not comfortable yet...

I have never worked in a place where I was assigned to pts. alone but I would do as much as I could alone,since its required at your job, but I would absolutly ask for help if needed. Especially with the combative ones. Im sure your charge nurse would rather you ask for help, than to risk getting hurt or hurting the pt. Combative ones can end up with so many skin tears just trying to change a brief.

Just jump in and do the best you can. Do as much as possible, then if /when you need help go ask. I've been doing this for a little over a year now, and that is still how I handle things.

For example, you need 2 people in a room to operate a lift. Don't go ask someone for help, then when they get there, run out for supplies. Get them dressed, cleaned up, try to get the lift pad underneath, lift in the room, make sure they are safe, then run and ask someone. If you tell them the resident is all ready and just a matter of transferring then they will be more likely to help.

That example may not be something you will be doing exactly working on nights, but you see what I'm trying to say.

If you are EVER uncomfortable or feel you are lacking in a skill, go get someone to show you how. Not that you are, but trying to be macho and handle it yourself risking the residents safety could end up in disaster! Life or death if a fall is bad enough.

We work in pairs mostly at my facility. There haven't been a lot of times that I absolutely had to do something alone. I know I can, but we have EXCELLENT teamwork where I am and provide each other a lot of support. It makes a big difference. Be willing to help others and they will help you.

I have been in the same situation! 3rd shift, alzheimers floor, all by myself. I had combative residents as well and I was sooo uncomfortable. But you really just have to have a positive attitude, do your best, and get it done. It feels good to accomplish a challenge on you're own! And for the most part, 3rd shift is pretty quiet since most everyone is sleeping. What I did was:

Got a thorough report from the CNA on 2nd shift. Without saying that I was uncomfortable..I asked many many questions about each resident and suggestions on how to handle them if certain obstacles arose. I made sure I had plenty of supplies in each room and went ahead and laid out briefs, gloves, wipes, etc. that I would need to change everyone. The charge nurse was for the most part downstairs the whole time and only came up to pass meds and give me a break. So I would set a time with her to help me change the combative ones. I would change everyone that was "easy to do" first and save the combative ones for the time the nurse would come and help. Like Dondie said, get your residents prepared as much as you can before you ask for help. Never be afraid of asking for help! It is better you ask and learn the right way and be able to do it again by yourself, than it is to shy away and always have to depend on others.

As for the combative ones: I have found that the only time they have become combative, is when they: don't know what you are doing to them, rough or impatient CNAS, or they are in pain and can't express it verbally. My trick is to calmly come into their room with the biggest smile you can give, go up to them (on their level) and give an affectionate touch (gently hold their hand, etc.) while calmly explaining what you need to do and why. I sometimes add in compliments on how they are looking or on some personal belonging in their room like a picture. Give reassurance such as, " It will just take a moment and then I'll be out of your hair," or "You're doing an excellent job helping me!" (if they try to assist rolling over, standing up, etc.) If all else fails and they start to become combative, get them situated in a safe position or place and walk the h*** away! Call the charge nurse and get their help. Don't take it personal either because if you were doing all the right things, the behavior has nothing to do with you. Good luck, jump in there, and like the Nike slogan says, JUST DO IT!

As far as drama between aides try to stay far away from it. I always try to avoid the drama and I keep my mouth closed about other aides and nurses because people love to talk and I do not want anything I say to be repeated. It is easier said then done but I would just stay out of it. I am much happier without the drama.

I think it takes awhile to feel comfortable with a new job and with new residents. Sometimes with Alzheimer's residents you can tell when they are escalating and know that it is best to avoid them. There has been many times I was getting no where with a resident and have left and come back in five minutes and they are a different person. Sometimes it is all in your approach. I have gone through showers singing to patients, dancing, etc looking completely ridiculous but it makes the resident calm. If the resident needs their brief changed and they are combative and you have tried many techniques and they do not walk grab another person and get help. Hope this helps.