shocked at what I saw!

Purple Princess · Nov 19, 2004

i'm very content lately. we now have about 5 or six aides and that averages to 10 or 11 a piece. We also still have our shower lady and the auxillaries. I guess management was bad before i came. they didn't have auxillary aides because they felt it was a waste of money. they get the same wage as the rest of us. we do use the hoyer lift but try to maintain a person's legs for as long as possible. I also make sure i get help and with adequate staffing it should get better. I still see the towels being used and it grosses me out. there's just no excuse for us to injure ourselves unecessarily. If i can't get my partner, or anybody i ask a nurse. Some do so happily, hell its' just a transfer or repositioning and we are a team taking care of our residents. Other nurses are like oh no don't you dare subject me to that lowly task. I know they're busy and don't bother them unless i have to.

Saundra · Nov 20, 2004

No, that's not what it's supposed to be like. I feel for you--Regs on medicaid reimbursement plainly allocate no more than 13 patients to 1 staff member doing primary care with low level function patients. You're BEYOND overloaded. At the load of 13, you gotta hustle, but it's do-able. Don't they have agency there? Or. let me guess, it's a chain and the administrator is being creative to get their annual bonus? What you're describing should not happen, ever. You're not only flirting with major skin problems, you're looking at possible abuse/neglect charges that sound like they'd probably be justified. Toileting / changing should occur at least every two hours, and double diapering is only for heavy wetters during the sleep periods. Towels??

I recently started at a new facility. We average 16 or 17 residents a piece. If it's real bad you have all 34 to yourself. We just have enough time to meet the clients very basic needs and that's it. I was changing a man last night for bed and I undid his diaper and I'm like what in the heck is a towel stuffed down in there for? It was soaked with urine and poop towards the back. I seen this done on other clients too. I guess they do this on daylight to save time so they don't have to change them as often. But unlike the diaper absorbing some of it and congeling the towel just presses against their skin and makes everything red. I'm not going to go against the tide this time but just make an effort to do the job and correctly myself. I try to change them often, cleanse the skin apply any necessary ointments or powder to protect the skin and keep it dry. They said they were having a staffing problem right now and newcomers come in from other facilities and just can't keep up and leave. I spent 3 hours giving pm care minus my 15 minute lunch break. I can't imagine having the full load of 34. is this the norm for a CNA? Also I might add this is a skilled nursing unit, few can even walk, most are in diapers, and all pretty much need complete care. We don't even pull basin, we just wipe them off , slap a gown on, and change the diaper.

webblarsk · Nov 20, 2004

i'm very content lately. we now have about 5 or six aides and that averages to 10 or 11 a piece. We also still have our shower lady and the auxillaries. I guess management was bad before i came. they didn't have auxillary aides because they felt it was a waste of money. they get the same wage as the rest of us. we do use the hoyer lift but try to maintain a person's legs for as long as possible. I also make sure i get help and with adequate staffing it should get better. I still see the towels being used and it grosses me out. there's just no excuse for us to injure ourselves unecessarily. If i can't get my partner, or anybody i ask a nurse. Some do so happily, hell its' just a transfer or repositioning and we are a team taking care of our residents. Other nurses are like oh no don't you dare subject me to that lowly task. I know they're busy and don't bother them unless i have to.

I agree with maintaining a person's strength as long as possible but if they are a 2 person transfer and there is just one of you I wouldn't be risking a back injury.!!!!! :rolleyes:

Nursebaby23 · Nov 23, 2004

On the weekends I work 7a-7p in a LTC facility and average about 25 residents, which isn't bad. But during the week I work 11p-7a 2 days, and we have 4 nurses for 160 people and no RN supervisor. If someone calls in, one nurse will be responsible for 64 residents. There are some nurses who are willing to accept this responsibility and some absolutely refuse. But the ones who refuse are considered "cry babies" because there are some nurses who will. I have cared for these 64 people before, and it's very hard. It's like being bullied when they expect you to do it. I live in NC, and I am trying to find exact nurse to patient ratios for every shift; with or without a RN supervisor present. Something tells me this is illegal as hell, but I need proof. If I didn't love my people..... :uhoh3:

GLORIAmunchkin72 · Nov 24, 2004

34:1 I don't know when she had time to stuff the towels inside the diapers. She should have refused to work under those circumstances. If nothing is done, there are other jobs

Towels inside the diapers??? Sounds like a combination of SEVERE short-staffing and laziness. I have come to work and found residents double-briefed (a state violation) but towels?? EEWWW.
34 to 1 is outrageous. No one can work like that. As you've seen, it's hurting the residents and they're being neglected. Document everything you see and report it.

Tweety, BSN, RN · Nov 24, 2004

I'm just shaking my head. Kudos to you for doing the best job that you can do! :)

PMHNP10 · Nov 24, 2004

I was changing a man last night for bed and I undid his diaper and I'm like what in the heck is a towel stuffed down in there for?

Just out of curiosity...was the man's member partially wrapped in the towel, or did it look like it might have been wrapped earlier (prior to becoming soiled)? This is a major no-no, especially for males because not only do the pts. marinate in their own excrement, but you have the potential of causing the man to have a priapism, which could become a medical emergency.

GLORIAmunchkin72 · Nov 24, 2004

this is a time when it wouldn't pay to be a hero. It's not worth losing your license over and endangering yourself and all those around you. There is not only ONE place where you can care for people. If that's what you like doing, look around you. There are plenty of people to be cared for

On the weekends I work 7a-7p in a LTC facility and average about 25 residents, which isn't bad. But during the week I work 11p-7a 2 days, and we have 4 nurses for 160 people and no RN supervisor. If someone calls in, one nurse will be responsible for 64 residents. There are some nurses who are willing to accept this responsibility and some absolutely refuse. But the ones who refuse are considered "cry babies" because there are some nurses who will. I have cared for these 64 people before, and it's very hard. It's like being bullied when they expect you to do it. I live in NC, and I am trying to find exact nurse to patient ratios for every shift; with or without a RN supervisor present. Something tells me this is illegal as hell, but I need proof. If I didn't love my people.....

renerian, BSN, RN · Nov 24, 2004

Oh that is very very sad..........

renerian :crying2:

highasthesky · Dec 7, 2004

I'm sure alot of Cna's as well as nurses have horror stories, but I had nightmares about this episode:

I had worked at a nursing home for approximately three weeks, not yet certified, not yet even in class, and they put me on a hall with residents I had never even met b4, much less knew their special needs. There were 22 residents, and I had no clue who was continent, incontinent, who was in their right mind, who wasn't.....anyway, had a little lady tell me she had to go to the restroom, helped her up to the bathroom, had a nurse come in and scream at me because the lady wasn't supposed to be on her feet. (Had no idea) After that I asked for charts thinking maybe that would tell me a little about each person. Was told I had to find them. While looking for them, away from my hall, a male resident got out of bed and fell and cracked his head. He couldn't reach his call light, couldn't get up. When walking back down the hallway the only way I knew was I heard him moan. I turned his call light on, laid his head on my lap and put pressure on his head, no one came...seemed like forever but I'm sure it was only a few minutes. We were told if we had an injured resident not to leave their side for any reason until help came. I was finally briefed after that incident that if anything like that happened and I had an emergency, the # to page someone. This poor resident had busted his knee, elbow and head, and I felt helpless and stupid. I felt and I'm sure it was partly my fault, but I feel that I was thrown to the wolves when I wasn't ready. I had nightmares about people dying while in my care for weeks after that. (Of course I quit.) I went to another facility that you couldn't even leave your hall to go to the restroom for 30 seconds without having someone cover you, and It was tedious, but I loved it.

GLORIAmunchkin72 · Dec 7, 2004

This is so typical!

I'm sure alot of Cna's as well as nurses have horror stories, but I had nightmares about this episode:
I had worked at a nursing home for approximately three weeks, not yet certified, not yet even in class, and they put me on a hall with residents I had never even met b4, much less knew their special needs. There were 22 residents, and I had no clue who was continent, incontinent, who was in their right mind, who wasn't.....anyway, had a little lady tell me she had to go to the restroom, helped her up to the bathroom, had a nurse come in and scream at me because the lady wasn't supposed to be on her feet. (Had no idea) After that I asked for charts thinking maybe that would tell me a little about each person. Was told I had to find them. While looking for them, away from my hall, a male resident got out of bed and fell and cracked his head. He couldn't reach his call light, couldn't get up. When walking back down the hallway the only way I knew was I heard him moan. I turned his call light on, laid his head on my lap and put pressure on his head, no one came...seemed like forever but I'm sure it was only a few minutes. We were told if we had an injured resident not to leave their side for any reason until help came. I was finally briefed after that incident that if anything like that happened and I had an emergency, the # to page someone. This poor resident had busted his knee, elbow and head, and I felt helpless and stupid. I felt and I'm sure it was partly my fault, but I feel that I was thrown to the wolves when I wasn't ready. I had nightmares about people dying while in my care for weeks after that. (Of course I quit.) I went to another facility that you couldn't even leave your hall to go to the restroom for 30 seconds without having someone cover you, and It was tedious, but I loved it.

chayslip · Dec 17, 2004

First of all I need to declare an interest here. I am not a nurse. I am a licensed health educator and a state approved community visitor (which basically means I have a badge which allows me to walk into certain facilities - public or private - which are licensed and regulated by the government at any time of the day or night without warning and cannot be refused entry). In the time I have been a community visitor I have learned to spot the difference between a facility which just happens to be short-handed on a temporary basis (which happens in every facility from time to time) and one in which tolerance of departure from basic licensing standards has become the norm and is excused and justified at the highest levels.
While I'm aware that the legal issues involved are slightly different in the US than here, my understanding is that the duty of care issues are not and that "junior" staff can be held legally responsible for not taking their concerns to the highest possible level (which in my nation is the state and federal ministers for health). Unless I have totally misunderstood US laws, your legal duty to the patient totally trumps any other consideration every single time and in the event that something goes very wrong and you say that the DON or the facility administrator or somebody else told you that they would handle it and didn't it is YOU who will be called to account for not going over their heads.
Document everything. 34:1. You've got to be kidding. We demand better ratios here for assisted living facilities and those are mostly old people who want to maintain their independence but want the assurance of onsite medical care being available in an emergency. High school classes aren't allowed to be that large here (and they're full of young, healthy people), and much as I think that you have some odd standards and benchmarks for medical care over in the US, I very much doubt that they include that kind of ratio under either state or federal laws.
While I appreciate Cherybaby's comment, any DON who doesn't know that ratio is unsafe and who isn't actively protesting against it on a daily basis probably isn't going to be of much assistance.

Well I hate to say it but this is the norm for many nursing homes and suprise it is legal! You see there is a major loophole in the staff/resident ratio, and that is they can count all staff! The nurse, med tech, and yes even housekeeping. Suprised, dont be I have worked in this field for 15 years and although sad it is common and state says and does nothing about it. A trick that many admisnistrators use is having numerous people work when state comes in and when they leave so do all the staff. That is why we do care for the love of the residents and not for the money or great working conditions. Sad but true!