LTC Workload + Speed and Time Management

What shift will you be working? When I worked 2p-10p, I found that if I went into each of my residents' rooms and set out pajamas, pull-ups or briefs, chux, and whatever else I needed to put them to bed and put those items in the top drawer of their cabinets, it made things go much smoother. Take notes on how residents like their routine until you get used to it and learn it. Watch for patterns of behavior. If you see someone wants a cup of coffee or snack at a certain time, plan to have it ready before they ask. I always ask the nurses about fall follow-ups, temps, vitals, etc. and get those done first. I check every closet for supplies and stock at the beginning of shift. Those are some things to start with; I'm sure others will come along with more.

I would need to know what shift you're on to give specific advice. I've done both day and night, so I'll give as much similar advice as possible. Have all supplies ready before you enter the room and bring extras. you can set up these supplies on the laundry carts and push the laundry carts from room to room. When giving a bed bath put the bottle of lotion in the basin with the wash towels spread soap over towels and let HOT water run in the basin while you get other supplies ready. By the time you set the basin in the room and get the towel on the patient, it'll be a comfortable temperature. Wash like you learned in your CNA classes, essentially wipe down arms and legs and really scrub privates, armpits and feet (careful with diabetics). Have the resident wash their face and hands if possible. Have a towel ready under the body part you're washing and dry off as you finish each body part. When you turn the patient to wash undo the soiled linens with one hand, hold up the patient with the other and tuck the fresh linens scrub the back, dry and use the lotion that's been warmed by the water. Dressing residents probably takes the longest time. Bathing is nothing compared to dressing them. Remember to do afflicted arm first. I like to put on the top and then put everything on the feet. brief or underwear then pants, roll them up to the knees, then socks, and shoes. If you can have the patient stand up to finish the pants that's awesome, if not SHIMMY! You may have to turn the patient several times and even then his pants may not be on all of the way. As you do all this have your dirty linen bag ready at your feet and discard as needed.

The set up is really what takes up a lot of time. If you're ready before you walk in the room, the battle is half done. Please clarify what shift you're on! I might be able to give better advice. What is it that you think takes a long time? 15 min/resident is more than reasonable if you're getting them up for the day! Let those other aides worry about themselves. You WILL gain speed as you continue to work, don't be discouraged!

Woops, sorry, I should have clarified before! Anyway, I'll be on the 3-11, evening shift. Basic routine is come in, pass ice water, give baths/showers if you can, get everyone ready and up for dinner, pass out trays and feed the residents that need assistance, take everyone back to their rooms, wash them up, change them into pajamas/nightgown and put them to bed. Pass snacks, chart ADLs, do any remaining showers/baths, and do your final rounds before leaving.

SuperMeghan91, I agree with you that dressing, especially a totally bed-bound resident, is something that takes a lot of time. Also, one thing that really slows me down that has happened more times than I can count -- I'll be in the middle of cleaning and changing a patient, having already washed them up and put on a fresh diaper, about to pull up their pants, when they have an accident all over themselves AGAIN! I know it's not their fault, but this is something that'll often put me behind, since it means I have to clean them up all over again and before I know it I'm late getting them to dinner, etc.

You might be getting to know what residents will regularly soil themselves. Get those up and out to the dining hall who require the least care first, then you will have time to concentrate on those who require heavy amounts of care. Have multiple briefs ready to go incase they mess after you clean them. I'd keep their pants off until you are ready to take them down to dinner so that you don't need a new change of pants. By all means ask another aide to help you with bed bound patients and learn from what they do. If they say that a real aide would know how to do it tell them that you need help since you're having difficulty. Often times people won't just flat out say "no."

While your patients are eating get their PJ's ready and wash and dress the patients at the same time.

Also, one thing I've discovered already that helps A LOT with keeping up w/ the routine, is getting to your showers and dressing your people for dinner ASAP. Like, pretty much as soon as you come in, get your assignment and pass ice water, start showering people and getting them up. When I first started, because I wasn't really familiar with the whole routine I'd make the mistake of waiting until the last minute to get my people up for dinner, or do my assigned showers/baths, and that would put me behind.

So I think I pretty much have the whole routine of 3-11 at my facility down, and the work itself; basically, I think the biggest hurdle I have to get over is just getting faster and speedier at the actual cares. If I can just get my speed up to par, I think I pretty much got it. But one thing I will say is that I think a lot of people don't give CNAs the credit they deserve. Some people think that it's a brainless sort of job anyone could do, and while it may be true that almost anyone can BECOME a CNA, I think it takes a lot of skill and practice to become a GOOD one. I find it really does require a lot of organization, efficiency, quick thinking, time management, etc. to succeed as a CNA, especially in the LTC environment. Not to mention, I think it's something you really have to have the heart for, too.

You might be getting to know what residents will regularly soil themselves. Get those up and out to the dining hall who require the least care first, then you will have time to concentrate on those who require heavy amounts of care. Have multiple briefs ready to go incase they mess after you clean them. I'd keep their pants off until you are ready to take them down to dinner so that you don't need a new change of pants. By all means ask another aide to help you with bed bound patients and learn from what they do. If they say that a real aide would know how to do it tell them that you need help since you're having difficulty. Often times people won't just flat out say "no."

While your patients are eating get their PJ's ready and wash and dress the patients at the same time.

I'd pass towels and soap to patients that can clean themselves while passing waters, then do patients that aren't incontinent before dinner and save the most incontinent and confused patient baths for the end of the shift. This way if they soil themselves multiple times during the shift you can assure that they will be totally clean and ready to sleep for the night shift.

Good luck to you and God bless you! I pray that you have a better experience this time around.

Sorry I was trying to edit and then I reposted and then I read your post! I'm so glad you're used to your shift! That's a big hurdle for most people and you're already past it!

I had the same issue with speed when I started in LTC - it was the first time I had worked as a CNA and I was on the 7-3 shift. I think it didn't help that I am in no way a morning person and did not enjoy getting up at 5am to be to work on time (I so enjoy 11-7 better, which is what I am doing now). I think its good that you are going to try not letting your coworkers get to you, but also be willing to accept some constructive critism from them - they already know the residents and the facility and may well have ideas and suggestions for you to improve on your speed. But the biggest thing for me was realizing that speed is not something that you will automatically have...although apply the ideas and suggestions of those here on allnurses and of your coworkers will definitely help in that area, your speed will mostly get up to par with practice and time. Other than that, the ideas already listed by previous posters are excellent, and I have nothing more to add. Good luck!!

This was a helpful thread! And all of you seem somewhat positive about the LTC environment which doesn't happen often on these boards! I am starting my LTC job (3-11 shift) next week. And it is good to have a basic run through of what we will be doing! Thanks!