Need Advice for increasing my speed

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Hi All!

I am a PCA in a dementia unit working 11pm-7am. Throughout the night we do toileting rounds/brief checks, paperwork, cleaning, laundry, etc. At 5:00am we begin to wake our residents (we have 20 who need to be woken, 16 of them also need assistance dressing), we have until 6:30am, when first shift comes in we need to do report and assist with seating for 7am breakfast.

There are two of us and we cannot seem to have everyone ready in time. But I''ve been told in the past everyone has been ready in time, so obviously we are doing something too slow! I just want to have peace and happy staff when they arrive at 7am, instead of coworkers who seem unhappy that everyone is not ready. I think it is the fact that we are two new CNAs on 11-7 (both of us are fresh out of school).

Here is my routine: wake resident, assist resident to restroom, assist resident with sitting on toilet (all of our residents are mobile, most with walkers). As the resident sits on the toilet I remove their clothes, and brief. If it is a male resident I shave him while he is on the toilet. I then wash the resident (face, under arms, peri area), apply deoderant, then dress them (fresh brief, clothes, socks, shoes), brush their hair, then assist with brushing teeth. It takes me about 10 minutes/resident to complete this. Once they are ready I have to direct them (and often physically walk them to the sofa to wait for breakfast).

What can I do to speed this up? I also am a med tech and pass meds from 5:00-5:30, so reality is just one PCA is on the floor until 5:30, when I hop in and start to assist.

I am a very new PCA, I finished CNA school just over a month ago and this is my first job. Within three weeks of my new job they certified me as a med tech so I can handle the am meds.

Thanks all! I really appreciate your help.

Aries

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I think that's too many people to get up in only 2 hours.

Most places I've worked, night shift only does 5-6 each.

It sounds like you are already doing the bare minimum.

It must be a personal preference, but I would not do oral care until after breakfast (unless the resident requested it done before breakfast). Their mouths will be dirty from eating 5 minutes later, so I don't see the point in brushing teeth when getting people up.

Do you pick out and set out clothes before or during get-ups? I would get all the supplies together and in the bathroom, ready for later use, while you are doing the q2h rounds.

Do you make beds? If so, I would leave them for day shift to do. I know they're busy too, but if day shift doesn't have to get people up in the mornings, the least they can do is make a few beds after breakfast.

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Also, are you required to do the AM med pass? Or are there enough nurses that one of them could cover for you during those 30 minutes? You could use that time to get people up and help lighten the load.

The first med pass of the day is a nightmare in and of itself. I hate doing them. I couldn't imagine the stress of having to rush through it and then having to get "X" number of people up for the day.

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Hi, thank you replying. I really appreciate your help.

Thank you for sharing your experience.

One thing the PCA I work with taught me was to lay out clothing during our q2h rounds, the other thing we do is add soap to the washclothes and lay them beside the sink, along with a drying towel for each resident so we have quick access for washing. If we do not make beds or brush teeth the LPN who comes on duty will document that it was not done (they do spot checks to make sure the toothbrushes are wet).

The AM shift is always mad at us for not having everyone up and ready at the table. It is miserable, and the only thing I do not like about my job; the HR rep has told me she has heard positive reviews for me, but the daily frustration from AM shift is upsetting for me. They remind us every time that everyone used to be done, or only two residents were left unready. I do have to pass the 5am meds (but there are only 5 residents who recieve 5am's, the rest wait until 7am). I expected a little bit of competition between shifts, as I am aware that is not uncommon in shift work, but this is frustrating, I just dont see how we can adequately meet the expectations. Reading your reply was oddly reassuring. I could skip washing residents, but that isn't fair to them, and I couldn't live with my own conscious.

One detail I was given regardin the issue, they used to get residents ready starting at 4am, and now pushed back to 5am.

I also rotate in the Assisted Living section of our facility, there are 3xs as many residents, but only 5 that require am care, it usually takes 90 minutes just to get them ready. Although our Demensia unit residents are able bodied, they are in need of direct care for dressing, if we leave them alone to dress, they will not dress.

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This is my first CNA/PCA job, and I have nothing to compare it to except CNA clinicals (during which I cared for no more than 3 residents at a time...pure luxury! I had time to take residents for "walks" and talk to them extensively, etc.).

I don't know if my current situation is how every facility runs, or if it is just this facility; I have nothing to compare it to. I have an LPN friend who wants me to apply for a position in her Dementia unit as a CNA, I would be reporting to her, she tells me her facility is nothing like the facility I am currently in, but I just don't know what to think.

My current facility has outstanding state and Dept. of Welfare ratings (by outstanding, I mean Perfect - Deficiency free).

I have never been one to back down from hard work or high stress situations, but something about this situation is bothering me tremendously.

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Specializes in LTC.

So the 2 of you have 90 minutes to get 16 residents done. Well, actually, less than 90 minutes because of the med pass. Is there any way you can get the meds passed earlier or later? What time are they supposed to be given? I mean there is a 2-hour window you're allowed and it seems weird that they wouldn't just have a nurse do them (we don't have med techs at my facility so I don't know). But the LPN has time to check beds and toothbrushes? Why can't she pass the meds? Because it you didn't have to do that you could each take 8 residents for those 90 minutes and that sounds do-able to me. Any more than that does not. Besides, I am sure there are plenty of lazy CNAs who just wet the toothbrush so it looks like they did it.

Does everyone have to be washed and dressed, or just sitting up? We don't use the dining room at breakfast so my partner and I have 16 people to get up in a half hour but they don't all have to be dressed. I usually get like 4 or 5 done though. Breakfast takes like 40 minutes and after that I do the rest of my assignment including my shower, toilet, reposition, pass water and snacks, etc.

If I have a 2-assist I get them done and then leave them in bed till the last minute. I also don't walk every single person to the bathroom. That would take forever. Some of them use a bedpan before they get up or I throw a commode next to the bed and they can use that. I don't waste time filling basins with water. I wet the washcloths and the bar of soap. It takes less time and anyway I just like it better because the ones without soap don't end up with soapy residue all over them from the water. Oh and the first thing I do when I walk into the room is turn the water on so I don't have to wait for it to get hot. For some reason we're not allowed to do this, but I know our 3rd shift does it: drag the laundry cart with a trash bag tied to the handle around with you so you don't have to make tons of trips to the dirty room. There are things you can do early too... like put lotion on people or jobst stockings. Those are 2 less things to do when everything gets hectic.

That's all I can think of. What they really need to do is have extra staff come in early to help. Your facility seems like the total opposite of mine in terms of the shifts. Our 3rd shift dresses only one or two people if we're lucky. No one is up. Usually they have excuses for not even doing that. Most days I come in and there are magazines open at the desk, and people are either all soaked- or all laying on clean dry pads, and when you get them up there is a brown ring hidden on the sheet underneath it.

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Hi AriesPanda,

How is coming along since your last post? Any progress?

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Iwork in a dementia unit myself and that is way too many to have up and especially with you doing a med pass. The only way I see you being able to give the quality care that each of your residents deserve is start earlier.I am sure some of them wake up ealier than five so dress the ones that are awake.I hope that helps we have around 12 to get ready and that is with two working on it.the nurse does med pass at breakfast.I am a new cna too but if i can give you any more help just ask or if you just want to talk about what an interesting and heart breaking job it is.this has been a very good learning experience in a short amount of time.:)

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Specializes in IMCU.

I think that is too many people. Have they been successful with this many people in the past?

What worries me more than anything is that, under that amount of time pressure, I have seen aides/techs get a little rough and not practice as safely.

The only thing I see that could be done is waking some up earlier -- but that isn't really a decent option (7am only seating for breakfast is a bit brutal).

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It sounds like you're doing your best. There are always little tricks you can do to speed things up, like doing a few things early. If a resident is able to brush his own teeth and shave, I might seat him by the sink to do this while I help another resident and then come back to finish up. Each resident has their own situation, and as you get to know them you'll find ways to speed things up.

There will always be complainers on the next shift no matter how long you work at the facility. What I would do is say, "I wasn't able to finish with so-and-so, would you help me with that before I go?" Most tasks go twice as fast with 2 people. Show them that you're really trying your best, and ask them for pointers. Also, if you don't feel like you've been trained enough, go to the DON or staffing, and ask for more orientation. When I first started, people were complaining and I got 2 more days of orientation which helped a lot. (If you can, get orientation with the people who complain about you! Then they have some responsibility to help you, and they'll get to know you better) It's easy to complain about the new people, but everyone's been there. Remind them of that, and they'll let up.

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Specializes in CNA.

Maybe they weren't able to get in done in the past either. People will push you as hard as they can because they don't want to help you. Maybe they are only telling you that it got done in the past so you will fill pressured to work at breakneck speed.

I have experienced this firsthand. People pushing me to go faster and faster so they can slack off.

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Specializes in Acute Care, Rehab, Palliative.

I would be a little suspicious of their clain that previous CNAs had everyone ready all the time. I would say you are doing fine. That is a lot of people to get up.

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