Question from a third shift nurse....

lindseylpn · Aug 20, 2013

I haven't worked ltc in a long time but, I totally understand. I'm not sure how many residents our cnas got up in the mornings but, It was a lot. We also had a shower team come in at 5a too. They always started with the residents in wheelchairs first, the cnas would get up whoever wasn't getting a shower. I'd say half the unit was up by 6:30a. We even had nurses (one nurse in particular) that half expected breakfast and coffee to be ready and waiting for them when they came in, lol.

nervousnurse, ASN · Aug 20, 2013

Interesting question. At my facility, (where night shift ends at 0600) they start getting residents up at 5:30, then the day shift comes in and gets up all the rest. They don't have time to start showers until after breakfast (and we hope breakfast is on time, since our dietary staff is known to walk out in the middle of a shift).

I used to work nights ---ohhh, how I LOVED nights!) I know what you mean----day shift thinks we do NOTHING :no: This was NOT an LTC/SNF; however, it was similar to one....What we hated was that we'd be in the middle of report, and breakfast would arrive. I always suggested ways we could change this, but the "suits" didn't agree. Night shift was expected to help pass trays. I do NOT mind that, I want the patients to get their breakfast nice and warm, and I don't mind helping at all...EXCEPT....

Our boss didn't understand that ***"JUST help day shift pass breakfast trays, then night shift can leave"*** (and by then it was 7:45 or so, so we'd been there almost 13 hours by then).....usually ended up meaning helping someone to the bathroom, helping them to transfer from bed to chair in room, helping them reposition in bed and open their cartons, chop their food, etc....So now it's 8:30 and we've now been there almost 14 hours. Some night shift (and even day shift) people were fine with slamming a tray down and telling the patient who DESPERATELY needed help to bathroom, etc. "we'll be right back"....nope, I can't do that. If they are half out of bed and needing to go RIGHT NOW and it takes me ten minutes to safely transfer them to the w/c, then onto the toilet , then stay with them to be sure they're safe, then so be it.

THEN, since report was interrupted by the trays, we had to then find a way to FINISH report, but by then, call lights are going off, people want salt/ butter/ more coffee, etc.....But ya know, night shift had just sat around all night doing nothing, so it's okay that we're stuck there until 9 am.....now we're at 14 hours.....and hoping we were done with all the paperwork by then...... :devil:

nervousnurse, ASN · Aug 20, 2013

Brandon, I also want to add that I would like to work in an LTC where the residents wake up, have meals, shower, etc. when THEY want to!!! I know those facilities exist, and I need to work in one! :yes: I hate that some of our residents are FORCED to wake up so early for breakfast when they don't want to. Oh, and we have a few residents who have requested their shower be at a certain time, and SOME staff go insane over that----WHY? This is their HOME, and if they don't want their shower on the RIGID schedule the CNAs are forced to follow, why is it such a big deal to do their shower when THEY want it? :madface:

amoLucia · Aug 21, 2013

Oh, and don't you love it when you have an extra morning get-up for early transportation to hosp for preop or consult appt? Oh, and the early morning M-W-F or T-TH-Sa dialysis? And you still have the regular get-ups.

And, of course, they're all on one poor CNA's lop-sided assignment. And the dialysis pts need a breakfast, too.

Oh, well. Same problems, different faces...

chrisrn24 · Aug 21, 2013

I'm with ya.

IowaKaren · Aug 21, 2013

OMGosh, I don't even know how to respond to HAVING to get people up before 6 AM. No one is gotten up before 6 AM unless they request to be. This is their home. I can't believe any NH still requires that much work to be done that early. I can understand getting someone up between 6 and 6:30 to help out and not just stand around for 1/2 hour but obviously the patient centered care model isn't being followed by all NH's and SNF facilities.

motherof3sons · Aug 21, 2013

Brandon, I also want to add that I would like to work in an LTC where the residents wake up, have meals, shower, etc. when THEY want to!!! I know those facilities exist, and I need to work in one! I hate that some of our residents are FORCED to wake up so early for breakfast when they don't want to. Oh, and we have a few residents who have requested their shower be at a certain time, and SOME staff go insane over that----WHY? This is their HOME, and if they don't want their shower on the RIGID schedule the CNAs are forced to follow, why is it such a big deal to do their shower when THEY want it?

Our facility is working towards this....breakfast is served till 10am and the CNA's try to honor letting people sleep in if they wish. So far is working well.....but I get the OP's point.....our night shift has a whole slew of things to do and it doesn't mean for your shift to do more if one resident is out.

Anne36, LPN · Aug 22, 2013

I feel the same way where I work. The midnight shift is treated as if we have nothing to do so all the busy work is pushed off on our shift, like stocking, etc. We are very busy with midnight meds, a full a.m. med pass that starts at 4 or earlier to get done in time for 6:30 shift report,they want ALL the skin assessments done on midnights and now orthostatic blood pressures of all things! Can you imagine being woken up at 1 am to get an assessment and then sit up to get your blood pressure taken for the second time? Also, we are supposed to do as many if not all dressing changes and treatments. I think its criminal to wake these people up by 6 am. We usually have at least 14 people up on the hall by 6:30 am. The day shift treats us like ugly step-sisters who are there to make shift a piece of cake.There is only time to do the bare minimum nursing care, God forbid anyone gets sick or needs extra attention.

lisaannejo · Aug 25, 2013

I just resigned from a LTC facility where I was the RN for night shift. We had a constant battle with day shift about how many to get up. They wanted ALL the residents up by the time dayshift got there. So the residents were being woken up and dressed at like 3 am so that all 40 some residents could be up by 6. We finally got the DON to listen to night shift, and no one was to get up that early. Can you guess how long that lasted??

Then for the nurses, they tried to implement the 0800 med pass to be at 0500 for the night shift to do it. Uhh, what?? Most, if not all the residents get 10+ meds at 0800 and now you want them to get them at 0500 on an empty stomach with breakfast 2+ hours away? Hmm, yeah that makes sense. I somehow don't think that's going to fly.

ktwlpn, LPN · Aug 25, 2013

I believe it's a violation of a resident's rights to drag them out of bed at dawn's crack unless it's their habit and their wishes. I have known many dementia residents whose behaviors are triggered by simply walking around in a thin nightgown.. I hate to walk on the unit at 6:30 am and see a few of them walking around in next to nothing. We had to implement an assignment for 11 to 7 because this kept happening.It's 4 people who are typically very early risers ,they are to be washed up and dressed when they get out of bed.If they are still asleep then they can stay there.They also have to get up anyone with an early appointment(before 7:30)

Many of the day shift cna's complain if nights does not get someone up-or get someone else up in place of one who is in the hospital.I just ignore it-it's not about making things easier for them, in our case it is truly about what is best for the resident.When there comes a time that we don't have any more early risers then nights will not be expected to drag anyone out of bed,it's as simple as that.

Any facility that engages in the practice of dragging folks OOB at dawn's crack because of staffing issues or leaving people in bed all day for the same reason or putting them to bed at 3:30 pm has much bigger issues,IMHO.

Also,nights does have a short list of chores to do.They do have more down time then any other shift.

ibegyourpardon · Aug 27, 2013

the staff members with that mentality are the ones who have been doing this too long and need at minimum an in-service on how to treat residents. I suppose I'm lucky in the sense that the two facilities I've worked in are on the luxurious side and residents are able to choose the time they get up, choose the time and days they get showers, choose whether or not they eat in the dining room or their private room, can stay up as late as they want if they are interested in a tv program or what have you. One reason why I love assisted living and am not sure I could do total SNF nursing home. It would be hard for me to watch elders get treated like nothing more than an assignment.