Scheduled toileting not being done by certain CNAs

mercy1975 · Nov 15, 2007

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!

Here's a tip to help you see if the residents are being toileted. Put a small piece of paper under the residents' belt or waistband . After the toileted time is past, you check to see if it's still there. Most of the time the paper will stay.

It may sound sneaky, but it works! You will find out who is actually toileting the residents. :devil:

CapeCodMermaid, RN · Nov 16, 2007

Here's a tip to help you see if the residents are being toileted. Put a small piece of paper under the residents' belt or waistband . After the toileted time is past, you check to see if it's still there. Most of the time the paper will stay.
It may sound sneaky, but it works! You will find out who is actually toileting the residents.

I would find it abusive if anyone stuck a piece of paper in or on a resident's brief.

Simplepleasures · Nov 16, 2007

Here's a tip to help you see if the residents are being toileted. Put a small piece of paper under the residents' belt or waistband . After the toileted time is past, you check to see if it's still there. Most of the time the paper will stay.
It may sound sneaky, but it works! You will find out who is actually toileting the residents.

Oi Vey:rolleyes:

Simplepleasures · Nov 16, 2007

I would find it abusive if anyone stuck a piece of paper in or on a resident's brief.

CapeCod, I never thought I'd say this, but I love ya!

mercy1975 · Nov 16, 2007

I would find it abusive if anyone stuck a piece of paper in or on a resident's brief.

It would be only with residents who are incabable of telling you themselves if they have been taken to the toilet or the attends changed. They don't know it's there. At least the same aide won't be letting the residents repeatedly soil themselves or sit in wet depends. We have to be creative and help residents who are incapable for taking care of themselves. You say you can't follow all the staff around. This would find the offensive aides.

I'm always open to better ideas and enjoying learning them. If someone has other ideas I'll gladly listen.

Simplepleasures · Nov 17, 2007

It would be only with residents who are incabable of telling you themselves if they have been taken to the toilet or the attends changed. They don't know it's there. At least the same aide won't be letting the residents repeatedly soil themselves or sit in wet depends. We have to be creative and help residents who are incapable for taking care of themselves. You say you can't follow all the staff around. This would find the offensive aides.
I'm always open to better ideas and enjoying learning them. If someone has other ideas I'll gladly listen.

I realize this may not happen any time soon, BUT IF nurse/ patient ratios were improved , this type of problem would also improve.Wouldnt it be a great day when nursing homes provide a safe place to live and work, which can ONLY happen with State and Federal Mandates. I dont expect the nursing home corporations to "care" until they are forced to .

pumpkin92356 · Nov 18, 2007

The decisions that are made concerning the residents are usually done by people who dont work the floor with these residents, (care plan meetings) are usually not attended by the CNA's or the licensed who are pushing around the medication carts in the morning trying to complete the "Med pass from hell" and this bowel and bladder training programs are almost impossible to keep up with as a cna(IM CNA) we try hard but when you are assigned 8 to 12 residents per day that all have different needs it can be frustrating trying to get them all on the toliet Q2h. And even if you have teamwork it is hard because your co-workers are doing the same thing. CNA to patient ratios need to be lowered for these programs to ever be effective. I offer bedpans and bedside commodes if I havent got my patients up yet before lunch. And then you have the patient that cant be left alone on the commode and you have to sit there till they are done and this can go on for a while. Currently at my facility there is a resident who is blind and confused and has a prolapsed bladder and therefore she is continent if you get her to the toliet as soon as you can but she requires approximately 25 trips to the toliet in my eight hour shift. This is the average amount of trips and then she doesnt always do anything but because she requests to go we must believe that she needs to go. It has caused much stress at our facility. What makes me angry is that these decision makers will sit at the station go answer the light and come and get you to take this woman to the toliet rather than put her on the toliet and then let you know that she needs to go. These are rns that are allowed to assist residents. Its no wonder that Cnas lie sometimes because they are overworked, underpaid and sometimes called upon to explain why they arent taking so and so to the bathroom Q2h. And one statement I absolutely can not stand is "Who has Mrs. so and so, she needs to use the toliet" and walk off. How does that make the patient feel I often wonder? Or this statement"Hold on I'm not your nurse today,your nurse is on break " So tell me what is the resident supposed to do go to the bathroom in 30 minutes when it is convient for the staff? The residents are the ones who are suffering here, they pay hugh amounts of money to be there at the nursing home and then are just as well being told "Pee your pants and then I will take care of it" Bulllll! In the name of money, staff these places with enough aides and nurses to attend to these needs but low and behold it might cost to much money!

Simplepleasures · Nov 18, 2007

The decisions that are made concerning the residents are usually done by people who dont work the floor with these residents, (care plan meetings) are usually not attended by the CNA's or the licensed who are pushing around the medication carts in the morning trying to complete the "Med pass from hell" and this bowel and bladder training programs are almost impossible to keep up with as a cna(IM CNA) we try hard but when you are assigned 8 to 12 residents per day that all have different needs it can be frustrating trying to get them all on the toliet Q2h. And even if you have teamwork it is hard because your co-workers are doing the same thing. CNA to patient ratios need to be lowered for these programs to ever be effective. I offer bedpans and bedside commodes if I havent got my patients up yet before lunch. And then you have the patient that cant be left alone on the commode and you have to sit there till they are done and this can go on for a while. Currently at my facility there is a resident who is blind and confused and has a prolapsed bladder and therefore she is continent if you get her to the toliet as soon as you can but she requires approximately 25 trips to the toliet in my eight hour shift. This is the average amount of trips and then she doesnt always do anything but because she requests to go we must believe that she needs to go. It has caused much stress at our facility. What makes me angry is that these decision makers will sit at the station go answer the light and come and get you to take this woman to the toliet rather than put her on the toliet and then let you know that she needs to go. These are rns that are allowed to assist residents. Its no wonder that Cnas lie sometimes because they are overworked, underpaid and sometimes called upon to explain why they arent taking so and so to the bathroom Q2h. And one statement I absolutely can not stand is "Who has Mrs. so and so, she needs to use the toliet" and walk off. How does that make the patient feel I often wonder? Or this statement"Hold on I'm not your nurse today,your nurse is on break " So tell me what is the resident supposed to do go to the bathroom in 30 minutes when it is convient for the staff? The residents are the ones who are suffering here, they pay hugh amounts of money to be there at the nursing home and then are just as well being told "Pee your pants and then I will take care of it" Bulllll! In the name of money, staff these places with enough aides and nurses to attend to these needs but low and behold it might cost to much money!

You are SO RIGHT! It is just like President Bush said, "I am the decider !", but is So out of touch OR knows but doesnt CARE about those doing all the HARD work.

lpnbecky123 · Nov 20, 2007

I would be tickled to death if the CNA's would come to me & say, "Mabel only uses the toilet when she first gets up & then after lunch, she stays dry the rest of the time. They would have made their own reasonable care plans. The Resident's needs would be met. Incontinence reduced, everybody would be happier. Instead we fill out gazillions of forms that are not correct, & don't provide the real info we need. Communication really sucks. When I was a CNA, I always figured it was easier to keep people dry & reduce their complaints by toileting them. I never did every 2 hours, but I did ask them frequently if they needed to potty till I figured out their schedule. We didn't use briefs back in the dino age, my folks wore panties. Yeah, we would have accidents, but I am finding that after you hit the big 50, accidents can happen to anybody, know what I mean all you menopausal females out there? So where you are trying to get a 98 you demented woman who has had 7 kids, has CHF & is on lasix daily to be totally continent of bladder, I guess you like pushing boulders up a mountain. When doing an incontinence assessment it is best to go to the toileters, not just make a cookie cutter statement & fill out some meaningless form.