New CNA - how to prevent resident call-light overuse?

[glittermoomin]

Hi there!

I'm a new CNA, and I am having a problem with a small number of my residents over-using (dare I say abusing) the call light.

This has meant I am unable to provide adequate care to my other residents, and I don't even get started charting until my shift is over.

One of my residents is on contact precautions, and yesterday I had to go into their room almost 30 TIMES in one eight hour shift. I don't know if that is deemed a lot for most people, but it felt like a lot to me, especially when I had to gown and glove etc. Incidentally, I know it was almost 30 times, because I went through 3 packs of gowns!

One out of every ten calls is actually a legitimate issue for these type of residents. The rest of the calls are all "pull my covers up, pull my covers down, close the curtains, turn the tv up, turn the light off, remove my tray table, find this phone number, find this other phone number, get me a coffee, now get me some sugar, now get me some creamer, get me some milk, turn the tv down, when is my medication, I need my medication, why hasn't the nurse come to give me my medication (I will get the call bell pressed literally TEN TIMES about medication, even although I have notified the nurse, and let the resident immediately KNOW I notified the nurse)...." etc etc.

A lot of it is residents waiting for me to return to the room with a first request to give me a second request, and then a third request when I returned from the second. I ask my residents to think of EVERYTHING they might need in one go, but it never works.

I don't think ANY of these requests are WRONG, but when the call bell is rung for each and every single request separately, I just end up getting SO BEHIND. I will bring a glass of milk, and THEN they decide they want a snack. I bring them a snack, and THEN they decide they want some creamer for their coffee.

I try to assess the room and bring EVRYTHING they might need in one go (water, ice, cream and sugar, etc etc) but there is ALWAYS something else. It is driving me nuts, and affecting my ability to care for the patients that ACTUALLY need something (brief change, hoyer lift, commode use etc).

Any advice on how to deal with people that abuse the call light would be much appreciated.

One final thought - I am quite a nice person, and I wonder if I should be a little more abrasive with patients. I hate to say that, but I think they tend to abuse the kindness of the people that give them attention.

[quiltynurse56, LPN, LVN]

Welcome to the world of LTC. One thing you can with the resident on precautions is to make sure there isn't anything else and then let them know about how long it will be when you are back. Before going in, could you stand at the door and ask if there is anything they need so you can get it before you gown and go in?

There will always be some residents who think they are the only person you have to care for and expect you to be at their beck and call. Some of these, you can go into the room turn off the call light and let them know you will be back in a few minutes when you finish another task you are in the middle of doing.

Also, make sure that you give them your undivided attention when are assisting them. This goes a long ways towards their feeling cared for. You see something hanging on their wall, ask about it. They love things like that and this can be slipped in when assisting them otherwise.

[TheCommuter, BSN, RN]

Moved to the CNA forum for more responses.

[andielbc]

I just saw this post and wondered if you'd managed to figure out a system? I hope so! I remember when I first started how frustrated I felt when my residents would press that call bell time and time again. (However, oftentimes it's because they have dementia and forget they've even rung it.) Now that I know them a a bit better, I can anticipate their needs and bring what they need when I round on them. I also let them know if I'm busy and that if they call it may be a while before I get to them. What about your co-workers? Do they not answer lights as well?

[Paws2people]

Do you round on them hourly? Ask if there is anything you can do for them before you leave the room?

Sometimes it helps to give them a time frame. You can say, "I'll be back to check on you in an hour. Do you need anything before I leave?"

[Missingyou, CNA]

Part of it may be attention seeking.

When the light is on and you were JUST in there, move onto the next resident who needs care and answer the light when you can. If your nurse questions you (or if you can discuss this with the RN first?) let them know you were, in fact, just in there and needed to change someone who was in need as well.

Get good at anticipating their needs. You know they ask for coffee, then sugar, then cream, then a snack after lunch, bring it BEFORE they ask along with all the goodies. Keep some sugar/creamer in a little cup at their bedside....etc

You, yourself, will have to learn to prioritize what and where you will go. If you were JUST in there 5 minutes ago and you know another resident has been waiting, then you know where you need to be next and the call light will have to wait a few more minutes.

The resident will, without a doubt, complain to family or anyone else, that they've had to wait for "hours" (even if it was actually 10 minutes) for help...which is why I suggest having some sort of discussion with the RN or with the unit charge. Make sure the nurse knows that your concern is for ALL your residents and being able to provide proper care for ALL of them...even the ones who don't, or cannot turn on a call light.

[coneal783, ADN, RN]

Unfortunately, there are just some people who ring a lot, while others never ring. Especially in a LTC facility, it does seem that people who ring a lot are lonely. Whenever I'm in their room to change or bathe them, I try to talk to them about their kids, hobbies, outside world, etc., to make them feel less lonely. Before I leave the room, I ask them if there's anything else they need/want because "I have several more people to change." I also usually tell them, "I'll be back in to check on you in a little while." Not sure if that has really helped with call bell ringing, but maybe it gives them a sense of security, and that I'm not ignoring them.

[sroseyos]

As others have pointed out, there's unfortunately not a perfect solution to this issue since taking the call bell away or otherwise restricting their actual use of the call system is clearly out of the question. I'm sorry to hear you say you've felt the inclination to be a little more abrasive with patients; certainly there is a type of nurse/nurse aide for whom this approach works, but honestly, I've found more success with the opposite approach.

It's counter-intuitive, but when I'm in a more "needy" patient's room, I like to take my time, even sit down or squat next to their bed so we're face-to-face, talk to them for several minutes, ask them about their day, and just generally make them feel that they have my full attention and I'm not in a rush to get anywhere else. It doesn't work with every patient, but I think you'll find a significant majority end up calling less often when you do this. A lot of patients ring the call bell all day because they want company and need to feel like their concerns are being listened to. Even if it doesn't reduce the frequency with which a patient calls, if you've taken it slow and been kind and attentive to a patient, they're 1000x more likely to cut you some slack when the inevitable rush hits and it takes longer for you to answer those calls.