how to be efficient

Nursing Students CNA/MA

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Hello!

I am looking for tips from experienced CNAs for how to care for multiple patients.

I'm starting a new assignment with more patients than I'm used to.

Does anyone have tips about how to cope with a larger workload (10-15 patients per CNA?)

:eek:

Please help! Thank you!!

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Multitask. If you are putting getting someone up or putting them to bed, dress them and do oral care while they are sitting on the toilet.

If someone is fairly independent, get them started on a task and then leave and get something else done. Check on them in a few minutes to make sure they are doing OK.

To avoid multiple trips to the stock room, put a few bottles of peri wash, wipes, and barrier cream on your linen cart.

Anticipate needs. Know your residents and know what they want done or might want done soon so that they won't be on their call light constantly. Making 1 long visit to someone's room is much better than 12 short ones!

Do all of your paperwork as you go along. Sometimes it helps me to carry the binder with me from room to room and fill stuff out when I have a spare minute (ie, waiting for someone to go to the bathroom who has an alarm who I can't leave in the bathroom by themselves).

If possible, get up/put down all of your residents who require lifts at the same time. It saves time from having to find an outlet, plug it in, uplug, etc. Management also won't be on your back about having lifts sitting in the halls (oh the audacity!!).

Get all of your "quick" people out of the way and save your "harder" people for last so that you can take time with them and it won't make you late for other things.

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I have 15 residents per night, so I know how you feel! What shift are you working?

The biggest thing I can recommend is to get EVERYTHING you need ready beforehand. On second shift, I get out their nightclothes, rags to wash them, clean briefs, and anything else I might need out and ready when I first get in. You save so much time if you aren't running around finding what you need.

Second, prioritize your residents. Try to get the more time consuming ones done first so you can whip through the others if you need to. If you need help with transferring any of them, get your second person, go through and transfer all of the two persons, and then you can go back later and finish them up.

It will take time, but you will eventually work out a routine that works well for you. Good luck!

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The best way to handle this is to team up with another CNA and do the assignment together. Learn how to complement each other. Two people can do one person faster and more efficiently than one. You will get faster as you work longer with your CNA buddy. Nurses prefer you to do this as long as you accomplish both assignments. It works best, if say, there are five CNAs. Two teams of two to do the assignments. The fifth person responsible for call lights and goes from team to team to help out when not answering a call light. I've seen this system work well.

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The best way to handle this is to team up with another CNA and do the assignment together. Learn how to complement each other. Two people can do one person faster and more efficiently than one. You will get faster as you work longer with your CNA buddy. Nurses prefer you to do this as long as you accomplish both assignments. It works best, if say, there are five CNAs. Two teams of two to do the assignments. The fifth person responsible for call lights and goes from team to team to help out when not answering a call light. I've seen this system work well.

The other good thing about this is that you have a witness to the residents who like to complain about their care. I also liked working this way, because you are not always looking for your team mate for help and you have an extra brian working to remember things.

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As long as your partner is a good one, working with another person is a lot of fun, too. It never seems like as much work when you have a "friend." I can't stand assignments where I don't have a partner.

At a former facility, we did the system with 2 teams of 2 CNAs each, plus a person to answer lights and do vitals. It worked amazingly well, until some people didn't feel like pulling their part. They thought it was faster to work an assignment by themselves, but that was because they did a terrible job and just "tossed" people in bed without changing them or doing oral care. We were only doing that system as long as all of the CNAs were unanimously agreeing to do it, so the charge nurse made us go back to the old system. It blew.

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It worked amazingly well, until some people didn't feel like pulling their part. They thought it was faster to work an assignment by themselves, but that was because they did a terrible job and just "tossed" people in bed without changing them or doing oral care.

Mmmhmm, this is exactly why we don't use the buddy system where I work. You have the aides who do the exact bare minimum, and then you have my favorites - the ones who ask you to help them lay down their heavier people, and then disappear when it's their turn to help you with yours.

The buddy system is GREAT and makes the job a lot easier, but unfortunately, it doesn't always work.

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I work evening shift with 10-12 residents by myself. Getting supplies ready early is very helpful because running back and forth wastes a lot of time. For example I stuff about 4 pairs of skid socks in my pocket because of course when I am in a hurry there is none in the resident's room. Knowing your residents & their needs helps so that, like someone said, you're not answering their call light 8 times to get them a glass of ice water, put a pillow under their arm, etc. Multitask. I always put my residents on the toilet, then get them undressed, do oral care, lotion their skin, get them up and do pericare then straight to bed. Clean up the room and on to the next resident.

Also, utilize their skills. One resident can brush her own teeth but needs help to bed, so while she is brushing her teeth I clean up her room, take care of her hearing aides, or answer a call light, etc. Another resident can brush her own teeth and put herself to bed so I do all her cares then leave her with her tooth brush and head out, do a quick check back later.

I priotize based on safety (I do fall-risks first) and also preference. Some of my residents like to stay up late, so I save them for later. Also I try to save my bath until I've got all of my high-priority people settled.

For baths: if resident is independent, I tell them about their bath early so they are ready by the time I come. If not, I just go in and inform the resident that "the bath water is running, its time for a bath." My residents HATE taking baths so my biggest task is just getting them out of the room. I get their clothes, slippers, etc, and I just take them fully dressed to the bathing room. Undress there, do the bath, get dressed and send them back to their room.

EDIT: I work the people who only need 1 person for transfers, but we also have a "buddy system" where a pair of CNAs do all of the residents who need 2 people for transfers. This works really well because no one is running around looking for help with a lift. Also the single CNA can answer call-lights too.

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Specializes in LTC.

It depends on the residents in your assignment and what shift you're working, but there are some good ideas here. On 2nd shift it saves a lot of time if you can get someone to help you put everyone to bed right after supper. Then you can go back and wash them, do oral care, turn, etc. for the rest of the night and not need any help except for a boost in the bed here and there. Plus you don't have that stress on YOUR supper break of knowing that half your residents could have been sitting in their pee since maybe 5 minutes after you got them up. It also helps on that shift to get everything ready in advance. Take down your beds before supper and lay out pajamas, toothbrushes, towels, etc at the end of the bed. We're not allowed to do HS care before supper, of course, but if I had a heavy assignment and didn't think I'd have time to keep up later, sometimes I would cheat by washing and lotioning people under their clothes during my first rounds so I would have less to do later on.

On 1st shift it's impossible to get things ready in advance because you hit the ground running with your AM care. I usually put some supplies in my pockets because 2nd shift never puts anything away in the same place and I don't have time to look. And I carry 2 bags from room to room- one for trash and one for laundry, so I don't have to make 10 trips to the dirty room. I try to get as many people dressed before breakfast as I possibly can because after breakfast much of my time is spent passing out drinks and doing my 2nd rounds. Some people have to be up for breakfast, some have to stay in bed until almost lunch, and the rest don't matter- if they're assist x 2 and incontinent it's usually easier to leave them in bed so you can change/bedpan/repo them by yourself.

Some people will get a person dressed and up and worry about the rest later- I like to get everything done at once. Teeth brushed, bed made, orthotics on, etc. Even if they have to stay in bed I will do everything else- jobst stockings, teeth, pants on up to the knees- then when it's time to get them up all i have to do is pull up their pants and make the bed. I find that I'm more efficient when I don't have all that mental clutter- I like knowing once I walk out of a room, I'm done. I don't have to constantly remind myself that Rm 2 needs her bed made and Rm 4 needs a shave and on top of the fact that 6 other rooms should have been toileted an hour ago!

If someone takes a zillion years on the toilet and we're not supposed to leave them alone in the bathroom I'll grab my paperwork before I answer the light. Or I'll leave the door cracked and do care on their roommate while i wait.

TOILET people. It drives me insane when there are CNAs who wait for someone to pee their pants before they change them. If they weren't totally incontinent when they came to the facility, they will be soon! I know there's no time to do it for every single person on every single round but aim for at least once or twice a day for everybody. Yes it takes longer at the time but it's better for the resident and in the long run it's much easier to wipe someone's butt crack than it is to scrub BM from every fold and crevice on their entire perineum and then have to go rinse out their clothes. Bedside commodes are great. You can put the bucket on the floor and then you know for sure if they did anything or not, you can wipe them while they're still sitting down, and transfer them more easily than in a cramped bathroom. While they sit there you can do their teeth, hair, make the bed, etc.

Before I toilet someone I like to park their wheelchair a distance away and make them walk into the bathroom. That takes care of their ambulation.

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Good ideas fuzzywuzzy on occassion I have to do AM shift and a lot of those tips are very helpful. I agree with getting everything done while the person is in bed and then going to find help to transfer so all you have to do is make the bed :up:

Also agree with the thoughts on toileting people :up:

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Thank you all for the great tips! This is extremely helpful!!

:)

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I used to work at a subacute PM shift where we had 18 patients and I was the only CNA on PM's. The nurses were supposed to help but that was usually a joke! I usually put every single one of them to bed by myself. We had a lot of patients there who were semi-independent and we had chairs in the bathroom so many of them I set them up with all of their materials and let them go at it. This made it a little easier.

My other piece of advice is just remember you are only ONE person. You can't be everywhere at once. At times I had 6 call lights on and I know I could only do one at a time. We are all human and sometimes you have to explain to patients that you are human. I would kindly say "I'm really sorry it took so long to answer your light, it's been a crazy night what can I do for you." Many of my patients were there for a long time so they understood how it works.

Just do one thing at a time and remember to breath. If it gets really bad ask the nurses for help, it's their patients too.

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