doing rounds on 11-7

Well, state law says they have to be checked q2hrs for incontinence and turning. The people doing it should be quieter so as to disturb as little as possible.

In my state it's illegal to get them up before 5:00 am. The aides will do it, tho, if they can get away with it.

Calgon,

When I worked nights as CNA and then RN and would work evenings or nights I would check on my patients every 2 hours(minimum). Vital signs every 4 hours and turning at that time if they weren't able to turn themselves well. If they had a decub or were at high risk for a decub(incontinence,etc) I would turn them every 2 hours. The earliest I ever got anyone up was at 0600 to weigh patients before the doc came in for rounds on a cardiac floor.

We help the CNAs with rounds - 2 and 5 am. The earliest that our nurse manager wants them up with showers or bed baths is 4:30. Sometimes showers are done earlier at 1:30 or 2:00 and the person is put back in bed to sleep. I don't like it, but I have no control over it.

There really is no way to get over turning on the light to do rounds. But there is no reason to be loud when doing it. Sometimes I think some nurses and CNAs forget that this is still nights for most people.

We do rounds in pairs, 4 LNAs on my unit. We try to do it discreetly and quietly, but sometimes, working with someone that you enjoy working with, it's hard. Especially if your residents that you're check and changing are completely unresponsive or interactive at all. Granted we don't talk loudly, we don't talk about inappropriate things, and we ALWAYS talk to the patient first, let them know what we're doing and try to talk to them first. Then again, when i get woken up in the middle of the night, i'm not too into being chatted up either.

I also forgot to add, about gtting people dressed. I've tried to address this with the DON at my facility, but nothing has been done. We are assigned the "heavy" residents to get up, i've been told that is because they need to be up for breakfast. But there's no way that we can get everyone washed, dressed, and up in their chairs by 7am without starting that early, because i'm not willing to sacrifice washing my pt. well to get them up later. As we are also expected to answer call lights while rounding and doing our "get-ups."

I think there is a post or two on this in the LTC forum.

I don't think it is state law...it might be a standard of care thing, but not written as law.

There are lotsa discussions on if the two hr checks are really appropriate for everyone and if they are really effective.

There are new incontinace products made specifically for evenings that would permit longer changes.

I know that if someone would do that to me...you bet you would recieve come behaviors from me. No wonder a lot of these folks are napping all day or want to go to bed at 7 or have behaviors...

I've seen much of the above, especially getting people dressed/showered early. There simply is NO WAY to get LTC residents up/washed (perhaps showered/dressed) and ready for breakfast when they're supposed to, even if the facility is trying to incorporate "culture change" (and don't get me started on that!). The CNAs have to cut corners to get them ready for breakfast because there simply is not enough staff to get the job done efficiently and more importanly, correctly. Residents may get dressed and left in bed by night shift to help day shift out... oral care may get left undone... long story short, the residents aren't getting the care they deserve and staff feels harried/pressured/guilty. The solution? HIRE MORE STAFF. The reality? Same ol' same ol'.....

I worked nights for a lot of years both as a CNA and as an RN. I often used a headlamp, a maglite flashlight or a combination of both. What I was shooting for was a high quality light that was very focused so that I could see skin, assess breathing, etc.

At most places, we'd discuss the need for q2 turns for each patient although everyone needed to be checked no matter what.

Getting up time...this is an issue EVERYWHERE*. At one rehab unit, the manager wanted everyone up, showered and dressed at the breakfast table by 0700. I had her come in and show me how to do that with a start time of 5 AM. She was then deeply impressed by the error of her request. We ended up getting everyone started and a set number of patients up and ready. You can only cram so much in 2 hours no matter how quick you are.

* except peds floors...I always found they were much more reasonable about who had to be up and out of bed by 7 AM.