cna assignments

[catskillrn]

I am a DNS in an 85 bed facility. CNA recruitment and retainment is difficult. We practice primary caregivers- cluster assignments. This means a senior CNA has the same residents every day. Previously this meant quality, efficient care. However, new CNA's/floaters are having trouble getting done, care is suffering, etc. Now I wonder is it time to rethink the way we assign? Do others practice team nursing? How do you assign residents? Does anyone have any creative approaches? We have minimum staffing requirements, mandatory OT. Days 11 CNA, Ev 9, Nights 5. We also have a hydrator. Sometimes we have a bedmaker. Any ideas would be appreciated. Thanks!

[duckie]

I have 42 residents on my unit and this is how I decided to divide the work load. First I made a list of all the residents, giving each a level of care rating: self, limited assist, etc Normally I have 4 CNA's so I evenly divided each level of care, making 4 sections. It may not be exactly even but pretty close. I take into consideration how much actual care and time a resident would require, for instance, I have one lady that uses her call light 30-50 times in a shift, mostly for "busy work". This resident takes up as much time as 2 other residents so I take that into consideration when planning my assignments. If I have more CNA's then I take some from each list and even out the load. I alternate my CNA's from list to list weekly, this helps keep them from getting burned out on any particular section of residents. It is very successful and the CNA's really like it. I also ask their input if lists need to be changed due to changes in conditions, etc.They do the hands on work and know better than I do what really needs done. Out of our 42 residents, 29 of them must have 2 people to transfer and ambulate, sometimes 3. It is a heavy workload and I try very hard to prevent burnout. Taking care of someone everyday that makes you want to jump out of a window is the easiest way to loose cherished staff members, that's why I alternate the sections. Hope this is helpful.

[km rn]

I work in a 192 bed facility. However, there are 4 units in our facility

On day shift and pm shift, each 48 bed unit is fully staffed with the following direct care staff: 2 charge nurses, 6 CNAs, 1 Transport Aide (transports residents, makes beds, passes water, etc.) and 2 nurses. When we are critically staffed - the CNA number drops to 5.

Most units split up so 3 staff work on the north side and 3 on the south side. Of that group of three - one person usually completes the residents who need one CNA for the majority of their cares, the other two CNAs work as a team to complete residents who are more heavy care in nature. When we have 5 CNAs - the 5th CNA floats to both sides and helps with the residents who need one person assist or are lighter in care.

We used to assign CNAs to a group of residents, but have found that this modified team approach work well - the CNAs feel comfortable working with different residents rather than being fixated on working with 1 group of 8 residents only.

Luckily, we only have 3 CNA openings right now. We are struggling with filling nurse positions (4 open positions) - a third major hospital opened in our area, plus the VA, psych hospital, etc. drain the nurse pool.