LTC nurses having to do CNA work all day

Specialties Geriatric

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I am a nurse at a LTC facility. We have anywhere between 30-35 patients on the hall. Two nurses. We have 2 CNAs typically for the hall. There are a lot of total care residents that require 2 CNAs. When we only have 2 CNAs on the hall, the nurses are constantly having to do the CNAs job of helping with transfers, ADLs, recording intake/output, BMs, making/changing beds, getting residents up and toileted before meals, assisting with showers, answering call lights, serving meals, feeding residents that cannot feed themselves, etc. Not that us nurses mind helping, but we are struggling to accomplish our own medication passes and documentation. We are lucky if we have a CNA that is able to come to work on time. A lot of days, our CNAs are an hour or more late, arriving when breakfast is being served, meaning that the nurses are then responsible to get all of the residents up out of bed prior to breakfast, serve breakfast, and attempt to get all of our vital signs, assessments, and morning medication pass done. Then, following breakfast the same CNAs that were late have the nerve to ask us if they can go outside for a 15-20min break. The nurses are never able to get breaks according to them apparently. I am wondering, Is this like this at all facilities? I am not trying to complain about giving care to residents but when the nurses are unable to do their job and are worried about missing changes of condition or administering the wrong medications due to being in a hurry to complete tasks, I feel like it is becoming a problem. We are unable to delegate to the CNAs because they are already putting us behind and do not do it when asked. Management has been notified and are aware but are choosing not to do anything about it, constantly making excuses for their behavior.

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Specializes in Geriatrics.

Your CNAs are allowed to come to work an hour late?? In my 25+ years of being a LTC nurse I have never heard of that. I would leave.

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Yes, any call ins or being late is typically excused. Its crazy

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Specializes in LTC, Hospice, Case Management.
Yes, any call ins or being late is typically excused. Its crazy

If that's not fixed then nothing is going to change. Your choice to deal with it or move on.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

First of all, there is no such thing as CNA work. CNAs do the tasks that can be appropriately delegated by nurses. Your issue is that your workload is simply not doable without CNA help, and the CNAs in your facility are allowed to run their own program.

Don't be afraid to complain. This is certainly a legitimate issue to complain about. But don't expect your complaints to accomplish much. The powers that be are accepting the revenue for caring for all these people and not caring how well they're actually cared for. If they can keep a few people around and a few others on the payroll (even if they don't show up) then the paperwork looks good for the regulatory agencies.

I would definitely start working for a new job. No, LTC facilities aren't all pits so hopefully you find one that isn't. After you quit this job, you might want to call whomever is in charge of licensing nursing homes and let them know the real story. Good luck.

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I have to say that is most healthcare related facilities (LTC, Hospital, Clinics, etc) we are all working short staffed. Warm bodies are better than no bodies so they let the crap staff stay. To be honest, we can't get good staff right now in our area. Too many employers and not enough QUALITY staff. There are a few people I'd LOVE to get rid of, they aren't awful, but they do the bare minimum. I just don't have a pool of decent staff to replace them. I do hold them accountable though. I'm currently addressing the staff that can't seem to show up on time.

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The fact that the morning CNA's have learned how to get out of morning tasks by coming to work late is only surpassed by management's support of such behavior. Obviously, nothing you say or do is going to make a difference, so fend for yourself by finding a new job.

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Yep! I know exactly what you are talking about. All of the above poster's are correct. They may be difficult to find, but yes, there are great LTC facilities with great CNA's out there. Don't bother going to administration about your current issues, they will do nothing about it and because you told on them, those particular CNAs will most likely withhold vital information from you about your patients, such as skin issues, going forward. I have seen it happen over and over early on in my career. Try to find something at another facility. Also, I have found that this nonsense happens less frequently on the day shift because management / upper management is around. Good luck!

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Specializes in Geriatrics, Dialysis.

No that's not typical at all. I work LTC and there are 24 to 28 residents on a hall with 1 nurse and 2 CNA's plus another CNA that floats between the 2 heaviest halls helping with cares and call lights. If there are call ins or late staff somebody from the previous shift is mandated to stay over to fill the hole, this applies to both CNA's and nurses.

The nurse will help with boosting/re-positioning residents if another CNA isn't available. Occasionally we will toilet a resident or help feed somebody but that's not a daily thing. Some nurses are pretty good about answering call lights, some not so much. Not a single one of us nurses ever stops our med pass to help with full ADL's and we don't shower/bathe residents either.

Granted that type of work isn't below a nurse and if you need to help with it every now and then that's ok, but while a nurse can do a CNA's job the CNA can't do the nurses job. If your employer is expecting that of you on a regular basis that's expecting way too much.

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Specializes in LTC, Rehab.

Urgh, that sounds bad. No, it's not (quite) that bad at all facilities. At my previous LTC facility for 30-35 residents we might only have 1 nurse, but usually 3 CNA's, although admittedly, sometimes only 2. But they weren't an hour late! Night shift CNA's sometimes, yes, but not day shift. If I'd had to get a bunch of residents up I'd already had back surgery(ies), probably ... I did help get people up sometimes, but not on a regular basis.

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Specializes in M/S, Pulmonary, Travel, Homecare, Psych..
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I am a nurse at a LTC facility. We have anywhere between 30-35 patients on the hall. Two nurses. We have 2 CNAs typically for the hall. There are a lot of total care residents that require 2 CNAs. When we only have 2 CNAs on the hall, the nurses are constantly having to do the CNAs job of helping with transfers, ADLs, recording intake/output, BMs, making/changing beds, getting residents up and toileted before meals, assisting with showers, answering call lights, serving meals, feeding residents that cannot feed themselves, etc. Not that us nurses mind helping, but we are struggling to accomplish our own medication passes and documentation. We are lucky if we have a CNA that is able to come to work on time. A lot of days, our CNAs are an hour or more late, arriving when breakfast is being served, meaning that the nurses are then responsible to get all of the residents up out of bed prior to breakfast, serve breakfast, and attempt to get all of our vital signs, assessments, and morning medication pass done. Then, following breakfast the same CNAs that were late have the nerve to ask us if they can go outside for a 15-20min break. The nurses are never able to get breaks according to them apparently. I am wondering, Is this like this at all facilities? I am not trying to complain about giving care to residents but when the nurses are unable to do their job and are worried about missing changes of condition or administering the wrong medications due to being in a hurry to complete tasks, I feel like it is becoming a problem. We are unable to delegate to the CNAs because they are already putting us behind and do not do it when asked. Management has been notified and are aware but are choosing not to do anything about it, constantly making excuses for their behavior.

There's a large gap between helping and "doing for" that often gets overlooked in situations like this. You're not helping, you're doing the work for them. Not the same thing.

They're "helping" you. Not the other way around.

And if your facility looks at it as enough, move on. Trust me, they won't change their approach.

Me, I've been in this situation before on out of control M/S units. It sometimes helps to suggest a change in staffing....such as going with more nurses (hence, less med pass and documentation per nurse) and less nurse aids.

In the mean time, stop "doing the work" for them and get into more of a "I'll help as soon as my duties are caught up" approach. Yes, quality of care will suffer and yes, complaints will go up up up...........

Usually that's the only thing that triggers admin. to look at the problem. Just be warned, usually their solution to the problem is to say you should be doing more, not to fix the staffing issue.

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If this were me, I would be looking for a new job and not stay there. If I can't get my work done since management chooses not to listen . Please do not stay there .

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