new cna. tips for time management PLEASE REPLY.

studentbear, CNA · Aug 14, 2013

A week is not a lot of time to know everything! As far as speed, I'll tell you what my first trainer ever told me and what I tell girls I train: "Focus on completing tasks correctly and speed will follow." Seriously! It's so much more important to make sure you are doing your job right, then to worry about speed. Don't worry if the veteran CNA's give you a hard time, just focus on doing your job to the best of your ability.

Take care of your back. Practice proper body mechanics and do strength exercises on a regular basis and never, ever do a 2 person transfer by yourself. Wear good shoes (New Balances are amazing!) It'll save your body in the long run and prevent potential injuries. I injured my back in 2011 and it didn't even seem bad at first, but I filed an L&I claim immediately and I'm so grateful that I did. I was able to have 6 months of rehab therapy through my chiropractor and massage therapist, all covered by L&I. But even with the rehab, I was still put out of caregiving for many months. A little over 2 years later and I'm finally almost back to normal, but it still bothers me sometimes. And I'm only 24 All it took was a transfer that should have been a 2 person but wasn't (we had been asking the nurses to change it) and the resident's legs gave out, injuring my left hip, left shoulder, and that whole side of my back. Plus, I didn't always practice proper body mechanics and I think that played a part in it.

When given my assigned residents for the shift, I like to rank each resident by number for who I'm going to get up first, second, ect. Some facilities give you a sheet and it says which resident needs what done (some need to be escorted only, some need to be dressed, or have a shower that day, and so on) but if they don't, I have little shorthand or symbols to remind myself. If someone needs checks, then I put the times I plan to check them, so that I can cross them off as I do. This helps me because I'm visual, so I like being able to see my plan for the shift. It also makes me feel accomplished when I can cross things off and helps with charting later. If anything special comes up, like a resident acting out or behaving differently, I make sure to write it down, too.

Please don't call depends "diapers." If a resident heard you say that, you could seriously offend them, and your job is to help maintain their integrity. As far as putting depends on larger residents, perhaps someone else has some tips? I'm not sure what you mean. I do have a nifty trick for changing depends that is very similar to the one explained in this video:

Once you learn how to do it quickly, it saves so much time! Plus some residents think it's "magical"and are amused by it.

Good luck :) If I think of any other tips or helpful info, I'll let you know.

mstearns09 · Aug 14, 2013

When getting them up for the day or getting them ready for bed, lay everything out in the order it needs to go on. If you do that, you won't be searching for socks or a pull up. I don't know if I saw what shift you're working but when I worked 2p to 10p, I would go in each room and get everything in would need to get the resident ready for bed together in one place such as a drawer, set their toothbrush and toothpaste with a wash cloth and a bottle of lotion and it would speed things up at bedtime. Efficiency and speed comes with time; like the PP said, focus on doing it correctly and the speed will develop on its own.

DavidSquire · Aug 14, 2013

thank you so much!! and believe me I don't call them diapers at work haha I don't know why I said that and im sorry. and I didn't mean the pullups. for example I have a REALLY big resident whos in bed almost 24/7 and when I have to clean him up I have to roll him to the side, tuck it under his bottom, roll him towards me and pull it out from the other said, then strap it on. but sometimes I cant seem to get it on the right way and its so frustrating!!!!

DavidSquire · Aug 14, 2013

I really hope I get the hang of things soon :/

ComeTogether, LPN · Aug 14, 2013

First of all, you are going to be slow for awhile until you really get used to things. I think you will find when you are on your on and not with a preceptor you will find your own system that works for you. Time management for me was one of the things that took a long time to get down and sometimes I still find myself behind....it happens. You have to roll with the punches in this line of work. You will always get your "routine" broken up with emergencies of all kinds. Be it a code blue or a code brown LOL.

I tell all new CNA's to try to make sure you have everything you need with you when you go into the room. Having to leave multiple times to get what you need is very time consuming.....so make a check list in your head that corresponds to the task you are about to do. If its a shower, soap, towels, washcloths, shampoo, etc. Only focus on the task at hand at first. Try to finish with that one person before you leave the room, when you get better at it you will be able to mulit-task patients better.

Changing an obese person isn't as hard as it seems. Depending on whats going on with them there are a few things you can do to make it easier. First of all, make sure the bed is high up...I like it to be a little above my waist. Again, make sure you have everything you need including an extra brief in arms reach so that you have it if you need it. If they are wearing pants I will have the patient bend thier knees (if they are able to bend them) or I'll bend them for them. With their knees totally bent i will lean over the bed, sometimes using my own knee to brace myself and grab the pants just below each buttock and pull them off. I'm not sure how else to explain that. The thing that is helpful for changing a larger person is getting them as far over to one side as you can before you roll them. So you may want to give the pad a tug so that they are as close to your side of the bed as possible if you are having them roll toward thier left hand side. What I do is I will bend their right knee and take their right arm and start it toward the opposite bed rail. I will then tell them to reach with that side and Ill help push them over. (Before i've done all of this i have un-fascened their brief on the left side and tucked it under their body as much as i can) this should have them all the way on their side and now you can do what you gotta do. Now you should be able to pull the soiled brief out all the way and clean them up and place the new one. When they roll back onto their back you they will only have to roll towards you a little bit for you to get that new brief out on that side. I hope this makes sense to you, i've never tried to explain without actually demonstrating.

Now, if the patient is a CVA (stroke) or is contracted or has joint replacements obviously you have to change the way you are doing it. If they are a stroke always always have them roll toward their weak side so they can use their strong side to help pull them selves over. Bending the one knee opposite the side they are rolling towards is going to help tremendously. Even if they can't bend it themselves as long as they are capable ROM wise you can do it for them and it still helps with the rolling.

As far as getting dressed you have to do it different everyone. If they use the toilet what I do is get them on the toilet, give them the wash cloth and have them get started washing up etc. If I can leave them alone I will and I will tell them to do the best they can. I'll leave the clothes within reach and ask them to put on whatever they don't need help with and when I come back I"ll finish washing and dressing them. You want to remember to save steps .....if you are toileting the patient its much easier to put the clean pants on while they are sitting there before they get up and wipe. That way its only one trip down, one trip up. If you toilet them, stand them, clean them, put them in the wheelchair, get them up again, take off the pants, sit down, put the new pants on......that's a whole lot of extra steps. I'm always talking to my patients while Im doing everything I do. I let them know my plan ahead of time so I can tell if they have their own way of doing things, which is going to happen.

If someone does not get toileted, I will wash and dress their lower half in the bed, transfer them and then finish thier upper half while they are in the chair. If they are able to stand I'll do the whole thing at the sink, saving as many steps as I can.

PM me if you need clarification or anything...... Hope I didn't confuse you!!

ComeTogether, LPN · Aug 14, 2013

I try to align the absorbent part of the brief along the outermost part of the butt cheek furthest from me on larger people. I'll kind of hold it against them and see how it looks.....once you get the hang of it you'll be like ohhhhhh. I also make sure the part around the groin is flush against the skin and not hanging down.

DavidSquire · Aug 21, 2013

Thank you for trying to help! I may have to read it a few more times to really understand but that's ok. Thank you!

fuzzywuzzy, CNA · Aug 21, 2013

I know exactly what you mean. I had a really hard time starting out, probably because of my anxiety about it. Try to relax (easier said than done, I know), because once you stop freaking out things automatically get a lot easier. Focus on safety for now, rather than little details. Before you leave a room, STOP and make sure that all those safety measures are in place-- low bed, alarms turned on, mats on the floor, call bell in reach, correct side rail position. IMO, if you have all that stuff taken care of but you forgot to brush someone's teeth or missed an incontinence check, that's okay. It's better than finding someone on the floor later!

I'm guessing since you asked about dressing people that are working day shift. Part of how you structure your day is going to depend on facility policy and also the type of residents you work with. Are you allowed to get people dressed before breakfast? I worked at one facility where the trays didn't come up for like an hour so I would try and get as many people dressed as I could. In the place I work now the trays come up right away and we are not allowed to dress anyone-- we just do a round of incontinence checks and then pass out the food, but I always make sure that as I'm checking people I'll go grab their wheelchair from the end of the hall and throw all the stuff that I need (towels, clothes, briefs, hoyer sling, and their basin of supplies) in the chair and that way I can make a mental note of any of their supplies are missing so i don't have to go running around later. If your unit has a lot of total care residents that are not alert, you can wash them on your own time but you'll probably have to make time for a lot of incontinent checks, whereas a unit full of alert patients will take longer to dress because some of them are picky about their routine, but most of them won't need much from you after that.

One thing that makes no sense to me is when CNAs wash a person up and put a shirt on them and leave them in bed. Then when they're ready to get them up they have to spend 50 years putting on pants, brushing teeth, looking for their shoes, etc. And then they wonder why they're behind schedule. I noticed that the people that do this are always the ones with the time management problems.

On the unit where most people are total care, after breakfast I do an incontinence check on half my people and then I dress the rest of them. Then I go back and dress the first group and get them up immediately, then I go and change/get up the 2nd group. That way everyone gets an incontinence check 3x before lunch. It's much easier to keep up with your incontinence care if all your people are in bed because you can change them by yourself. But watch the clock because you don't want to have 3 or 4 residents still in bed 10 minutes before you're supposed to go to lunch! If you're new and slow, chances are you'll just have to aim for getting everyone dressed and that's it. If you're dressing someone and leaving them in bed, put their pants and socks on too. Pull the pants up around their thighs and if they use the hoyer, put the sling next to them in the bed.

One thing that can suck up a lot of time is waiting for help with transfers. What I do is I get the resident all set up for the transfer before I ask for help, because that way if the other CNA is available immediately, I'm not making them wait. This means I have the person's clothes on and the chair and hoyer lift (if necessary) in the room. If the other CNA is in the middle of something I usually help them finish what they were doing and then we go do my resident. If I do get stuck waiting in the room I'll do something that doesn't matter if they're in or out of bed for, like mouth care or shaving. Basically you do not want to be standing around for any reason. CNA work is never done, so you should always be able to think of something to do!

Basically you just have to get to know the residents and their routines. i am pretty creative when it comes to finding little ways to save time but most of them are resident-specific so they wouldn't be much help to you. Just remember to calm down and check for safety. Those should be your priorities right now. If your facility doesn't provide "brain sheets" then you should definitely make your own. For me personally, it helps if I write things down. Like if I skipped brushing someone's teeth or I noticed someone's fingernails were dirty and I don't have time to deal with it immediately, I write it down and cross it off later. Otherwise, I keep thinking about it and I get frazzled. That's another reason why I like to finish what I start and then move on to the next thing. I work with some CNAs who can never get out of their own way and they're always disorganized and will run around starting things but not finishing them.

penny186, ADN, BSN, CNA, RN · Aug 21, 2013

I felt the same way when I first started. Time is the key to getting great at your job. After you know the residents, staff, routine, and facility, you will be popping residents out like its nobodys business! Prioritize yourself by who needs showers, who will take the longest, who is a 2 assist, and who needs to be up for breakfast. When I first started, I took a long time, trying to wash them very well and do stuff by the way I was taught. I learned quickly that cna classes are unrealistic. Get all supplies so you dont have to leave the room and do as much as you can by yourself before you need assistance. Make sure they look presentable, smell good, have their alarms, safety equipment, call lights, wheelchair devices, and their beds are in the lowest position. Follow the care plan exactly ask the nurse about any discrepancy. Dont be afraid to ask for help. Make sure they are safe and their rooms are clean at the end of the shift. Write things down on paper like what size briefs they wear, order of get ups, and when they voided. Make a list of names, room numbers, number of assists, alarms, safety equipment, and info like who wears dentures and who gets back to bed for each resident. Get their clothes on so you can turn them the least amount of times possible. Sometimes it is easier to get their shirt on once they are out of bed. I feel accomplished when I get someone done and I cross them off my list. Overall, have a plan for what needs to be done at what time and it will guide you through your day. Make sure they are dry for the next shift. All you can do is your best and if you know you put forth an honest effort, you did a good job good luck!

mintygirl · Aug 24, 2013

I really hope I get the hang of things soon :/

Give yourself time, speed will come later. Don't overwhelm yourself with needing to finish "fast" like others. Every cna is different and does things differently that is easy for them. Some tips I can give you are things like like:

I always tend to arrive 15 minutes before my shift and get a report off with the prior cna and do my walk through to make sure the pt is changed and hasn't been sitting in urine for 2 hours, or worse: they are dead. I make sure the room is clean and the trash room is empty, then I start to prepare myself for pt care and start prioritizing pt's.

If its an AM shift - I talk to my charge nurse and find out if anyone has dialysis or is a family is coming to get them, do they think anyone will be discharged? If they don't know, that's cool, I wait until they call us back.

Then I clock is like 5 minute earlier because I'm able to do that and get started with the CNA. I assess the pt's by easiest first, waking them up, asking them if they like to sleep more. I do a shower or two if I can help it and then bam, breakfast. So I pass out trays, feed pt's that need assistance, pick up trays and then start my run.

I'm fast with picking out shirts and getting it all ready, then I let the pt take their time getting dressed or if there is anything they can do for themselves, I let them do it because it saves me time + plus its the right thing to do. Meanwhile I strip the bed if they are sitting up and have my linen ready, then ask the pt if they want anything washed before I haul it off to laundry.

I'm pretty much moving as fast as I can without speeding up the pt because they can take as much time as they need.

For PM things are a lot more chill and Noc is relatively slow. Once you get to know your pts and their routines, things will fall into their natural order. Sometimes though no matter what I do, I still fall behind because the run is hard and the shift is crazy. A last minute appointment which throws my priority for pt's out the window.

Two small important tip: never lift a pt without a second cna present and keep with you a mini notebook so you can write down the vitals / what their food intake was and what they drank / so it saves time on charting.

steph83 · May 25, 2014

As a CNA with a very heavy assignment I have found a few ways to make the brief changes a bit easier and faster. Again make sure the bed is at a comfortable height for you, Of course unfasten the front and tuck the front of it between the legs, if your person can moderately assist you sometimes raising the foot of the bed will help them to get a little more leverage to push from and help the turning process, cloth chucks and draw sheets will be your best friend use them, get the patients body to the opposite side you rolling to and give a count 1,2,3 and roll helping them along the way, Once rolled take the back side of the brief and chuck and roll it into itself, do your peri-care, layer your new brief and chuck and place it in the appropriate position, I put the clean stuff under the soiled stuff, have them roll back onto their back, go to the the side of the bed, position them in the same ready to roll position, roll them on your count, the soiled stuff i there ready to be pulled out, if there is anymore cleaning to do now is the time, apply cream/barrier lotion ect.., unroll the clean stuff and roll the resident back to there back, pull the new stuff through he legs and fasten, and re-position your resident!! I know it seems complicated but once you get the hang of it it will be second nature!! Good luck hang in there and do the very best you can by your residents and you'll be fine!!! Practice makes perfect and remember someone else way will not always work for you... find your way while keeping your people safe and happy!!!