[locolorenzo22]

Hey, all. Just really down today after what I got talked to about last night at work....Apparently, day shifts been saying that I leave people incontinent, trash cans full, linens in room, falsifying vitals, etc......I'm majorly PO'd.....
In order of issues,

1. With 2-3 aides and average of 28pts....it's really tough to feed, bathe, redress, do vitals, get to bathrooms, etc...as quickly as we'd like to. I always check my people on first rounds and at least half the time, my pts are wet too. Being me, I just figure that they happened to get wet between the time the day shifter checked them and the time I do rounds....so I change them, suck it up and go on.....

2. I take out linens/trashes/change waters/pick up rooms/final check pts, anywhere from 330-445AM. I save my incontient pts for the end so I make sure they're as clean as possible when days comes on. If a nurse comes in behind me to put in an IV or make a lot of trash after my rounds, I do NOT have the chance to go back around and empty trash again. If a pt voids after I check them, how am I supposed to make sure they're dry?

3. I NEVER WOULD DREAM OF FALSIFYING VITALS!! Supposedly, there's inconsistancies, but I always copy my sheet for nurses and if there's a question, usually it's because the nurses wrote them down wrong on their careplan sheets, not that I didn't chart correctly!

4. I think there's just this perception that the night shift has all sorts of time, when in reality, we don't. If you have many pts after you for different items(like the night 5 out of 7 wanted bedpans all at the same time....), if you have a pt who needs a lot of time because they're slow, if you need to recheck items or do things for their nurse...it all adds up....

I guess maybe I need a new job because this work environment seems to just be very toxic....Some nurses are just after me all the time, it seems like, even when I don't have ANY of their pts, they'll ask me to do something for them. I HATE quitting, cause it's almost like it causes other people to "win". I would rather be fired, then just give up.
It's really got me wondering, can I handle being a nurse if I'm supposedly such a "bad" CNA? Skills, pt care I have NO problem with. It's all the extra housekeeping crap I seem to be behind with....Just had to get it off my chest.....

[Daytonite]

Sorry to hear you're having some problems. First, let me tell you that as a manager, they can't accuse you of falsification of the chart without proof. How are they going to prove that you are falsifying vital signs unless they are coming behind you and interviewing the patients? When I was a manager we had a aide who was falsifying fingerstick blood sugars. The way it was found was when a nurse went to give a patient her morning insulin and the patient asked her if she was going to do her fingerstick first. The nurse was staring at a list of blood sugars the aide had given her. The other patients were then questioned, and sure enough, the aide had done no fingersticks on any of them. She had made all the blood sugars up. With that kind of evidence we fired the aide.

When I was an aide in a nursing home, and as a charge nurse in a nursing home, we often had this shift-to-shift problem of patients being left incontinent, overflowing trash cans and the biggest sin of all was piles of dirty linen left in the shower rooms. Things really got bad in one place when we started finding piles of clothing with poop in them, I'm talking about chunks of poop, that was supposed to be washed out before being put into the dirty linen in the shower room. Just who was doing this? Where was Jessica Fletcher when you really needed her? As a charge nurse I merely instructed the oncoming aides to make rounds with the offgoing aides. If they didn't and came to me later with complaints about the way they found patients, I looked them in the face and asked if they made rounds when they came on? No. What do you want me to do about it now? You should have made rounds and found this stuff when I could have done something about it for you. Most of the time, before I even did my narcotic count with the offgoing charge nurse, I was out on the floor rounding up the aides and making sure they were making their change of shift rounds to avoid these kinds of problems and to try to try to catch the phantom poop-in-the-clothes-the-shower-room-person. This works both ways. You can insist on an oncoming person to make rounds of your patients with you before you leave to make sure you don't get blamed for any problems. That way if there is a complaint you can say, "I made rounds and I took care of any problems right then and there." You can also tell the people who are blaming you that you would appreciate that they make rounds on your patients as soon as they come on shift and tell you immediately about any problems that they find so you can fix them before you leave.

I know this is not accepted practice, but we used to put a second plastic bag liner in the trash cans underneath the one actually being used. We started emptying the trash cans at 4-5am. During the last round, it was easy enough to grab out any bags that had new trash in them and get rid of them because there was already another bag under them set up and ready to be put into use.

For incontinent patients, we double chux'd them. That way if they had an incontinence after the last round, all we had to do was roll them from side to side and remove the wet chux or diaper and they already had a clean one under them ready to go. For patients that are intent on having diarrhea or potential poop, lather their behinds with lotion. The poop slides off the skin easily and it's easier to clean off. We did quick peri-care and they were good to go. We also used to fold their patient gowns up to their waist so they wouldn't get wet (this was before diapers) and cover them with the linens so they wouldn't get cold. That way their gowns didn't get soiled or wet if they were incontinent and didn't need a gown change on top of everything else. Another trick is that if the patients are able to get up to the bathroom have them get up to the toilet at the 5am rounds if they have been incontinent or you expected them to be incontinent and the dam hasn't busted yet. They empty their bladders much more efficiently when they actually sit up on the toilet and, hopefully, will be less likely to wet again before you leave.

Linens in the room? What are they talking about? Clean linens or dirty linens? Most rooms have shelves and such for extra linens. As long as the clean linen is neatly stacked, who cares if it is there? Dirty linens are something else. We took a dirty linen barrel as well as a cart with clean linen with us as we went from room to room in the nursing home. Especially on the night shift. I think you can still do that as long as you keep a cover on the thing.

I think the safest thing you can do to protect yourself is insist that someone from the day shift make rounds of your patients with you before you leave to make a point that in each room (1) the patient is dry (or you will change them before you leave) (2) the trash has been emptied and (3) there is no dirty linen and I would make it a point to open the bathroom and have them inspect there as well. Remember this, because when you are someday the charge nurse you may find yourself having to solve disputes like this between subordinate workers. If someone objects and then later accuses you of all this nonsense your defense is that you asked them to make rounds with you and they refused. By the same token, my dear, you should be doing the same when you come on shift. If these people who are complaining about you are the same ones who are leaving you a bunch of messy patients to clean up when you come on duty, make them tow the line as well. I'm serious. When you get to be an RN and in charge, you are going to have to deal with these problems. It's interesting that the nurses in charge haven't gotten involved in this and offered some suggestions like this. Maybe they don't know how to handle it either, ya think?

Anyway, excuse my attitude. Hope my suggestions help. Just out of curiosity, who gave you the "talking to"? The charge nurse? Or, another worker at the same job level as you? When a supervisor corrects an employee it is always appropriate and responsible of them to offer up suggestions as to how to correct the misbehavior. From your post it doesn't sound like that was done. Now, that is bad supervision and management.

[locolorenzo22]

Daytonite, appreciate all the suggestions and advice. Of course, we are trying to institute walking rounds and a few day shifters are not receptive to them, and I guess I'm not too much either. I'm man enough to admit that my own faults there.
However, we cannot double chux with depends....good idea about the gown hiked up a little above the areas. Another tech at my own level, let me know I was being "watched". I'm going to try to watch my own butt for the next month and just go beyond what I should do and do more than that. I guess I just needed a good butt kicking.
On the plus side I get to go watch surgeries tomorrow!!! YAY no research!!!

[Daytonite]

You know, I have a problem with coworkers who take other coworkers aside and say things like this to them. First of all, how does this person know you are being watched? That bothers me a lot. Whenever there was an employee that I needed information about I might have asked questions about them from the other employees, but I certainly didn't tell them that I was not happy with the employee and I was collecting information about them. That's just not the way a good manager works. It promotes gossip and it creates situations where it puts some employees in the position of thinking they are "pets" and the other person is on the "s**t list". That's a bad situation to create among team members. Are you sure these were legitimate complaints coming from the manager? Or, is this just a coworker who is playing a few games here and trying to get a bit of an upper hand over you?

As uncomfortable as it may be, do the walking rounds. After a few times it gets to be routine and/or you develop a trust between yourself and specific coworkers. It's a good way to CYA. This is also a good situation for you to think on and think about what is a priority--poop, pee or debris. Hang in there. We all started out as beginners. We learn from our faults. I learned the lotion to the butt to clean up poop trick from an LPN.

Have fun in surgery tomorrow.

[november551]

We used to do the offgoing/ongoing shift rounds with the other CNAs too for a while until everyone got tired of doing it. People on my shift, including myself, used to get accused of doing the same stuff all the time.

I won't go into too much detail, but unless the DON brings it up or you get written up I wouldn't worry too much about it. You're a guy - you're hypervisible and going to get singled out - especially if your employer is predominately female (which was my situation).

I just got in the habit of making sure everything was pristine over the course of the night and before I left. One of my responsibilities was passing fresh water to each patient in my wing each night - so I got in the habit of doing a thorough visual check of their rooms and bathrooms as I passed water out to make sure everything was straight. Yes it took longer but it was as efficient as I could get. And as you continue you will also learn to complete patient care more efficiently. I remember at first it used to take me 30-45 minutes to do bed baths/dressing/etc but eventually I got it down to ten minutes or less when I learned to stop dilly dallying and fussing over unimportant things (like when a patient is being fussy about something like a bedside table being JUST SO just learn to say NO - they can do it themselves). Once you get your efficiency down you will have more time to do other things.

The faking the vitals thing - There isn't much you can say to that except don't do it. If they don't have proof there is nothing that will happen to you. That's a pretty ridiculous thing anyways in my opinion. Why would someone think that?

Most of the time the RNs silently called bull$hit on a lot of the stuff that was getting blamed on our shift - If anything ever even got brought out in the open beyond gossiping nothing ever came of it. You can deal with it or crack under the pressure. Sometimes you just have to grin and bear it.

I remember when I was under tons of pressure from the nurses and telling an aide I worked with that there was no way I would quit and they would have to fire me if they wanted me gone. That was in the early days of my employment when I was still learning the ropes and felt retarded half the time. The criticism wasn't always directed at me, but often to my shift in general. It just made me feel bad. Eventually I earned the respect of my coworkers, was accepted as part of the team, and they left me alone. The cycle continued any time there were new hires though. That place was a neverending bitchfest.

By the way, I was never ever written up for anything, and I never had a supervisor criticize me. It was always my coworkers/aides from other shifts.

[locolorenzo22]

Thanks, November, your post was just what I needed. I agree that unless my boss brings something to me, then what problem is there?

[november551]

I always thought it was kind of dumb to complain about people being "left wet" anyways. I mean, if a person is incontinent ...they're going to be wet. They're adults for christsakes and they're going to do nature's business. Some moreso than others.

But really, the thing that really got me was that they (day shift) would complain about these wet people. But their job in the morning was to wash them up, get them dressed, etc. So if they were going to change them anyways then what does it matter if they are wet? The shower aides would complain all the way into the shower room that so/so being wet. Ridiculous. Is it in your job description to empty out every single trashcan? Why don't the RNs do it if they are making such a mess, anyways? I'm in my last semester of nursing school and I see RNs on the floor empty trash out all the time. Some people just need to find things to complain about.

Stand up for yourself, man. One time we had this patient take a fall and she was bleeding all over the place. This was early in the morning and the housekeeper was around pretty early. We got the patient taken care of and there was blood on the floor, and I had been distracted trying to help the RN take care of the patient. The housekeeper and a dayshift aide were standing there and the housekeeper said to me when I walked up, "You didn't get the blood off the floor!" The dayshift aide said," You said you were going to do it!" Where I worked we had no cleaning supplies out on the floor whatsoever, except toiletpaper, water, and those dry sani-wipes. There was a blood cleanup kit somewhere but I didn't know where it was. The housekeeper with an entire cart of cleaning supplies, with a MOP and BLEACHWATER was standing there - waiting for me to clean up this obvious biohazard mess with my bare hands or whatever she expected me to do. So I said the first thing that came to my head, "It's not MY job!" They both looked shocked and said, "Oh yes it IS your job to clean that up!" I refused to clean it up, and told them I couldn't because it was the end of my shift and I was going home. The housekeeper said she was going to write a complaint, I told her to go ahead. That morning the housekeeper went crying to the DON about it. I told my side of the story to the DON the next day and explained why I refused to clean it up. Guess what? I never heard another word about the whole situation. I always felt sorry for the DON that she had to put up with all the pettiness.

And if you feel like you are being pulled in all directions, that's normal. Learn to prioritize your time. Sometimes you'll just have to level with patients and tell them that they have to wait for a bit if they want a bedpan / changed. For some of the most frequent bedpan requesters, I worked out deals. They could only call for a bedpan once every hour or two unless it was a dire emergency. Otherwise, they just had to hold it and wait until the pre-agreed upon times (centered around breaks and rounds). Be nice/sweet but firm or even stern if necessary.

Explain to the nurses that you are super busy and you'll help them as soon as you can. Communication is really important on a team. Then there is the last resort option of just not doing what they ask if you are too busy...they'll catch on and stop asking you to do so much and let you do your own job. If you're bending over backwards at their beck and call you're just enabling them to continue the behavior. Whenever I got called out on it I'd just tell them that I got distracted and forgot (never do this over something important, but if they're asking you to go microwave their lunch in the breakroom; feel free to use this tactic). Or make a mental note of their request and group your tasks together. Do the easy short tasks first and then do the more complex time consuming ones. "Do I get water, or do I help Mr Q (whom the nurse woke up when she went to pass meds) get on the bedpan/go to the bathroom?" Well, get the water and pass it on your way into Mr. Q's room. If Mr Q has to wait a few more seconds then oh well.

If nurses from other teams are asking you to do stuff all the time and it is affecting the care of the patients on your team, then you need to speak to your immediate supervisor (the RN/LPN) and explain your concerns.

Don't worry, you'll catch on. For some reason I'm getting the vibe that you're kind of new to this area of the health care arena. Maybe it's because I often felt the same way when I first started too! Now take a deep breath and say, "It's just a job."

[The Bell Jar]

One thing they started doing at my old job was putting the date,time,and initials on people's briefs with a sharpie when they checked/changed them