What to expect on PM shift?

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    In my clinicals we were at a facility from 7-3 three days a week for a month so if I were to get an AM shift I would know how to handle it. However I have no clue what to expect on PM shift that starts at 2:30. I am assuming to start out with brief changes and toileting. Then what do you do before dinner starts? After dinner more toileting, teeth brushing/denture care and then getting residents changed for bed. Do you take vitals before bedtime? I really want to practice taking vitals and observe different heart and lung sounds.
    What else do you do during PM shifts? How do you handle sundowning? What other surprises will I be un prepaired for only having AM experience? Also is eight to ten residents a heavy load or a normal number of residents? During clinical we were in teams of two taking care of two to three patients so handling eight by myself seems like a lot!
  2. 15 Comments so far...

  3. 2
    I worked PM shift for a while. So you come in at 3ish, for you it's 2:30. If your facility does PM shift showers, I would knock those out before dinner, because they're likely to refuse when it's colder. Then you probably should toilet the ones that need to be toileted before dinner time. If I remember right dinner was like 5pm, maybe 5:30pm. Then after that it's usually meal breaks for the CNAs. After that Around 8ish you start putting people back into the bed if they haven't already right after dinner. As you're putting them into bed you're usually toileting them. Some, you may have to do last rounds on later if you put them into bed earlier, especially if they're incontinent and heavy wetters.

    I hope that helps. As far as sundowning goes, if they're wheelchair bound the nurses don't usually mind if the CNAs put them in wheelchairs right by the nurses stations for monitoring, especially if they're a fall risk. Not sure if I missed anything.
    anie10 and SlaveHeart like this.
  4. 2
    I have worked every shift. Currently I am on second shift (2p-10p). And THANKFULLY we are going to all 12 hour shifts at my facility.

    2:00: (usually clock in a few minutes early and get report) get to work, get report, do a first round, put anyone to bed that is ready, make sure everyone is turned at dried

    3:00: Usually done by then. My partner usually starts charting/keeps an eye on call lights (we have to chart 20 questions/resident on ADLs, transfers, all that good stuff) and I do our showers (I much prefer pt. care to paper work). I help her finish charting, we pass ice

    4:00: Do another check on everyone. My facility has a dining room and my halls have about 8 people who go to the dining room. We make sure they all have their medicine and carry them down there. If the other halls is behind, I help them take their residents to the dining room as well. Chart any voids/bowel movements from the 4:00 round. Offer to take anyone to the bathroom that needs to before dinner comes out.

    5:00: Trays come out (all halls pass trays together). We pass trays out from 5-6

    6:00: Usually when our feeder trays come out. Feed residents, pick up trays, chart dinner. My partner usually takes her break at 6:30. I stay on the halls, offer anyone to go to bed/the bathroom. Talk to the residents, do nail care. Keep an eye on the hall.

    7:00-8:30: We do our last big round (check, turn, dry everyone, do cleaning, make sure rooms look neat and organized). Usually get done around 8:30. I take my break from 8:30-9. While I am on break, my partner keeps an eye on the halls, charts voids and bowel movements, etc.

    9:00: Do last round (only lasts 30 minutes usually). do our last bit of charting, fill out shift change papers, make sure trash is taken out of our barrels. Help nurses with skin assessments/skin treatments.

    10:00: We give the next shift report and go home!

    Sorry this is so long I tried to be very detailed!
    anie10 and SlaveHeart like this.
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    future: that is the exact detailed response I was looking for! Thank you.
    By giving showers do you take the residents to the shower room and clean them yourself. Or is there typically a shower CNA that stays in the shower room and the hall CNA's bring the residents to the room? That is how the facility I did my training at did showers. They said it saved time and money for the facility in the long run and there were more CNAs on the floor to toilet everyone so there were less brief changes. Is that not the norm at most faciliites? The shower room was my least favorite part of training, but we did an eight hour shift in there so just and hour or two a day would probably not be too bad.
    Also I hope this isn't a weird question but for those who have worked all shifts are there more or less BM's in the PM shift? I would imagine more because you get there right after lunch and then stick around after dinner.
    Any other weird questions or I should be asking or information that could be useful?
    Thanks again!!
  6. 1
    I've worked LTC in three facilities so far and none of them have had dedicated CNAs to just showering. All places have had designated shower days for certain Residents, whether it's 2 or 3 days a week. Certain ones, I guess, prefer AM or PM. We had to do all showers ourselves, and if it was a two person assist it wasn't too hard to find help because the rest of the CNAs know which ones you need help with.

    I wouldn't say there's a pattern to the BMs in any shift particularly in my experience. I think that would depend on the Resident. Some of them need medications in order to help with that, because of lack of movement or medications they're on.

    In general, I would say that Day shift is the toughest, PM would be next, and Nights if you are a night person are the easiest. Some people can't sleep during the day, so they say nights are too hard for them.
    SlaveHeart likes this.
  7. 1
    8-10 residents is pretty good for second shift. The thing with 2nd is, things are really crazy for a few hours after dinner, and then it gets boring. Whereas on first shift the pace is the same all day. Not many people are riding your butt to get up in the morning, but on second shift you get all these people who either nag you to death to go to bed as soon as they take that last bite of supper or they don't bother with the nagging and simply try to launch themselves into bed on their own. Sundowning is less of a problem if you can get the agitated people into bed earlier, and it's easier to tell the alert people approximately when you'll be in to help them. I always used to tell my alert people when I was going on lunch break, what time I would be back, and I would ask them what time I should try to get to them, even though I knew what their answer would be. Having that conversation helps prevent the resident from ringing constantly and working themselves into a lather while you are gone on break or doing care on other people.

    Where I work we get a designated shower aide once in a great while, but only on day shift, which has the most showers. And a few people will have a BM at the same time every day, but most of them just go randomly. Some nurses are freer with the laxatives than others, which can make a big difference.

    2nd shift at my facility goes like this:

    3pm: Pass out linens. Toilet/change all residents and get anyone who is laying down OOB. Walk the ambulatory ones while you are at it. In my facility, on first shift they all get walked in the hall with great fanfare, but on 2nd if you walk them from the bed to the toilet that is good enough because most of them are tired by then. Normally we get one shower apiece and if you can get it done during this time, fabulous. My facility sorta frowns on this, and I don't know why.

    430pm: Someone should be doing all the vitals, another person should be refreshing water pitchers. Hopefully, you're not working with lazy people, or you will get stuck doing both of these things. If i have time I also like to go around to all my residents' rooms and get EVERYTHING ready for HS care- washcloths, basin, gown, toothbrush, pad on the bed, etc. Round up any supplies the resident has run out of, etc. I would also check on a few of my residents that are heavy wetters and change them again before supper, so they don't get lost in the shuffle after the meal, because that's the busiest time of the shift and you'll want one less thing to worry about.

    5pm: Dinner trays come out. Pass and feed.

    6pm: Start putting people to bed. CNA lunch breaks start. Try to get as many people in bed (washed or not) before your break time. Do HS care. I always elevate everyone's legs in bed all the way so they don't slide down.

    830: You should be finishing up with your HS care. Pass out snacks, turn/change people you haven't seen in a while. Start your paperwork.

    930 or 10: Final round. Make sure everyone is dry, turned, pulled up in bed, and there are no messes for 3rd shift, liners are in all the trash cans, etc. This round is easy. Then do whatever chores you need to do.
    SlaveHeart likes this.
  8. 1
    I really appreciate the replies! Hearing about the subtle differences in the shift and how experienced CNAs approach them is giving me a bit to brainstorm and anticipate on a 2nd shift. So far what has stood out in my mind the most are:

    1. Get showers done early before it's cooler.
    2. Toilet before and after dinner
    3. Sundowners that wont sleep put w/c near station
    4. Get sundowners to bed first b/c its easier to tell alert peeps to wait
    5. Elevate legs in bed so they don't slide down

    I feel like a dork for taking notes but hopefully these important ideas won't get lost if I repeat them a few times.
    Oh and FuzzyWuzzy, I've always enjoyed reading your posts since I first started lurking on allnurses a couple of years ago.
    fuzzywuzzy likes this.
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    Hi there! I actually thinking the PM/Evening shift is the BEST shift of all. Maybe it varies from place to place, but this is what I
    do.

    I make rounds on my residents (changing/toiletting as needed-- but if the last shift did what they were supposed to do, there shouldn't be much to do except lights at this point), check who to shower, give the showers, document, and take all my vitals I am asked to take. I DO NOT deal with lung sounds and whatnot; that is the responsibility of the nurse. I'm not about to go do something I wasn't trained or permitted to do. I avoid taking vitals at bedtime.

    Then an hour before dinner, I get the residents who need the most help up first; the easiest go last because it's not hard to lose track of time and stay with a difficult patient halfway into dinner. I pull down all the sheets before I leave each room, so that I won't have to do it later. If I have time, I go into each room with a fresh gown. At dinner, I pass trays and feed residents as needed. Then afterwards I take everyone back to get ready for bed. I put everyone in bed and check on them every half hour to an hour afterwards to ensure they are clean and safe. I record on the ADL flowsheet at the end of the shift, as that is our facility's procedure. I gather trash as I make my last rounds, so that the night shift doesn't have to deal with overflowing garbage bins.

    I would say 8-10 residents is a very fair assignment. That's what I get on the skilled unit. Typically I get 14-16 on LTC, but on bad days (i.e. epic scheduling failures), I magically end up with 18 people.
    SlaveHeart likes this.
  10. 0
    Quote from nguyency77
    Hi there! I actually thinking the PM/Evening shift is the BEST shift of all. Maybe it varies from place to place, but this is what I
    do.

    I make rounds on my residents (changing/toiletting as needed-- but if the last shift did what they were supposed to do, there shouldn't be much to do except lights at this point), check who to shower, give the showers, document, and take all my vitals I am asked to take. I DO NOT deal with lung sounds and whatnot; that is the responsibility of the nurse. I'm not about to go do something I wasn't trained or permitted to do. I avoid taking vitals at bedtime.

    Then an hour before dinner, I get the residents who need the most help up first; the easiest go last because it's not hard to lose track of time and stay with a difficult patient halfway into dinner. I pull down all the sheets before I leave each room, so that I won't have to do it later. If I have time, I go into each room with a fresh gown. At dinner, I pass trays and feed residents as needed. Then afterwards I take everyone back to get ready for bed. I put everyone in bed and check on them every half hour to an hour afterwards to ensure they are clean and safe. I record on the ADL flowsheet at the end of the shift, as that is our facility's procedure. I gather trash as I make my last rounds, so that the night shift doesn't have to deal with overflowing garbage bins.

    I would say 8-10 residents is a very fair assignment. That's what I get on the skilled unit. Typically I get 14-16 on LTC, but on bad days (i.e. epic scheduling failures), I magically end up with 18 people.
    I totally understand that lung sounds and heart sounds are outside of the scope of a CNA, I was just wondering if it is possible to observe the sounds or if that takes up too much time. Of course I would use radial pulse and observe the chest rise to take those rates. I'm thinking it wouldn't be more than a few extra seconds to take a listen since I'd be using the stethoscope to take bp anyways. But I suppose those few extra seconds would add up and make me behind on things..
  11. 0
    Speaking of work, I just got home from it.

    To answer your questions, we do not have delegated CNA's just for showers. I get the resident, gather clean clothes, diaper, etc. and give them their shower and get them dressed. I almost always do all of our showers. Working second shift, we have 30 residents to 2 CNA's (my facility claims "according to state" we can have 3 techs on our unit instead of 4 with 60 residents). On the BM's, it depends on the person. I have one woman that constantly goes and we have (at least) 2-3 large BM's on our shift and some people never go on my shift (unless they are laxed). The vitals signs vary depending on the nurse I have. Our nurses typically get their own vital signs but if they are busy I'll just get the 3-4 they need that night. Every Sunday is full vitals day where we get everyone. Thankfully the day nurse I share weekends with is amazing and gets our vitals on Sunday for us!!! We have a few toileting programs but if someone is incontinent to the max, we don't toilet them. I will toilet residents that have incontinent episodes or can tell at all because most of the incontinent people on my unit are total dependencies (full body lift) and are pretty much impossible to get on a toilet. But we do have toileting programs. Any more questions?


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