of 1person who is only present 8h/d..

[wcextraordinaire]

Now that I got that off my chest...let me clarify that I love my job....not necessarily all the responsibilities and EXPECTATIONS...but what I "do". The few of the things listed in the topic above that actually make a difference in peoples lives make it truly rewarding. Although I may be taken advantage of by many and hated by several, I am appreciated by some...and those are the ones who count. I love my patients, and do the best I can to send them home complete:up:.

[tyvin, BSN, RN]

It seems that is doesn't matter what the house load is that most places have 1 wound nurse if that. I was put in charge of doing the wound care team thing at one place. The wounds are more involved then ever and the residents are coming in with infected wounds. Negative pressure, $500 DNA creams, new wave gels, etc...it's a science that can be interesting and fun but if no one backs you up, it can be a complete disaster.

I feel for you. When I would ask the other nurses to assist me or take on some responsibility they wouldn't. When I would put an order into the TAR I would flag it and make sure it was put into their shift report. I understand...it's self survival and no one has time. This pits nurse against nurse and takes us back to cave mentality; it's truly sad.

If you are inputting in the TAR and the orders are not getting done by the nurses then start writing them all up. Just because you're the wound nurse doesn't mean you do all the treatments or what is the expectation? Let it be clear; communication is key. Have a talk with the DON. Make it clear what is expected of the floor nurses when it comes to wound treatments.

The main concern I see is communication and responsibility. Wounds go south fast, skin is frail , senses are dulled and no one has time. It's not the resident that will be able to tell you their wound hurts or is going bad. These things must be assessed q shift. It is also the responsibility of the charge to make sure all their nurses are assessing the whole body of each resident q shift. At least look at the coccyx, heels and back. Along with the population comes the super fast way their skin breaks down. Good luck to you

[wcextraordinaire]

Thanks for responding! We have no wound team. The wound team is me. Ive gone to the DON, and we both know that if the floor nurses have to start doing treatments most of them will quit. They have been use to wound nurse doing all of that for years (before wound count exploded, more work was added to wound nurse, and back then it was possible). If i put treatments on night shift (which is what I hear other facilities without wound nurses do)...they will protest and likely quit. (I have protests every time I put a wound order on other shifts, and I never do it without good reason)...AND the charge nurses don't like being educated/oriented. I don't know if it has to do with me being a LPN, but I get MAJOR attitude and resistance, dirty looks, back talks from certain RN's, and the CNA's see and hear that, and I see why they don't take me seriously, so they know the RN's will back them up, especially when bullying me is a personal mission for them. I can tell the RN's things in polite, asking manner, as a favor...with please and thank you...and they stil get offended, like I am insulting them or sentencing them to hard work. When I blatantly find heels smashed into the mattress with wounds as evidence, the RN's get defensive and defend their staff with everything, and I become a villain, persecutor. They rage about how "last shift didn't do it...why should we have to"? "We doidnt have time to get position devices from storage" or..."that was there". Then it becomes each shift blaming the other, until the finger gets pointed at me for basically not being there at all times...and if I write someone up (which I do not have the authority to do other than with CNA's) ...I have to write every one up...problem is, I'm not there every shift. And like you said...It is the charge nurse who needs to make sure staff is following orders, but since they have authority over me...I cannot enforce it, and DON will not help me with that. Going to DON created more work for me by generating audits that the charge nurse is suppose to perform on all shifts. Everyone just signs them. And I come in and i find they are just lies. All those audits do is add insult to injury, give false confirmation that ppl r doing what they are suppose to and backs them up further while making me look even more like a trouble making lunatic. And to prove that this is going on...I would have to assign myself the task of auditing the audits, which in turn would obligate me to correct what was wrong, and discipline/orient everyone for everything on every shift. and and I don't have time to even update the regular audits I have and why should I or anyone have to audit when they are signing off legal documents that instruct them and supposedly prove that they implemented their duties? Everything I put in place to treat or prevent wounds just seems like nuisance to the staff, and the first thing they are encouraged to short-cut on. I always put into consideration with delays of treatment/adl's, when they had a crazy day, and do not get upset or draw attn with honest mistakes when they were attending to higher priorities, but I see this without relation to if it was a horrendous day with tons of admissions/incidents/behaviors or a easy day with low census, and pot luck, cell phones and facebooking all shift long...its always the same. One thing I am not worried about is job security. With all the wounds coming and all the wounds developing, I should maintain employment, but sadly, without collaboration...no matter how hard I work...I appear as a complete failure.

[rn_nxt_dr]

If you have no worries in life like a small child, a husband ---- go become a Travel Wound Care Nurse. There's tremendous need for your experience. Go for it! I would again....after I obtain and become CWCN. Forget about the SNFs....they're a pain and low pay. Go for it!

[Apentti]

I feel your pain. I recently took on the role of wound care nurse at the SNF I work and was immediately dumped on. I don't do daily treatments, but pretty much everything else you mentioned I too am expected to do. My administration has (in their opininion generously) given me one day a week to focus on wound care, the other 3 I work I supervise the facility AND am expected to also do all things wound care related. Like you said, you need time to think about what you're doing, you are being scrutinized and if come survey time your facility gets cited...it's your career on the line! I wold demand a job duties description in writing and once it's given to you go over it with a fine tuned comb and negotiate. And the feeding at meals has to stop. You are a skilled professional trained to deal with medical issues no other staff member is trained to do, don't let them waste your time feeding residents. A cna can do that as long as one of the floor nurses is supervising.

[Mistyrose123]

I work in a LTC/SNF facility. yes all things are dumped on you. I do all treatments pressure injuries, skin tears, surg wounds, arterial, venous, diabetic, trach care, PAC flushes, PAC/CL dressing changes. I do not supervise, I do not feed at meals, MDS does the careplans, unit managers are responsible for shower sheets, weekly skin assessment done by med nurses, I do weekly measurements, call the families, QA nurse is responsible for audits, I have to get the heelbos, low air loss mattresses, wedges, order supplies. other shifts complain or just don't do the treatments or change the outside dressing and don't change the packing. I do have back up of DON. You must get your job duty list, You must have some support somewhere. what about your corporate nurse consultant. you may need to find a job somewhere else. this seems very overwhelming and dangerous to me. are you wound care certified? this may help to assert yourself and stand out.