first three weeks, need some advice.

chouxpastry · Apr 21, 2011

yay!!! congrats on getting through your first three weeks! wow, you're able to change 6 residents in 30 min??? i don't know how you can get much faster...i had the same exact dilemma during post-meal hours, and unfortunately, i had to remedy the situation by changing some residents just before their meal (especially if i was familiar with their bm/output behavior and knew that they probably wouldn't go again afterwards)...it helped lighten the load during final round crunch time. [does anyone have better methods?] as for leaving trash in the residents' rooms and such...again i had the same issue! haha! you can't help it...you're in such a rush that you just forget these things. but as you said yourself, you're catching on. don't worry, you're doing great :) i believe that in time you will get faster/catch onto "time-saving" tricks/get into the groove of your facility :)

zippeh · Apr 21, 2011

well 6 patients assuming their all just wet and not stinky, (if you know what I mean ;]) and if their able to help you move, then its just as easy as 1 2 3. But yeah I mean I'm catching on, and the nurse even said, I told them your new, but just so your aware. It just made me nervous because as I left the CNA asked me if I checked everyone. *Sigh* I know if 2 or more people are dirty, guarantee I get a talk to, but like I checked everyone within the hour before leaving, I know that. We'll see. Btw, thanks for posting :] its always good to talk to someone that went through the same thing.

fuzzywuzzy, CNA · Apr 21, 2011

So if you start doing your HS cares around 7 and you finish at 10 that means that some of your people have been laying in bed in one position, possibly wet, for 3 hours by the time you come around to change them again. So yeah, that's not fast enough, but it's hard to reasonably say that you're "too slow" without knowing the people you have on your assignment. However, I don't think there's a facility in existence that has enough staff to allow CNAs to care for people *without* rushing and/or leaving things out.

Where I work 2nd shift finishes feeding about an hour before yours does, so it's a little different. We have 10 people per assignment and I usually aim to have everybody washed and in bed by 830. That's about 2 hours if you take out the half hour dinner break. That averages 20 minutes a person for care, which sounds reasonable, but a lot of them get less than that because you have to spend time looking/waiting for help with transfers, assisting others with their transfers, answering call lights, and dealing with fussy residents who take up a lot of time. At 8 I change and turn everyone pass the snacks, do some paperwork and chores, and at 10 I do another round followed by more paperwork and chores. My last round I take extra time to make sure the person is pulled up in bed, the room is neat and there is nothing in the trash. If you're scrambling to get people changed during this time after doing cares all night it's no wonder you're leaving trash around.

Some things I noticed about new CNAs, or learned when I was new:

-if you have time before feedings, make sure all your beds are turned down and your supplies are out. Get absolutely everything ready so you can just go room to room without making a ton of stops. Put side rails in position, oral care supplies out, trashbags, washcloths, everything you can think of.

-if you can get away with it, do your shower(s) before mealtime. Same for vitals and walks.

-don't let other people start their cares while you get stuck picking up all the meal trays, answering all the lights, or doing the vitals. Obviously it's rude to the other CNAs to start doing care on people who's trays are still in the rooms, but I have seen both things happen with new CNAs- those who get antsy and jump the gun as well as those who get saddled with most of that work without realizing it.

-don't waste other people's time. If you ask someone for help with a transfer and they come with you, make sure they can immediately assist you with the bare minimum and get back to their own work. On the other side of the coin, don't let someone waste your time either. If they ask you for help and they don't show up right away go back to what you were doing and let them find you. If you ask them for help and they don't come right away find something else to do solo... preferably in the same room if possible so you can get right to business when they come. i.e. get someone next to the bed with a gait belt on, then ask for help. While you are waiting you can start oral care, but if the other CNA follows you into the room you can pop the person in bed and do oral care after she leaves.

-don't do the same routine for everyone. Unless you have a picky resident, always think about what's faster, easier, and can be done alone. It's best to wash people up on the toilet but that's not always reasonable. One person might need 2 people to transfer to a commode but only one person + a grab bar to get to the toilet. For some lift people all they have to do is get raised up in the sling to go. If they go during HS care that gives you more time before you have to start worrying about them being wet.

-put people to bed in a brief if you can get away with it, especially heavy wetters. It is much faster to change a brief than do a complete bed change and having the time to change everyone is better than only doing a few people because you were changing beds.

zippeh · Apr 22, 2011

So if you start doing your HS cares around 7 and you finish at 10 that means that some of your people have been laying in bed in one position, possibly wet, for 3 hours by the time you come around to change them again. So yeah, that's not fast enough, but it's hard to reasonably say that you're "too slow" without knowing the people you have on your assignment. However, I don't think there's a facility in existence that has enough staff to allow CNAs to care for people *without* rushing and/or leaving things out.
Where I work 2nd shift finishes feeding about an hour before yours does, so it's a little different. We have 10 people per assignment and I usually aim to have everybody washed and in bed by 830. That's about 2 hours if you take out the half hour dinner break. That averages 20 minutes a person for care, which sounds reasonable, but a lot of them get less than that because you have to spend time looking/waiting for help with transfers, assisting others with their transfers, answering call lights, and dealing with fussy residents who take up a lot of time. At 8 I change and turn everyone pass the snacks, do some paperwork and chores, and at 10 I do another round followed by more paperwork and chores. My last round I take extra time to make sure the person is pulled up in bed, the room is neat and there is nothing in the trash. If you're scrambling to get people changed during this time after doing cares all night it's no wonder you're leaving trash around.
Some things I noticed about new CNAs, or learned when I was new:
-if you have time before feedings, make sure all your beds are turned down and your supplies are out. Get absolutely everything ready so you can just go room to room without making a ton of stops. Put side rails in position, oral care supplies out, trashbags, washcloths, everything you can think of.
-if you can get away with it, do your shower(s) before mealtime. Same for vitals and walks.
-don't let other people start their cares while you get stuck picking up all the meal trays, answering all the lights, or doing the vitals. Obviously it's rude to the other CNAs to start doing care on people who's trays are still in the rooms, but I have seen both things happen with new CNAs- those who get antsy and jump the gun as well as those who get saddled with most of that work without realizing it.
-don't waste other people's time. If you ask someone for help with a transfer and they come with you, make sure they can immediately assist you with the bare minimum and get back to their own work. On the other side of the coin, don't let someone waste your time either. If they ask you for help and they don't show up right away go back to what you were doing and let them find you. If you ask them for help and they don't come right away find something else to do solo... preferably in the same room if possible so you can get right to business when they come. i.e. get someone next to the bed with a gait belt on, then ask for help. While you are waiting you can start oral care, but if the other CNA follows you into the room you can pop the person in bed and do oral care after she leaves.
-don't do the same routine for everyone. Unless you have a picky resident, always think about what's faster, easier, and can be done alone. It's best to wash people up on the toilet but that's not always reasonable. One person might need 2 people to transfer to a commode but only one person + a grab bar to get to the toilet. For some lift people all they have to do is get raised up in the sling to go. If they go during HS care that gives you more time before you have to start worrying about them being wet.
-put people to bed in a brief if you can get away with it, especially heavy wetters. It is much faster to change a brief than do a complete bed change and having the time to change everyone is better than only doing a few people because you were changing beds.

Thanks a lot, I'll try my best to implement all of these things as soon as I work again. I know that I get a table and roll all my supplies to the hallway, but I always seem to get caught up in other things and just leave it there, even though it easier to just grab stuff from there than go all the way to the clean linens, it'd be easier to actually bring everything to the rooms. I just recently started getting comfortable with transferring people by myself that can't stand up at all, so that helps a lot. I know the number one issue I have is getting vitals and everything done before dinner, because their usually not in the rooms or nursing station. I just need to get everything ready before bed time and find the people to take vitals. (I always get my showers done before dinner). Thank you for you advice! It was extremely helpful!!

Also, I see C.N.A's hook trash bags to the roll away tables and have them sit in the hallways after dinner. They'll have 1 for garbage and 1 for dirty linens. Is this sanitary?

Carolinathe3rd · Apr 25, 2011

you're able to change 6 residents in 30 min???
i had to remedy the situation by changing some residents just before their meal

How do you change 6 people in 30mins?

I am struggling with my speed. Only 1 person was in bed today. I changed him and when I put him to be he was soaked.

Avoid leaving trash by stopping and checking the room before I leave.

Carolinathe3rd · Apr 25, 2011

S
-put people to bed in a brief if you can get away with it, especially heavy wetters.

You change them after you put them in bed? I was told speed up by putting everyone in bed and then change them. Fuzzy I wish I could be as organised as you are.

zippeh · Apr 26, 2011

Its not that hard to change someone, as long as they don't wet through their diaper, you just pull their underwear down, whip them and make sure their clean cause you wouldn't want urine all over the inside of your legs, then most patients can roll very far on their side, making it easy to just slide the diaper all the way under and you don't have to go to the other side to pull the diaper, this makes it easier for the next person to change them also, or.. if you have to change them again. If they poo, then my quickness goes down, although I'm still getting faster since I'm still new, today I had a new hall and I had to get help for 4 out of my 10 patients, ridiculous, but, I'm not going to learn until I am around everyone. :) The best trick I've learned is, take like the top part of the diaper that is clean, get all their poo with it, then take 4-6 whips and get more of the big stuff, then whip everything out with single whips. Fastest and most efficient way I've found so far. (Also, if they've been in a wheel chair for a long time and their heavy urinators, I always put 3 draw sheets down, because you can't change them until their on the bed and most likely their pants are wet, so this prevents you from changing the entire bed.)

zippeh · Apr 26, 2011

You change them after you put them in bed? I was told speed up by putting everyone in bed and then change them. Fuzzy I wish I could be as organised as you are.

Oh, and I used to do that, and it was chaos, it's easiest to just put 1 person in bed, then change them. instead of coming back later after you put everyone to bed. It takes a max of 5 extra minutes, and if your fast, you'll do it quicker. Also, then they won't be sitting in their own **** and feces.

Carolinathe3rd · Apr 26, 2011

Oh, and I used to do that, and it was chaos, it's easiest to just put 1 person in bed, then change them.

Yeh I like doing it all at once. For I almost forgot whom I hadn't changed. Also found if they are wet best to change them quickly or they get their hands in the mess.

Carolinathe3rd · Apr 26, 2011

Also, if they've been in a wheel chair for a long time and their heavy urinators, I always put 3 draw sheets down

I shall try that. For there are plenty of draw sheets. But shortage of bed pads.

zippeh · Apr 26, 2011

I shall try that. For there are plenty of draw sheets. But shortage of bed pads.

I've only used a bed pan once, if their super duper wetters, it would be best to just get a matress pad and put it under them, that way, clean them, take out the pad, and you should be good until you leave. :]]