Flustered new CNA, in desperate need of tips on how to get everything done

Nursing Students CNA/MA

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Hello,

For the past three years I have wanted to become a CNA, but never had the opportunity to switch jobs. The time finally came and I was so excited! I studied my CNA skills nonstop, and passed my state test. I plan to start my LPN next September, and always felt that a good nurse is one who is willing and able to do it all. However, from day one, this job has challenged me. Let me start off with that the challenges have nothing to do with wiping butts and doing all the dirty work, but just on how to get it all done on time. The staff never really seemed to want to explain much in training. I find that people are constantly yelling at me and I feel like I am being pulled into four different directions. For example, after dinner almost every single resident wants my help getting ready for bed at the same time. I am polite and explain that I will be with them next, but some just freak out. Then in the middle of helping someone to the bathroom and getting their pajamas on, a nurse or another CNA will come find me to be like "Joan has to go to the bathroom". Knowing that the current resident I am working with takes at least 15 minutes to change into PJ's, put brief on, brush teeth, pull wheelchair out of bathroom and over to bed, and lift them up onto the bed, fix their sheets and such....and that's only if the resident doesn't start making me hunt stuff down in the room. I have one resident, who every night, has me searching for things (bag of candy, bottle of lotion, ect.) I feel as though a few of the nurses just expect me to do 15 minute jobs in 5 minutes, and don't realize how the residents are slow and confused. Tonight I had a resident who was supposedly having a reaction to some medication, and it was like he was on some LSD trip. He was hallucinating nonstop and thought people were breaking into a window, only he was referring to the hallway. He also kept trying to get up out of bed, even though he can't walk, and he would end up diagonal on his bed, so I would have to ask someone to help me straiten him and boost him back up. I fixed him twice, in between taking care of other residents. I was walking a resident to the shower room and noticed he had done it for the third time, and I called down to the nurse and explained how he might fall out of bed, and she told me to start the shower and leave the resident in the shower alone and go and fix the guy in bed all by myself. The lady in the shower was completely independent....but it's still not the point. she wanted me there to wash her back and help her dry off...and then I have to deal with that guy hanging out of bed....and all the nurse does is just give me a dead look. Is this job challenging for all new CNA's or is it just me?

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I'm a CNA at a not so well run nursing home. It isn't a house of horrors, but it sure isn't perfect. I have 9 people on my hall that need constant attention. There are a few extra people that take care of themselves. I am fast, efficient, and I know what I'm doing. I had one resident screaming at me, another that was mildly upset at me because she wanted to walk her, several wet residents that needed changing throughout the day that were bed or wheelchair folks. I had very little help from the other CNA's that night and I got all my work done. I just make a list of what needs to get done and my hourly checks. I try to hit every room every hour. If its just peeking in the door I do that. You gotta have a system and the whiners have to wait. There is no way to set down what you are doing with one resident and take another resident out to smoke right when they want to. It is also unsafe to leave a person alone in a wet shower if you are there to help and insure their safety while bathing. I would have told the nurse to straighten the guy up in bed herself. When I'm bathing someone everyone knows and they will answer my lights or choose not to. Sometimes they choose not to and that is not my problem. I answer their lights when they are bathing. The main thing I learned working in a nursing home over the past year is to not do any more work than you are assigned. You can not possibly take care of every resident in your facility by yourself. You are doing a disservice to the ones on your hall if you try to. I will answer a light now and then on another hall if I am bored or if it has been going off for a long time. Not everyone will help you if you ask, but it helps to observe what others do and get help with a resident you are not familiar with. I just do what is expected of me and I always do things as safely as possibly and I take as much time as I need to get the job done.

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Specializes in LTC.

That's second shift for ya. They ALL want to go to bed before supper is even finished. How long have you been working there? It takes a while to get used to it, and you'll start picking up tricks along the way, but even the most seasoned CNAs get stressed out sometimes.

After a while I ended up with a system for every assignment. Part of that was specific to the residents, but I can share some things that can work for anyone:

Lay out everything you need before dinner. Take down the bed and get every *possible* thing you will need at the foot of it. There will be no searching later, or stopping to wonder if you forgot something.

I would get to work at 3 and we would change everyone. Normally no one would change anyone again until after dinner, but dinner came out at around 5:30 so by then my heavy wetters would need to be changed again so I would sneak off and change them right before the meals arrived. Then I could "save" the HS care on those people for later because they'd been changed more recently. Most of the other CNAs didn't worry about changing people 4x a shift like we're supposed to, but I do, so it gave me peace of mind.

Don't be that girl that runs around answering everyone else's call lights if you're not working with people who would do the same for you. At the end of the night you'll have nothing done, and those same people won't help you. You are most responsible for your own residents-- don't shaft them. It's the same thing when people keep interrupting you to do things. If Joan has to go to the bathroom just say, "Ok I'll be done shortly and I will go there next." If someone needs your help with a transfer, give them a timeframe (5 minutes? 10 minutes?) of when you can meet them. Then when you help them, ask them if they can help you with your next resident in however long. Communication is the best way to get things done. I always tell my coworkers what I'm doing. And if I need help and I ask someone, chances are, they're in the middle of something, so I'll stay and help them finish up. That way it gets done faster and we can go directly to my person's room without wasting any time or allowing that CNA to "get distracted" from helping you.

Some of the residents will tolerate being put to bed and washed up later.

I always put the pads low on the bed, and cranked the person's feet up. Then they're less likely to slide down and if they do, the pad won't end up under their neck and you won't have to fix it/change the whole bed. We're not supposed to put briefs on people at night but I always did it up until last rounds.

After you wash someone leave a couple washcloths at the end of the bed for a quick incontinence cleanup later.

Don't get caught up searching for things for the same resident every night. I have a few of those and usually I'd try to either save them for last or get them out of the way first. And when they start making you look for things you just have to tell them you'll do it later and get out of there. They are just doing whatever it takes to keep you in the room. Sounds mean, but your other residents have needs too.

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Specializes in LTC.

Sorry about all the mixed tenses. I work in a nursing home but I haven't done second shift in a while.

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Thanks, Fuzzywuzzy!

I liked all of your tips, especially about putting the pad low and cranking the feet up high. I have only been doing this for 2 months now. I think my biggest problem at this place is that some of the nurses will ask me to answer other people's call lights, and I end up getting stuck in the room for 10-15 minutes, meanwhile, my call lights are going off. Then, my nurse will just give me weird and sometimes dirty looks, thinking I'm slow at answering my own lights. It also bothers me, cause I try to get everything done, which is why I'm running around like a chicken with my head cut off. One of the other girls who has worked there 4 years, and also gets favored by mgt, told me last week she was only going to give one shower b/c she didn't feel like doing the other two. Also, when she trained me, she wasn't changing people every two hours, just mostly right before the next shift came in, so it looked like she was doing her job. I feel like everyone else there is allowed to cut corners, and me the new and inexperienced person is expected to do it all. I was thinking of trying to pick up a few first shifts, but was told it was even faster paced due to people having to be up and at therapy,,,,and they cannot be late. How long have you been a CNA? At what point would you say, you felt like you knew exactly how to do your job?

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Oh, and I forgot to mention, that I mostly work in the Rehab section. This means that the residents are not long term where I am scheduled...they are only there for around a month...some more, some less. So getting a routine for those folks is a little more difficult. I would like to work upstairs with the older, long term residents, but the same girls get the same sections daily up there. I worked up there a couple times and the girls were VERY mean to me. I was told by other employees that it is much easier up there, and no one wants anyone else taking their section, so new people get treated poorly by them. It is like being back in high school if you work up there. Management tries to deny they put people in the same sections, b/c our DON wants the sections rotated, so the entire staff is fully trained and capable of working with all the residents. I'm wondering if I should just look for another job, but I don't want to be a job jumper, plus I get medical benefits in another month. Oh, is full time in a nursing home really only 30 hours a week? I was told it was 40...but I only get scheduled four, eight hour shifts. Some of the other girls get 40 hours.

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Hi missvickie! :)

I started out on the rehab side, just like you! I know it gets crazy because like you said--the rehab side is not long term. At my facility they are patients, not residents. The rehab side was all about "customer satisfaction." There is a lot of pressure to get things done in a timely manner so that satisfaction surveys don't tank.

Anyway, my advice to you is to ask questions while you're taking report. Ask the previous shift's CNA who takes the longest to get ready to do anything, who has to toilet constantly, if any of the patients seem to be confused, etc.

It's harder to learn a routine when these patients are not there long term, but if you have the answers to those questions, the rest will fall into place!

Sometimes I set up people who take forever to get ready for bed-- I tell them (if they're not confused or a fall-risk) that I'm going to be right back, but in the meantime..."How about you brush your teeth and wash your face while you're waiting for me?" And of course, come back.

Don't give up-- the first few weeks are not easy! But once you get used to it, you'll do great.

All the best!

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I think when they figure out the staffing ratio at LTC facilities, they figure what are the maximum number of residents a competent CNA can safely take care of, then they add an extra resident or 2 to that number.

Im only partially joking too.

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I think when they figure out the staffing ratio at LTC facilities, they figure what are the maximum number of residents a competent CNA can safely take care of, then they add an extra resident or 2 to that number.

Im only partially joking too.

Throw a couple of idiot CNAs into the mix and you have your typical LTC. Most of the people at my old facility worked just fine; there were the one or two bad apples who didn't do what they were supposed to do and caused us all to fall behind.

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Specializes in CNA.

You need to delegate on terms of immediate importance, such as "code vs. find my lotion."

Alternately if there are no such "terms of importance" like for example, "find his lotion vs. find her toothbrush" then do it in the order it was asked.

Be through, do work that you are proud of and learn from this situation, both "clinically" and as an example of what to be weary of in future job hunts.

I have 2 years of Aide experience and am starting Nursing school in January and I believe it when I tell you (and I hope) that getting your chops busted now will pay dividends in the future.

Keep your head down and stay focused.

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Don't be that girl that runs around answering everyone else's call lights if you're not working with people who would do the same for you. At the end of the night you'll have nothing done, and those same people won't help you.

I agree completely. I used to dread working with this one lady who I'll call "Susan". She never answered her own call lights, and I felt bad for her patients. So I helped her. This became a habit. Every. Friday swing shift.

What ended up happening was that this woman would sit in the break room for nearly two hours, munching Cheetos and reading a magazine. When it was my turn to go on lunch break... Guess what? She ignored all of my lights AND her lights. Patients complained, staff complained. Needless to say, she didn't last very long.

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Thanks everyone, for the great tips. I'm glad to know that other people had frustrations somewhere along the way too. Some days are better than others, and I'm just trying to keep my eye on the big picture....I need to get at least one year experience, and also receive a paycheck to pay my bills.

If anyone else feels like sharing horror stories involving their work experiences, feel free :)

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