First week on job/night shift/wants me to start rounds later?

Posted
by camci Member

I just started my first nursing home job (rehab) and so far the night shift is very easy, the staff and nurses really like me and commend how I care for the residents and that I go in and talk to them before every shift instead of sitting down watching tv waiting for a light.

We're supposed to do a round every 2 hours, but every cna and nurse told me that if I wake the residents up every 2 hours they wont get their rest and will give the morning and evening staff a very, very hard time. So they told me to do atleast 2 rounds if I can.

My CNA orientators from my first 3 days told me to start my round a couple of hours before the end of the shift (6am) but i've been starting at 3am, get through my 20 residents, and then start on waking up who I have to get up that day, and as soon as I finish it's exactly 6am. But the other night, a cna asked me why I was starting so early and he told me that starting that early there might be a resident wetting his diaper right before I leave and the morning shift might think I didn't change him at all.

But if I start at 4:15 like they said, I might not be able to finish in time because i'm not as fast yet like the other cnas and the people I wake up are very heavy and I have to get them on the sit and stand which usually takes 20 minutes each, and I also have 2 heavy residents I have to change in the middle of the night and usually no one is around to help me so it takes allot of effort and energy to get them on their side because their entire body covers the draw sheet.

Any advice? How do you guys do it?

WandererRNBSN, BSN

Specializes in LTC, Med-Surg, Special Care, Postpartum. Has 9 years experience. 16 Posts

I say do whats works for you. When i worked in LTC, I would do walking rounds with the shift leaving. then between 1 and 130 I would do my first round. and i would do my second rounds around 3 or 3:30 and by the time i was finished with that round it would be close to time to do my get ups. Once you get to know your residents, you will know which one's are heavy wetters, or need to be changed more often than others. There would be some that won't need to changed first rounds consistently but by last rounds will be wet. Also you can also do rounds when you come in and make sure everyone has went to the bathroom if they need to go, if you don't do walking rounds with the shift before.

Edited by kale724
just left out some little words :-)

caliotter3

38,332 Posts

We did our first rounds to check that the doors were locked and to get a look see with the residents. Many were found to be needing a changing already because PM shift was lax and it was obvious they had not done their last rounds. If you have to start at 3 for your last rounds, that is too early and some will pee before you get off. Try to work on getting it together like kale says. Look at your watch and cut your start time by five minutes every week until you get it down. We worked in pairs so were able to start last rounds at 5:30 or 6:00. This would be your goal if you had someone to work with you. Just do your best and you will find that you get faster as time goes on.

yousoldtheworld

Has 5 years experience. 1,196 Posts

I'd definitely wait and start at 4, because if your dayshift aides are anything like ours, they would love to have an excuse to get a third shifter in trouble. I know it can be hard, but you will gain speed in time.

We have 18 total care residents each at my job, and we have to four rounds...yeah, sometimes one set of rounds takes the whole two hours.

That's the fun part of 3rd shift. The other shifts think you don't do anything but sit on your butt all night, and will give you a hard time if things aren't perfect.

I'd definitely wait and start at 4, because if your dayshift aides are anything like ours, they would love to have an excuse to get a third shifter in trouble. I know it can be hard, but you will gain speed in time.

We have 18 total care residents each at my job, and we have to four rounds...yeah, sometimes one set of rounds takes the whole two hours.

That's the fun part of 3rd shift. The other shifts think you don't do anything but sit on your butt all night, and will give you a hard time if things aren't perfect.

Hey that's interesting. There seems to be a prevailing attitude that the NOC shift (3rd shift) has time to sit around on their *sses because everyone's asleep and don't really need much care.....when the truth is most NOC shifts have chores to do along with their rounds (such as in our facility they clean wheelchairs and sanitize commodes, bedpans, and urinals) as well as deal with behaviors that only come out at night. Then the day shift comes on in the morning and....yeah they think the NOC shift people are a bunch of slouches because they actually still have to toilet and change people when they get there. :p

yousoldtheworld

Has 5 years experience. 1,196 Posts

I know, right?

At our facility we have to clean wheelchairs, fold and put away laundry, clean closets, and pack school/workshop bags. Our resident's are also 100 percent total care, and all have to be changed and repositioned every two hours. We have 16-18 each. And yet I still hear constant complaining about how those "lazy b$tches on 3rds don't do anything."

It's lovely. :)

newway

117 Posts

also take note on who your heavy wetters are and do them last. that way there is less chance for them to be wet when daytshift comes in

Tricia76

Specializes in CNA. Has 5 years experience. 291 Posts

So this is what I have to look forward to? Geez I am scared! But I will tell ya one thing I do want the 3rd shift and I don't care what others think..let them think I am a lazy B****...they will just have to get over it..or move along :D

yousoldtheworld

Has 5 years experience. 1,196 Posts

Yep. I love 3rd shift. I've always been a night owl, and I love having my afternoons and evenings free without having to get up at the crack of dawn. And I love the more relaxed atmosphere.

It DOES get frustrating when you've had a horrible night, like last night - we had two call ins on 3rd shift, so I had two whole wings to myself. That's 39 total care residents to change and turn. Needless to say, I did not get to take a break or barely have a moment to breathe.

When morning came, I only had time to get two kids dressed. (We are only required to do one, I normally get up about 4 just to be nice). Before leaving, I still heard the dayshift aides complaining that only two were up in the back, and how it'd be nice if the "lazy@$$" third shift would help out. These are the aides that take at least four smoke breaks per shift in addition to their lunch break, who show up 10 minutes late every day and who spend 40 minutes at the nurses station griping when they get there in the morning. Even on my GOOD nights, I generally take only my lunch break. If I'm on the easiest wing, I might take one of my 15 minute breaks to go get a drink. When I've worked days, no matter how behind they were, these aides (I'm referring to 4 in particular) still took extra breaks. Yet I'm the lazy one.

Most nights, I just let what they say roll off my shoulders because anyone who has worked 3rds knows that you do not just sit on your butt all night - but mornings like this morning are the times when it gets to me.

When I was a CNA I worked noc shift, and let me tell you DON'T WAKE THE PATIENT UNLESS YOU HAVE TO. You can do your rounds every 2 hours and not have to wake them up. All you have to do is make sure they are breathing and not endangering themselves or another resident. If they are sleeping, then let them sleep. You don't have time to sit there and do 3 or 4 rounds of cleaning up poop. Do your rounds when you get there, then when you're done do the other assignments you're assigned to do. Then start your last rounds around 4:30, and you should be done by 6:30. If you can partner with another CNA then even better because you can make it go faster and it's easier on both of you. Good Luck

yousoldtheworld

Has 5 years experience. 1,196 Posts

...I personally have to do 3 or 4 rounds of cleaning up poop. It's not okay to leave them sitting in it all night, and that's the whole point of rounds - not just to make sure everyone is breathing, but also to change incontinent residents. You have to reposition them, as well. I know I wouldn't want someone to leave me sitting in a wet and poopy bed for 8 hours.

If you work at a facility where most are independent, you might be able to get away with not waking them all night, but that's just not an option for most of us.

I understand what you're saying, and more people need to be as compassionate as you are. But for the load that you're carrying on noc shift and the work that you're doing you will get burnt out fast. I see what you're saying, and I totally understand where you're coming from. I personally would do two rounds of changing because that's what we were required to do. That was at a minimum. I had 36-40 patients on noc shift with another CNA. One would pass water and the other would do vital signs on all of them. Then by 12:30-1am we would start on our 1st rounds of changing. Then by 2am we would be finished. One would break at 2am, and the other would break at 3am. We had nobody there to help us, so by 2:30am we were turning the high risk patients and before the next person would take their break. When the other person would come back from break by 3:30am then we would do I & O's and charting while the call lights would go off. Since this was a rehab unit those call lights always looked like the Las Vegas Strip. When we would get out another light would be on. By 4:30am we would finish all of our charting & I & O's so then we would get the laundry for our last round of changing and turning. By 4:45 we would start the rounds and be finished by 6:30am and input the last of our poops into the charting. Night shift wasn't easy and the day shift always complained that the patients were wet. Yes, they were because they wouldn't start getting them up until 7:30 or 8:00. Mind you these are the same day shift CNAs that would put their patients to bed after lunch and who would only change their patients one time during the day. It's sad but true.