Scheduled toileting not being done by certain CNAs

[old rural nurse]

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!

[CoffeeRTC, BSN, RN]

What is a LNA? Licensed Nursing Assistant?

[Marie_LPN, RN, LPN, RN]

I really don't know what to advise, except possibly asking the A and O residents if they are getting taken to the bathroom.

I just can't get over those that skip on this, and how they live with themselves by lying on those charts. To me, my residents having better skin integrity, wearing one ONE set of clothes that day, etc. was PROOF that these things WORK.

[Marie_LPN, RN, LPN, RN]

What is a LNA? Licensed Nursing Assistant?

Yes.

[Marylou1102]

When we were having the same problems I started spot checking. If a resident was on a toileting program and wore briefs, (we used disposable) I would periodically make rounds and using a marker, date, time and initial the briefs. I would focus on a particular CNA if he/she was a problem child. After an appropriate amount of time I would check again, and if the resident had not been changed I called the staff member on it and they were written up. It sounds harsh but when they knew I was really paying attention they started paying attention too.

[Marie_LPN, RN, LPN, RN]

It's ridiculous that people have to be watched like that, but unfortunately it's necessary.

[CapeCodMermaid, RN]

We gave up the every 2 hours program as well and TRY to be more patient specific. Mrs Jones gets toileted BEFORE meals, at bedtime and at 4am...around the time she's had falls. Mr Smith gets toileted AFTER meals, at bedtime and 6 am. It's certainly not a perfect system, but at least it's based in reality and has a chance of working.

I worked in one place once...everyone had q 2 hour toileting on their careplans....the surveyors came one day with a stop watch to see how many people actually got toileted q2..not a pretty sight!!

[Undecided7]

I totally understand there are many aids out there that avoid any actual work like the plaque. On the other hand, if other areas of the country are like mine, the medical facilities are staffing so poorly (to increase profits for the big guys at the top), that it should be a crime. Sometimes it's not a matter of caring, but the aid should not have to hold his/her bladder for 8-12 hours while "toileting" everyone else. One person can only be in one place at any given time and aids deserve to take a break now and then too (just like any other employee including nurses). I think upper management finds nurses and aids easy to push around and take advantage of because most of us will put up with it- for the sake of the patient- because we care. You know what? I'm as caring as the next person, but I'm a person too and I refuse to be run over at work all the time. If we really cared about our patients, we would refuse to be abused with poor staffing and force management to look at ways to improve pt. care. Of course, we would have to stick together as professionals- something which nurses will never do because we are so "caring". You think most men would put up with that? Think of the men you work with....do they get stepped all over at work? Women will work harder for less money and as long as they can get away with it- it's not going to change.

[CoffeeRTC, BSN, RN]

We gave up the every 2 hours program as well and TRY to be more patient specific. Mrs Jones gets toileted BEFORE meals, at bedtime and at 4am...around the time she's had falls. Mr Smith gets toileted AFTER meals, at bedtime and 6 am. It's certainly not a perfect system, but at least it's based in reality and has a chance of working.

I worked in one place once...everyone had q 2 hour toileting on their careplans....the surveyors came one day with a stop watch to see how many people actually got toileted q2..not a pretty sight!!

I thought that is what the new regs wanted. Figure out the resident's toileting pattern and individulize the program to fit them?

That is what we are trying to do.

[old rural nurse, RN]

I should have clarified in my original post, we have developed our program using the new guidelines, and toilet residents according to their toileting patterns. Very few are on a Q2H schedule, most are Q3H, and I still question whether it is being followed by all staff. I did expect to be able to justify more staff, if all the CNAs stayed busy and we did the program as intended, but I don't see them putting much effort into it, they seem to finish toileting residents much sooner than I expect after meals.

I do thank you all who responded, the idea of marking the brief was a good one! I will try that!

[CoffeeRTC, BSN, RN]

Just be prepared. There will be alot of grumbling from them. I've marked briefs and put cards under residents (turning checks). I've also hid the stuff they should be doing vitals with( funny how they appeared on paper)

We used this as an eye opener. Boy did it ruffle feathers, but it did prove my point.

[CapeCodMermaid, RN]

Just be prepared. There will be alot of grumbling from them. I've marked briefs and put cards under residents (turning checks). I've also hid the stuff they should be doing vitals with( funny how they appeared on paper)

We used this as an eye opener. Boy did it ruffle feathers, but it did prove my point.

WOW...if I were working for you, I'd be very insulted.

If we tried this at my facility, the union would be there faster than you can say pay your dues!!!

[Plagueis]

It seems like toileting residents every two hours is doable, according to management, but what if the home is understaffed, like most nursing homes? For example, say a CNA has 12 residents, and it takes about 10 minutes to toilet each one. (This doesn't even include residents that require a Hoyer lift, which would take more time.) It would take two hours just to toilet all 12 residents, so by the time she was done toileting the last one, it would be time to take the first one to the toilet again, and start the cycle over! Also, add in time to feed, pass trays, take vitals, and get residents up/put them to bed. How are CNAs supposed to have time to toilet every resident every two hours? Don't forget about lunch/dinner breaks, too. To me, the only way that a CNA can comply with the two-hour rule would be to have more CNAs on the floor. (That's a whole separate story right there.)