NEGLECT during Night shift

[naide88]

Hi everyone.

I worked this morning in a dementia unit at my facility with just one other coworker (we were short by 2 people). I was filling in because 2 other people did not show up...I usually work 3-11.

This is just horrible what I saw when I came in. I saw one resident who was absolutely soaking wet, she had on depends and a pad on her bed, the urine went through the depends, through the pad, and even through the mattress so the mattress will need to be changed. Her pillows and her blanket was wet too! The smell of urine was so strong that I smelled it immediately when I opened her door.

I found another resident, she was dressed in her clothes but she was wearing two depends and still she was wet, through the 2 depends, and through her pants onto her sheets.

These are the only two residents I found like this today, but the thing is, I know the night shift was not short last night, because I worked 3-11 the night before and I saw who came in so...I'm thinking...WHAT IS GOING ON?

Other times when I get called in to work in the morning I see skin tears on residents that are from them being changed too roughly...

I don't know what else to do but report these incidents and document but things like this keep happening.

[psalm, RN]

If you've documented and reported it and it keeps happeniing, then make an anonymous call to the state and tell them. Suggest a spot inspection early morning sometime so they can see and smell what you see and smell.

[texastaz]

The situation sounds horrible. Soaked patients with wet mattresses are going to happen every now and then. I know double diapers are used for heavy wetters in some places - but over all is not allowed, the same with double padding, or using a rolled sheet/towel between a person's legs to soak up the overflow. I would recommend showing up for your shift earlier to do a walk through. I could possibly help solve the problem if the CNAs going off know they are going to be checked. While it is the nurses responsiblity to do this - if you do it yourself two or three times it may save a lot of conflict that has no solution. Otherwise you can just do your walk through 15 min prior to shift and report your findings to the nurse and have them handle it. The situation sounds so extreme I would also consider looking for another facility to work at and in the mean time if it does not change - report the the facility to the state. You cannot blame the cause of skin tears unless you have witnesses it personaly and still it is your opinion. If you stand by that it is due to roughness - this must be reported to the nurse.

[sonomala]

If you've documented and reported it and it keeps happeniing, then make an anonymous call to the state and tell them. Suggest a spot inspection early morning sometime so they can see and smell what you see and smell.

Well said. I agree!

[MichaelCNA]

I just starting working the NOC shift and we have scheduled rounds at 12-2-4, however, I spot check the "heavy-wetters" by an additional 2 rounds (as long as I'm not breaking my back answering call-lights). There is no reason why this cannot be done elsewhere. Yes, the NOC shift is much easier than 1st or 2nd shifts, but even then, I rarely get to sit down because there is always something to do!

Some general advice for you on reporting; We have a CNA book to report what you describe and then some. Our DON reads it everyday and tries to resolve all reported issues. If your facility does not have such material, recommend it to them! Oh, and keep that Provon fully stocked on your linen cart for irritated skin, works wonders!

Hope all works out for you and your Residents.

[CNA_Coco]

Yes, the NOC shift is much easier than 1st or 2nd shifts, but even then, I rarely get to sit down because there is always something to do!

Michael- while I agree that the NOC shift has fewer duties (no meals, often no showers, etc.), I have to say I don't agree with you when you say that the NOC shift is easier than 1st or 2nd shift.

I have worked in several different facilities, and have worked all three shifts. I would never say that any one shift is any easier than another, just because there's a "balance". Yes, AM shift has two meals. They have family members coming in, the majority of activities often happens on AM shift... but to balance it out, they have fewer patients to be responsible for than the other shifts.

PM shift is kind of in-between- one meal, showers, fewer family members, fewer activities. So they have an in-between amount of patients- more than AMs, but fewer than NOCs.

Noc shift would be the easiest, if a CNA had the same number of patients. Often, to keep a balance going, they are given the largest amount of patients to be responsible for. This is what accounts for a lot of the issues- It can be highly difficult to keep everyone clean and dry for the entire night when you're responsible for 30+ patients, and Mr. Johnson needs a shower because he just finger-painted himself, and Mrs. Smith keeps climbing out of bed and is going to fall if she doesn't get immediate attention when this happens.

Neglect happens on all shifts, and what happened in the main post (residents being absolutely soaked, being double-briefed, etc.) is inexcusable, regardless of what shift it was. I worked PM shift at this facility for over 6 months before switching to NOCs (my five-year-old just started kindergarten this year- if I stayed on PM shift I'd never have seen him!), and I have to say that I've actually worked much harder on the NOC shift just because of staffing issues and the utterly crazy number of alarms and call lights we have to deal with some nights.

To the main poster- I suggest either calling the ombudsman or talking to the administrator about what you found- AFTER pulling the night shift CNA(s) responsible for those particular patients aside and talking to them about it. It may be that they are inexperienced, or that they had bad training, or whatever. Maybe after they get a good talking-to, and hear that their methods obviously aren't working, they will try something else. If this happens multiple times, calling the ombudsman to report a violation of residents' rights, calling state (if it happens often or throughout the whole facility, if these things are not done by just one CNA), or writing to/talking to the administrator.

We all face problems like this! The easiest way, nine times out of ten, to fix the problem without making huge numbers of enemies is to follow a few simple steps- 1) ALWAYS do bed-to-bed rounds. The CNA before you should go from room to room, bed to bed, with you, and ensure your residents are all clean and dry. 2) TALK to the CNA who made a mistake before you talk to other CNAs, supervisors, or management. It could be (except the double-briefing, that's just plain wrong, imo) an honest mistake.

Good luck- hope things get better!!

[CNAmonica65]

When i complained about patient neglect.. I GOT FIRED! nICE HUH??

[emmasma]

Definately do rounds and politely ask them to correct the problem before they go next time. In the places I have worked this is the rule you should do rounds anyway just to make sure that everyone is safe and has their alarms and so on because you are taking over that liability.

If this does not take care of it then you should report neglect, and document it.