Things That Make Us Laugh

If you work in long term care there are always those residents that frustrate us to no end with either their words or behaviors. I want to tell a couple of stories about what these residents drive us to. My first story is one that one of my nurses told me. She said that she had had a couple of trying days with one particular resident over the previous week. The night before she said, I had a dream with you in it. My first thought was OMG. The nurse told me that in the dream I told her she could hit him with a broom as long as she used the bristle end not the handle. It was even funnier because the nurse saying this is such a sweet kind person that never raises her voice. I hope to share more stories on the post.

Another Typical Day as a Nursing Home Administrator

Today I decided to go into work a little later because I knew the doctor would be in the building (I am also the Director of Nursing, That's a whole other blog story)and I would have to stay late to put orders on the computer. I got there about 9:30. The parking lot was full. There were 2 people doing the resident satisfaction survey in the building (in the middle of all that was going on). The fire people were there testing the smoked detectors so they were setting them all off throughout the building. The doctor was there. Carpet people were there putting down carpet on one of the units and the dietician was there doing her visit. After about the 5th alarm going off I finally quit jumping a foot in the air. I was sitting in my office and a resident down the hall turned his TV up as loud as it would go. I went to the door and had to yell to be heard and asked him to turn his TV down and he began screaming at me that he would when that noise stopped. The satisfaction people are talking to residents that are very confused (because they have to ask everyone). One resident is telling them I don't want to talk to you. Another resident is over heard saying ( I can't wait till they hear what I told them). The nurse aide I hired or thought I hired failed to show up for her physical. Of course I need to fill 2 nurse aide positions. I worked for an hour putting new notebooks together for the nursing unit to make them look neater and more professional but couldn't get on the computer to make my labels until later just to find that someone had written on one with permanent maker instead of letting me label it. Finally, a resident tells me that he overheard someone calling him a liar that morning (of course before he was questioned about his satisfaction with the facility). Well I am not going to hold my breath that our satisfaction survey results will be very good. At least the day went quickly and I finally left at 6:30PM.

If You Couldn't Laugh You Would Cry

A long term care director of nursing job is 24 hours a day. I get calls at all hours in able to help direct my employees to make appropriate decisions and be aware of what is going on. Well my morning today was just one of those days that become a lasting memory. First of all I went in late because I had worked the last 2 evenings as the nurse because one of the nurses that had already had vacation was off again for a trip. I left home at 10 AM and on my way I get a text that a resident had fallen (no injuries fortunately)as I am driving I notice a policeman but thinking the speed limit was 45 and I'm doing 40 I'm OK. Well wrong the speed limit was 25 starting about 1/4 mile back. He follows me and pulls me over. Fortunately I only get a warning. When I get to work I am told that an employee that started Monday and called off the day before quit. I did not schedule an extra RN and the doctor is there. Great doctor but writes lots of orders. I get to stay until 6:30 to put them on the computer. Another nurse comes and tells me she is pregnant. The night before a resident threw a cup at me because I watched him take his medication and he didn't want me to. I can't wait to see what the rest of the week goes. Never a dull moment.

A difficult day

I have worked in the long term care business for a long time. I know you should never say that a day was the worst you ever had but I feel the need to describe a very difficult one. Most people don't have a clear understanding of the difficulties that a long term care manager has to deal with. My day started out by coming in the door and sitting down and an employee coming to the door and announcing that an employee quit with no notice and another did not show up for work. I tried to call the employee that did not show up and their voice mail was not set up on their phone. I then text them a message to call me. The employee text back and said she was moving and would not be back. I then met with a family that was bringing their loved one to our facility from a hospital that was not being very helpful to them. This took a considerable amount if time because I had to go over everything and took them on a tour. Next I had to start working on change over orders for the next month which started the next day. During this I was told that a family member would be there in 10 minutes that was upset with us and moving their loved one to another facility. That conversation took another 30 minutes. In those situations all you can do is explain what your facility did and say your sorry they feel that way. The only thing I wish could happen differently is that hospitals don't throw nursing homes under the bus. The doctor in the ER had told the family some things that I could not recover from. When families do not understand medical conditions it really makes a nursing home look bad. Ok I got to work at 9AM and it is now noon. Another family came in that were bringing a loved one in because of the treatment at another facility. While going over their care another person came in where we were meeting and began talking about their loved one that they wanted moved here. I told them that I would go do an on site visit as soon as possible and take them if I could. While finishing my conversation with the other family found out they had some medical issues I was not aware of and had to make arrangements for. After that I started putting their orders on and placed a call to our physician. When our physician called I was told that they didn't know when they could get in they were short staffed (OMG). I finished the orders on the resident and when I tried to print them off I could not find them in the computer. After about 20 minutes finally discovered that the name was entered wrong by the social worker. That being done I completed the assessment and charted and was able to leave just before 8PM.In between all of this I got several questions from the nurse, NA's and had to explain this all to my boss.

Work Ethics

I am finding it hard to understand the over all work ethic that I am seeing as I get older. I know when I was still in high school I had a job and paid for my own cloths and other things. I didn't have a car but was able to use my parents. I went to work when scheduled. I can't say I never called off but very rarely. I picked up shifts and voluntered for events. I never asked to have the schedule changed. If I needed a day off for an appointment I scheduled it in advance so my boss would know. I worked as a nursing assistant for the first 3 years of my carreer. During that time I attended nursing school for my LPN. It was hard, I was young and newly married. Fortunately I didn't have any children yet. After recieving my LPN I went to work in the hospital.During that time I went to RN school and had 2 children. That was a very different experience. I rarely got a break and that is where I learned the bad habit of scarfing down what food I was able to take the time for. But again I worked the schedule I was given and asked in advance for days off. I didn't get every other week end off for a long time. I did finally get enough senority to get week ends off. After 10 years of that back to long term care I came. I worked in many positions Supervisor, ADON, DON and finally in 2000 I finished my degree in LTC Administration and became and administrator. I then worked in several regional roles to land once again back at a facility as the DON and administrator. I don't mind wearing multiple hats but have found myself dealing more with human resources than I should have to. People think nothing of telling me I need a day off after the schedule is made. (I make corrections if a request was made and I missed it)Calling in less than 1 hr before the shift starts, and refusing to stay over if necessary. Unfortunately I feel that I have made myself the bad guy by being too lenient with people. Also staff quit without notice and or don't work out their notice.Here are the main issues as I see them. I hope if someone reads this that you will make a comment and or suggestion: 1. Not working scheduled days 2. Calling in less than 1 hr before the shift 3. Spending more time worrying and discussing who is coming in or not 4. Discussing what someone else did not do 5. Not giving any notice when quiting 6. Refusing to stay over and help I find all of this very disrespectful and need to work on these issues. I would love some input from others.

Survey 2012

My facility completed our state survey in November. This was 15 months since our previous survey. As I have discussed previously, these surveys are completed anywhere from 9 to 15 months apart. I would like to share some of what happens during a survey. This year we had 7 surveyors. Remember we have a 50 bed facility with 40 beds filled at the time. The process started around 9AM on a Monday and was completed on Thursday at 4PM. The new process is being used which is computer driven. What that means is that questions are answered on the computer that trigger more or less investigation depending on the answer. There are a lot of interviewes during the process of residents, staff and family members.The main problem for our facility was trying to keep up with 7 surveyors with a small staff. One of the most annoying parts of the survey was that 5 of the surveyors had to ask me (the director of nursing/administrator) the same questions. The following are some recommendations: 1. Make sure your residents know your policies and practices and that they report issues to you 2. Make sure staff understand all aspects of their job, this year they looked at restorative programs including documentation, staff and resident interviews 3. Make sure that if surveyors ask questions and or to watch procedures or to do meal temps that they report this to you immediately 1 resident reported that food temps were not always hot enough, the surveyor then asked for a test tray, the kitchen did not tell anyone this and during tray pass they did not tell the surveyor until after they fed the last resident instead of after the last tray was passed 4. A staff member stated that she did not do oral care ( without thinking ) and went back a few minutes later and said she did (too late) make sure they think about what they say 5. Make sure your family members know to report problems to you, a family member reported that sometimes their loved ones breath was bad (this is why they asked the NA about oral care) If I can recommend anything it is communication. Ask and answer questions to your staff, residents and family members.

The Staffing Saga Continues

I tend to write about staffing when it is a problem, but I guess that's when it's on my mind the most. I really feel that nursing homes could improve the unemployment situation if people would just come to work. Right now I have a very tired and frustrated staff. I hired 4 state tested nursing assistants in August and all 4 are gone in less than 30 days. The biggest issue is over time. I have a mandation policy in place to cover scheduling problems that does not make the new person always be the one that has to stay. The reasons they left were: 1 didn't want to work the assigned unit and just left 2 hours into the shift without telling anyone, 2 due to mandation and 1 never was able to get a reason. None of these people gave any notice. Over the last few weeks I have lost employees to other facilities because they pay more. It is hard to be compeditive in a privately owned facility. On the lighter side I have recieved some very funny schedule requests. A couple of my favorites are: One was, I would like to cut back to 3 days per week with no week ends unless I am asked. Another one was I need to call off on Thursday to orient at my new job. Unfortunately in almost all health care in patient settings we are 24 hrs per day 7 days per week and everyone including managers must work weekends and holidays but I thought these were funny. If you don't laugh sometimes you would cry. I never get any remarks on this blog but if anyone has any other stories, comments or ideas to improve staffing I would love to hear from you.