Hey guys,

I'm detecting higher levels of burnout in the care aides across the board, and there's more tensions between shifts as a result. More bickering about tasks not being done before the next shift comes on. It may be related to the recent turnover in our resident population, especially younger residents with higher medical and social needs. Nurses do unit clerk and nursing duties, so they're struggling to keep charts in order, handle family calls, book appointments, in addition to assessments, med passes, faxes and phone calls to doctors, etc. They don't have time to help much with direct care. Care aides handle serving up and assisting with meals as well as cleaning the servery, tables, sweeping dining room, and all other direct care needs.

As a non-management professional, it's easy to see that an extra dietary aide and/or floating unit clerk would go a long way to helping nurses and aides help each other. But that is unlikely to happen.

So the question is how to present management with these observations as well as some solutions to consider. Where to start? Maybe a survey/interview of each shift to see what specific tasks they are doing and what times they are struggling with/are busiest? Bottle-necking of demands, especially during and after mealtimes seems to be part of the problem, at least in the evening.

Does anyone have any articles on this topic that might be helpful?

When I worked for a facility, we had nurses meetings once a month. These included the DON, ADON and many times the Administrator. There were times we discussed needs as you are talking about. Admin might already know about these issues too. Don't know about your area, but in my area, it is hard to get staff. If there aren't the applications, you aren't going to have adequate staffing. This is part of the burnout you see. People are having to pickup extra shifts and do extra duties. Sometimes the get additional help through a staffing agency. This may or may not be a good thing depending on the employee sent.

There might also need to be assessing times for doing certain things. My observation is that it is hard to prevent the bottle necking after supper. You have all these residents wanting to go to bed, now. That just can't happen.

Start with talking with your unit nurse manager and then on up with DON being next.

We shift staff around depending on needs. For example, Hall 1 has the largest number of residents who are two assist and frequently want to go to bed immediately after dinner. Hall 3 has maybe two or three residents that need to go to bed immediately after dinner. Since there's usually two CNAs on hall 3, usually one of these CNAs will float to Hall 1 after supper until at least most of the residents there are settled in. As long as the same CNA is not always being floated, it usually works out okay.

Agency helps, too. Occasionally we get a CNA that has never taken VS or has no interest in doing anything other than holding the wall up, but we have at least 3 dependable agency CNAs that will usually show up when we need them the most. I'm talking the agency CNAs that can man a hall by themselves, if need be, and know the residents because they're there so often.

Our facility also recently started implementing staff meetings, which I experienced at the acute level but has largely been absent in LTC. Basically, it's a time for the staff members to voice their concerns/worries with admin without fear of repercussions. Elevating staff members who are working hard to make a positive change to roles with more power can be beneficial, too.

Do all these non-nursing tasks generate overtime for the licensed staff? Years ago I ran a very busy sub-acute unit. I asked for a unit secretary and was told it wasn't in the budget. I spent the next two weeks making a note of all the time I spent on non-nursing tasks: 30 minutes making appointments, 25 minutes booking transportation, 15 minutes at the copy machine...you get the point. At the end of the two weeks, I took my list and a copy of my pay stub to the corporate guy who was in the building. I had my overtime hours highlighted. He looked at the overtime, looked at my list and said "We could hire a secretary and save money on what we're paying you on overtime." (duh, that was my point). The next week there was an ad in the paper (yes,we used to use the news paper to advertise jobs) and shortly after that, we had a secretary. Sometimes the money people have to see it in black and white.