what is it like?........

yousoldtheworld · Dec 1, 2008

Working in LTC is challenging, but often fun and rewarding, too.

The best thing you can do for yourself early on is work out a routine that you can follow every day. Pay attention to which residents like to get up earliest/go to bed first (depending on which shift you work), which ones like to do so later, and which ones don't care.

Start out your shift by making sure you have enough linens to last your shift. Go around and put towels and washcloths in each room before you start getting people ready, otherwise you'll end up wasting time making a billion trips to get them.

When I worked days in LTC, a typical day for me would go like this:

-Get report from other shift

-Stock linen cart, pass towels and washcloths to each room

-Start getting the residents up, toileted, and dressed, starting with the people who like to get up early and ending with the ones who like to sleep a little more.

-Helping the residents to breakfast, feeding when necessary.

-After breakfast, check the incontinent residents, toilet those who need it, and start showers.

-After showers, start getting the residents toileted and ready for lunch.

-Assist with lunch.

-Toilet residents/check for incontinence, at at this point, many like to lie down for a nap.

Once they're fed and many are napping, you have time to do your charting and just watch for call lights.

Evenings go something like:

-Come in, start getting the residents up and toileted from their naps.

-Assist with dinner.

-Bring the residents back, start getting them ready for bed. There are always some who want to go to bed RIGHT after dinner. Get them done as soon as you can.

-Once a resident is in bed, make sure you check them for incontinence every 2 hours.

-Chart/answer call lights.

Nights goes something like:

-Come in, get report.

-Do your first bedcheck - make sure everyone is breathing and dry. If you have people who need turned, do that on your bedcheck also.

-Begin whatever cleaning tasks you are assigned on your unit. I usually have a little laundry to do and we clean walkers/wheelchairs at least once a week.

-At 2nd bedcheck, I check for incontinence and ask residents if they want to get up to toilet.

-Charting, more cleaning.

-Another bedcheck.

-At this point, I usually go around and get out everyone's clothes for the day, and I pass out towels and washcloths. Also make sure you've passed ice water.

-Last bedcheck.

-After this, I begin getting people up for the day. Usually nights willb e assigned to get 2-5 people up and dressed before their shift is over.

Now, keep in mind that on nights, you will have people who are awake, so it's not quite as laid back as it sounds, sometimes. Dementia patients often wander at night, too.

Whatever shift you work, the key is forming a good routine and trying your best to stick to it!

yousoldtheworld · Dec 1, 2008

Also, I forgot to mention that on dayshift, you might have anywhere from 5-15 residents.

Evenings, you might have 10-20.

Nights, you'll probably have at least 20, usually a whole hall to yourself.

This is in a typical LTC setting, only. Some do have better staffing but those were the normal numbers in both LTCs I've worked at. So as you can see, finding a good routine is REALLY important or you'll never get everything done!

Speed Freak · Dec 1, 2008

I am starting my class and training at an LTC that is going to provide the schooling and certification. In return I have to work there for a year. I was looking at the employment section of the paper today and there were at least 20 openings for CNAs. Some of them were offering hiring bonuses.

I am going to try to move up to LVN and see where I go from there. I don't start for two weeks but I am all giddy with excitement. This site has really helped with showing me what I should expect.

The one who is really excited about my new career direction is my daughter who is an RN. Thanks to the credit she was given for her training and experience as an Army medic, she really did not have to do much to become an RN. Real world experience wise she was miles ahead of the other trauma nurses where she works. She saw and learned alot during her tour in Iraq.

fuzzywuzzy, CNA · Dec 1, 2008

It'll be easier when you know the residents, their routines, how much they can do for themselves, etc. In the meantime, ask questions, like what time they usually go to bed, and write everything down.

Passing out what you need at the beginning of the shift- linens, pads, briefs, washcloths, johnnies, denture tabs, etc. helps a lot. You won't have to go running out into the hallway (and get distracted by call lights) in the middle of caring for someone.

After supper you'll be busy trying to get everyone in bed on time (they will let you know if you're running late!), so try to get your walks, vital signs, etc out of the way as early as you can.

And the rest is pretty much just multi-tasking. On second shift everyone gets toileted right after supper and a bunch of people like to go to bed right away. You can put several people in the bathroom at once and quickly wash them up and change into nightclothes while they're on the toilet.. Tell them you're giving them a few minutes of privacy and to ring the call bell when they're done. Some people can wash everything themselves, except for their perineum, so they can do that while they sit.

Then when they're in bed you can put the bedside table way up and set them up with their toothbrush. Or you can do it as you pick up supper trays, so you won't have to bother with it later.

You also have to plan on people with alarms (they can't sit on the toilet by themselves), getting help with your 2-assists, and helping other people with theirs. Watch the clock. If you spend 15 minutes total on HS care for each resident you can get 4 residents done in an hour.

Speed Freak · Dec 1, 2008

I copy posts like yours to my notepad to I can print them out later. They are really helpful.

yousoldtheworld · Dec 2, 2008

Another thing I didn't mention:

DON'T leave your 2 assists and hoyer lifts for last. Ever. I try to get them done first. Grab a 2nd person to assist you as soon as you can, and THEN move on to the easier people you can do yourself. If you get started on your one assist patients, it's really easy to get on a roll and leave the difficult ones for last, and then you either run out of time or can't find someone to help you, meanwhile, they sit, probably wet and/or dirty, and uncomfortable if they are sitting on a hoyer pad. No matter what shift you work, this applies!

Pauligirl · Dec 5, 2008

You will have to prioritize what needs to be done. And realize that with a heavy patient load (12+ patients) it's next to impossible to give the kind of care you'd like to provide. :eek:

Always get help with lifting and transferring patients that can not or will not assist with their own care. You can really injury yourself trying to do it all on your own! I've got a herniated disc and back problems which I suspect is from lifting and turning patients all on my own.

Encourage your patients to do as much as they can for themselves. Some of them will gladly allow you or rather expect you to lift them up and boost them up in bed even though they are capable of doing much of it on their own!:angryfire

I once had a patient that amazingly was able to stand on her own and get in/out of bed and chair with minimal assist once she learned that I had back problems. :madface:

And don't forget to take care of yourself! Always take your breaks and put your feet up!

fuzzywuzzy, CNA · Dec 5, 2008

Another thing I didn't mention:
DON'T leave your 2 assists and hoyer lifts for last. Ever. I try to get them done first. Grab a 2nd person to assist you as soon as you can, and THEN move on to the easier people you can do yourself. If you get started on your one assist patients, it's really easy to get on a roll and leave the difficult ones for last, and then you either run out of time or can't find someone to help you, meanwhile, they sit, probably wet and/or dirty, and uncomfortable if they are sitting on a hoyer pad. No matter what shift you work, this applies!

Yes. If a lot of your 2-assists are confused and not very demanding, you can pair up with someone and get them all into bed one right after the other, and THEN go back and do the care. It's much faster and more efficient, and you'll know who's been incontinent so you can get to them right away.

That only works if you've got a certain type of resident though. I always end up working on a very mixed wing where some people are alert and some are confused, but most of them are very demanding, with either behaviors or heavy call bell users, and the alert ones are picky, picky, picky about how everything gets done and at what time. The best way to do it on that wing is to communicate a lot with the residents and other CNAs, and when you need help from a CNA have everything ready for when they come in the room!!!!!! There's one aide I work with who's really sweet, but she asks you to come help her put someone in bed and you go in there and nothing is done, and you have to waste time either standing there or doing things that she could have done by herself. If I'm going in to help you, I expect to walk in there and see the person washed up, the bed down, the gait belt or hoyer pad on, the hoyer or commode or whatever within site, the foley unhooked from the wheelchair, supplies ready, etc. None of this is done when I go in to help this particular aide! And then half the time I'll start doing all the work while she stands there staring at the resident's TV until I say something. She's not lazy, she's just a spaceshot!! And I hate to say anything to her because she's very nice and always willing to help YOU when you ask. :yeah: lol