How do I provide the care the residents need in such little time?

surreal · Jun 19, 2005

work at a facility where this isnt happening? i dont know where that is.. but all the LTC places i have been to are like what you describe. its sad. as a nursing student i was only given one patient and they got a ton of care and some people dramatically improved (mood-depression) after getting one person to care for them 5 hours a day.. but sadly its unrealistic.. i wish you the best. i love the geriatic patients, but alot of people dont like it because of how you have to treat them in most places (rush rush). i think its a system problem...

I just started at a LTC facility as a CNA. I must say, I really do enjoy the work, but since I just started, I'm being oriented and I have been working with other CNA's the past two days. I get this for a week and then I'm on my own.
I find it overwhelming that there are nine patients for every CNA. That's nine people that must be woken up, cleaned, dressed, bed made, room cleaned, in time for breakfast. We only have an hour to get them up, so that's about six minutes a person. Yesterday, my second day, I managed to get two people up on my own, because I like to take the time to talk with them and make them as comfortable as possible. Also, I only managed to get two fed (for the residents who cannot feed themselves at all), because I just couldn't bring myself to shovel the food down their throats like the other CNA's (I wouldn't want the food shoved in my mouth like that, so I wasn't going to do it with them. Plus I spent a lot of time talking to them, even though they couldn't respond back).
How am I ever going to get all of this stuff done quickly? Are there any tips? I don't know how to get nine patients up and give them the care that I want. Heck, I don't even know if I could manage it in that time frame if I rushed. What should I do? I feel very overwhelmed!

Antikigirl, ASN, RN · Jun 19, 2005

It will take time, but you will get your routine down and be able to do the chatting while you do your work.

My CNA's have 12 patients on their service areas and have to pass meds! (assisted living). It is really hard on the new hires because it is really a rush rush rush to get their meds, ADL's, transfered and ready for breakfast and down to the dining room on time. We usually have a few floats to help, but normally someone calls in and the float must take a service area...so it becomes very difficult.

I have CNA's that have worked there a long time that do their jobs and get it all done because they have a routine they go by. Very time managed! You will find your own unique way of doing this over time if you stop and really think about time management as it pertains to you and your patients! But remember..it will take time so don't be hard on yourself, you can only do what you can do as a new hire...this is all new, no one expects you to be perfect (and if they do...they are kidding themselves!).

Good luck, and when I started as the Nurse at my assisted living facility (one nurse to 160 patients because the CNA's do all the ADL's, med pass, and such...I am for Nursing treatments, CBG/insulins, all the paperwork, all orders and getting meds into the carts and mars, acute situations...etc.) I kept a notepad handy and when I went home I thought about how I could improve my time management since I was getting to know my routine...that really helped, but remember to leave room for suprizes or things that may suddenly take more time (ie a patient who suddenly has diarrhea all over themselves making a shower and change a priority, or a fall, or a skin tear/skin issue, or more emergent situation...these happen!!!!).

Good luck! :)

lovingtheunloved, ASN, RN · Jun 19, 2005

Just for your consideration. It's wonderful that you want to take the time to talk to your residents and take time with them. But remember that all that time you spend with one resident is taking time away from another resident who needs more urgent needs met. Multi task. I had to learn that I can't do for one resident at the expense of another.

CapeCodMermaid, RN · Jun 19, 2005

Is there some reason EVERYONE must be up and totally dressed for breakfast? We get the people up who absolutely, positively have to be in the dining room for breakfast. The others get a boost up in bed, their breakfast on a tray, and a little more time to relax.

leopold · Jun 19, 2005

Is there some reason EVERYONE must be up and totally dressed for breakfast? We get the people up who absolutely, positively have to be in the dining room for breakfast. The others get a boost up in bed, their breakfast on a tray, and a little more time to relax.

Yeah, I don't know why that is -- maybe so they'll go to bed early? I've heard that there has been a lot of debate about how to make culture changes so that residents have more control over their lives. I know one complication with the breakfast issue is that if we give a resident a room tray we need to be in the room with them when they eat in case they choke -- and it has happened. That really makes things complicated when there are residents in the dining room that need to be fed.

December716 · Jun 19, 2005

If we don't get all the residents up for breakfast in the dining halls, we have to feed them in their bedrooms and be with them the entire time, so they don't get to eat until we (the aides) are finished with breakfast and getting the residents up for the day after breakfast or back to bed if they prefer.

leslie :-D · Jun 19, 2005

i'm w/capecod mermaid.....i don't understand nor do i agree with having a total assignment bathed and dressed before breakfast.

i've known cna's that try to get up as many as possible before breakfast so they can take it easy after breakfast.

but unless the residents are in an assisted-fdg program, there's no reason to have them totally dressed.

get them oob in a bathrobe if they need supervision.

i just can't see this being mandated.

when i did charge, if pts were sleeping, i'd let them sleep; reheat their breakfast and took full responsibility for feeding/supervising them when they awoke.

and i used to get furious when 7 pts were all dressed before breakfast, which meant they wouldn't be changed/toileted and would be in that damned wc for 12 hrs. the cna's didn't like it but i made sure they were changed after lunch, even if they were max assist of 2.

and they thought they were taking the easy way out. hah.

redwinggirlie · Jun 20, 2005

Is there some reason EVERYONE must be up and totally dressed for breakfast? We get the people up who absolutely, positively have to be in the dining room for breakfast. The others get a boost up in bed, their breakfast on a tray, and a little more time to relax.

My reasoning on this issue goes back to my days at in home care: You get people dressed and up for meals. Too many people get the boost in bed and get left alone. Next time you "boost" someone up, take a look at their tray afterward. Did they eat? Did they get any attention? 'Did they feel alive? People need help, incentive and that feeling they are a part of things. That's why we dress, pay attention and get them up in the morning.

Think about yourself. If you spend days and days on end in your jammies, how's that feel? Sorry. Sensitive on this issue and I do wish more people could stay at home with their family instead of being at a facility.

redwinggirlie · Jun 20, 2005

Also, I defy anyone to tell me they feel comfy at breakfast in a hospital johnny.

leslie :-D · Jun 20, 2005

My reasoning on this issue goes back to my days at in home care: You get people dressed and up for meals. Too many people get the boost in bed and get left alone. Next time you "boost" someone up, take a look at their tray afterward. Did they eat? Did they get any attention? 'Did they feel alive? People need help, incentive and that feeling they are a part of things. That's why we dress, pay attention and get them up in the morning.
Think about yourself. If you spend days and days on end in your jammies, how's that feel? Sorry. Sensitive on this issue and I do wish more people could stay at home with their family instead of being at a facility.

i don't see where staying in one's pajamas is being encouraged.

but there are many residents whose sleeps patterns are so altered that to be fully bathed and dressed by 7:30 am is just downright inconsiderate to sev'l of these pts.

we had 2 cna's in the day room where the assisted fdg group was, as well as those who were already awake and ready to get dressed.

those who stayed in bed were supervised by nsg and the cna's. even though the cna's had assigned feeders, we would all ensure that no one was ignored and was always reported to those who were still sleeping or ate poorly.

but my heart used to break to see some of these people awakened from a sound sleep and be fully dressed at an unGodly hour. and yes, we did get pts up in their wc's with their bathrobes on. i am the one who would talk to the cna's to slow down in their am care, just so they could have 2-3 pts left from 8:30am-12 noon. not right.

leslie

StarNurse2006 · Jun 20, 2005

To the OP, I completely understand your concerns and fears. I worked as a CNA in a SNF on day shift (which is the busiest, and I have worked all shifts!) and when I first started it was HARD! TIME MANAGEMENT! That is what it's all about. Most of our residents had to be up for breakfast, and usually the NOC CNA would get at least half up for us. But there were "those days!" The ones where you had 10-12 residents and only 2 were up when you got in, and we only got a half hour to get everyone up. Everyone will find their own routine and every facility is different, but here are some things that worked for me:

1. If residents don't get a daily shower, don't dress those who have their shower that day. Put them in a robe...saves time!

2. Clean as you go...ADLs will go faster if things are kept neat on a daily basis. Don't waste time searching for toiletries.

3. Follow the advice of your fellow CNAs. Be a team player. Some of us would often team up or delegate...i.e. "I'll get up your residents if you make my beds," or we would simply work together to get all of our residents up faster. (We had a lot of two person transfers, etc)

4. Look at the ways other CNAs save time...for instance, I learned how to schedule my day before I even stepped out onto the floor by looking at which residents needed vitals, had showers, had doctor's appointments, were sick, etc to plan my day out. I always carried paper and pen for this. Also, look for the best way to dress, roll patients, make beds, etc. You can save a ton of time by learning from those more experienced people.

5. Do not be afraid to tell the NOC CNA to fix or re-do something. Always do walking rounds. Make sure they did their work, i.e., that the residents are dry, that the rooms are clean, etc. Walking rounds means there will be no surprises at the busiest time of day, like a soaked resident or misplaced items.

Now, as far as spending time with the residents, the sad fact is that we can not give each person all the interaction they need. The best way to serve your residents is to be kind, respectful, and always smile and address their concerns. Better to evenly spread your time than ignore residents. I found that I would often come in on my days off to visit residents (and I would bring my kids, they loved that!) to give them a little more than what I could on a shift. But you will find that when you master time management, the time to give a little more will be there.

Good luck to you!

Jennee