Turning q2h, any ideas?


I (very) recently started at a LTC facility. I am an LPN and will soon be an RN. This is my first job as a nurse, and I have very little experience in any sort of leadership/management position. Needless to say, this all very new for me and I am out of my realm. I know that as I become more experienced many things will become a lot easier. I am wondering if any seasoned nurses out there have any creative ideas about how to check your patients and make sure that the CNAs are turning patients q2h? I have noticed that the CNAs get very busy, and I know they are not getting to some of the patients often enough. I don't want to be the bossy newbie, but I also can't just let my patients lay in bed without being turned often enough. I have noticed that some of the patients have red bottoms, and I want to get a handle on this ASAP. I have heard of nurses initialing chux, giving candy as rewards, and other such things when CNAs get their patients turned on time. Any ideas you have would be very helpful.


The Newbie :nurse:


190 Posts

Our hospital has a q2 clock that we use hospital wide. Every patient will be on the right side from MN-0200, back 0200-0400, right side 0400-0600, etc. It is a card in every patient's room. Good luck!


38,333 Posts

One of the best ways to do this is by using a "turning schedule". At 11 pm on left side, at 1 am on back, at 3 am on right side, at 5 am on back, etc. Make an original, then give a copy to each CNA for their own use. You can also post somewhere in the rooms, like on the back of the door. Tell the CNAs that you will be checking and expect to see your residents where they should be for the time you check. If CNAs balk at this, well, like everything else, go through the disciplinary process. Have them work in pairs for their 2 hour rounds and they can get the incontinence changing and repositioning done a lot faster. Sometimes they don't like to work in pairs because then one can't goof off. Too bad, work in pairs and get the job done, then there will be more sitting time. In the end, things work out better. Good luck.

(Actually, the better times are 12 pm, 2 am, etc., because at 11 they have other duties that coincides with their first rounds.)

A schedule works. One way to check -- and it's sneaky, but sometimes necessary -- is to stick a note under the resident. See if they find it.


197 Posts

or......... you could just see what way the resident is laying and come back and see if he is still like that in a few hours. I would be really annoyed if you could go through all the trouble to stick a note under someone to see if I am doing my job. If you had the time and went all the way in there why did you not just turn the resident.

If you have questions then ask for answers.

What you will find is the aids who do the job will do the job if you are looking or not, a few might need a reminder, and the remainder wont do it no matter what you do! The good aids will recognize a good nurse who tries to help out with simple tasks if they can... such as turning a resident if you are already in there tube feeding... why not! OR instead of taking more time to run down the hall to find aide to tell them that so and so needs to get out of bed into her chair just pivot transfer them there... you are already standing right there. You will probably find the favor returned. Ever left a medication on the table or dropped the tube on the floor and not noticed? It might get quietly returned to you if you treat the others with respect. Or have you ever forgot a Neb treatment on a resident? I bet everyone has. Things happen and sometimes its great to work as a team.

Establish yourself as a team player and then make suggestions on change or state defencies you see. Comming in as the new guy and the bully will NOT get any help from the aides. I have seen it happen several times.

I do not suggest jumping down someones back for not turning a resident exactally at teh 2 hour mark, nor do I suggest putting a note under a resident. I also would not give out candy for someone turning a resident!


48 Posts

Specializes in Just school!.

Thanks CNA2day! It's nice to get some feedback from a CNA. I do NOT want to be a bully, as I stated in my OP. And I agree about not giving candy to someone doing what they should already be doing. :)


114 Posts

Specializes in Critical Care & ENT. Has 10 years experience.

The best thing is to bring your concerns to your manager and ask to see if they have adopted a method to turn patients on a regular schedule. There is a lot of research out there on how to implement patient turning (positioning) into other task, such as rounding. Creating a log can help track this. However, some patient may be able to turn themselves before or after being repositioned. If you educate the staff on the benefits of turning patients that should help with getting their buy-in. After a procedure is in place and the education has gone out, hold them accountable. You have a job to do, I do not think giving them candy each time is the right thing to do. You can bring in candy as something that you are sharing but not used for rewards.


141 Posts

What works for my team is teamwork.. 3-11 shift.. is something like this its not an exact science, more like a "goal" that we use to gives us a good idea who needs tending to at the time.

"3 see me" (when doing first dry rounds position to face the door) When doing my first med pass I am face to face with the Res when I walk thru the door.

"5 dinner time" (Res positioned on back and setting up for dinner) As dinner time approaches, they are ready to eat when trays arrive, makes tray set up alot easier don't have to fool with raising head of bed etc.

"7 window heaven" (Res positioned to window to see last of daylight) this is when I go to lunch,and do charting and its easy to walk past the doors and see without taking any time or effort.

"9 sleepy time" (Res. positioned on back) Again very easy to check and to help out the girls if needed when I do my 2nd med pass.

The oncoming 11-7 nurse has the Res. back facing the door at 11 so she can see their face on her first visit.

Like I said it isn't an exact science, but it works for us and gives us a good time line, helps me to see if the girls are running behind and if I need to pitch in and help them. I tend not to "bust" them if so and so isn't looking out the window at 7:15 or 7:30, I take that as my cue that they need assistance and put my charting off until later and help them out.

Be good to your aids, don't try and trick them, and don't try to bribe them with candy, you couldn't do your job without them. Don't have the attitude of being their boss, focus on building a relationship built on trust and respect, work together, listen and use their ideas, they probally know what works with each Res. better then you, so don't be afraid to take their advise, they will teach alot, and may end up even liking you... lol

Good luck to you


437 Posts

Specializes in Med/Surg/Tele/Onc.

We have turnclocks too, but they aren't universal. You can't say at 5:00 everyone in facing the door, etc. for example. Pts with a stage I or II might be on a side to side schedule where they are never on their backs. Pt's who have had surgery or an injury on their right side might be on a left-back-left-back schedule. Most patients are on a left, back, right, back, left schedule. The "clocks" are laminated, put together on a ring and hung on a hook on the wall behind the bed. It's the nurse's job to make sure the proper turn clock is showing.

or......... you could just see what way the resident is laying and come back and see if he is still like that in a few hours. I would be really annoyed if you could go through all the trouble to stick a note under someone to see if I am doing my job. If you had the time and went all the way in there why did you not just turn the resident.

Why would you assume that I didn't go in with someone else and turn the resident?

I have had to resort to this tactic to have proof that some of the aides were documenting what they had not done - turning - so that I could justify the write-ups that ensued. A decubitis does not happen from occasionally getting busy and forgetting *a* turn.

And I can't be there 24/7.


48 Posts

Specializes in Just school!.

Thanks everyone for these great ideas! When I go in on Wed I will talk to my mgr and see what has worked in the past :p


12 Posts

Specializes in IMCU, TELE, ONC, REHAB, LTC, SNF, ETC.... Has 16 years experience.

If you're doing your job, there is no reason to get offended no matter how someone checks on you. The nurse takes responsibility for the resident for care that is also being done by the cna. His/her license is on the line! Part of the job is making sure the cna's do their job, and however that needs to be done shouldn't matter. I'm all for being sneaky and finding out which cna's actually care about the residents and do their best to provide quality care.