showers on nightshift and time for residents to get up in the morning?

[FROGGYLEGS, LPN]

Recently I have been instructed to have my CNAs to get up certain residents for a shower on 3rd shift because of the residents refusal to shower on 2nd shift. I have two excellent CNAs working with me on this dementia unit. We have 30+ residents who are ALL expected to be up and dressed before the morning crew arrives. We try to wait as long as possible before waking the residents up but the CNAs start dressing people by 5am at the latest. I am unable to offer them much assistance with their tasks as I have morning meds to pass on this hall plus one additional unit that I also have to begin giving very early.

In order to give any showers the residents will have to get up even earlier and many already don't seem thrilled to be gotten up at 5am. Of course the notion of showers did not go over very well when it brought up to the res that early. 11-7 showering was declined and never requested by resident.

I have heard more than once that you can't give showers at night. I have it set in my mind that I've been advised at least once that having residents get up that early to shower was against regulations or against their rights. In the years I've worked nightshift I can't think of a single time that a shower was given to a resident on 11-7 unless the resident had gotten something all over themselves that a shower was necessary to remove it or unless they simply wanted to take the shower at that time. Some coworkers on nights agreed that they were also under this impression while coworkers from other shifts disagree. Perhaps I am mistaken but I'm quit sure that I didn't just conjure this up in my mind.

I've tried to search out information on this from the internet without any success. I'm hoping someone can set me straight on what the guidelines are for showers or for what time in general is acceptable for residents to be awakened and dressed for the day. I want to say the time to wake up is supposed to be no earlier than 5am or 530am but I'm not sure. If I've got things completely wrong, I don't mind being corrected :wink2:

I'm primarily concerned with this because it seems like they introduce things slowly to start and then leave you with a whole list of new tasks. I'm hoping this isn't going to turn into regular shower days being set for 11-7 on multiple residents but I wouldn't be surprised if thats what happens.

Thanks for any information or thought you may have about this

[Blackcat99]

I know in the old days they use to start getting patients up at 3am and then they would all sleep thru breakfast. Yes I recall that there was something done and they put an end to it. I don't remember exactly how they put an end to that insanity. I would call the ombudsman or the state and tell them what is going on at your facility. I would think that it would be a violation of a patient's right to sleep. Good luck:wink2:

[Bird2]

This is a sad situation. I agree with you that residents should not be gotten up prior to 5 AM. I don't think anyone should have a shower on midnights unless the resident requests it or they had a code brown. These poor residents need to sleep. Your management needs to be creative in a different way. What time does your CNA shifts begin and end and how many CNA's do you run on each shift? How many residents are in the building? Maybe we can help you come up with a different solution that you could present to your supervisors and end the madness.

[abnerRN]

seems to me someone is forgetting that the residents are the ones who matter. It should never be made more convenient for the employees at the resident's expense. I agree that if 11-7 shift gives showers, these poor residents will be getting up at three in the morning. Where I came from showers were given on 7-3 and 3-ll. And only some of the residents were up and dressed before 7-3 came on.

[LPN1974, LPN]

How awful. Someone might get into alot of trouble about this.

I agree...no showering unless they really need one, or the resident requests it.

[suzy253, RN]

I can't imagine getting the poor dears up so early to shower!

[Aneroo, LPN]

Not to mention these are dementia patients- I cannot imagine how the disturbing their normal patterns would mess them up even more, ya know!

What about a bath team during the day? When I worked as a CNA, the bath team was the best thing ever invented. They came in around 0530-0600 and started getting patients up for baths/showers. Some patients would already be up in time for breakfast, but not all would. Folks didn't mind signing up to work bath team either- once you were done, you went home (meaning a much shorter shift). -Andrea

[lovingtheunloved, ASN, RN]

See, this is why I love where I work. Nights does start getting people up at about 5, but they start with the ones that are already crawling out of bed. The ones who don't want to get up, don't. Usually when I come on, about half of the residents are still in bed, and that's fine. God help the dumb fool that tries to drag my Alzheimer'ed self out of bed at 5. The ones that are still down we either get up, or toilet/change and let them sleep. I work with dementia patients too, and honestly, if they don't want to get up, they'll get mad and refuse to eat anyway, so why not let them get up when they're ready? We have residents we used to have to feed, until we started this program, and now they feed themselves because they're rested.

Showers on night shift? When I'm on the nice locked "special care unit," if someone decides that 11-7 is a good time to schedule my shower, my poor nurse will be writing many, many behavior reports, because I will knock the crap out of them.

[bethin]

Would you want to be dragged out of bed at 5am to take a shower??? And then sit there, waiting for breakfast?

Not me. And if some poor soul tried it, I'm afraid they'd be a dead soul.

When I think of pt. care, I think "what if it was me."

[casi, ASN, RN]

They tried this on the Memory Care unit I work as well. Management seemed to think that nights just didn't have enough to do. I just wrote up several forms about how certain residents kept refusing and became agitated during showers, or approach. Things got changed rather quickly.

If dementia resident is refusing a shower in the evenings, what are the chances it has something to do with sundownning? Have day shift try to approach these residents for showers.

[all4schwa]

in my understanding the official rule is, no get ups before five am. however, you can dress them in the bed earlier and then do a final 'get up' round. the ones on our night shift shower list are the ones that are bedridden and have no concept of time.

[jonamb]

In our facility, all baths are sceduled on 7-3 and 3-11. 11-7 will occasionally do a bath if the resident has been refusing on other shifts, if they (resident) is awake and agreeable at the time, and if there is time (and of course the occasional "too messy for a bed bath"). What other shifts seem to not realize is that 11-7 has much less staffing than the other shifts. Granted, there are no meals, appointments, activities, etc., but they have 3-4 times as many residents to care for. And contrary to popular belief, the residents do not sleep all night. Our dementia unit is especially active at night.

Another thing that concerns me -- how do two CNAs get 30 residents up and dressed in just two hours? How can they possibly be giving proper AM care to that many residents in that short of time? On our dementia unit, (40 residents) about half of them are total care, requiring mechanical lifts to get out of bed, incontinent, combative, etc. We get the majority of them out of bed before day shift arrives, but some of them are just in a robe and slippers until after breakfast. Total AM care is done for the "quick" ones, but some of these people take a while to wash and dress.

My other concern is this: how long are the non-ambulatory residents sitting in their wheelchairs waiting for breakfast? Does 7-3 shift come on and immediately start toileting and repositioning the residents that have already been up for several hours before serving breakfast? This just seems like skin breakdown and pressure ulcers waiting to happen. Maybe I'm misunderstanding what you mean by "up and dressed". If not, my heart goes out to you guys for having to run yourselves ragged every morning. What do you do when something unexpected happens that requires extra time? It sounds to me like they need to get more help on your unit if they're expecting you to do all of these things. Good luck to you.

P.S. I know what you mean by not being able to help out like you would like to. I also work 11-7 and have 2 units to cover with med pass, dressing changes, prn meds, and all the other things that go bump in the night. Good thing we were born with super-human powers.