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.
yeah i feel for you. I hate, HATE working midnights. I too am not as fast as some of the longer term aides and getting 20 people up, cleaned and dressed is not easy by yourself. Sometimes i wonder "how can you get everyone up in an hour (1 hour/ 20 pts = 3 minutes per pt!! wth) ? Did you wash their butts at all??" Plus the midnight nurses Ive worked with will not answer a call light let alone help dress/change a pt. My advice is to get off midnights, but if you like the shift then just take your time and let days get over it. Id rather have a few well cleaned and dry pt up and ready on days then to have everyone up but i still have to go back and undress/change/redress them.
Do people really complain when residents are not up? I know some like to get up really early, but I don't see the point in dragging people out of bed before 7am. I actually prefer it when 3rd shift leaves people in bed because it's easier for me to change them before breakfast. And I like to pick out my own clothes for the residents because for some reason 3rd shift always picks out the ugliest things, lol! Having some people washed and lotioned in advance is great though.
Yep, they sure do complain. We leave at 6, so anyone we get up is up before then.
Now, a lot of our residents do go to school and workshop, so they have to be ready by 7 and 8 so it's a little different than geriatrics, but it's still more than 2 hours for them to sit and be wet if they go again.
I usually get my one resident required up in their chair, and the rest I wash and dress in bed.
Do people really complain when residents are not up? I know some like to get up really early, but I don't see the point in dragging people out of bed before 7am. I actually prefer it when 3rd shift leaves people in bed because it's easier for me to change them before breakfast. And I like to pick out my own clothes for the residents because for some reason 3rd shift always picks out the ugliest things, lol! Having some people washed and lotioned in advance is great though.
Since we were a rehab unit the OTs would leave notes for the patients that they were seeing in the morning and we were instructed not to touch them!!!! The OTs would take care of it since ADLs were part of their treatment. Yes, even the CNAs would still complain even when they had less patients to do.
I am so glad I signed in today. I work 11-7 am float, I am on a unit that has no get ups. 18 residents per cna, we do 1 round for call bells, and resident checks, and vitals, 2 rounds for changing, This particular assignment I have has many heavy wetters, and they have bowels movements all night usually both rounds at least 15 out 18 residents. Some residents fight really hard and don't want to be changed, if i leave them for 2nd round there skin is red from urine. One resident hits, another threatened to have me fired if I changed her, I have to change them it isn't an option.
my question, the resident is supposed to have the right to refuse care, if you leave them until morning it is neglect, and it will be a guarenteed bed change which makes morning rounds longer. What do you do in that situation.
2nd problem-I can't imagine doing one changing round, on my first changing round I change them , reposition them, check foley , colostomy bags, fix the beds,get them drinks, hang up the clothes 3-11 left around the room, I start at 12am I finish at 2am, the other 2 aides are done by 12:30. What am I doing wrong. I can't seem to get the things needed to be done in 1/2 hour. I am hoping it is impossible, becuase I will never be able to do changing rounds that fast for 18 residents. What is the turn around time for 18 residents. :heartbeat
You'll find that the people who get done so much quicker tend to be doing the bare minimum, if that.
At my facility, we have a couple who tend to get done with their assignments on 2nd and 3rd shift in about half the time of everyone else. Know how they do it? They don't reposition them. They don't wipe them after they've urinated, only if they've had a bm. They leave bm on their skin and in their pubic hair. They don't change wet/dirty sheets. They don't wash them before bed or before getting them up. They don't do oral care. They don't make sure they have water. Etc, etc, etc.
On a normal night, I also have 18 or 19 residents on 3rd shift. Occasionally on certain units, rounds might take me only a half hour...but that's usually the 2 am rounds after most of them were soaked and/or poopy at 12, and that's if I'm really on the ball, and on a unit where they are easy to position (like the wing with most of the little ones. A 4 year old does not take as long to position as a contracted adult!)
Most often, average rounds take me an hour to an hour and a half. This is changing and repositioning everyone (100 percent of our residents are total care, it's a facility for the profoundly disabled). I put away my clothes, set out the next day's clothes, and do my cleaning type things separately before my first real rounds, because I like to have a little downtime between rounds to take care of other tasks.
Just move at your own pace and don't worry if you take longer than others. Just do your best and know that you took good care of your residents. That's what really matters!
Thanks for the reply. I think changing rounds on 18 residents should take approximately 1 1/2 hours. That is 180 minutes that is 10 minutes per resident. To do the rounds in 30 minutes is1 1/2 minutes per resident. Some of the beds take 30 seconds to raise. That is 1 minute to wash and cream ,diaper on an adult person. Most over 160 lbs. I float, most units the first changing round is 1-2 hrs for all cna's, I was recently floated on to a unit I never work on, I realize since my first blog that the other cna isn't doing the right job. I cover her assignment when she is on break and I have had her residents ring the call bell for a complete bed change, which means they were never changed.
speed is going to come with time and knowing your residents. i work in a facility that has a ltc, rehab and Alzheimers unit. the best advice i can give you is to get a cart if you have one and load it up with extra linens, wipes washcloths or whatever else you normally use and take it with you down the hall on rounds. and do all of your scheduled changing rounds. that way you dont have to clean up after yourself. at my facility our trash and linen bins are on wheels. so you dont have to walk the entire length of the hallway to toss things. try thinking of things that might make your job more efficient too
taalyn_1, CNA
124 Posts
yeah i feel for you. I hate, HATE working midnights. I too am not as fast as some of the longer term aides and getting 20 people up, cleaned and dressed is not easy by yourself. Sometimes i wonder "how can you get everyone up in an hour (1 hour/ 20 pts = 3 minutes per pt!! wth) ? Did you wash their butts at all??" Plus the midnight nurses Ive worked with will not answer a call light let alone help dress/change a pt. My advice is to get off midnights, but if you like the shift then just take your time and let days get over it. Id rather have a few well cleaned and dry pt up and ready on days then to have everyone up but i still have to go back and undress/change/redress them.