Just ONE CNA on night shift?

Surprised1, MSN, RN · Aug 23, 2014

Hello,
I'm just wondering how others handle the night shift when there's one CNA only for up to 36 pts. The charge makes two of your patients total care, where you do the vitals, turns, cleaning etc. Is it doable? How do you organize yourself? This is regarding an upcoming job. Thanks.

Do you know how many patients you'll typically have? We operate without UAP most nights, with a fair amount of total care patients. Fortunately, we have a culture of teamwork on our unit, so we take turns helping each other.

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zacarias, ASN, RN · Aug 23, 2014

Apparently we'll have four patients each, three if we have a gtt. I guess that is not too bad.

anon456, BSN, RN · Aug 24, 2014

Try no CNA about 3/4 of the time and 24 pediatric patients, some trach/vent and most total care or infants, about half without parents. We have a smaller nurse/patient ratio but are still responsible for turning Q2H, diaper changes and checks, VS, in addition to meds and assessments and taking care of other needs of the patient/family. I really think having CNA's is much much safer. They are an extra set of eye and ears between the time the RNs are in the room.

As far as how to organize, just circle on your brain sheet the hours you need to turn/check your patients, or add a column to record what position they are in so you can chart that later. I am not sure what your brain sheets look like, but I prefer more detailed ones even if I have to carry several sheets around on my clipboard.

I just found this one on-line and it's pretty good to start with and then tweak to your own needs.

http://1.bp.blogspot.com/-oEIuajEZz8k/URrvbvDIxKI/AAAAAAAAF1M/lFnVuK66oXo/s1600/a.jpg

anon456, BSN, RN · Aug 24, 2014

Apparently we'll have four patients each, three if we have a gtt. I guess that is not too bad.

That's not bad at all! That's about what we have too, somewhere between 2-3 patients with a max of four depending on acuity.

zacarias, ASN, RN · Aug 25, 2014

I agree that it seems safer with CNAs. I agree that more RNs mean safer outcomes, but having CNAs to be also on the lookout seems appropriate. I see hospital systems all around using CNAs less and less.

Anon, thanks for the link to that "brain." It's a nice one.

Z

KelRN215, BSN, RN · Aug 25, 2014

That was pretty par the course anywhere I worked acute care. I don't see the big deal with nurses doing their own vitals. Even when I had a CNA, I did my own vitals. If I was already in the room assessing the patient, why WOULDN'T VS be part of my assessment?

Penguin5332 · Aug 25, 2014

I work in a long term care facility where I charge at night with just one CNA and sometimes a float. We have 33 patients and quite a few are total care. I just do my vitals and assessments down the hall with the CNA during a bed check. I don't know how that could work for you but it is doable. It will make for a longer night though. Once the first bed check is done I may do a few other things that need to be done while the aide cleans or does what ever she needs too. If worse comes to worse, always do your patient care, use your brain sheet, and just stay late to chart.

jadelpn, LPN, EMT-B · Aug 25, 2014

OP-- What you may want to organize is at the begining of the shift after report directly say to the CNA, "I have 2 total cares. Can we go now and have me assess and we can turn them? Then we can meet up every 2 hours? Would that work for you?" If it may not, you could say the same thing to a fellow nurse "we each have 2 total cares. If you are ready, I will go help you turn your patients, now, then we can turn mine. We can meet up every 2 hours".

Because someone is total care doesn't necessarily mean that they can't help. And some have the ability to turn with your help and the side rail. And never underestimate the power of a draw sheet!! Sometimes at first turn, you can do 2 draw sheets and underpads. That way if things get hairy and you need to do a pad change, you only need to take off a layer. Just make sure you have your supplies, and extra pillows/padding you need to have person on their side for a time in the night.

zacarias, ASN, RN · Aug 26, 2014

Thanks all for your suggestions. I'm not against nursing doing their own vitals, it is just that sometimes and the start of your shift there is so much going on that vital signs is one more thing to do, plus sometimes vital sign machines are in short supply. I'll get used to it though.

I agree that making a plan with the CNA at the start of the shift is a great way to plan how things are going to go in the shift.

Surprised1, MSN, RN · Aug 26, 2014

Thanks all for your suggestions. I'm not against nursing doing their own vitals, it is just that sometimes and the start of your shift there is so much going on that vital signs is one more thing to do, plus sometimes vital sign machines are in short supply. I'll get used to it though.
I agree that making a plan with the CNA at the start of the shift is a great way to plan how things are going to go in the shift.

I wasn't even thinking about aides doing vitals or anything like that. Ours, when we even have one, don't do vitals or nursing-type care. I was thinking more along the lines of you needing help turning and changing your total care patients. That's where your nurse buddies come in. :)

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zacarias, ASN, RN · Aug 27, 2014

Yeah it does seem that at a lot of places the CNAs don't do vitals. That's OK I guess as long as I plan on being organized.

Thanks again.