RGuadagna

Reading these replies makes me even more thankful for my place of employment. We have a max census of 30 residents (we're usually at 29-30) and day shift usually runs with total staff of 8 including 1-2 RN, 1-2LPN, rest CNAs. Eve shift runs with 7: 1 RN + 1-2 LPNs + CNAs, and nights is 6: 1 RN, 1-2LPNs + CNAs. There are ALWAYS 2 licensed staff to pass meds, every shift. Our staffing is definitely adequate, and most of our staff members do a decent job of keeping busy...most of the time. Honestly, it breaks my heart that there are so many LTC facilities with such terrible staffing ratios. Good luck to all who are trying to make a difference.

Change is difficult and you've probably learned that it comes very slowly in the healthcare field. Many long-time healthcare workers are very attached to the way things have "always been done." You might try looking in healthcare management texts for references. So to successfully introduce change, you need buy in and change agents, right? The idea needs to be presented to end-user staff in a non-intimidating fashion - I usually have "random" conversations with other staff, try to find out their feelings on the subject, and thoroughly educate myself on the process I'm looking to change. Then, I identify end-users who are interested in promoting change and encourage them. I use those "change agents" to promote the change and accept that 1. it will take time, 2. persistence will pay off (if it's a 'good' change), 3. there will always be some people who will not want to change. Don't know if that's helpful for you or not. Hope it is. Good luck with the project and finishing school!

I agree with a lot of what's been posted. I worked as an NA for a couple years before getting my BSN, and I actually supervise co-workers that I used to work with on the same level. I attribute the fact that each one of them said they'd be comfortable working "under" me to a few things. For one thing, the power of leading by example cannot be understated. From your post, it seems that you are already interested in, if not already, doing so. Turn the residents when you can and just *let the CNAs know* that you did it so 1. they know they don't need to rush back in there, and 2. they're aware that you're aware and care about what's going on. Anyone in the healthcare field knows that there's a pretty wide margin when it comes to "quality" of staff members. Get to know who you're working with so that you know which CNAs will need more frequent reminders. And I am all about being direct. If you want something done, either do it yourself or ask someone who is qualified to do it and provide clear directions. i.e. For CNAs you notice routinely forget to T&R, "xxx, could you please turn Ms. xxx? I noticed she's been in that position since our shift started." If it's not done in a timely manner, ask again. If this doesn't work and it's clearly due to personal irresponsibility on the CNA's part, utilize disciplary action. Thank the CNAs who are doing their job. For anyone who thinks it's unneccessary to thank someone for "doing their job," try working as a caring and compassionate CNA for a week. It may be fairly free of "responsibility" (license-wise), but it's physically exhausting and can be emotionally draining (depending on how much your residents open up). Knowing you care that they are caring is important. To AlmostABubbieRN, please remember that not everyone works in conditions similar to your own. On our LTC unit, we have plenty of staff available to T&R q2hrs if indicated. We utilize the Braden scale to identify those at risk for breakdown, and have a very low rate of pressure ulcer development.

Thanks to all who commented and understood that I am trying to find the best procedure for the comfort and good care of our residents. Clearly I was tired and should have been more explanatory about the "letting them sleep." I was not implying that we ignore incontinence altogether during the night as I am well aware of the skin issues and would NEVER advocate for someone "sleeping in their own urine." I work in LTC; for many of our residents, it is their home. My problem is that if someone came barging into my room every two hours during the middle of the night turning lights on and (many CNAs are not quiet and gentle, no matter how many times you speak with them about it) rolling me over - I would never get a good night's sleep and my overall quality of life would be worse. I agree that rounds - looking in to make sure people are asleep, not getting oob, still breathing, etc. should continue - at least every 2 hrs. I just wanted input on other LTC routines because apparently our CNAs need very clear and direct instructions.

I am currently filling in for our regular night RN who is on vacation (read: new to the night shift). Our facility is really focussing on patient-centered care etc, and I was just curious what the routine is out there in other ltc homes with regard to nighttime incontinence care? My question is this: should we be padding the beds really well and letting them sleep OR should we continue to wake them up several times/night to change linens? If it were me, I'd say let me sleep. However, I could totally understand others not wanting to sleep in urine. So for those who can't speak for themselves, which is the more resident-centered approach?