Night shift CNA question

[Daniellerdh]

I work at a long term care facility on night shift 7p-7a. On my hall I have one partner and we have over 40 residents 35 check and changes. We have around 12 feeders. Every morning on our last round we get around 6 feeders up for breakfast. All of which are with mechanical lifts. One feeder we had not been getting up for a while because he is always still in his chair and soaked when i come on at 7p. He had developed skin breakdown and had pressure ulcers. He was healing good since we had been leaving him in bed in the mornings. But all of a sudden they give us a list of 15 residents who need to be up in the mornings. Some of them are not even feeders.Now he has developed pressure ulcers again since they are making us get him up. I understand its good for them to be up out of bed but some of them dont want up at 4:30 which is when we have to start getting them up to be done by 7am. I always thought they have the right to decide what they want to do. Ive reported that several refuse to get up that early and I was told MAKE them get up. We were also told that we get them up and put them back in bed when we get there. Wouldnt it make sense if these residents are laid dowm to be changed on day shifts last round that they would already be in bed? Why would they change them and get them back up to sit and wait for night shift to come? Am I right or wrong for leaving them in bed? Does any one else think 15 get ups is too much?

[Here.I.Stand, BSN, RN]

Dang!! I worked overnights as a CNA in LTC years ago. We had 2 CNAs and 30 residents; I don't remember how many were incontinent or used the Hoyer. We got three residents up and to the dining room. We started around 0530. One had severe dementia so she never really agreed or refused anything; she was also put to bed soon after dinner, and was lain down for a 2-hr nap in the afternoon. The second of the 3 residents had been a dairy farmer -- he had gotten up at 0430 every single day of his adult life, and actually would set off his bed alarm trying to get up, because in his mind it was time to get up. The third resident was a&ox4 and agreed to get up at 0600.

If a resident refuses and you physically "make them get up," that is called battery. They absolutely have the right to refuse -- you and the other staff are in their home. If that doesn't stop honestly I would be making a call to your ombudsman.

Thank you for your willingness to ask these questions; it's the first step in advocating for these vulnerable people

[sallyrnrrt, ADN, RN]

Amen to Here I Stand

[caliotter3]

Your situation sounds almost identical to a facility where I once worked. When these questions were posed to the DON, she responded that the disoriented residents had no idea that they were getting up at 4 am to take showers because they had no idea what time of day or night it was. No wonder that the good employees started looking for work elsewhere, even after that DON left. Follow the lead of your charge nurse. S/he should back you up on decisions about who should be transferred to and from bed by the night shift. If your charge nurse won't stand up for the residents, it might be time to look for a job.

[Daniellerdh]

We have 3 or 4 who can make their own decisions. I always ask them before I do anything, even if I am just checking sheets. I always ask if its okay for me to do so. So in the morning if i ask them if i can get them up and ready for breakfast and they tell me they dont feel like it, my nurse will ask also to make sure they refused. If a resident has diarrhea my nurse will tell us to leave them in bed because day shift does not do a first round until 10 or so, so its a long time for them to sit in diarrhea. But DON has threatened writes up to CNAs who dont get all 15 up, and the nurses on the shift as well. I know these residents that we get up are not being put down or changed during the day because when we start to put them dowm some of them are wet, their pants are wet, their shirts are wet, the chair, the sling. Its sad really I cried last week when I found a resident like that.

[NurseSpeedy, ADN, LPN, RN]

There are several issues that I can spot in this situation and I don't even have to get into the increased work demands.

First issue, why the heck is this resident always still in his chair and soaked at 7pm? He obviously isn't being changed often enough period or he wouldn't be in a cold wet mess at the start of shift all the time. Ready for bed or not, the man needs to be cleaned up more frequently. If this means he wants to get back in his chair afterward that's fine, but the change seemed to be getting skipped over instead.

Second issue, how many people honestly want to get up at 4:30am??? I worked dayshift in an ALF with over 110 residents. Want to know how many of them were up and about every time I came in at 7am? ONE. If they want to be up that early is one thing, but if they don't they have the right to refuse. I'd be one hell of a pain in your rear if you forced me out of bed that early. My grandmother used to stay up past 11pm and woke up no earlier than 9am. She was 95 and there wasn't any way that would change for staffing convenience.

This seems like management not wanting to adjust/increase staffing based on the residents needs. Sad to see the way that some facilities think it is okay to treat a person once they require more custodial care. These residents still have the right to get up and go to bed when they want to. No wonder so many have sleeping issues. I know it's more common when we age, but messing with someone's natural sleep/wake cycle doesn't help them any.

[TheCommuter, BSN, RN]

Am I right or wrong for leaving them in bed?

You are correct for leaving a resident in bed who does not want to be awakened at 4:30 a.m.; however, expect repercussions and potential disciplinary action from management for not following directives.

Does any one else think 15 get ups is too much?

Getting 15 total-care residents up in a nursing home setting at the end of the night shift is entirely too much work. Management often scratches their heads to wonder why employees do not stick around. Gee, I wonder why...