My new job in nursing home

RNGriffin · Feb 17, 2014

Hi, I'm RN, works in home health before. I just started night shift in a nursing home, per the nurse who oriented me, I need to help the CNA changing the patients as part of my routine since there is only 1 CNA. This floor is 28 beds all dementia, I felt confused why changing the patient is a routine for nurse? i can help them out for heavy patients if I have time, but I 'm new to this floor and I have to watch my time to finish my things. Is this an unspoken rule for nursing home? Thanks for any input!

No matter what facility you are in, ADL(s) are also apart of your job. To be more exact, maintaining patient's hygiene and skin integrity is part of your scope of practice and is defined in the nurse practice act.

It baffles me why some are against touching the patients. This is the best time to assess your patient's skin.

Put your blue( non latex gloves) on and help your CNAs

If the facilities were to rid some nurses of tech and CNAs, I would be fearful of the patient outcomes.

nynursey_ · Feb 17, 2014

No matter what facility you are in ADL(s) are also apart of your job. To be more exact, maintaining patient's hygiene and skin integrity is part of your scope of practice and is defined in the nurse practice act. It baffles me why some are against touching the patients. This is the best time to assess your patient's skin. Put your blue( non latex gloves) on and help your CNAs If the facilities were to rid some nurses of tech and CNAs, I would be fearful of the patient outcomes.[/quote']
I completely agree with this post.
I wasn't a CNA prior to becoming an RN, but one of the most important things I've learned since becoming an RN is that extremely detailed assessments can be performed by assisting with a patient's ADLs. So much valuable information can be gained simply by toileting and changing your patients. Please consider how important this info is to your practice. I think you'll be pleasantly surprised.

Here.I.Stand, BSN, RN · Feb 17, 2014

This floor is 28 beds all dementia, I felt confused why changing the patient is a routine for nurse?

Because hygiene care is part of nursing care, and because this would be completely unreasonable to ask 1 person (in this case, the lone CNA) to do alone.

j0yegan · Feb 17, 2014

I hear ya. We have our own nursing duties to deal with and just don't have time to change every single patient 2-3x a shift. If there are heavy patients, we will help change them. As for the others, the CNA is the one that changes them most of the time.

micstn · Feb 17, 2014

Thanks guys...

NurseNightOwl, BSN, RN · Feb 17, 2014

While I agree that personal care is definitely part of nursing care, this is also a way for the facility to get around hiring enough CNAs. I worked in this exact position, and frequently the CNA would call in (and for some reason was never fired even with the absentee paperwork being completed faithfully) and of course no one is willing to come in for night shift when you call around. Very unpleasant experience!

When my CNA was at work however, I never minded doing my part. It just made it difficult to complete any unforeseen or unexpected tasks that would come up, because all of your otherwise extra time is already taken up.

Sam J. · Feb 18, 2014

It's too difficult for one person to change some patients, and not a good idea for many confused or demented or combative patients, anyway. The time you spend helping will make the rounds go faster, and save you time on IRs for falls, bruises, skin tears, and etc. You can also use that time to give some meds, do skin checks, do treatments, and other 'nursing' tasks. Not to mention impressing the CNA? If you consider every patient, there probbaly aren't that many, anyway, that really require two people to change or toilet- make a list for the CNA, and take care of those patients first, then let the CNA do the others? I don't imagine a 28 bed unit would ever have 2 CNAs at night, so might want to think out a plan for your night that includes assisting your 'assistant'.