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

Sue7573 · Jul 8, 2005

I worked last night in LTC I had 29 residents. It was a really good night as far as the residents sleeping and no wandering. I started at 10:30 and did a walk thru with the afternoon shift. Everyone was dry and all but one in bed. I got the one up a bowl of cereal and a banana and then put him to bed. ON my first round (I started between 12:30 and 1:00 am) I got vital signs on the way around. (12 sets of weekly routine) I was finished with that round around 2:30 I started my second round about 3:15 and finished just after 4:00. I had 7 residents to get up. We can't get any one up before 5am so around 5:15 I started getting my residents up. I started with the earliest riser (on side note: just a little funny I went to get her up and she is pleasantly confused she was sitting up on the side of her bed and some how gotten ahold of a roll of toilet paper and had wrapped two or three layers around her breast and proudly stated that she had gotten her bra on already. ) I got my 7 residents up and went back to check and /or change the others that I didn't get up. I finished at 6:45 did my charting and went home at 7:00 Day shift in my facility does not usually do a round unless they have been burnt before. I have seen CNA's before not do anything for most of the night or call doing their last round around 4:00 and then not understand why any one get mad at them for leaving residents wet. Most all residents get up for breakfast each of the night shift girls get up seven a piece and then one girl comes in early and gets seven up also. when the day shift girls get there they start on the rest of the residents that get up for breakfast. So really a round is pointless they will all be changed before brkfst. Anyway it isn't so bad once a routine is established but it seems it took me years to get in a niche of it. I normally don't work midnights or for that matter either of the other two shifts either I work when they need me doesn't matter which shift or station.

Sue

lovingtheunloved, ASN, RN · Jul 9, 2005

Good lord. People are incontinent. They're going to pee. It is very obvious when someone has been neglected and when they're just, well, incontinent.

leopold · Jul 10, 2005

I have worked every shift as a CNA and I agree that day shift has to be on board with the fact that residents are incontinent and they may be wet when the shift starts. However, there are residents who are alert enough to complain about lack of care. I had one resident who I didn't want to put a brief on at night because she had skin breakdown and she became frantic because she said she would wake up at night soaking wet and call the CNAs and no one would come. After a few times of coming in and checking in on her at 6:30 in the morning and finding her soaked from head to toe I had to come to the conclusion that she was right (I also knew the aides on the night shift well so I wasn't surprised). Me, when I work night shift, I do rounds right before I leave. If a resident is wet I stay and clean them up. If I have to stay late, well that's just too bad for me.

Carolyn_61 · Jul 27, 2005

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![/quote
Hi, December! I'm pretty new at this also. I've been working at a LTCF since June 28 or 29. I'm also trying to figure out how to give everybody the care they need. One tip I got from a seasoned CNA was to not spend so much time giving bedbaths like the way I was taught. Most of the time, wiping them off with a damp cloth is suffiecient, especially if they are scheduled for a shower later that week. I hate cutting corners like that but I guess that's better than getting behind and neglecting other residents.
Why don't CNAs have their own forum on here? We certainly could have enough to talk about. :)

leopold · Jul 27, 2005

I don't know about the damp cloth. As a CNA I too was taught to give these long, detailed bed baths with nail soaking and back massage, lotion and the works, towels placed just so, drapes, etc. etc. But with practice I learned to do a good bed bath in about 10 minutes. Residents get sweaty, and kind of ripe if they're confined to a bed which promotes bacterial growth and you never know if some other CNA down the line is going to say, Oh, they get two baths this week, I'll just wipe him down. It's also a dignity thing. No one wants to lie around feeling stinky.

Don't want to criticize, just want to let you know that you can give a bed bath, just takes a little practice. :)

CapeCodMermaid, RN · Jul 28, 2005

If you're a CNA in my building and I find you are just "wiping them down with a damp cloth", I'll write you up. That is NOT sufficient even if they are getting a shower later in the week. My CNA's are supposed to do full bed baths twice a day with a shower once a week. Our facility NEVER smells like urine and neither do the residents. We just initiated (long overdue) a 1-8 ratio on the day shift. The patients are happier and the CNA's are less stressed.

chadash · Jul 28, 2005

I found that if the LTC will allow you to have a regular assignment, you really get to know your folks and their desires and you can get really fast. I am with you about the feeders: you really need time to get an adequate amount of food in someone safely and considerately. It is important to have those who need fed divided amoung the assistants and any one else who can help. The problem is: you can't be two places at once, and you can't beat yourself over the head either! Just keep em dry, fed and loved, and don't sweat the little stuff...

Carolyn_61 · Jul 28, 2005

If you're a CNA in my building and I find you are just "wiping them down with a damp cloth", I'll write you up. That is NOT sufficient even if they are getting a shower later in the week. My CNA's are supposed to do full bed baths twice a day with a shower once a week. Our facility NEVER smells like urine and neither do the residents. We just initiated (long overdue) a 1-8 ratio on the day shift. The patients are happier and the CNA's are less stressed.

Whoa! Maybe "wipe them down" sounded bad, though that's exactly how she put it. Everybody gets 2 showers a week at our facility, not just one. The reason it came up was because I couldn't find a basin to give a bb with. Apparentally, this resident didn't have one! The other CNA said they always just use the sink and "wipe them down". I'm sure she didn't mean to never rinse the cloth or anything. That would be yucky! I KNEW what she meant. I'm sorry if it wasn't clear. I figured you'd use a little common sense! I guess that's why these online forums don't always work so well.

Good grief! I've already got someone writing me up on here and I didn't do anything wrong!!

BTW, not having the right materials to work with has been a pet peeve of mine.

Edited to add: I'm a very good CNA even if I am fairly new at my job. I actually LOVE my residents, much more than some so-called nurse who looks for reasons to write people up instead of teaching them.

This might be my last post on this site. I didn't come on here to be attacked for posting.

chadash · Jul 28, 2005

Good grief! I've already got someone writing me up on here and I didn't do anything wrong!!
BTW, not having the right materials to work with has been a pet peeve of mine.
Edited to add: I'm a very good CNA even if I am fairly new at my job. I actually LOVE my residents, much more than some so-called nurse who looks for reasons to write people up instead of teaching them.
This might be my last post on this site. I didn't come on here to be attacked for posting.

Good grief is right! If we are going to do our jobs, we need help and training, not "written up"! You keep the CNAs that really care if you train them and help the through their difficult times. And you also create an atmosphere of teamwork and EVERYone benefits.

Sue7573 · Jul 28, 2005

If you're a CNA in my building and I find you are just "wiping them down with a damp cloth", I'll write you up. That is NOT sufficient even if they are getting a shower later in the week. My CNA's are supposed to do full bed baths twice a day with a shower once a week. Our facility NEVER smells like urine and neither do the residents. We just initiated (long overdue) a 1-8 ratio on the day shift. The patients are happier and the CNA's are less stressed.

Do you guarantee a 1:8 ratio. What do you do if there are call ins. Can I assume that if I come to your facility to work that I will never have more than 8 residents.

On paper our facility looks like we are adequatly staffed. When state comes we have no problems proving that we had enough certified or liscensed staff there, trouble is that is only on paper in reality there are 47 chiefs and 2 indians. The chiefs heading up anything from mock survey teams to quality care groups. (4 or 5 cna's and or nurses that go around asking the residents if they are getting the care that they expected).

Are you saying that each resident gets two full bed baths, meaning the; basin is pulled out, towels drapped fingernails soaked, back massages, lotioned twice a day on day shift? With two meals and getting everyone up and activities and vital signs, that is just hard to believe. Do the nurses help? How many residents are in your facility?

In the early 90's when I first started as a cna we had only 8 residents a piece. I worked for almost a year before we became short staffed. We had all baths and showers on day shift. We could do it but just barely. Each resident got a a full bed bath in the morning before getting up, unless it was their shower day. They got a shower at least twice a week. We had two showers a day plus 6 bed baths. With two meals to feed and activities and vital signs there was no more time for anything else. I never got either of my two small breaks and usually had to cut my lunch at least in half if not more. I just can't see where another bed bath for each resident comes into play on day shift.

Now with being short on cna's for almost 15 years we don't hardly give a bed bath. I don't even know what the policy is on that anymore. I had quit working at this facility for about 4 years and when I come back everything had changed. More than half the residents had to be up before breakfast to eat in the dining rooms. Midnights would get a few up and we don't have enought time to actually give all of them baths before breakfast. I don't know about everyone else but what I do is (when I work day shift) when I start getting my residents up I check the shower list if the resident is scheduled a shower that day I wash their face and bottom before getting them up. If they are scheduled a shower tomorrow I wash face armpits and bottom. If they are not scheduled a shower until the third day or so then that means they should have just gotten a shower the day before. I assess them if it looks/smells like they need a bed bath then I give them one. It is quick but thorough. I always put some kind of moisture barrier on their bottoms and if needed under breast or anywhere skin folds over itself. I myself don't worry about the nails or feet so much because I work all the shifts and in different areas. On afternoons when I have more time I will check residents finger nails and will clean/trim as needed also if resident doesn't care or doesn't know to care I put lotion on feet and up legs. (that is regular lotion) (I say if they don't care becuase we have two residents in one section that will not let any one touch their feet except the nurses or toenail dr. ) Yes I do feel like that is not enough. But I have also figured out over the years that I have to what I can for everyone.

I was considered the worst cna in our building for the longest time, I couldn't figure it out. We would have 12 + residents a day. On some days the only thing I got done for a few of them was the first round of drying (and that was a good day). This is before I left for those 4 years. I could get a couple of baths done before breakfast and have them up. Then we would have to stop baths and pass and feed and pick up. Then I would get back to baths. In there some how I had to get anywhere from 6-10 full sets of vitals (no most of the time nurses would not help unless DON was milling about) I would get a couple to three more baths done between breakfast and lunch. By the time lunch was over it was 2 oclock or close too it. I would still have 3-6 residents I had not touched or had only just got to change once. I would get in trouble the nurses would yell at me and write me up. I couldn't figure out what I was doing wrong. All the other CNA's were getting all of theirs up before lunch and would be sitting around wondering what was taking me so long. The nurses would haul me into the DON's office we would argue, but nothing was ever resolved. I would leave there everyday crying and miserable. :crying2: I finally resigned. I started working at another facility in another state and there is where I figured out that it is physically impossible to do that much work in a day shift. That the other cna's faked it. They were not giving baths they were dressing them and getting them up. I didn't like the idea of that either, however I figured out that it is better to do a little for all of the residents than everything for just a few. My friend from the other facility told me that she understood, but that somthing had to change so she suggested that I only give half my baths today, and give the other half tomorrow. Since then I have realized that there is only so much that one person can do. I don't play around and I am not lazy. I know that I am doing the best for ALL of my residents that I can do. I don't leave there crying any more.

Sorry so long winded... only meant to ask how the two baths in one shift worked.

Sue

mediatix8 · Jul 28, 2005

I have an idea. Why don't you work for elderly individuals in their homes. You'd only have 1 patient, and the money is the same if not more. In Illinois, you can make 10-15 an hour doing that. You'd have plenty of time to chat and take your time with everyhting.

leopold · Jul 29, 2005

I'm not sure where all of this is going but I was taught as a CNA and also as an LPN that elderly residents should not get a full bath every day as their skin is too fragile. This is what I have observed in all the LTC facilities I have been in. I strongly believe that residents getting bed baths should get a thorough job with SOAP and water and that between baths they should be cleaned in their vulnerable areas with soap and water and moisturizer/creams should be applied. Residents in bed are more susceptible to infection and breakdown than residents that can get up so you have to be extra careful with their care. So there is no excuse for not doing it. If you can't find a basin, get a clean plastic bag and heat up some wet, soapy cloths in the microwave. But I really have never heard of giving residents baths that often. :confused: