How Do You Organize?

vintagemother, BSN, CNA, LVN, RN · May 22, 2015

When I was a CNA, my orientees taught me to take it easy at the beginning of the shift. Eg: just fill water pitchers and address emergencies. Toward the end of the shift, change briefs, put pads down, etcetera.

I heard there was a CNA who kept busy by turning her pts Q 2 hrs. She was my inspiration!!

I hope you get more replies from experienced CNAs!!

Missingyou, CNA · May 23, 2015

Note pad & pen will be your best friends! :) I use them to remind me of things that I need to chart when I get a minute while I wait on my hallmate to help with a 2 assist. I also use it when I take vitals, list my resident's if I have others added on so I don't forget anyone.

At the beginning of my shift I stuff my pockets with packets of ointments, little bags (for dirty stuff), an extra pair of gloves (incase I need them NOW!), toothettes, and anything else I can. This way I won't have to go searching for them later or dig in resident's drawers.

I get all my linens for each room, including extra gowns and bed sheets for the known heavy wetters and put them in the residents closets.

Since I have more "extra" time at the beginning of a shift, I sometimes unfold clean briefs and set them in resident's draw for later...one less thing to do during a rush.

I have 2 resident's who are tube feeds and have to be in bed by 3pm so I change & dress them in PJ's and reposition them at the start....again, less to do at dinner rush.

The best organization I think, is to use your down time to do whatever you can so it's less you need to do later. We never stand around and chat, we are always moving and doing what we can to keep ahead of the game.

hookyarnandblanket · May 23, 2015

It really is about routine, and in sub-acute, that can be a little tricky to pin down. What I do is get all my vital signs at the very beginning of shift, get report, get patients up and ready for breakfast and strip any beds that need to be stripped. Once breakfast is over, I start bathing people and getting them ready for the day. Once everyone is bathed, dry, and comfortable, it's usually lunch time and time to do any q4 vital signs. After lunch, I toilet patients, and I put those who need to be in bed back in the bed. We pass ice and snacks at 1400 and then do bed checks, drain foleys, calculate I and Os, and charting, then report off to next shift and go home. Among all of that, of course, are admits, discharges, call lights, and other minutia. We are responsible for making all the beds in all rooms, occupied or not, so that is a good "busy" job when there is a lull in between patients. I keep a piece of paper and several pens and markers, a roll of trash bags, alcohol swabs, and a roll of tape in my pockets so I am always prepared. I try to organize all bath supplies and gowns and underclothes in one location for bath time, usually in a drawer or in a closet where it is out of sight.

Ultimately, it really comes down to what works for you, and that is trial and error. Watch what others do and ask for their tricks. Sometimes your unit manager is going to have a specific routine he or she will want you to follow. Make a cheat sheet for yourself that is small enough to fit in your pocket and refer to it.

Good luck.

Bubbly26, BSN, RN · May 26, 2015

I'm a fairly new CNA but I have started a routine that works for me.

I work 12 hr shifts so the first thing I do is my accuchecks and rounding to make sure my patient is still amongst the living. Next, I get report from my nurse if they are close by which is very rare. Next, I grab all the linens and put those into the patient's room so when it comes time to change the bed, I don't have to scramble to find anything.

Next, I get my patients up for breakfast. When they are up to the chair or walking the halls, I go ahead and change the linens and ask them if they need items for a bath/shower/etc.

Usually, I am done with my beds by 10am which is when I start my first set of vitals. I get the vitals done then get the next set of accuchecks for lunch.

After lunch, I get all i/o's done and chart everything as I go along.

At around 2pm, I start vitals again. For my hospital, they are due at 11, 3 and 7.

By 3:30, things begin to slow down and I begin to chart i/os, get water for the patient, and other minor things before the next set of accuchecks at 4:30pm.

At 6pm, I start my evening vitals and finish my last bit of rounds and charting of how much the patient has eaten for dinner.

By 7pm, the next shift has already started and I am standing next to the time clock waiting to punch out at 7:30pm.

mindofmidwifery, ADN · Jun 2, 2015

I work in a nursing home and this is my routine:

When I come in for evening shift, first thing I do is rounds.

Print off my to-do list.

Grab everything I need for the shift and put them on a cart so I have easy access and don't have to run across the building when I need something.

Do my daily bath(s).

At this point I might start getting bored and call lights may be slow so I check on all my residents and reposition and toilet. At this point I may also do one-on-ones.

Get everyone up and ready for dinner.

Serve and feed/gather and pass out food trays.

Lay everyone down.

Chart.

Give report.

Do rounds with night shift.

Done :)

The key part to this is carrying your to-do list (which may be called something different at your facility, DON'T LOSE IT) and/or a small notebook and carabiner pen. Another key point is if you get bored or "lost," just reposition and toilet as needed.

Don't worry, you'll find your flow.

valliloves · Jun 7, 2015

I just started my first Healthcare job as a CNA in a rehabilitation and sub acute facility. I was hoping to get tips from my coworkers on how to organize yourself at the beginning of your shift, but none of them have a specific thing they do as they are all seasoned and have everything down to a set routine.
I was curious what you all do to get yourself organized and keep yourself from forgetting things along the way?

One thing I have learned about being a CNA of only a few months is that every single day is new. Really, every single day is unpredictable. There is no routine, but you can organize. I work in a hospital on a med/surg floor so I realize some things may be different, but you can copy my list, paste it into Word, make adjustments and print it out. You can use this list to establish your own "routine". You will pick this up as you go along. You will be pushed to your brink but you will catch on. Be encouraged by that! It will happen :)

Here is what I do every day during a 12 hour shift: (It's very helpful where I work because we all have spectralink phones--call lights are pushed through to a monitor tech and they call our phones to tell us which room to go to; also we all have our own extensions so we can call each other rather than running around to locate someone we need)

0630: Stretch. Look on the board to see which rooms I have. Get out my notepad and list the room numbers in list form. Go to the electronic charting system to write down the chief complaint of each patient. Get report from night shift CNA. Write it down next to each room number (ambulatory w/ assist, independent, total care, urinal, 2 person assist, bedpan, who is in isolation and for what, who is SOB bc HOB will need to be monitored, who are feeders, or whatever). Write down who is DNR, NPO or who gets a CHG bath for that day. On the second page in my note pad, I write the title, "Get". On the third page, I write "B" with a circle around it at the top as well as each pts room number in list form. On the fourth page, I write "Outputs". On the fifth page, I write "ADLs".

0700: Get a cart and place a towel over it. Go to the nourishment room, fill up large cups with water and ice (minus the number of pts who are NPO) and place them on the cart. Get two drinking cups for each room and a grip of straws. Place a towel over the cups so they aren't contaminated while wheeling down the hall. Go to each room, introduce myself to the patient, make sure their bed is low position and bed alarm is applied. Make sure fall mats are applied. Always make sure the telephone and call light is within reach. Change the day, date, RNs name and extension, my name and extension, CNs name and extension on the white board.

Change the pts water pitcher, ask them if they need to go to the bathroom, ask them if they are comfortable, let them know that I will be back with breakfast in an hour and will be checking on them hourly. Leave the room. If they ask for anything, I mean anything other than to be taken to the bathroom, I take out my little note pad and write it on the "Get" page. I go to each pts room until I'm done passing out waters.

0730-0800: Go to the linen room and fill up my cart. I count out the number of items per room to align with how many pts I have. I count out extras for total cares or incontinent pts so I will not have to run to the linen room every time. Well, we don't put Pampers on our pts unless the family requests it which is rare. We just don't believe in them (tip: Place the extras for those pts in their rooms when you pass out breakfast trays. Anytime you go to clean a code brown pt, double up your gloves so if you get any on your gloves while wiping, you won't need to go back to the wall to get more. Place two or three chucks on top of the bed pad so you can just remove one at a time when someone is incontinent).

I then go to the central supply room and fill up a basin with supplies to align with how many pts I have. For example; 10 pts--10 cleanser bottles for baths, 10 toothbrushes, 10 bottles of mouth wash, 10 lotions, etc.). If I run out of room in the basin, I will get a clear plastic bag to add more stuff and place it on top of the basin of supplies. Also, I make sure I have a pack of toothettes for my NPO pts. I put the cart out of the hazard zones in the hallway against the wall. Then, I go and get the items on the "Get" list in order until complete (usually there will only be half a dozen things or less).

0800: Pass out breakfast trays (pass out isolation room trays last if you have any as well as feeders) I am learning that it's best to position the pts bedside table so that it will be easy to place it over their bed if they choose to eat that way. This way, you won't have to struggle with it later. Some of the ones in our hospital have legs that can only go over the bed in a certain direction and with the fall mats being so tough to slide the table across; this is a must because it saves time later. Again, if pts ask for something, write it down on your "Get" list.

Then, I go to turn Q2 pt rooms and turn them.

0820-0900: Go to room with feeder (I usually only have 1-2 max but not every day). Sit while you assist as it's better on your back and it's also more respectful for the pt. Make their eating experience enjoyable. Don't just put stuff on the fork/spoon and put it in front of their mouths. Tell them what's on the tray and ask what they would like to try first. And don't rush them! After about 15 minutes, set the utensil down, let the pt know that you just have to run out for about five minutes but that you will be back. This is your chance to get the items on your "Get" list and hurry back to finish feeding. If you don't have feeders, do a couple of bed baths in this time frame if you can.

0900: Go to every pts room, ask them how breakfast was, ask if they need anything (if so, write it down on your "Get" list--I find that hourly rounding helps to reduce "Get" list over time, it reduces call lights, lessens pt anxiety, and ), look at their tray, get out your notepad, flip to the "B" page, write the percentage and the intakes next to the corresponding room #. Let the pt know you will back to check on them in an hour and reinforce the call light feature.

09:20 Go to NPO rooms and give oral care with toothette (I usually have 1-3 max)

0935: Take your 10 minute break. Call or tell the other CNAs that you are taking your break so they can cover for you while you're gone. Communication is so important. Even if everyone looks at you like your immature for it, do it anyway. Even tell them when you are back if it's a large facility. Find a quiet room even if it's the bathroom lol Sit down and close your eyes. Don't think about work. Drink water and breathe. Do not get up for anything until your 10 minutes is over.

0945: Stretch. Go to independent pts rooms. Bring your cart outside their door. Stack a fresh gown, towels, wash cloths, soaps and supplies on the top of your cart on one side. Stack fresh linens for the bed on the other. Crouch at the knees when pulling items from your cart to protect your back. When you stand up, place the gown-towel pile on top of the bedding linen pile. Go into the pts room. Let them know you'll be placing the gown-towel pile in their bathroom on the counter for whenever they are ready to clean up. Tell them to press the call light when they are going into the bathroom so you can come and change their bed while they are doing so.

9:45 Go to NPO rooms and do oral care with toothettes (I usually have 1-3 max).

1000: Turn Q2 pts (for me, the RNs help with turning so I don't always have to do it Q2). Chart I&Os and any ADLs. We have a 2.5 hour time limit.

1030-1200: Make hourly rounds. Start assisting with ADLs. Go to total care pt rooms first--straight down the line. When your hourly rounding mark hits, finish up what you are doing and don't begin your next bed bath or whatever until you've rounded and written down items on your "Get" list. Also, don't start a bed bath or whatever 10-15 mins before that hourly mark or right before you're to pass out lunch trays. These are just tips that I've learned so you don't fall behind. In between baths, get items from your "Get" list if you have any at this point.

1200: Pass out lunch trays. Do the same things as in the morning. Turn Q2 to supine if they aren't already in that position before you set those pts up with their tray. Go to feeders, etc.

1300: Get cart with new ice water. Look at trays, etc. Same as in the morning, pass out fresh waters. Give oral care to NPOs right after you look at trays. Pass out fresh waters. See if anyone needs to use the bathroom, etc. Write down get list items. Get those items.

1330---: Take my 30 min lunch break.

14:00 Stretch. Turn Q2. Hourly rounds. Chart I&Os and ADLs. Continue with ADLs. I usually have all of my baths and stuff done by 1400 because I don't have a lot of total care pts in the hospital. It all just depends on the day. Some pts want to wait until before dinner to take their baths so I am doing that stuff all throughout the day. I respect that preference.

1500: Hourly rounds. Continue with ADLs if needed. Answer call lights. Get to know my pts. Comfort them. Learn about their spiritual preferences. Pray with them if they want. Listen to their stories. Meet their visitors. NPO oral care.

1600: Hourly rounds. Turn Q2, etc.

1700: Pass out dinner trays, same as before, etc.

1800: Look at trays. Turn Q2. NPO oral care (we have to do it 4 times per day). See if anyone needs to use the restroom. Stretch.

1830: Take out soiled linen bags and change to a new bag. Chart ADLs, I&O. Give report to night shift CNA at bedside. Tell my pts goodbye.

1900: Clock out.

As I was typing this out, I realized that I can't believe I do all of this in a 12 hour day lol and about 40% of the time, there is no way that I can do all of this. There are so many times when doctors are in the pts room, lab techs, echocardiogram techs, etc so I have to wait until they are done!! At the end of the day, we are only human. We aren't invincible. It's OK to ask for help and I do it often. Thankfully, I work at a hospital whose staff is all about T-E-A-M-W-O-R-K!

I haven't figured out how to put my other two 10 minute breaks into this equation lol but I'm going to start being adamant about it because I really really need them. Sometimes, I swear when I go in to go to the restroom, I just sit there on the toilet for five minutes to relax :laugh: I hope this list at least helps you understand that you're not alone. You will get this down and before you know it, you'll be on top of it!

No matter what, don't stop making your lists no matter how sharp your memory was when you were a waitress ha ha! I don't know if you were. I'm just sayin' because I was and I thought it would be funny . It will make your job a whole lot easier. Our brains aren't designed to multitask that heavily so any way you can find efficiency and short cuts without taking away from pt care, you'll be much more effective.

Also, when you take your lunch breaks, try to get outside of the facility as much as possible. Eat in your car with the radio on or sit in the sun with a good book. And drink water!! Hydrate! Even a 15% drop in water does some crazy stuff to your brain and body. Congratulations on your new job. Best wishes to you. And if you learn any tips along the way that you can share with me, please do. I need all the tips I can get

NurseLamar · Jun 8, 2015

Piggy backing off some of the other comments, I always come to work with my note pad and black pen. I work third shift at a assisted living facility so I arrive 5 min before my shift starts to meet with the second shift staff. I write everything that I do down because that's my sole recollection of what happened and when it took place. I do my rounds every two hours and get my patients up and dressed in a timely manner in the morning, then I leave. I don't stay around and mingle with people because that's how drama starts. Don't worry you will develop your own routine after about two weeks.