not enough CNAs

pinkiepieRN · Feb 6, 2014

YES YES YES - I totally get your problem. We work at least 2-3 GNAs short everyday, due to people on light duty, scheduling conflicts, requests off and call outs. I work as the 11-7 supervisor and the schedule is usually short at least 1 GNA and I get at least 1 call out every day too! We should have 3 GNAs on each unit (34 beds to all 3) and 2 on the smaller unit (28 beds) but it often ends up 2 GNAs to each unit and maybe 1 on the smaller unit. Also, we don't have PRN, agency, or contract staff, so when our staff call out because they're burned out and won't come in extra because they're burned out, the staff that do come in get overworked and it becomes a vicious cycle. So many of our residents are acute fall risks (fall at least 1x/month or are found on the floor) or total care or need to be fed, that there's just not enough time in the day for the short staffed aides to do all of their work! Last week, the DON was helping out with some aide work because we were short on nights and then short again on days, so I believe corners were cut by some aides.

Sam J. · Feb 6, 2014

Sorry for the vent. I just care deeply about my residents, and today was by far the most difficult day of them all. I'm usually positive, and find as many positive points throughout the day I can. BUT
Any other nurse out there who is struggling and at your wits end, not because of nurse resident ratios, but because you don't have the CNA coverage you need to get your job done? How am I supposed to pass roughly 800 meds in one shift, accuchecks and insulin, answer very interruptive phone calls at the worst times from family, answer family questions (who are at the bedside) that are THE LAST PRIORITY on my list when compared to the other residents who truly need me at the moment, not the pillow fluff the family wants, assess residents who have a change in condition, page MD, enter the new orders or send resident out, pharmacy/lab reqs, ....I could go on and on, AND keep all my fall risk residents from falling? Not to mention CHARTING????? I know, welcome to LTC/SNF but there are certain places where they are sooo short in CNAs it makes the facility completely unsafe. Unfortunately, I have to take what job I can get in this over saturated market. Plus, I truly care about my residents, and pray for them all the time that they get quality care.

Families can be your best friends, and make your job a lot easier- or they can be you worst enemies. You said their questions are you last priority- that said, no advice from anyone on how to make your job easier would in fact make your job easier. Might want to rethink working in LTC, altogether.

SleeepyRN · Feb 6, 2014

Families can be your best friends, and make your job a lot easier- or they can be you worst enemies. You said their questions are you last priority- that said, no advice from anyone on how to make your job easier would in fact make your job easier. Might want to rethink working in LTC, altogether.

I did not say ALL family questions are my last priority. Just the pillow fluffing type ones when im clearly busy. And if I meant that they are not a priority at all, I would have not even used the term priority. I also never asked for advice on how to "make my job easier. " I asked if anyone else was in the same boat as far as not being able to provide the care their residents need and deserve because there are not enough CNAs.

Families can sometimes give me the greatest joy on the job. 2 real cases in point. 1 family member approached me the other day with concerns of her loved one not eating and throwing away his food, hiding it. At the same time another family member approached me, interrupting the conversation I was having with this poor exhausted, frustrated woman, and started to say how she wants her loved one to be raised up in bed at exactly 4:30 pm every day. I politely told her I would be glad to discuss this with her once I was finished with the current conversation I was having. I then brought the first family member in the resident's room and proceeded to converse with her for a while on this very important issue of her loved one not eating. I could see this woman was ready to break. She had no idea what to do with her father and some of his behaviors. That was the most meaningful part of my day, allowing her to be heard, and thanking her for bringing this to our attention. She was concerned the resident was losing weight, so I assurred her we would weigh him, call the doctor, start a calorie count, make sure he's supervised while eating, encourage fluids, try and get an order for MedPass (he drank that for me).... She thanked me numerous times. I LOVE LTC. I'm at my wits end at this facility because of how poorly it is run.

NutmeggeRN, BSN · Feb 6, 2014

We have a policy that if a resident is transported someone goes with them and sits until family can get there......really hard to do when

1) youare already shortstaffed

2) you already have someone going with a resident to the MD

3) one of the staff working are on light duty so you really do no have that 4th person....

Sam J. · Feb 6, 2014

We have a policy that if a resident is transported someone goes with them and sits until family can get there......really hard to do when
1) youare already shortstaffed
2) you already have someone going with a resident to the MD
3) one of the staff working are on light duty so you really do no have that 4th person....

One place thought outside the box for this reason, and hired CNAs (they were never pulled to work the floor, however) as activity assistants and for staffing and for central supply- that way there was always someone on hand for transports.

Another option was CNAs that volunteered (not as in volunteered as in not being paid) to come in on off days for transports. But good luck getting that approved from 'the budget'. But missed appointments not only cause more work for many people, they don't help with a SNFs PR image.

whatdidigetmyselfin2 · Feb 6, 2014

This!!! It sounds like you work at my facility! I completely understand how you are feeling because I also go through this while at work. And don't forget about some of the management staff walking around watching you drown, not sitting with the pt that is a chronic faller, then coming and asking how your day was at the end of your shift. :mad: I try to document everything that I can especially on those hectic days when we are short on CNAs just to cover my self in case an issue arises.

SleeepyRN · Feb 7, 2014

This!!! It sounds like you work at my facility! I completely understand how you are feeling because I also go through this while at work. And don't forget about some of the management staff walking around watching you drown not sitting with the pt that is a chronic faller, then coming and asking how your day was at the end of your shift. I try to document everything that I can especially on those hectic days when we are short on CNAs just to cover my self in case an issue arises.[/quote']
Ohhhh yes. Our ADON watches us like a hawk. We have a resident who yells a lot, saying "help!" (Its a behavior, occurs all day. ) I was on my way to her room when I saw a fall risk resident trying to get out of her bed. I walked in the room, got her to sit there for a moment, then stepped outside the room and scanned the hall for a CNA. Right then, the ADON yelled down the hall from her comfortable spot on her butt at the desk to go in and check on the resident who was calling out. I yelled out this resident is about to fall. Did she get her butt up? No. Luckily right then a CNA walked out of a room and I asked him to take care of the fall risk resident. Then I walked into the "yellers" room (she's actually one if my favorite residents; I know she is simply scared.) And what was it she was yelling about? This being a half hour before dinner... "I'm hungry."
I do not by any means think all ADONs are lazy and clueless, so please don't harp on me about this. And I do admit, I don't know squat about her job. But what I do know was that when she was yelling at me to check on the yelling resident, she was showing pics of her dog on her phone to the supervisor sitting right next to her.
All my complaining aside....I do love my job. Every so often I feel "at my wits end" but that's why I decided to be a .8 with benefits instead of 40 hours, so I don't get burned out quickly.

Here.I.Stand, BSN, RN · Feb 9, 2014

I have called out my superiors during times when they need to do more than sit there and be superior. Your ADON sounds like a piece of work, based on this thread and another of your recent threads (which I still need to reply to!)... Once I was working as a CNA in the rehab wing of a SNF; the other CNA had gone on break, and we had multiple call lights going off. The RN was sitting w/ her feet up doing CROSS STITCH. A used a little humor in my voice, but said something like "I need you to help w/ these call lights. I'd love to divide myself up and get them all, but haven't quite figured out how!"

I'm sorry you're having a hard time. I can tell you're extremely frustrated, and clearly care about your residents. I'm sure that for every irritated family member there is, there are 20 that think "Thank God for people like SleepyRN!" I think people are more likely to complain than to express their thanks. Hugs!!

SleeepyRN · Feb 9, 2014

Once I was working as a CNA in the rehab wing of a SNF; the other CNA had gone on break and we had multiple call lights going off. The RN was sitting w/ her feet up doing CROSS STITCH. A used a little humor in my voice, but said something like "I need you to help w/ these call lights. I'd love to divide myself up and get them all, but haven't quite figured out how!"[/quote']
I would LOVE to hear what the nurse had to say. That sounds like you handled it perfectly.

TheCommuter, BSN, RN · Feb 9, 2014

This is the reason why I preferred night shift back when I worked in nursing homes. The families typically were all gone by 9:00pm, and the stupid phone calls stopped at about 10:00pm, leaving me free to do my job without questions and constant interruptions.

Night shift might shorten your life expectancy, but it is worth it to me!

SleeepyRN · Feb 9, 2014

The irony of this post is that tonight we were short nurses. Pm shift. 3 halls. 2 nurses splitting one of the halls. This is a psych/skilled unit. Extremely challenging. So I was to have 55 residents with trachs, g-tubes, wounds, plenty of accuchecks, so so very many scary fall risks. The 2 ADONs refused to come in as well as the other supervisors. Luckily!!!!!A nurse came from the easier (a&0 × 3) first floor after the first 2 hours of this 2 nurse disaster on our floor to be the 3rd nurse on our unit. (Still leaving first floor understaffed in RNs)I stated I don't know squat about ADONs. But I know I don't want to be one. Because a competent one should have viewed the scenario as an unsafe environment for residents and staff and have done ANYTHING to make sure each unit was covered.

The ADONs get on us nurses and the CNAs about petty things, then go and leave their building, their residents, understaffed? We nurses talked about calling the state. The staffing is in such chaos.