Fast versus Thorough

It's frustrating, isn't it? A lot of that goes on where I work. There are some aides who will be finished putting their 15 residents to bed by 8:00. These aides are the ones who trained me, so I know their routine - change their shirt, toss them in bed, check/change their brief, and that's it.

On the other hand, there are older aides who do absolutely everything, including range of motion exercises, full bed baths, etc. This would be good, except those aides are a half hour to an hour late getting out every night, which upsets the management because it really adds up to pay that much overtime, and it causes management to crack down on overtime, which negatively affects the rest of us.

I'm somewhere in the middle - I've found a routine that allows me to finish right around the time I need to. I don't get to do all of the extras I would love to be able to do, but my residents at least get washed, lotioned, and their teeth brushed. It's not ideal, but sometimes that's the nature of the job.

While you do sometimes have to cut corners in order to get done on time, there is absolutely no reason to do the bare minimum just to get done early and sit. If you are getting your work done, there is no reason they should complain at you, and I wouldn't take it to heart. We need more aides willing to do the right thing!

Yup. You have to strike a balance and settle for that. If I gave my residents the level of attention I wanted to, I'd have like 4 of them. It feels like the only way to give good care is to do it at someone else's expense. I rush not so I can sit around at the end of my shift, but so that I can do other things that may not get done otherwise. I remember my DON telling me during the interview that the girls all rush to finish their assignments early and there's no reason for that- if it takes you till 11pm to finish putting people to bed then so be it. What she obviously doesn't take into account is that you have other things to do besides HS care. So if supper ends at 6, then I have 5 hours to put 10 people to bed, which means a half hour per person if I want to finish at 11. Unfortunately if everybody is incontinent and most of them can't turn themselves, then I need to be done by 8 so I can change and turn them all within the 2 hour time limit. You can't spend 6-6:30 pampering a resident, then toss them in bed and let them lay there till 3rd shift! Or get someone up at 3 o'clock when you come in and then let them sit there in the chair till 10:30. You'd probably have urine dripping off the chair at that point. And let's not even mention the fact that you're expected to pass drinks, help others with transfers, go looking for help with your own transfers, do paperwork, fold and stock linens, empty trash, clean the showers, and answer tons of call lights. And we all know a few of those residents that ring literally every 2 minutes, or that won't let you out of their room in under 45 minutes. But yeah it's just that simple. The only reason a CNA would have to rush is because she's lazy.

It sucks being a CNA student right now, because we are learning how to do everything right, and our teacher has told us that some of the best care the residents get at the facility i'm studying at is when we go upstairs for clinicals. I'm nervous about finding that balance. I don't like having the spare time to sit at work, but not getting out on time means I miss my bus and will leave me stranded 45 miles from my home. But hearing the horror stories about how neglected these residents are when their CNA's cut corners is disturbing. If that were me or my mother not getting peri care or only getting oral care when they "feel like it" I'd probably flip out.

I'm somewhere in the middle, too. I somewhat take my time so that the resident doesn't feel completely rushed. I always empathize that I would be stressed out and wouldn't be able to sleep either if some stranger just barged into my room, ripped my clothes off in 6 seconds and tossed me into bed, threw the covers over me haphazardly and walked out. On the other hand, I will try to hurry people at times and get things done as soon as is possible. If someone wants to spend 10 minutes washing their face, I'm leaving; they can call me when they're finished. If they're wanting to go to bed immediately or don't want me to leave then we'll compromise and I'll wash their face for them. I get it done quickly but still do a good job without being rough.

I do take longer to get people up and put them to bed, and I do get a lot of flack for it at times. The other CNAs don't realize that spending a few minutes doing something now will save you time later. Like if you let a resident sit on the toilet for a few minutes after dinner (even if they are "incontinent"), they will have a BM then instead of later in their brief. It takes a few minutes for them to sit, but you save time in the long run because you don't have to wipe up their BM and change their brief (and possibly their bedding) in the middle of the evening/night. I know some CNAs only take 2-3 minutes to put someone to bed, but they end up spending more time later having to do the things they forgot to do before/did poorly.

I also try to take my time because I've found my back hurts less. When I'm running around like absolute crazy, I will get stressed out and start feeling it in my lower back. When I'm more calm, I have little/no pain. Running from room to room doesn't get me there much faster than if I had walked.

I'm definitely one of the slower ones at my facility, partly because I am also one of the newest and am still figuring out the best ways to structure my shift to minimize wasted time. I think it's also partially because if the choice is going to the resident next on my mental checklist or answering the call light that belongs to another aide but has been going for a while, I always answer the light. Drives me nuts when my coworkers don't do that, especially if they're out smoking instead of helping. If you're taking multiple breaks each night & still finishing fast, chances are it's because someone else is picking up your slack. Argh!