11-7 Getting Residents up.

[CoffeeRTC]

I've seen alot of postings on the duties of 11-7 shift including getting residents washed, dressed and oob for breakfast. Just curious on a few things.....is this a routine thing? Is this only for residents that are already awake and wanting this? What is your staffing ratio? How do you get around this with the state?

Do you notice any increase in behaviors, etc?

In my facility..48 beds on 11-7 nights has one nurse and 2CNAs. These numbers never change. On occasion they will get a few residents washed and dressed if they have early appts or dialysis or they are already awake and trying to get oop. In years past they tried having nights get 1-2 res up off of each assignment for days. Never really went over well. We noted lots more behaviors, skin issues, residents would sleep all day and more complaints. The state also frowned on this. Of course we still have a nice sized 6 or 7 a med pass that some nurses will start at 5 am! BTW, breakfast isn't until 7:30 or 8 am.

[Lisa CCU RN, RN]

In my facility I will only allow the nurses to have max 25 and CNA's to have max 10. I believe in extra staffing for resident's sake and safety.

Like I said you probably have very happy residents and staff. Are you a DON? Please tell me why is it not a law that agency must be called if we are short staffed? Money should be no object when it comes to resident care. I mean I love being a CNA and the only reason I want tobe a nurse is because I cannot live off of this salary and I would have to work two or three jobs just to survive. Plus, I can't take working like a dog. I have feelings just like the residents do and if I have to get up 40 residents and have no break and wash laundry, they can keep that! I hear people say that we are taking care of these elderly people and that we should espect them, well I can't do that because am physically exhausted and can't provide good care. I remember when I worked at the facility that had us get up all the patients, I was like a zombie the next day and usually I can stay up even after working all night. I wanted to cry my legs hurt so bad from running up and down that hallway all night and then racing no stop to get up 43 people! My throat was dry, my head hurt, back hurt, I had to pee, but all I kept thinking was if

i don't get them up I'll be fired or written up. I mean I just knew we were not going to have to still get up all those people, but I still did! I forgot to mention that the shower tech who came in got up ywo of my people, but got up at least 12 of the other techs residents because they were friends and I had only been there a few days. Lord, I will never forgot that awful place.

[lovingtheunloved, ASN, RN]

Like I said you probably have very happy residents and staff. Are you a DON? Please tell me why is it not a law that agency must be called if we are short staffed? Money should be no object when it comes to resident care. I mean I love being a CNA and the only reason I want tobe a nurse is because I cannot live off of this salary and I would have to work two or three jobs just to survive. Plus, I can't take working like a dog. I have feelings just like the residents do and if I have to get up 40 residents and have no break and wash laundry, they can keep that! I hear people say that we are taking care of these elderly people and that we should espect them, well I can't do that because am physically exhausted and can't provide good care. I remember when I worked at the facility that had us get up all the patients, I was like a zombie the next day and usually I can stay up even after working all night. I wanted to cry my legs hurt so bad from running up and down that hallway all night and then racing no stop to get up 43 people! My throat was dry, my head hurt, back hurt, I had to pee, but all I kept thinking was if

i don't get them up I'll be fired or written up. I mean I just knew we were not going to have to still get up all those people, but I still did! I forgot to mention that the shower tech who came in got up ywo of my people, but got up at least 12 of the other techs residents because they were friends and I had only been there a few days. Lord, I will never forgot that awful place.

Your situation is an isolated, extreme one. (or common, I hear lots of stories like yours) And if I remember from other posts, you're not there anymore. Bless you for doing the best you can. You sound like a very caring person. Just remember not all facilities are like that, and there are places where you CAN give excellent care, and not kill yourself.

[CoffeeRTC, BSN, RN]

Like I said you probably have very happy residents and staff. Are you a DON? Please tell me why is it not a law that agency must be called if we are short staffed? Money should be no object when it comes to resident care. I mean I love being a CNA and the only reason I want tobe a nurse is because I cannot live off of this salary and I would have to work two or three jobs just to survive. Plus, I can't take working like a dog. I have feelings just like the residents do and if I have to get up 40 residents and have no break and wash laundry, they can keep that! I hear people say that we are taking care of these elderly people and that we should espect them, well I can't do that because am physically exhausted and can't provide good care. I remember when I worked at the facility that had us get up all the patients, I was like a zombie the next day and usually I can stay up even after working all night. I wanted to cry my legs hurt so bad from running up and down that hallway all night and then racing no stop to get up 43 people! My throat was dry, my head hurt, back hurt, I had to pee, but all I kept thinking was if

i don't get them up I'll be fired or written up. I mean I just knew we were not going to have to still get up all those people, but I still did! I forgot to mention that the shower tech who came in got up ywo of my people, but got up at least 12 of the other techs residents because they were friends and I had only been there a few days. Lord, I will never forgot that awful place.

In order to call agency staff in, your faclity needs to have a contract with them before hand. We use agency for nurses, but not for CNAs?? Lots of times they (corporate) won't approve this because of the cost:angryfire Their nursing budget gets blown when they hemmorhage money for agency:angryfire

What state are you in? Have you ever looked at the staffing ratios/ laws? I'm still appauled at what they expected you to do on an 11-7 shift.

[CoffeeRTC, BSN, RN]

In order to call agency staff in, your faclity needs to have a contract with them before hand. We use agency for nurses, but not for CNAs?? Lots of times they (corporate) won't approve this because of the cost:angryfire Their nursing budget gets blown when they hemmorhage money for agency:angryfire

What state are you in? Have you ever looked at the staffing ratios/ laws? I'm still appauled at what they expected you to do on an 11-7 shift.[/quote

[Lisa CCU RN, RN]

In order to call agency staff in, your faclity needs to have a contract with them before hand. We use agency for nurses, but not for CNAs?? Lots of times they (corporate) won't approve this because of the cost:angryfire Their nursing budget gets blown when they hemmorhage money for agency:angryfire

What state are you in? Have you ever looked at the staffing ratios/ laws? I'm still appauled at what they expected you to do on an 11-7 shift.

I'm in TN. where do I look for those laws?

[casi, ASN, RN]

I work 10-6:30am shift. I work on a memory care unit with 15 residents and always staffed with 2 aides (most of the time), night shift gets 4 people up startting at 5:30am. 3 out of 4 of these people get put back to bed. And yes, we do see an increase in behaviors and people falling asleep at breakfast. It's really sad, but if we don't do it we get a slew of complaints from the dayshift because their shift is absolutely crazy.

[CoffeeRTC, BSN, RN]

This is PAs staffing regs. Try looking on the Dept of heath web site or emailing the board of nursing to help. I tried looking for TN buy couldn't find anything.

(f) In addition to the director of nursing services, the following daily professional staff shall be available.

(1) The following minimum nursing staff ratios are required:

Census Day Evening Night

59 and under 1 RN 1 RN 1 RN or 1 LPN

60/150 1 RN 1 RN 1 RN

151/250 1 RN and 1 LPN, 1 RN and 1 LPN, 1 RN and 1 LPN

251/500 2 RNs 2 RNs 2 RNs

501/1,000 4 RNs 3 RNs 3 RNs

1,001/Upward 8 RNs 6 RNs 6 RNs

(2) When the facility designates an LPN as a nurse who is responsible for overseeing total nursing activities within the facility on the night tour of duty in facilities with a census of 59 or under, a registered nurse shall be on call and located within a 30-minute drive of the facility.

(g) There shall be at least one nursing staff employe on duty per 20 residents.

(h) At least two nursing service personnel shall be on duty.

(i) A minimum number of general nursing care hours shall be provided for each 24-hour period. The total number of hours of general nursing care provided in each 24-hour period shall, when totaled for the entire facility, be a minimum of 2.7 hours of direct resident care for each resident.

(j) Nursing personnel shall be provided on each resident floor.

(k) Weekly time schedules shall be maintained and shall indicate the number and classification of nursing personnel, including relief personnel, who worked on each tour of duty on each nursing unit.

(l) The Department may require an increase in the number of nursing personnel from the minimum requirements if specific situations in the facility--including, but not limited to, the physical or mental condition of residents, quality of nursing care administered, the location of residents, the location of the nursing station and location of the facility--indicate the departures as necessary for the welfare, health and safety of the residents.

[boulergirl, CNA]

I posted on another post that I have been in a facility that wanted at least 100 residents up at 700 am even if there were only 2 techs on that night. We also had to do the laundry for the 7-3 shift. We had to do it no matter what because if we didn.t 7-3 wiuld have no linen. this is absolute hell to do and I quit after 3 weeks. now it wasn't impossible with say 5 techs, but two was not happening. Isn't it illegal to get residents up at 4 am? That 's the only way I could get them all done by 7 am.

2 techs to 100 residents??? WHOA!!!!!!!!!! :redlight:

How did you handle this job for THREE WEEKS?????

I had a co-worker once who told me that she walked out of a facility at 2 AM because her supervisor ordered her to do her showers at ONE IN THE MORNING. If someone tried to force ME out of bed at one in the morning for a shower, they'd get a foot sandwich.

[Monica RN,BSN]

This is PAs staffing regs. Try looking on the Dept of heath web site or emailing the board of nursing to help. I tried looking for TN buy couldn't find anything.

(f) In addition to the director of nursing services, the following daily professional staff shall be available.

(1) The following minimum nursing staff ratios are required:

Census Day Evening Night

59 and under 1 RN 1 RN 1 RN or 1 LPN

60/150 1 RN 1 RN 1 RN

151/250 1 RN and 1 LPN, 1 RN and 1 LPN, 1 RN and 1 LPN

251/500 2 RNs 2 RNs 2 RNs

501/1,000 4 RNs 3 RNs 3 RNs

1,001/Upward 8 RNs 6 RNs 6 RNs

(2) When the facility designates an LPN as a nurse who is responsible for overseeing total nursing activities within the facility on the night tour of duty in facilities with a census of 59 or under, a registered nurse shall be on call and located within a 30-minute drive of the facility.

(g) There shall be at least one nursing staff employe on duty per 20 residents.

(h) At least two nursing service personnel shall be on duty.

(i) A minimum number of general nursing care hours shall be provided for each 24-hour period. The total number of hours of general nursing care provided in each 24-hour period shall, when totaled for the entire facility, be a minimum of 2.7 hours of direct resident care for each resident.

(j) Nursing personnel shall be provided on each resident floor.

(k) Weekly time schedules shall be maintained and shall indicate the number and classification of nursing personnel, including relief personnel, who worked on each tour of duty on each nursing unit.

(l) The Department may require an increase in the number of nursing personnel from the minimum requirements if specific situations in the facility--including, but not limited to, the physical or mental condition of residents, quality of nursing care administered, the location of residents, the location of the nursing station and location of the facility--indicate the departures as necessary for the welfare, health and safety of the residents.

one rn for 59? Geez... it amazes me how the rules change from state to state when the funding sources medicare and medicaid.. set the rules for federal guidelines (known as our F tags) that are nation wide.

[Monica RN,BSN]

Like I said you probably have very happy residents and staff. Are you a DON? Please tell me why is it not a law that agency must be called if we are short staffed? Money should be no object when it comes to resident care.

Yes I am the DON. There are laws that state what minimal staffing is, and they vary by state. As I said in Fl. 40 to 1 nurse 20 to 1 cna (max)

With MY RULE of staffing ratios of 25 per nurse and 10 for cna (max)

it does make for happier residents and staff, but it also makes them less productive at times. For example: IF a CNA calls out, and they have to go up to 12 each, they are complaining they are short staffed.. not at all by guidelines, but short staffed in their mind because it is not the norm. They tend to take too many breaks sometimes with less staff. It has benefits and drawbacks.

If a facility is not meeting minimal staffing numbers, they can obviously get in trouble with state, but they also are required to place themselves under a self imposed moratorium, which means they cannot accept new resident admissions until staffing increases to acceptable levels.

I believe the CNA's are the backbone of the facility. We cannot do our job without them. They are the least paid and get the first brunt of an unhappy resident or family member. I advise you to go back to school no matter what you have to do. You will be glad you did, CNA work is very hard for the $9.00 an hour they get in our area.

[Lisa CCU RN, RN]

Yes I am the DON. There are laws that state what minimal staffing is, and they vary by state. As I said in Fl. 40 to 1 nurse 20 to 1 cna (max)

With MY RULE of staffing ratios of 25 per nurse and 10 for cna (max)

it does make for happier residents and staff, but it also makes them less productive at times. For example: IF a CNA calls out, and they have to go up to 12 each, they are complaining they are short staffed.. not at all by guidelines, but short staffed in their mind because it is not the norm. They tend to take too many breaks sometimes with less staff. It has benefits and drawbacks.

If a facility is not meeting minimal staffing numbers, they can obviously get in trouble with state, but they also are required to place themselves under a self imposed moratorium, which means they cannot accept new resident admissions until staffing increases to acceptable levels.

I believe the CNA's are the backbone of the facility. We cannot do our job without them. They are the least paid and get the first brunt of an unhappy resident or family member. I advise you to go back to school no matter what you have to do. You will be glad you did, CNA work is very hard for the $9.00 an hour they get in our area.

I'm in school now for a BSN. Trust me I know and I will graduate.

[NebbyLPN]

This is probably not going to sound real nice to some people reading this, but I'll say it anyway. About half the nursing homes I worked in had the night shift getting up patients before the day shift arrived. Now, this is just my own observation, but it seemed to me that the private paying patients were not patients that got this kind of treatment. Neither do the Medicare and rehab patients. They can get breakfast in bed or stay in their rooms. Some years ago I would see patients gotten up, wheeled to the dining room or in front of the nurses station and sit there slumped over and sleeping until they got breakfast. What kind of existance is that? At the home I currently work, the night shift has only a couple of patients they are assigned to get up in the morning. This list was supposedly carefully considered by the DON. They are patients who are heavy lifts or confused and beligerant. I believe the criteria for this was because they take time to get out of bed due to their conditions and behavior. Otherwise, as soon as the day shift CNAs come in they start getting their patients up.