Hello. I am your CHARGE NURSE. Please keep this in mind for future reference. Thank you.
This weekend at work. Oh. My. God. The anguish. By the end of last night I was ready to gouge my eyes out with a toothpick. A dull toothpick.
Saturday began with, as usual, a plethora of dayshift call-ins. These, I have become used to - it's routine to be at least one CNA short on each hall every Saturday & Sunday. The day before, I'd ended up covering the entire south hall on my own after 9ish, because the nurse I was working with was deathly ill and we had to convince her to go get a doctors appointment. In fact, it came to the DON and ADON threatening to put her in THEIR car and drive her to the ER before she actually went. That afternoon, before I went home, the ADON *and scheduler* gave me staffing instructions for if the nurse called in sick Saturday.
Of course, she did. That wasn't my problem. I more than expected it.
I would like to make note at this point and time that I was the ONLY RN in the building for Saturday. The licensed staff was myself, and 3 LPNs.
I did as the ADON had asked me to do - I moved the nurse from the Alzheimers unit out to the floor. I sent the bath CNA to the unit to cover as a 3rd helper *since it can be staffed by CMAs in charge*. The other hall had also had a CNA call in, so they had pulled THEIR med aide, usually one of my staff, to the floor. That hall is hard. I wouldn't want to work it without a full CNA staff either. But the CMA in question had just come back from light-duty for a major back injury, so she didn't feel comfortable working that hall on the floor. I traded one of my CNAs on the floor, for her. That leaves the other hall still fully staffed, but without a CMA at their own choosing.
On to -my- hall. We are scheduled to have 2 nurses, a CMA, and 4 CNAs. Which would have been fine - except one of the CNAs was on the schedule in error. So after I fix everyone else's staffing issues, I have 2 nurses, a CMA and 3 CNAs. I ask my CMA if she wants to work the floor. She is on her 15th day in a row *which is 15 solid days of work, including occassional 12 hours and sometimes 16*, and quite frankly, is beyond tired. She says she will help get people up, put them down, and do a couple of baths, but she would rather not be assigned to the floor, but help out inbetween passing her meds. The other nurse and I also get 2 people at least, out of bed. I let my CMA remain on the cart, and leave the floor with 3 CNAs.
Apparently, the other hall which is fully staffed MINUS their CMA at THEIR OWN CHOOSING, is now annoyed that I have kept my own CMA on the cart while the floor is short. If they had to give up theirs, why do I get to keep mine? This starts the heads bobbling and the mouths running.
I start to get comments from my own CNAs, who, up til this point, have been running along, and getting people out of bed with no trouble. It started after one of them went to the other hall to get the mechanical lift. She returned with the statement "I thought the rule is that if the floor is short, you pull the CMA to the floor?" My CMA explains why she wanted to stay on the cart. At this point, she's already passed 1/4 of her pills, gotten 2 people out of bed, and given a shower. I give the girl kudos for being able to keep it up. But this? Is not enough. I hear scattered comments throughout the next hour and partway through breakfast - despite the fact that we had every resident up and in the dining room 10 minutes earlier than we had the day before when we were fully staffed. So I move to the next step of the 'fill the holes in the schedule' master plan.
I ask my rehab aides (there are 2) what their day is looking like. They inform me they have 25 residents to give therapy to today. Without the backup of the Physical and Occupational Therapists, since it's the weekend. I leave them where they are.
After breakfast, I am told by one of my CNAs that "I'd better not expect them to leave their hall and bust their asses after they did all THEIR work to help out the CNA on the other side of our hall since I MADE THE DECISION NOT TO PULL MY MEDAIDE". And the comments continue til after I return from lunch at 11am, which ironically is the time the ADON called to check in on the staffing :)
I don't want to complain all the time. I don't want to be the one that they see coming and roll their eyes and think 'Oh no, here we go again.' So I ran everything that I'd done past her, and she said I'd done nothing wrong and that there was no rule about pulling the CMA, that it is charge nurse's discretion for each floor and that I am the only RN in the building. They also say they know I love our residents, that I would never do anything to put them in jeopardy, and that as long as everyone was cared for and their safety was insured, that they would back me up 150%. She then furthered it by saying if I really felt like it and thought it would shut them up, I could leave a note on the daily schedule saying everything that had been done today had been approved by her, and sign my name to it. I chose not to. But the thought that I could tell them all to suck my left nut sure did make my day a little easier.
So Saturday ends. I get to go home, and relax. HA. After a less than stellar night at home, Sunday rolls around. I get up, get ready and go in. Things go a little smoother. There are still rumblings about 'yesterdays staffing', which are started over the fact that we have to replace a CNA in the unit again. But since we were overstaffed to begin with, this just returns things to normal. However, after lunch, the question of using multiple resident alarms came up - as in, if a resident has a bed alarm, they were told they don't have to put the personal, attach to their clothing alarm on. Or if they are in a wheelchair with a chair alarm, they don't need to attach the personal alarm. That they were told this was 'double alarming' and was costing the facility extra money to keep all the alarms in house. I gave them the answer that I felt was appropriate. I gave them the answer that made sense to me and was safe for the residents. I gave them the answer that said "When you work with me, you will do it THIS way."
This was not good enough for them. Instead of accepting the fact that I was the charge nurse for the day, they chose to tell me the following:
And then, to top it all off, they decided to wander down to the other hall, to ask that RN, because "She knew everything." When she gave them the EXACT.SAME.INSTRUCTIONS. as I gave them, they complied and did what I originally wanted done. GAH. I think I made the comment at that point and time that I had gone to school for 3 years to learn to pull string out of my nose, because obviously I didn't know anything else.
Finally, at 2pm? YET ANOTHER STAFFING CONFLICT. To which I am told, by a CNA no less, that I don't have the authorization to keep an agency CNA without 'talking to my ADON', because 'the facility isn't going to want to pay for agency staff just because you said so'. Despite the fact that the agency itself said the CNA in question was on their list to work a double with us.
I ended my day by writing a 3 page letter to my DON that started nice and was trying to address the whole 'alarms' issue, but quickly morphed into my relase of the fact that I do NOT pull the charge nurse card and grunt like a caveman... "Me Chargenurse. You CNA. UNGH UNGH. UNGH." But that I do expect the respect that my title provides, and I expect my orders to be followed unless it is obvious that following my instructions would put someone in grave danger.
I seriously thought about giving my 2 weeks notice yesterday. Hell. I seriously thought about calling the DON and telling her I was done. Then I thought about Immigration and the last 8 months, and sucked it up. Thank GOD today was my day off. I think I would have lost my mind if I had to go back again today.
Saturday began with, as usual, a plethora of dayshift call-ins. These, I have become used to - it's routine to be at least one CNA short on each hall every Saturday & Sunday. The day before, I'd ended up covering the entire south hall on my own after 9ish, because the nurse I was working with was deathly ill and we had to convince her to go get a doctors appointment. In fact, it came to the DON and ADON threatening to put her in THEIR car and drive her to the ER before she actually went. That afternoon, before I went home, the ADON *and scheduler* gave me staffing instructions for if the nurse called in sick Saturday.
Of course, she did. That wasn't my problem. I more than expected it.
I would like to make note at this point and time that I was the ONLY RN in the building for Saturday. The licensed staff was myself, and 3 LPNs.
I did as the ADON had asked me to do - I moved the nurse from the Alzheimers unit out to the floor. I sent the bath CNA to the unit to cover as a 3rd helper *since it can be staffed by CMAs in charge*. The other hall had also had a CNA call in, so they had pulled THEIR med aide, usually one of my staff, to the floor. That hall is hard. I wouldn't want to work it without a full CNA staff either. But the CMA in question had just come back from light-duty for a major back injury, so she didn't feel comfortable working that hall on the floor. I traded one of my CNAs on the floor, for her. That leaves the other hall still fully staffed, but without a CMA at their own choosing.
On to -my- hall. We are scheduled to have 2 nurses, a CMA, and 4 CNAs. Which would have been fine - except one of the CNAs was on the schedule in error. So after I fix everyone else's staffing issues, I have 2 nurses, a CMA and 3 CNAs. I ask my CMA if she wants to work the floor. She is on her 15th day in a row *which is 15 solid days of work, including occassional 12 hours and sometimes 16*, and quite frankly, is beyond tired. She says she will help get people up, put them down, and do a couple of baths, but she would rather not be assigned to the floor, but help out inbetween passing her meds. The other nurse and I also get 2 people at least, out of bed. I let my CMA remain on the cart, and leave the floor with 3 CNAs.
Apparently, the other hall which is fully staffed MINUS their CMA at THEIR OWN CHOOSING, is now annoyed that I have kept my own CMA on the cart while the floor is short. If they had to give up theirs, why do I get to keep mine? This starts the heads bobbling and the mouths running.
I start to get comments from my own CNAs, who, up til this point, have been running along, and getting people out of bed with no trouble. It started after one of them went to the other hall to get the mechanical lift. She returned with the statement "I thought the rule is that if the floor is short, you pull the CMA to the floor?" My CMA explains why she wanted to stay on the cart. At this point, she's already passed 1/4 of her pills, gotten 2 people out of bed, and given a shower. I give the girl kudos for being able to keep it up. But this? Is not enough. I hear scattered comments throughout the next hour and partway through breakfast - despite the fact that we had every resident up and in the dining room 10 minutes earlier than we had the day before when we were fully staffed. So I move to the next step of the 'fill the holes in the schedule' master plan.
I ask my rehab aides (there are 2) what their day is looking like. They inform me they have 25 residents to give therapy to today. Without the backup of the Physical and Occupational Therapists, since it's the weekend. I leave them where they are.
After breakfast, I am told by one of my CNAs that "I'd better not expect them to leave their hall and bust their asses after they did all THEIR work to help out the CNA on the other side of our hall since I MADE THE DECISION NOT TO PULL MY MEDAIDE". And the comments continue til after I return from lunch at 11am, which ironically is the time the ADON called to check in on the staffing :)
I don't want to complain all the time. I don't want to be the one that they see coming and roll their eyes and think 'Oh no, here we go again.' So I ran everything that I'd done past her, and she said I'd done nothing wrong and that there was no rule about pulling the CMA, that it is charge nurse's discretion for each floor and that I am the only RN in the building. They also say they know I love our residents, that I would never do anything to put them in jeopardy, and that as long as everyone was cared for and their safety was insured, that they would back me up 150%. She then furthered it by saying if I really felt like it and thought it would shut them up, I could leave a note on the daily schedule saying everything that had been done today had been approved by her, and sign my name to it. I chose not to. But the thought that I could tell them all to suck my left nut sure did make my day a little easier.
So Saturday ends. I get to go home, and relax. HA. After a less than stellar night at home, Sunday rolls around. I get up, get ready and go in. Things go a little smoother. There are still rumblings about 'yesterdays staffing', which are started over the fact that we have to replace a CNA in the unit again. But since we were overstaffed to begin with, this just returns things to normal. However, after lunch, the question of using multiple resident alarms came up - as in, if a resident has a bed alarm, they were told they don't have to put the personal, attach to their clothing alarm on. Or if they are in a wheelchair with a chair alarm, they don't need to attach the personal alarm. That they were told this was 'double alarming' and was costing the facility extra money to keep all the alarms in house. I gave them the answer that I felt was appropriate. I gave them the answer that made sense to me and was safe for the residents. I gave them the answer that said "When you work with me, you will do it THIS way."
This was not good enough for them. Instead of accepting the fact that I was the charge nurse for the day, they chose to tell me the following:
- Not all charge nurses do it the same, so what I tell them may not be what another nurse tells them
- That they were not going to get in trouble for doing it 'my way' when another nurse confronts them on the above
- That they were also responsible for the instructions of other management in the facility, and the rules they provide
And then, to top it all off, they decided to wander down to the other hall, to ask that RN, because "She knew everything." When she gave them the EXACT.SAME.INSTRUCTIONS. as I gave them, they complied and did what I originally wanted done. GAH. I think I made the comment at that point and time that I had gone to school for 3 years to learn to pull string out of my nose, because obviously I didn't know anything else.
Finally, at 2pm? YET ANOTHER STAFFING CONFLICT. To which I am told, by a CNA no less, that I don't have the authorization to keep an agency CNA without 'talking to my ADON', because 'the facility isn't going to want to pay for agency staff just because you said so'. Despite the fact that the agency itself said the CNA in question was on their list to work a double with us.
I ended my day by writing a 3 page letter to my DON that started nice and was trying to address the whole 'alarms' issue, but quickly morphed into my relase of the fact that I do NOT pull the charge nurse card and grunt like a caveman... "Me Chargenurse. You CNA. UNGH UNGH. UNGH." But that I do expect the respect that my title provides, and I expect my orders to be followed unless it is obvious that following my instructions would put someone in grave danger.
I seriously thought about giving my 2 weeks notice yesterday. Hell. I seriously thought about calling the DON and telling her I was done. Then I thought about Immigration and the last 8 months, and sucked it up. Thank GOD today was my day off. I think I would have lost my mind if I had to go back again today.