Sunday, May 30, 2010
A Day In The Life of a Nursing Assistant
A typical day started out by getting up at 8AM and planting some flowers in my yard and then cleaning the carpet in my living room and dinind room. Took a shower and went through the drive through for a sandwich on the way to work at 12:30PM because I hadn't eaten all day. I get to work and the off going shift tells me that it has been a pretty good day no big problems. The first thing I do is pass 2PM snacks. No one seems to want what I have so I go back and get everyone chocolate icecream. I only have 12 residents on my side and I am working with a nurse. During snacks one of my residents is yelling and confused and wants to go home. Nothing I do changes her mind so I place her in a wheelchair and put her in the lobby where I can see her and give her the news paper. Another resident is yelling nurse take me to the toilet. I do this and then pass my ice water. I take 3 pitchers out of a residents room and give her fresh ice water in a clean pitcher and she follos me around telling me someone took her glasses. No showers tonight so I go around emptying the trash and wiping off stands. The lady that was upset earlier is brought to me by the nurse and I am told she needs changed but she won't let the nurse take her. I take her to the bath room and she tells me she doesn't need to go she can do it her self. I assist her to the toilet where she does go to the toilet and I wash her and take her to her loung chair. In the mean time a resident is yelling nurse again and he wants fed. ( He is unable to eat he has a tube. The nurse feeds him and I take him to the couch and play ball with him. I then pass supper trays. After super I pick up trays and again the lady that was confused is scooting off her chair. One of the nurses volunters to sit with her outside. I also take out a couple of other residents. I then check the bathrooms and mop 2 of them because the floors are dirty. It is now 6:30PM and I am relieved by another NA because this is my day off. I am also the director of nursing and administrator and in between all the above met with a family about possible placement, did a residents treatment and fed a resident their tube feed before I went home. I only added this part because I want to point out that as I have said in earlier posts nursing homes do not work short. They make sure that all the care is provided and more regardless of what a persons title is. True team work can only happen if everyone in a facility is willing to help when needed. I am proud to work in a nursing home and I am very proud of the people I work with.
Monday, May 24, 2010
Attendance
I do not understand why people cannot just come to work when they are scheduled. Today I already had 1 hole in the schedule for a nursing assistant and I had 3 additional call offs,1 nurse and 2 other NA's.That is 28% of the daily nursing staff.I do understand that people and their families get sick and I don't expect people to work when they are. What I do expect is communicating that you will need to be off so that schedules can be covered and for staff to schedule appointments when they are scheduled off. I had one person call and tell me they couldn't come because their car was being worked on. I told that person to try and find a ride and to call me if they could not come in. Of course they did not come in or call and will propably try to say they thought they were to call if they could come in. Well what ever. I tried to call that person 4 times and left 2 messages on their cell phone. Don't tell me they didn't get the message. Another problem is not having correct phone numbers or answering calls or not returning calls. I don't know what the answer is I just know I am tired and frustrated with all the stress that this causes.
If people would only follow the rules set up there would be no staffing issues
1. put in requests timely
2. schedule appointments when off unless it is an emergency
3. call in in advance at least 2 hours
4. call back when called to let someone know that you can or can't work
5. don't tell your employer maybe you can work say yes or know
6. if you need time off ask someone to trade
I feel that these few rules for working will make the work place better for everyone.
If people would only follow the rules set up there would be no staffing issues
1. put in requests timely
2. schedule appointments when off unless it is an emergency
3. call in in advance at least 2 hours
4. call back when called to let someone know that you can or can't work
5. don't tell your employer maybe you can work say yes or know
6. if you need time off ask someone to trade
I feel that these few rules for working will make the work place better for everyone.
Thursday, May 20, 2010
Information Available to the Public
There are several ways to learn about a nursing home.
1. call numbers in the phone book
2. ask a friend
3. ask your doctor
4. ask your pastor
5. look on the internet
The problem is that there are 2 sides to every story. All of those ways will give you information. The information will probably be accurate. The only thing is that the information is not always complete. The reason I am saying this is mostly due to what you can find on the internet. You can look up several pieces of information about a nursing home including
1. state survey results
2. 5 star rating
3. resident satisfaction surveys
I would like for you to make sure that you get all of the information. First of all if you do not understand how a survey deficiency is rated you can be misled. A facility can have a lot of deficiencies but still be a good facility.What people don't understand is the scope (number of people effected) and severity (if there is actual harm) of the results. What they should look at is if the letter by the deficiency is a G or higher. This means that there was actual harm. A letter A,B or C doesen't even require a follow up visit. A D or E means that more residents coud have been effected but there was no harm. If you look up a survey call the facility and ask them about it. Better yet visit the facility and ask to read the survey. It is public information.
Second the state has set up a 5 star system to rate nursing homes. The areas that are looked at are as follows:
1. survey results
2. staffing
3. quality indicators
The survey results are misleading as stated above. A good facility may have 15 deficiencies while a poor facility could have much less. Staffing is based on the state and federal requirements and the QI's. The quality indicators are determined by an assessment completed by the facility and sent into the state. These scores are being looked at and hopefully will be improved upon.
Third there are the resident satisfaction surveys that are completed annually. These are conducted by people not associated with any facility which is very good. The only problem is that they are scored on by an average. Therfore a small facility with a 2 or 3 unhappy residents can score very low. They also interview all residents regardless of ability to comprehend. A facility that has a lot of behavior and or dementia patients can have a very low resident satisfaction score even though the families are very happy and satisfied.
Please be sure that before you make a decision to choose a facility you look at everything. Talk to the staff, take a tour on the weekend or in the evening to see how things are going. Check for odors and poorly kept residents as indicators of a poor facility not just new carpet and furniture.
1. call numbers in the phone book
2. ask a friend
3. ask your doctor
4. ask your pastor
5. look on the internet
The problem is that there are 2 sides to every story. All of those ways will give you information. The information will probably be accurate. The only thing is that the information is not always complete. The reason I am saying this is mostly due to what you can find on the internet. You can look up several pieces of information about a nursing home including
1. state survey results
2. 5 star rating
3. resident satisfaction surveys
I would like for you to make sure that you get all of the information. First of all if you do not understand how a survey deficiency is rated you can be misled. A facility can have a lot of deficiencies but still be a good facility.What people don't understand is the scope (number of people effected) and severity (if there is actual harm) of the results. What they should look at is if the letter by the deficiency is a G or higher. This means that there was actual harm. A letter A,B or C doesen't even require a follow up visit. A D or E means that more residents coud have been effected but there was no harm. If you look up a survey call the facility and ask them about it. Better yet visit the facility and ask to read the survey. It is public information.
Second the state has set up a 5 star system to rate nursing homes. The areas that are looked at are as follows:
1. survey results
2. staffing
3. quality indicators
The survey results are misleading as stated above. A good facility may have 15 deficiencies while a poor facility could have much less. Staffing is based on the state and federal requirements and the QI's. The quality indicators are determined by an assessment completed by the facility and sent into the state. These scores are being looked at and hopefully will be improved upon.
Third there are the resident satisfaction surveys that are completed annually. These are conducted by people not associated with any facility which is very good. The only problem is that they are scored on by an average. Therfore a small facility with a 2 or 3 unhappy residents can score very low. They also interview all residents regardless of ability to comprehend. A facility that has a lot of behavior and or dementia patients can have a very low resident satisfaction score even though the families are very happy and satisfied.
Please be sure that before you make a decision to choose a facility you look at everything. Talk to the staff, take a tour on the weekend or in the evening to see how things are going. Check for odors and poorly kept residents as indicators of a poor facility not just new carpet and furniture.
The staffing saga continues
OK, I met with another hiring stumbling block today. I was unable to verify a nurses license on line. The medical records person called the board for me and they told her that the nurse did have a valid license and it was not on the web site. Fortunately I am inquisitive so I called the board back. I told them that I needed something from them to show that she was indeed not on the web site but had a valid license. I was asked where this person had told me she worked last and why. I told them and they told me that she had had an additional job since then and I might want to ask why the license was not on the web site. They were unable to give me any additional information and asked me to fax a copy of the application that was filled out. I called the other facility and fortunately was told that this person was let go do to an investigation into missing medications. Of cource I am not hiring that person but if I had not been dilligent I could have hired this person and been put in a bad situation. I don't know the answer but health care facilities need to be honest with each other and not pass around unacceptable health care providers.
Wednesday, May 19, 2010
Hiring
Well this week has been interesting. I need 1 FT nursing assistant and 1 PT licensed practical nurse. I have interviewed 3 people this week. 1 positive thing is that they showed up for the interview on time and dressed appropriately.Once again trying to get references has been like pulling teeth. 2 said they didn't keep their records on site, 1 said they worked there but that was all. After this I hired 1 person that could not pass the physical and was sent to their own physician who still did not pass them. I did manage to get 1 hired with promise, but once again no information except they did work there. I have my fingers crossed that this will work out. Another one's license is not on the board of nursing web site and she told us she knew this and just to call the board????? Ok maybe next week will be better. My staff is tired of working overtime. I'm tired of interviewing and the residents desirve better. It is time that health care managers start being truthful with each other and stop these people from getting jobs they won't keep and or can't do.
Sunday, May 16, 2010
The truth about long term care
I am starting this blog to share what a nursing home is really about. I have been a nurse for over 31 years and have worked in long term care nursing homes)and acute care (hospital) settings. I have worked in many roles in nursing homes from a nursing assistant to a licensed practical nurse, registered nurse, nursing director, administrator and regional vice president. I have worked for individually owned homes and large corporations. The whole reason for this blog is to change the publics view about nursing homes. I feel that I have a lot of experience and would like to share it with the public.
First of all I want everyone to know that not only have I worked in nursing homes but I have had to place loved ones in nursing homes as well.I want this blog to help those that are in the decision making step to placement in a nursing home as well as those that already have a loved one in a nursing home. I also want to help other health care providers as well.
It is my plan to discuss actual scenarios and issues that I have to or have dealt with. I hope this will help people understand the importance of a nursing home.
The first thing I would like to talk about is the reputation nursing homes have that needs to be over come. First, a nursing home is not a place that someone goes to die. Nursing homes are a place for people to go to recover and or live. I want to discuss the long term patient. Patients in nursing homes are from all age groups, sex, size and nationality and financial background. For an example the nursing home I currently work at has patients from 29 years to 102 years. There are more females than males (mostly due to life expectancy for females being higher). The patients are not from 1 specific area. Many people think that the persons in their local nursing home are all local. Unfortunately this is not true. Many bordering states do not accept patients with expensive health care needs or behaviors. That leaves our state to accept these patients to fill our beds.For example if a patient in a West Virginia hospital has a wound vac, tube feeding or intravenous infusions the nursing homes in that state will not take them. They are farmed to other states such as Ohio where the Ohio Medicaid system must pick up the bill.I will discuss this later. Nursing home patients are all treated the same weather they pay privately or Medicaid pays for their stay. All nursing homes are held to the same federal regulations plus their individual state regulations. I am rambling a bit so I will talk about 1 area tonight.
Staffing in a nursing home.
I don't care where I have worked or who I have worked for all nursing homes have the same problem. Hiring and keeping good staff. First of all the hiring process is very expensive for nursing homes. They are required to do several things before they can even hire anyone. They are required to complete finger print checks, drug screens, employee physicals and reference checks. All of these cost the facility money they can never recoup. The cost for the facility I work for is about 150.00 per employee just for thoses 4 items. This doesn't include the time for interviewing, paperwork and then the orientation proces. The cost is usually between $5000.00 and $10,000.00. After all that most employees particularly the line staff don't make it past 90 days.
The staff at a nursing home has special requirements for training, education, certification and licensure. All nursing assistants must be state tested. The training for a nursing assistant is about 3 weeks. After that they can work for 120 days before testing which costs over $100.00. If a facility hires someone that is not state tested the nursing home must pay for the test. After that all nursing assistants must have 12 hpours of in-services per year to keep their certification. Nursing assistants are at the forefront of providing care. They are responsible to perform all of the residents direct care. Therefore this training and education is very improtant. As I mentioned before nursing homes must get 2 reference checks for all staff hired. The only problem with that is that nursing homes do not share any information other than hire dates and seperations dates due to the fear of legal issues. This makes the process of getting a reference check very ineffective. Staff jump from facility to facility with no ramifications for leaving a previous employer. As a manager I feel that this is not in our best interests. I feel that all facilities shoud share the reason that the employee left. This would stop the job hopping that is being done. As an example I had the following happen. I rehired a nursing assistant that had worked at the facility before. The staff said the person had been a good worker but had some attendance issues. I discussed this with the person and decided to give it a chance. The employee was a good worker got along well with the residents and staff but started having some attendance issues. I followed our attendance policy and the persone was never at termination. The employee called off one day for personal reasons and then just did not show up for 2 days. I tried to call this person for several days and shared that I was worried with the staff. They obviously told her and she called me. I decided to let her come back on a different shift to help her out. Things went along well and later she did the same thing called off for personal reasons and then was a no call no show. I did not persue her anyfurther. I was told that she went back to work at another local facility where she had worked before. This person need to be stopped and or held accountable. Again per our policy if the other facility had asked for a reference I would have only given date of hire and seperation. I feel that facilities with the help of the governing board for Nursing Assistants needs to do something to stop this.
An additional frustration is staff quiting without notice. It used to be that you never heard of a licensed nurse doing this. There has always been this problem with non licensed lower paid staff but nurses never did this. I know of 3 director of nurses that quit without notice in a 1 year period. Other nurses do this as well. I think professionalism is gone for nurses. People say it is their age, the work, pay whatever. This is very unprofessional and I feel that nurses should be held accountable for this. Maybe if the board of nursing looked at this as something that is placed against someones license maybe this would stop. Being a nurse is a profession not a job and someone with that license should show professionalism in how they approach begining or ending a job. All nursing jobs are not alike and not for everyone.
My last thoughts on staffing for nursing homes is this. I don't care what facility you go to you will hear someone say "we're short staffed again". Well I am here to tell you this is completely false. No facility is ever short staffed. What happens is that when their are call offs and or emergencies other staff step in and do the duties of that person. For example a nurse may do the duties of a nursing assistant, other staff are certified as nursing assistants for example the activity staff. No facility just lets a shift go by with out additional help. I have personally worked as a nursing assistant in every facility I have worked at. Of course a nursing assistant cannot do a nurses job but there are always additional nurses working in other roles that can help out for nurse call offs or emergencies. Remember if you hear someone in a nursing home say we are short staffed ask them why they feel like that and make them explain who is helping out or ask the charge nurse to tell you. Nursing homes do not work short staffed.
First of all I want everyone to know that not only have I worked in nursing homes but I have had to place loved ones in nursing homes as well.I want this blog to help those that are in the decision making step to placement in a nursing home as well as those that already have a loved one in a nursing home. I also want to help other health care providers as well.
It is my plan to discuss actual scenarios and issues that I have to or have dealt with. I hope this will help people understand the importance of a nursing home.
The first thing I would like to talk about is the reputation nursing homes have that needs to be over come. First, a nursing home is not a place that someone goes to die. Nursing homes are a place for people to go to recover and or live. I want to discuss the long term patient. Patients in nursing homes are from all age groups, sex, size and nationality and financial background. For an example the nursing home I currently work at has patients from 29 years to 102 years. There are more females than males (mostly due to life expectancy for females being higher). The patients are not from 1 specific area. Many people think that the persons in their local nursing home are all local. Unfortunately this is not true. Many bordering states do not accept patients with expensive health care needs or behaviors. That leaves our state to accept these patients to fill our beds.For example if a patient in a West Virginia hospital has a wound vac, tube feeding or intravenous infusions the nursing homes in that state will not take them. They are farmed to other states such as Ohio where the Ohio Medicaid system must pick up the bill.I will discuss this later. Nursing home patients are all treated the same weather they pay privately or Medicaid pays for their stay. All nursing homes are held to the same federal regulations plus their individual state regulations. I am rambling a bit so I will talk about 1 area tonight.
Staffing in a nursing home.
I don't care where I have worked or who I have worked for all nursing homes have the same problem. Hiring and keeping good staff. First of all the hiring process is very expensive for nursing homes. They are required to do several things before they can even hire anyone. They are required to complete finger print checks, drug screens, employee physicals and reference checks. All of these cost the facility money they can never recoup. The cost for the facility I work for is about 150.00 per employee just for thoses 4 items. This doesn't include the time for interviewing, paperwork and then the orientation proces. The cost is usually between $5000.00 and $10,000.00. After all that most employees particularly the line staff don't make it past 90 days.
The staff at a nursing home has special requirements for training, education, certification and licensure. All nursing assistants must be state tested. The training for a nursing assistant is about 3 weeks. After that they can work for 120 days before testing which costs over $100.00. If a facility hires someone that is not state tested the nursing home must pay for the test. After that all nursing assistants must have 12 hpours of in-services per year to keep their certification. Nursing assistants are at the forefront of providing care. They are responsible to perform all of the residents direct care. Therefore this training and education is very improtant. As I mentioned before nursing homes must get 2 reference checks for all staff hired. The only problem with that is that nursing homes do not share any information other than hire dates and seperations dates due to the fear of legal issues. This makes the process of getting a reference check very ineffective. Staff jump from facility to facility with no ramifications for leaving a previous employer. As a manager I feel that this is not in our best interests. I feel that all facilities shoud share the reason that the employee left. This would stop the job hopping that is being done. As an example I had the following happen. I rehired a nursing assistant that had worked at the facility before. The staff said the person had been a good worker but had some attendance issues. I discussed this with the person and decided to give it a chance. The employee was a good worker got along well with the residents and staff but started having some attendance issues. I followed our attendance policy and the persone was never at termination. The employee called off one day for personal reasons and then just did not show up for 2 days. I tried to call this person for several days and shared that I was worried with the staff. They obviously told her and she called me. I decided to let her come back on a different shift to help her out. Things went along well and later she did the same thing called off for personal reasons and then was a no call no show. I did not persue her anyfurther. I was told that she went back to work at another local facility where she had worked before. This person need to be stopped and or held accountable. Again per our policy if the other facility had asked for a reference I would have only given date of hire and seperation. I feel that facilities with the help of the governing board for Nursing Assistants needs to do something to stop this.
An additional frustration is staff quiting without notice. It used to be that you never heard of a licensed nurse doing this. There has always been this problem with non licensed lower paid staff but nurses never did this. I know of 3 director of nurses that quit without notice in a 1 year period. Other nurses do this as well. I think professionalism is gone for nurses. People say it is their age, the work, pay whatever. This is very unprofessional and I feel that nurses should be held accountable for this. Maybe if the board of nursing looked at this as something that is placed against someones license maybe this would stop. Being a nurse is a profession not a job and someone with that license should show professionalism in how they approach begining or ending a job. All nursing jobs are not alike and not for everyone.
My last thoughts on staffing for nursing homes is this. I don't care what facility you go to you will hear someone say "we're short staffed again". Well I am here to tell you this is completely false. No facility is ever short staffed. What happens is that when their are call offs and or emergencies other staff step in and do the duties of that person. For example a nurse may do the duties of a nursing assistant, other staff are certified as nursing assistants for example the activity staff. No facility just lets a shift go by with out additional help. I have personally worked as a nursing assistant in every facility I have worked at. Of course a nursing assistant cannot do a nurses job but there are always additional nurses working in other roles that can help out for nurse call offs or emergencies. Remember if you hear someone in a nursing home say we are short staffed ask them why they feel like that and make them explain who is helping out or ask the charge nurse to tell you. Nursing homes do not work short staffed.
Subscribe to:
Posts (Atom)