NEW CNA: Running behind on workload! Feel awful!

Nursing Students CNA/MA

Published

Hi all,

Brand new CNA.

Already had 6 days of training.

So far, have worked 6 days of being assigned my own patients, ranging from 6 - 12, but typically 10 to 12 patients.

Problem? I am not fast enough, I work my best and prioritize.

Here's how I prioritize:

1. Help/clean patients who need to immediately get to the bathroom

2. Vitals if needed

3. Meal times

4. Simultaneously change soiled clothes/briefs/drawsheet or pads for anyone else who I didn't get to change, especially getting FIRST to the patients who have therapy or dialysis soon.

**MAIN PROBLEM: my guilt for failing to care for every single one of my patients, since I did prioritize who needed what first. Some of the patients I want to change, say they want to be changed later...so then I do it later, and move on to a higher priority. Yet, when I sit down and chart, I realized, I had FORGOTTEN like 1 or 2 patients! Even though we are REQUIRED to do bed baths for every patient, there is just not enough time to do that for every single patient! However, I find in the charting, that nearly everyone SOMEHOW has the time to do it. Is this true?! I don't know how it is realistically possible! I am still learning which things I can do to take short-cuts, b/c there is just too many patients in so little time

I honestly did my best to keep the patient safe and clean. I feel SO overwhelmed handling 10 or more patients!! The teamwork goes well, but sometiems we only have 3 CNAs for like 30 beds. Finding help can be hard, and delays my other tasks.

Thank you for reading, I tried to make this as concise as possible.

funtimes: yeah, i work at a nursing home. i'm pretty much on my own, and yeah the nurses are super busy with their agenda so they just alert cnas of any adl care needed. actually, i was lucky one day...i had this one nurse placed this resident on a bedpan, but i took responsibility for removing him off the bedpan and getting him cleaned up. she was a great nurse in teamwork. :)

eatmysoxrn: i understand, the nurses are busy with like 25+ patients, so i try to do the best i can to do total care for the patients. yeah, you're right, it's really just about trying new things. the more days i get to work, the more i realize what works and what does not, and the closer i get to establishing a routine. i really don't like leaving my responsibilities to other people, so like one poster said, it really is all about teamwork. if i can, i try to offer help to other cnas, but most of the time, i try to focus on my patients--because for right now, i am still new. however, i think after like a month or so, i'll be able to be more efficient ;)

thank you guys for your advice!

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Specializes in LTC.

I didn't enter nursing as a CNA but I think you will get up to speed soon, don't compare yourself to the other CNAs and remember they were new and slow once too. Don't be afraid to ask for help if you need it

Figure out a routine and stick to it as best you can. Have all your supplies ready too.

I see most new CNAs start slow but they usually get quicker within a month or two on the job as they get to know their residents.

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Specializes in Alzheimer's, Geriatrics, Chem. Dep..
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**MAIN PROBLEM: my guilt for failing to care for every single one of my patients, since I did prioritize who needed what first. Some of the patients I want to change, say they want to be changed later...so then I do it later, and move on to a higher priority. Yet, when I sit down and chart, I realized, I had FORGOTTEN like 1 or 2 patients! Even though we are REQUIRED to do bed baths for every patient, there is just not enough time to do that for every single patient! However, I find in the charting, that nearly everyone SOMEHOW has the time to do it. Is this true?! I don't know how it is realistically possible! I am still learning which things I can do to take short-cuts, b/c there is just too many patients in so little time.

I can say that exact same thing about being a nurse. The guilt is overwhelming. These people have legitimate needs that we don't seem to be able to meet, there are just not enough people and not enough time :( It does get better though! If you can get through all this with a sweet smile and give your residents the knowledge that someone really does care - if you can continue to figure out what IS most important - and do it - then you will be ok. Don't give up though because with so little time under your belt, you are going to learn how to be faster and "work smarter." So give it at least a year I would say. (just my humble opinion)

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First, use a cheat sheet. Your cheat sheet should have residents' initials, room number, and care plan details that you, as a CNA, need to know, such as whether they're able to ambulate, whether they're a one or two person assist or a Hoyer lift, whether they're incontinent, what their level of orientation is, etc.

Also, what shift are you on? This will make a difference. For example, if you're on days, you'll be doing morning ADLs, getting residents up and ready for the day, etc. If you're on evenings, you'll be doing HS ADLs and putting them to bed, and if you're on NOCs, you'll be doing a lot of turning, changing, and toileting.

Getting into a routine and finding your rhythm are key, and will come with time, and with experimentation. How I might organize my shift would be to first get report from the off-going CNA, making any needed notes on my cheat sheet, then check in with the nurse to find out if there is anything specific they need you to pay attention to, then doing a first round on every resident. The first round is not to do anything other than check in with each one and see what kind of condition they're in (Are they breathing? Are they soaking wet?), talk with them about the plan for your shift (i.e. "Tonight after dinnner, we'll do your bath" or "Since you're going to dialysis today, we'll do your bath right away, but first I need to check in with everyone else, so I'll be back in a while to do that").

With your heavier residents, you should team up with another CNA. Make a deal with them, where if they help you with so and so, you'll help them with one of theirs. This makes it a lot faster with those residents who have hemiparesis with spasticity, or who are obese and immobile, or who take a long time for whatever reason.

The toileting thing is tricky. I know a lot of people have urgency and simply cannot wait to be toileted, or they will be incontinent. Plus, it's uncomfortable to have the urge to void or stool and have to wait, and if the person decides to ambulate to the toilet without assistance, they may fall. On the other hand, a resident should not be left stewing in a soiled brief any longer than absolutely necessary, or skin breakdown will occur. So, to me, they are both of pretty high priority.

This is where clustering your care can be a lifesaver. For example, when you're assisting a resident to dress, toilet them at that time. Explain to them that even if they don't feel the urge at that moment, it may take you a while to get back to them when they do have to go, so they should try while you're there to help. They have every right to refuse, but if they're cooperative with this plan, it can help prevent some of those "I gotta go right this very second" types of calls. Also, some people are very regular and have a predictable pattern. The more you become familiar with your residents, the more you will learn their patterns and be able to incorporate them into your routine. You can even pre-empt some of those call lights by addressing the predictable needs while you're already in the room.

Good luck!

Edited to add: It may very well be that your workload is not humanly possible, so you do have to prioritize and let some things go. When I worked NOCs as a CNA, I had on average 20 residents, 15 of whom were in briefs and needed changing Q2. If it takes 15 minutes to change a brief because you're doing it by yourself, then it will take three hours and 45 minutes just to do your first round of changing on 15 residents. Factor in calls for assistance to the toilet, HS snacks, and the three residents I was required to dress and get up for breakfast before the day shift arrived (one was a stroke with hemiparesis, one was morbidly obese and immobile and required a hoyer, and the other was in a wheelchair and used orthotic devices), and you can see that the workload is simply not humanly possible.

When you work in a culture where everyone else is charting stuff that they didn't do because they didn't have time, it makes the powers that be think the workload is possible, and you'll get no sympathy if you try to tell them that you don't have time or the workload is too heavy.

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Specializes in LTC.

You haven't been doing it long enough, that's all.

What shift do you work? On second shift it's easier to get all your people (especially the 2-assists) in bed as soon as you can right after dinner because you can change them by yourself all night once the initial transfer is over, without waiting for others to come and assist you. Also that way you can go to your lunch break knowing that none of them are sitting in wet briefs-- if your shift is 8 hours long you should be doing 4 rounds on everyone, and that already takes care of two of them. The third round is done while you wash people and the 4th is a cakewalk because that's all you're doing.

On first shift it's a little more complicated and I do it differently with every person, depending on if they need to be in a chair for breakfast, their assist level, how much they pee, etc. You want to leave some of them in bed so you can change them alone as needed, but you don't want to leave ALL of them in because you need time to get them all up for lunch and have their beds made.

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I'd be pretty upset if my CNA asked me to do total care because of poor time management.

Well I dont see a problem with it IF as a CNA I have say 20 patients I have to do HS cares and vitals on in between call lights and toileting people, and im working with say 4 RNs with 5 patients each. Obviously I keep in mind RNs have their own duties they cant pawn off on anyone, so its not something Id ever do because Im lazy, and im more reluctant to do it than other aides. We have some who automatically ask the RNs at the beginning of almost eve4ry shift which patient they wanna do total care on. I reserve it for rare situations, and if im ahead of schedule Ill usually end up doing most or all of the cares and vitals on the patients the RNs took anyway.

Our supervisors prefer we do that over trying to do it all ourselves and have patients waiting until they soak their bed and have vitals that are late. Time management can only get you so far when you have situations like a bed jumper whos on isolation precautions and a fresh surgical patient who just came up at the beginning of your shift.

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You shouldn't be feeling guilty. The companies give ridiculous amount of work to the CNAs to do, expect to provide quality care, but not willing to provide the support needed to provide for this quality care. I am trying to change all that. I need your help though. Please sign this petition limiting CNAs to 8 patients, which is a manageable workload, in both a hospital and long term facilities. If we as a group can get this petition implemented, then the patients will be able to receive the adequate care, and the CNAs will not be breaking their backs trying to provide adequate care for your patients. They will finally receive the care they deserve.....

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You should create a new topic or submit an article to raise awareness for this. It's a very important issue, thank you for sharing!

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Its all about Learning your own routine. And you have to be stern with the resdients, when your doing rounds and you know the person is wet, you have to politley but firmly do the job. Good luck it took me a while to get a routine

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Seriously a bed bath for everyone - everyday?!

Realistically speaking, I bet many of your co-workers are lying about doing those everyday, lol.

But dont you lie! I believe you can do it all with more practice. You're still a newbie.

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I just finished a 4 week CNA class, we did a 5 day clinical rotation in a "well respected" facility in my area. I was completely shocked by everything I witnessed. Most on day shift had 9 residents and some up to 12. They all take major short cuts and ALL have been trained to chart 15mins for just about everything regardless if it was done. This is a place where rule breaking clearly comes from the top and it trickles down. (I would bet this is how they chart where you are.) I was actually told by a CNA who has been there 20 years, that the residents are lucky if they get, "face and A$$" after asking how they give bed baths and mouth care to that many people. It was eye opening how understaffed they are and how it's just generally accepted, especially by Medicare and they state actually. Everyone knows what really goes on. I was told to basically forget mouth care as its lowest on their priority list and you do the best you can with everything else. I honesty don't know if I can work as a CNA in LTC, I'm not even certified yet and I'm already guilt ridden. So it's not you at all, it's the nature of the job. I had 1-2 patients assigned to me and I absolutely respect those who have 10+, its just not easy.

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