Residents that need constant supervision

[Anne36, LPN]

I often find that the residents themselves interfere with me getting my nursing duties accomplished. During med pass they wheel over to the cart, stick their hands in my pockets, the trash, try to grab things, stick their hands in the sharps box. Tonight I had to pull a resident out of several different rooms. He wheels in and takes things, gets into things and even took the hand sanitizer off my cart, put it in a med cup and tried to eat it! Another time was in a room pulling on someones Foley catheter. A resident was even found in an isolation room drinking out of another residents straw. I had a 10 min break the entire shift, so did one of my CNAs. Constant alarms going off because the residents wont keep them on, etc. Im just so frustrated, what can be done?

[NewLPN11]

Sounds exactly like my hall to a T lol ...do the best you can..thats what I was told at least...

[Anne36, LPN]

I think some of these people are a danger to themsevles and others. Is the best way to deal with this to just let them roam the halls? There should be some other type of supervision set up for them. We do have activites and try to find ways to divert them but the activities doesnt last all day and some of them cannot be redirected.

[Anne36, LPN]

Its almost the equivalent of letting toddlers at a daycare center run all over the building without supervision. Everytime I see something going south it seems like the only solution is more staffing. I know thats never going to happen.

[chrisrn24]

I work nights, so maybe our situations are different, but we occasionally have residents who are hanging out with us because they can't sleep. What my fellow nurses do is give them a task/activity. Write their name on a piece of paper, play some music, listen to a book on tape, read the newspaper or another book, etc.

[NamasteNurse, BSN, RN]

Refer them to psych. Some behaviors are inevitable, (I work on a similar floor with 40 alzeheimer's pts), but these resident's are in distress and it's not fair to THEM. I understand about not getting your work done, believe me I have joked "I could do my job so much better without the resident's!", but of course that's silly.

In the best world psych has most behaviors under control with the exact right amount of drugs to keep the resident's comfortable without being snowed. (I hate seeing them snowed). AND, you have a dedicated activities person to keep the higher functioning ones somewhat occupied for some of the time.

Inevitably, you will have hangers on, crying and calling out, wheelchair collisions, falls and many many trips to the bathroom, (for them) in between doing your other work. Because when you work on a floor like that, EVERYTHING is YOUR work. The resident's and their needs are your work. I know we all want to get out on time, and admin may insist you do, but that's unrealistic. Working with these resident's is a lobor of love and some people don't want to do it. It's emotionally and physically draining in a way that other nurses don't understand or don't want to deal with.

And you're right, more staffing IS the answer and it's probably NOT going to happen. IN our facility we are even told "they have the right to fall" WHAT??

So, you do your best. You work with and around them. You help the aides and they help you. AND ask the doc and the psych doc if some of the ones showing anxiety, depression, etc (you have to have a dx they can work with, not just so-and-so is a pita and they follow me all day and night) can have something to take the edge off. Best of luck, you either sink or swim in this business. Some days I'm the bug and sometimes I'm the windshield....oh, and go to bed early, you're gonna need your sleep! :/

[lovingtheunloved, ASN, RN]

When I worked in LTC, our activities staff spent more time at the nurse's station charting their activities than actually doing any. They really just spent most of the day sitting back there irritating me. Didn't matter how many times I kicked them out, they came back like flies to manure. It was sad, because 90% of the residents' behaviors could have been controlled with activities, but I could never convince activities staff or management of that.

[NurseCard, ADN]

I always go grab some towels... not TOO many, just enough... and say to the resident "Hey Myrtle, I need

help with the laundry, will you help me fold these towels?" Works just about every time. Then when they

are done folding those, I take them to the "laundry" room, mess them up, then bring them out again "Hey

Myrtle, here's some more towels that need folded". Helps for a little while anyway, long enough to get a

few things done.

[ktwlpn, LPN]

I often have to keep a clean towel draped over my med cart during my med pass.I don't have anyone that has the cognitive function to figure out that there are fun things under that towel so it works for me.The trash is always kept covered as is the sharps container-no one can get a hand into either opening.

When we are fully staffed we have human service aides who are supposed to hang out with the residents and help the acitivities staff but they don't start until after the am med pass.Weekends can be pretty rough because our frequent fallers are gotten OOB first and brought to the area in front of the nurse's station and we can't leave them unattended.We nurses (2) usually take turns running our meds out on the floor.

I have found that these folks always have an agenda-they just can't verbalize it.Think about the basic needs.You can often significantly decrease or even eliminate alot of these behaviors by looking at a resident's basic needs.Toileting,drink ,snack and tylenol often works really well.You'll find out what works for each of your residents by trial and error.A psych consult is a possibility if the behaviors are negatively impacting the resident and your documentation should reflect that.I don't like to pop them with short acting benzos if I can avoid them.

The problem on my unit now is getting all of the staff on board.Things have changed over the years and we treat dementia so differently.Remember the days of re-orientation? AWFUL and in-effective.I have co-workers who think that by responding to a resident immediatly we are "spoiling" them,teaching them to repeat inappropiate behavior.If a 94 yr old is screaming over and over at 7am "I want my clothes now" and is sitting in front of the nurse's station in a night gown then someone better get her dressed. Some of the staff just don't get that these folks are all reaction and their "reasoner" is broken.

[dmerrick]

I am an ADON of Education and looking for ideas and policies for 1:1 resident supervision. How do your facilities handle the situations, how long you keep a resident on 1:1 (what are your criteria for assigning 1:1)

Any suggestions would be appreciated.

[ktwlpn, LPN]

I am an ADON of Education and looking for ideas and policies for 1:1 resident supervision. How do your facilities handle the situations, how long you keep a resident on 1:1 (what are your criteria for assigning 1:1)

Any suggestions would be appreciated.

We assign 1 :1 for residents who are physically or sexually aggressive towards peers, high elopement risks in the general population (we have secure units but often residents on other units will become increasingly confused and elope) threaten suicide or frequent fallers. We generally do 7 days for elopement risks due to increased confusion because we are working them up at the same time.The other things are case by case, we always call pysch and the PCP and make a plan from there.We involve PT/OT and activities for frequent fallers.We have had people who have fallen dozens of times in a month and we've had folks who were one to one for YEARS!!! Plays havoc with staffing

[IowaKaren]

Yes, and I do not believe it will get any better in the future. Such a sad state in many cases.