Staff eating with residents

weirdRN, RN · Apr 14, 2006

Our facility is very similar to yours with regard to the supper breaks. The CNAs NEED their breaks AWAY from the residents. They need to get off the floor as much or more than I do. The best way is to tell the CNAs that their supper breaks need to be later in the shift. The kitchen can set their trays on a covered Cart in the break room and get the soiled trays from that same cart in the AM. The CNAs can Microwave their meals and everyone is safer and possibly happier.

rehab nurse · Apr 14, 2006

pt's and residents falling right after dinner is a issue at our facilty as well. here, our CNAs usually take 15 minute break right before dinner, then take lunch break 7pm or later. our cna's usually do not leave until their pt's are either laid down or at least ready for bed. i usually request that all the high fall risk residents are left near the nurses station so they can be monitored by the other cna's not on dinner and/or the nurses as well.

like previous poster said, staff needs their time away from the residents.

MissJoRN, RN · Apr 14, 2006

When I was a 3-11 CNA our breaks were 4-4:30 and 4:40-5, before resident dinner. That seemed to be the routine at most of the LTCs I went to as agency, too. I guess it worked for the reasons you cited... dietary was already there if we were buying a tray, ne interruption with resident meals, we could all start our PM care lists after dinner, etc. Personally I just didn't like eating so early and was the type of worker who had a hard time leaving my assignment during PM care for that much needed 15 min break. No CNA is going to "cover" another while he or she is trying to get through their own resident list, answer their own bells, etc. (doesn't say much for team work does it? Also never changed from facility to facility) So if I really busted *** I got my 15 min break late, just before 10:00 rounds. If not, no break (you know, the "too bad, so sad" shrug shoulders attitude) Of course I guess if I skipped washing a few faces or cleaning a few mouths, I could have had a 45 min break like some collegues I do think if my meal was later, and scheduled, and was expected to be covered (there's the key!) I would have really enjoyed the timing... and 6-7ish is when I needed a change of scenery and noise level.

I do private duty homecare now, and let me say you don't want to eat with your residents! I can accept eating at the desk in a facility as fine (not ideal but OK) but I really don't enjoy my meals in homecare. I can never just sit down and eat, let alone breathe or look over the paper or chat like I liked to in a facility (even at the desk) I am always up and down because my clients always have little needs that can't wait until I just finish my peas. And of course, I need to wash my hands after every little "need" before I touch my food again! Even just having an autistic kid "in my face" asking questions annoys me while I'm eating but I can handle the other "7 1/2" hours. Especially "Are you done yet? - Now are you done? - when will you be done? - what are you eating? - Can I smell it? - How much more do you have?" Granted you don't have autistic kids, but I remember the adult world and some of them will be just as tough on you!

Legally, you are entitled to a 30 min break away from your work area... they can't require you to eat and attend to residents at the same time, so I'm sure they won't let you either.

My "la-la-land" opinion/solution: I know from homecare that there are some moms and nursing students who would like a short evening shift after kids are home from school and soccer or classes are over... but before the kids head to bed, or homework gets finished. I loved my PM care visits... I'd bop through a seniors apartment to get a few clients settled for the night, then back home. I was usually out from 6-9 or even 7-9. Just enough to make a few dollars but not really interfering with my weekday life. My point? I wish nursing homes and hospitals would take advantage of these types of people who don't want/can't "commit" to a job and use them to give "staffed" breaks. If someone came in and took 4 residents for an hour, then went to another floor for an hour... wouldn't that help you? A win-win situation, I think, that would cost the facility, what, $15 per floor per day/eve shift? (lets pay this aide a little extra for the drive) To ensure safety and decrease burnout?

Antikigirl, ASN, RN · Apr 16, 2006

Where I worked, breaks were scheduled per service area to provide a break with coverage starting an hour and half before meal periods were to begin...so that residents would have full CNA coverage during and after meals. That worked out well...and the working times were set that those times would be on time for a break at the half point or close to!

If a CNA was busy, the other CNA took their break...but typically our CNA's knew those service areas very well, and only worked in two of those areas in their employement so they could really tag team! They knew the schedules of their residents and had it down so most got their breaks on time!

And me, as their charge nurse made SURE they got them (and I would help out), and that they were NOT disturbed during that break unless it was a life threatening emergency! LOL, sadly they usually couldn't do that for me...LOL! (one nurse only per shift...so I was basically at the hands of fate if I wanted a break).

The trick was total teamwork though! You really had to be a team player for this to work out for everyones best interest...and thankfully for the day shift...we worked as a well oiled machine and always looked after eachother!

vampiregirl, BSN, RN · Apr 16, 2006

At the LTC where I am a CNA, typically 2nd shift takes dinner starting ~7pm. Not everyone goes at once, so there is always coverage. Most of the residents are out of the dining room by 6pm - 6:15pm, so that leaves sufficient time to do after meal toileting and ensure that high fall risks are safe (either in bed, involved in an activity, or in a location where there is staff able to supervise). An aide from another unit was responsible for covering call lights (ususally it's a I'll cover your hall during dinner, and you can cover mine while I'm at dinner situation). The nurses also will help with urgent resident requests as they are passing meds on the units at this time. They can also page for a CNA from another unit to come assist if a resident has a need that can't wait. Some evening we get really lucky and activities is offering a activity after dinner too. As for the meals, if a CNA wants a meal, it's on a covered tray and can be reheated. At the end of the shift, all the trays are taken to a designated area.

Megsd, BSN, RN · Apr 16, 2006

I was always told that eating in a resident area was an OSHA violation and not to do it. Besides, like others have said, having time away from the hussle and bustle is really important for one's mental health. I worked first shift for a while and our lunches were 10:30-11:00 and 11:00-11:30. I could never get everybody toileted by 10:30 and it always seemed like they had appointments, bingo games, etc. during this time of the morning, plus everyone had to get ready for lunch at noon. There is really no "good" slow time to take your break... the other staff just needs to pitch in and help out while you're gone.

donmomofnine · Apr 20, 2006

As part of culture change at our facility, we are looking at permitting staff to dine with residents, not as their "break" time, but as a social thing. How many residents say to staff who are feeding them or serving them, "aren't you going to eat?" That camaraderie and shared time could increase meal consumption for some residents. In fact, we would like to have the residents participate in some of the meal preparations. It is not an infection control issue.

CapeCodMermaid, RN · Apr 20, 2006

As part of culture change at our facility, we are looking at permitting staff to dine with residents, not as their "break" time, but as a social thing. How many residents say to staff who are feeding them or serving them, "aren't you going to eat?" That camaraderie and shared time could increase meal consumption for some residents. In fact, we would like to have the residents participate in some of the meal preparations. It is not an infection control issue.

DONMOMOFNINE, I've read enough of your posts to know you work in a faith based center where there are no full codes, etc. The state of Massachusetts would never permit staff to eat with residents in a skilled facility.

Inquisitive one · Apr 21, 2006

My facility is also becoming involved with culture change and it is not a faith - based facility and we do have full codes as well as Rehab patients. It is for profit and not part of a corporation. The way of the future in long term care is culture change and many of our staff have been attending seminars related to change. The easiest way to change is to start with something small and having staff eat with residents won't take much effort at all. Staff will not be denied their break but they will take it later than they do now. It would involve may be 1 or 2 CNA's per unit, those who are not at an assisted feed table. Staff trays for those eating with residents would come up on the food cart and the meal would be free for them. There will be kinks to work out at first. Donmomof nine, what has your facility done to promote culture change? As for breaks, the law states that if you work more than 6 hours you are entitled to a 30 minute break. Any other breaks are freebies. Where can I find the law in Massachusetts that states that staff cannot eat with the residents? Sometimes just because we do something or not allow something for a long time it becomes "law". Anyone else work for a company that is forward thinking and starting to make changes for the good of our residents and their families?

Noryn · Apr 21, 2006

It is sad that long term nursing is in such a state when we have to go to these kinds of extremes to cover up the real problems--lack of staff. I adamantly disagree with letting staff eat with patients. There may be a few independent patients in nursing homes but in my experience most are really dependent on staff. When I worked long term care I had to feed 2 people at the same time--I dont know how I would add myself to the mix. If I did eat it would be rushed and wouldnt be very pleasant.

I say that but there is no way I would eat in that environment. Hospitals and nursing homes are full of germs--despite the care that the patients recieve along with housekeeping there is still VRE and MRSA floating around. I bet OSHA would have issues with feeding yourself then feeding someone else without washing your hands. Also what about foods such as hamburgers or fries that you generally do not use utensils for?

Even ignoring all the other problems, I have seen many bad things in my life. Still I dont have the stomach to eat in that environment. God bless our patients, dementia and strokes are cruel, these are mothers, fathers, sisters, brothers and spouses but those disease processes are horrible. Coughing and sneezing are frequent and they are no longer capable (mentally or physically) of covering their mouth, they drool, they grab and touch, etc. They cannot help it but it really isnt an environment that someone should eat in if they dont have to. And I may very well be in this situation one day, if so I would not want my caregiver to have to eat with me.

Of course it will depend on the patients and facilities, assistant living may not be that bad but in most long term facilities I dont think this would work. If I were you though I would call the long term surveyors and get their input on this.

donmomofnine · Apr 23, 2006

Donmomof nine, what has your facility done to promote culture change?

Well, attended a lot of seminars! Actually, we have a wonderful spa program. We have dining that is steam table service for lunch and dinner where nursing, dining and housekeeping work together to make a better dining experience. Next month we are going to have a come and go style breakfast so residents can wake up when they want to. It is a hard journey into resident centered care, but well worth it, I think! We are going to begin construction on a new nursing facility with all private rooms and each cluster of rooms having a great room with cooking facilities. It is exciting!