Scheduled toileting not being done by certain CNAs

LPN1974, LPN · Feb 3, 2006

Gosh, how are you gonna do that? It's gonna be an "honor" system. If the aides are not honest, they can just check on the sheet it was done whether it was or not. The only thing I know is are linens or clothing being replaced more often or are attends being used for the residents on the program.

I just don't know how you're going to know that it was done unless the CNAs are honest enough to do it and say that it was done, and not lie about it.

dekatn · Feb 3, 2006

I truly understand where you are coming from, I wish I had an answer for you. I'm a charge nurse on 7-3, we have one CNA per q 10-14 pt. for each hall (my area has 3 halls), toileting schedule is q2h, say you have 6 pt on each hall that requires toileting. CNA has 2 meals to pass and help feed pt., 5 to 7 showers, call lights to answer, and their own paperwork to do. (this is an 8 hr. shift) If you toilet 6 pt q 2h that's 4x per shift, takes anywhere from 10 to 15m to properly toilet, what with assisting pt. to toilet, helping to undress, redress clean properly and wash hands and assist back to WC or bed. The CNA's also get a 15m break 2x daily and a 30m lunch, that is 1 h out of the day, which leaves 7 hrs. , 10 min. for each pt to toilet X1 is 1hr, X4 is 4h, which I know all pt. don't take 10 m, but it is time consuming to take a confused pt. to the toilet and do it properly. I don't think the CNA's mean any harm or to neglect the toileting program on purpose and I am by no means attacking the OP because I truly do understand her position, I wish these people that make the rules and apply the deficiencies had to actually work the floor and do all the things they want done right and that WE would like to do right. Maybe then there would be some sort of pt. staff ratios put in place that are realistic and not just figured as "nursing and staff hours per pt." as is posted by the state. I hope this makes sense and if anybody has any suggestions, I think we are all open to them.

CoffeeRTC, BSN, RN · Feb 3, 2006

Well if it is a time issue....dekatn post summed it up......more staffing is needed (Ha, ha, ha....when pigs fly). We all know when that will happen.

If they staffing ration is good and others are getting the toileting done, but the aid is neglecting to do it...then it is an issue of insubordination or failure to do job duties.

In my facility it is half and half. Call offs and madatory OT is rampant. The staff is tired, overworked. Excactly how mangagement expects programs like this to work is beyond me. Just look at the math and numbers! Now on good days, there really is no excuse. I work with a great crew, but sometimes its sprinkled with a few slackers. It doesn't take much to see that the res aren't getting toileted. As the charge nurse I will ask/ remind them that so and so is on the toilieting program, then go from there.

debRN0417 · Feb 3, 2006

You cannot be everywhere at once, but when you make rounds and periodically assess your residents it will soon become obvious who is getting toileted and who is not. Skin issues would crop up, increased agitation ,falls and the like, in relation to residents not being toileted. You have to trust that the CNA's care enough about the residents and their job to do the right thing. Now I know that is not always the case, I do live in the real world, but if they know you are monitoring and if they are held accountable for skin issues, falls and such that can be related to incontinence then maybe it will get easier as they will do what they're supposed to be doing for the residents.

It is not easy...I applaud all long term care workers who care enough to want to provide quality of care and quality of life for our residents. Anyone can mark a sheet, it's simply a paper process, and the surveyors do look at the papers, but the main thing is the resident...if the paper is not marked, but the resident is clean, content, no skin issues, no falls, no odors...etc...then where is the negative outcome? It is a challenge and again I applaud all LTC caregivers.:)

GooeyRN, ADN, BSN, CNA, LPN, RN · Feb 3, 2006

I used to work as a CNA and we had 16 patients each on a bad day. Day shift, with all the showers and 2 mealsand vitals. There wasn't enough time. If the resident didn't ask, they didn't go. I know its sad but there wasn't time. And I only took one five minute break for myself to pee during the shift. Even on the days I only had 10 patients it was impossible. On the very rare days I had only 7-8 patients everyone got toileted, changed, and turned as scheduled.

CLA-Amy · Feb 3, 2006

:banghead:Im sorry to hear about the difficulty your having. I am currently a CNA myself. I can proudly say in the assisted home I work in we all take care of the residents right away. There really is not much you can do but keep an eye on the Cna's to make sure they are getting the job done. I would explain to them how it affects the client not being tolieted or changed. Ask the clients if so n so is toileting them. If they are not find out who is not doing it and warn them. Then next write them up and if it came down to it fire them. Its neglect! I have seen my share of bad employees. I can not believe people can be so mean and cruel. Why do people become Cna's and nurses etc if they are so uncaring and neglectful towards people. Hope it gets better for you!

miccay · Feb 4, 2006

We had the same problem at our facility, then we did away with the q 2 hr program and implemented the upon awakening, before and after meals and q hs and of course if the resident requests. It has worked out much better and we do have less skin breakdown. The q 2 hr program is unrealistic.

GooeyRN, ADN, BSN, CNA, LPN, RN · Feb 4, 2006

We had the same problem at our facility, then we did away with the q 2 hr program and implemented the upon awakening, before and after meals and q hs and of course if the resident requests. It has worked out much better and we do have less skin breakdown. The q 2 hr program is unrealistic.

This program sounds more realistic. How can you be toileting someone for the second or third time and still not have someone else out of bed and showered and dressed yet? No one would be getting dressed and showered if everyone had to be toileted every 2 hours. If you get a group of 15 residents, its hard to get them all up by lunch time to begin with. (Assuming 11-7 doesn't get anyone up like the place I worked at) But upon awakening, before and after meals and bed time (and at request) sounds doable.

bethin · Feb 4, 2006

We had the same problem at our facility, then we did away with the q 2 hr program and implemented the upon awakening, before and after meals and q hs and of course if the resident requests. It has worked out much better and we do have less skin breakdown. The q 2 hr program is unrealistic.

I don't work LTC, but on our med/surg floor that's what we do and it works out so much better than q2. I'm an aide and I start work at 0630. While I'm getting daily weights and blood sugars me (and other aides) go into the rooms who we know need help getting to the BR. Then it's before and after meals. Of course, if a pt. is getting Lasix or puts on their call light we will toilet them as needed. It's helpful to know who is getting Lasix because then you are aware you need to check them more often than others. It's not always easy as sometimes I have ten total care patients but for the most part it works well. It's hard to look at a clock and say "it's been 2 hours, time to go toilet so and so." Also, it can be difficult remembering who has went and who hasn't.

K205 · Feb 4, 2006

as a former LNA, I can tell you they fake 'em. Is there an LNA there that you could delegate the task to?

Our facility got deficiencies earlier for our incontinence program, which I corrected with new forms etc. The staff was very gung ho about the new program at first. But now I suspect that not all the CNAs are following the schedule for toileting certain residents. Any ideas how I can follow up on them other than me or the charge nurse following them around all day to ensure it is done? I figure if they had a check off sheet, that they could just write it was done without actually toileting the resident, but I am so busy I would like some ideas that would not be too time consuming. What do you all do in your facilities? Any help would be appreciated!

rouqie · Feb 4, 2006

well i am glad to see that i am not the only nurse with people not being changed properly. i don't like the idea of people not having to stick to the every two hours policy. our policy at work is changed and repositioned every 2 to 2.5 hours depending on group size. i don't think my inc. patients need to be on a toilet every two hours. but i do expect my cnas to change their patient's if inc. of b&b, and reposition every 2 hours. they do it whether they have 7 or 15 resident's a piece. sometimes i have to help with the repositioning to get the work done but we get it done. i have learned that if you have most of the cnas getting the work done and couple not doing it then you need to start disciplinary action towards those staff and make them do their job or find a new one.

:angryfire these cnas that you think would say they are doing it and not doing it are bad news all around. if they would lie about something little like the time of an attend change then, how can you trust them with everything else.

:balloons: i have learned that truely dedicated cnas can get the job done, no matter what. i have to give a great big thank you to all the cnas that can do it all in days work. you are truely like little angels