How do you remember?

I'm in the same boat as you! This week is my 2nd week on the job, orienting with an experienced CNA. I was pretty overwhelmed my first 2 days...I noticed that some of the CNAs carry notebooks in their pockets with pt room numbers and list their notes (vitals,i&o, etc) throughout the whole shift. The girl I'm working with has a small clipboard for all her notes, and does charting halfway thru shift and near the end before report. I think all of the things to remember will come naturally with job experience. I will be keeping a small notebook on me though, just to be accurate! It really seems like so many things to do! We can never really stick to a strict schedule (with call lights going off all the time), but I have been starting to get into a routine by following a general timeframe to get everything done. I have also been making a big effort to do things on my own so I can get used to the job, and if I need anything I'll just ask someone for help. Others know what it's like to be new to a job and most of the time are totally willing to help. Don't worry I'm sure after a few weeks you'll have everything down.

Sorry, I left out about making a bed! The things I do to make it easier for me:

1) Communicate with your patient so they always know what you're doing.

2) Encourage the patient to help you as much as possible if they can! Ask them to roll to the side and help them over

by supporting their hip and back, have them hold onto the handrail while you tuck (dirty) under them and make one half side of the bed (tuck clean under). Then have them help you roll them to the other side and pull (dirty) out and pull clean through. You would be surprised how much strength some people have to hold onto the rail, even being sick.

3) Make sure the bed is raised up to working level, you should not be bending over to make it. Lower it back down when you're done.

4) When finished I always thank the patient for doing such a great job helping me out!

If someone is incapable of helping at all, or a very large person too heavy for you to move-get help. The other night I had this situation where I couldn't support someone and he couldn't hold himself up. I asked one of the other CNAs if she could help me, and she did. Later on, I ended up helping her with one of her patients. Teamwork!

Hmmmmm. You will develop your own system for remembering what you did for who. Get a small notepad and write down your vitals, I&O's, temp ect. You will see everyone do it a different way. What counts is that its in the computer the right way.

Asking for videos for body mechanics and making an occupied bed at this stage of the game is like putting the cart before the horse. I understand your training is in medical assisting but these two things are the backbones of being a nursing assistant. I suggest you search you tube and perhaps practice with a coworker/friend on your own time. Practice makes perfect. Good luck.

For the most part, you do the same thing with everyone on most days, so you remember it. Then, if you do something out of the ordinary with someone, you remember THAT because it was out of the ordinary. I don't know, I've never had a hard time remembering anything I needed to chart, and things like intake and output, I write on my ADL sheet so I have them there when I chart later.

Wrote it down.

Whenever I had a few spareminutes, I'd ask: who was 'thicken', who was a 'wetter', who I had to get up for lunch, etc...

Charting? Well...I'm in an LTC and we don't use computers there. So, the first night I just went from room to room. The third night, I just kept a note of any that did anything extra special and their roommate. It helped with recall...

****

Ah, the occupied bed.

This is why I stay on top of my rounds...

I have some coworkers who will hardly do their rounds. Then...when the last one rolls around, they're stripping beds because the resident has urinated to the mattress.

Then they're begging everyone to help them...which I'm usually ok with. Newbies will be slow and some people, while diligent workers, are just slow-er. But, there are others who slack off and do this ALL the time...and they're usually more experienced than I am! In fact, when I was new, these are the same senior aides who told me that I didn't have to do my rounds on time.

Now, I'm pretty fast. I get done and do some spotchecks and light fanny wiping. 45 minutes until end of shift and about to chart.

I hear, 'Can you help me with MR M --'

Sure. We get in there. She says, "I haven't looked at him all shift...hee, hee."

(he wasn't the only one, either)

*laugh*

Yet, this same girl has the good grace to be surprised that the incontinent's beds are all peed up!

*laugh*

She's having to change everyone's bed and frustrated that it's 5 minutes until end of shift and she still has work to do.

She's a fun girl, but - she's so backwards.

Unless the cafeteria folks and nurses are putting Dulcolax in the food, the last round should be the lightest...but, y'know how it is with some people: Everything the hard way.

She likes me b/c I'm all about 'teamwork'.

The other CNA's don't really help her. Before I didn't understand - but, I now see why.

ANYWAY -- that was one heck of a tangent.

Learn who your 'wetters' are and stay on top of them.

Remember, it's way easier to change a diaper (a pad, even) then it is to change an entire bed.

Here's how I change an occupied bed. Many of my residents can't assist much.

- Lift the bed all the way up.

- Pull dirty sheets from mattress ends and fold corners inwards towards the resident.

- Put clean fitted sheet on bottom ends of mattress. Just yank the fitted sheet, grab the opposite mattress corner and stuff it in the fitted sheet.

- Roll up incontinence pad halfway. Center top line at hiplevel and put pad into clean fitted sheet.

- Grasp dirty sheets and lift resident up and away. You're actually just propping them up. Stuff clean sheets under pt + dirty linen as far as you can go.

- Pull fitted sheet over top ends of mattress, if possible to do both. Yank, grab and stuff.

- Move to the other side of bed.

- Grab dirty sheets that surround resident and pull both the resident across bed towards you a bit. This helps get them up on their side as they may be too close to the end to be turned. Also makes it easier to remove the dirtier sheets in the end.

- Grasp sheet +resident and push them up and away from you.

- Pull clean sheet and incontinence pad from beneath resident. Pull pad towards you...this also brings resident towards you and moves the dirty sheets.

- Grab dirty sheets and remove.

- Straighten corners of fitted sheet. Straighten that pad.

- Grab flat sheet and fold top portion LENGTHWISE. THEN...place folded corner down resident/bed's midline. Unfold the corner on the bed/resident. This ensures that the sides get equal amount of sheet. Do same with blanket.

- Smooth wrinkles. Stuff blanket/sheet under mattress. Military fold. I like to put some slack in the foot of the sheets. I believe they call it a 'toe-fold'.

Uh, hope that makes sense to you.

*laugh*

*NOTE*

Some of our resident's beds are on the floor... Those are a pain in the butt to deal with because the little ladies are always snatching their diapers off and peeing in the bed. For those 2 residents I always put them in pants for bedtime. It saves the night CNAs the headache (and backache).

Also, you want to encourage the pt to help whenever possible. But, some can't. Some aren't even 'aware'...

Just how it is.

Everyone isn't a 'textbook' case.

Also worth mentioning: Use gravity to your advantage.

For instance, if you have to move the resident up the bed?

- Tilt the head down

- Lock the wheels and move to the head of the bed

- Move pillow

- Grip incontinence pad and pull the pt+pad towards you.

- Straighten pad. Replace pillow. Tilt head up.

The end.

If you have to move the resident across the bed?

- Grab the pad and pull.

- Straighten out pad as needed.

Use leverage to your advantage:

Gaitbelts, pads, sheets, pads....

When I mentioned rolling the pad+resident or linen+resident to get them up...I plant feet firmly, hunker down and pull the pad+pt towards me. It's like doing arm rows. Sure, you could probably unlock wheel/move bed/lock wheel, etc...but, it's much faster this way. Sheets are easier to grip vs flesh.

I only do the whole bed moving thing when I'm dealing with someone who is too big AND dead weight to be moving without some locomotion.

In truth, the greatest issues I have occur when transferring residents from chair to bed or bed to chair.

This is when it becomes an issue for my lower back. The gait belt offers...some relief, though.