What is so darned difficult about oral care?

CoffeeRTC, BSN, RN · Apr 4, 2005

I totally agree staffing shouldn't be an excuse, but yesterday am..we had 3 aids for 48 residents (2 that were mandated from 11-7)...I wasn't pushing oral care...just satisfied for cleaning, turning, feeding. I did let 3-11 shift know this.

Maxs · Apr 4, 2005

Short staffing is not a problem!!!? hypthetically, an aide works for 7 hours with 3 aides on a floor with 58 residents, that are obese, disabled, and contracted. The average time an aide will spend per resident with is 21.7 minutes. On top of that, CNAs have to pass dinner, feed the one's who are on bed rest, and maybe do 2-3 showers. For an experienced aide, a quality shower would take around 20-30 minutes per resident(remember it's not the same as taking a shower yourself). Feeding an MS patient would take around thirty minutes or more. So, (7 hours (after breaks and lunches) - 60 min shower - 40 minutes feeding = 5.33 hours or 320 minutes for the rest of the day (this maybe more or less, however it's the minimum time). If you divide the rest of the time 320 min/per/res = 16.6 minutes/per/res. Divide this time for Passing water, taking garbage out and laundry in and out, dressing and undressing res, put residents to bed, get residents out of bed, bed bath, wheel residents out for phone calls, run after the crazy residents, diaper changes every 2 hours, answering call lights, making bed, oral care, putting MS patients to Bed (30minutes or more because of how sensitive they're) and the list goes on. Also charting bowls, urine output, fluid intake, meal intakes, and etc can be very overwhelming. The shortage is due to adminstrators because they want to save money. The only way an adminstrator would look good on paper is if the savings sky rocket. How does this savings come about ? 1. Eliminate more CNA's, and 2. cut down overtimes for CNAs. They can't do this with nurses because it jeaopardizes the facilities licencse, and when the state is about to pay a nice visit, the facilities will even hire temporary agency CNAs to keep the ratio down. If you want, you can go to different facilities and research it a little more.

In conclusions for assured quality care and as agreed by most researches on this matter. When residents are very dependent and require complete care the ratio can be 1:3. For higher funtioning residents the staff resident ratio may be 1:6. This allows facilities to develop ongoing relationships with residents and act as mentors/buddies while helping them achieve their goals. Otherwise, I can spend sixteen minutes with my dad per day instead of taking him to a nursing home.

Marie_LPN, RN, LPN, RN · Apr 4, 2005

Short staffing is not a problem!!!?

No one said it wasn't a problem, what was said it that it's not an excuse.

Maxs · Apr 5, 2005

No one said it wasn't a problem, what was said it that it's not an excuse.

There is no such thing as an excuse in a professional setting unless you are not present. And more to the point, if one cuts the number of construction workers to build a house, one increase the time to build the house (you dig). Time is valuable and the ratios speak for themselves. CNA's are full filling one of the lowest paying jobs in society and no one has the right to make it harder than it is.

Maxs

unknown99, BSN, RN · Apr 5, 2005

There is no such thing as an excuse in a professional setting unless you are not present. And more to the point, if one cuts the number of construction workers to build a house, one increase the time to build the house (you dig). Time is valuable and the ratios speak for themselves. CNA's are full filling one of the lowest paying jobs in society and no one has the right to make it harder than it is.
Maxs

Time is valuable, yes, but so are the health and welfare of the patients that rely on the staff to care for them. These staff members would not say "Oh, I don't have 2 minutes time to brush my teeth, or rinse my mouth. I just won't do it." Have you (collectively) ever seen a patient with pressure ulcers and black eschar in their mouth from being neglected when it comes to oral care? It is not a good thing to see. This patient nearly died from bacteremia and septic shock because the nursing home staff felt that because they did not have time to do oral care then that made it alright.

Maxs · Apr 5, 2005

Time is valuable, yes, but so are the health and welfare of the patients that rely on the staff to care for them. These staff members would not say "Oh, I don't have 2 minutes time to brush my teeth, or rinse my mouth. I just won't do it." Have you (collectively) ever seen a patient with pressure ulcers and black eschar in their mouth from being neglected when it comes to oral care? It is not a good thing to see. This patient nearly died from bacteremia and septic shock because the nursing home staff felt that because they did not have time to do oral care then that made it alright.

You must have misunderstood my point, I wasn't only talking about oral care, I was talking about the total care and oral care being part of it. You're saying there's a direct link, and I am saying there's a solution to it. You got to understand that the residents are paying for 1:3 and 1:6 ratios, but they're getting the 1:18. If you say there's no excuse for not giving an oral care, I agree. However, I say there are no excuses for shortness of staff members.

Maxs

Maxs · Apr 5, 2005

If you're saying work under staffed and not take actions, then you're probably advocating neglects.

Maxs

lovingtheunloved, ASN, RN · Apr 6, 2005

If I walked into work and would be responsible for 18 residents, I would refuse to take report. That is dangerous for the residents, dangerous for the staff, and I happen to value my CNA certification, which I wouldn't have long with insane staffing like that. That's why God invented agencies.

dizzejan · Apr 6, 2005

sounds like you are preachin' to the choir here ..everyone is short staffed..it is the responsibility to work as a team...i do everything from the router to the tooter..and oral care is a biggie with me...have gotten residents from acute care and other ltc with dangerous oral cavities...good ol'fashioned nursing care fixed most of em'..some needed meds to correct..

Purple Princess · Apr 6, 2005

once, very angry, I stormed into the DON office after finding out that I would be the only aide on D wing for the evening. for nearly 32 residents, at this time most beds were full. and it is a skilled unit. we are lucky of each resident gets more than 15 to 20 minutes of our time the entire shift and some may only get about 10. but they told me I would be accused of job abandonment, neglect, loose my cna, and not get my unemployment for quitting. There is too much red tape and if you say anything and you're in health care there's a chance you could get black balled for life and deemed a trouble maker. we have time for the basics. and that is it! and who gets in trouble for lifting residents and resulting injury the aide, or me, does. i've only been there less than 6 months and I've already hurt my back bad enough to see a doc, take medication, light duty,and physical therapy. I was so embarassed every day. everyone would groan oh she's on light duty blah blah blah. i still had a list of residents to do on top of my light duties, had a list of about 15 things they wanted done every night.

Maxs · Apr 6, 2005

sounds like you are preachin' to the choir here ..everyone is short staffed..it is the responsibility to work as a team...i do everything from the router to the tooter..and oral care is a biggie with me...have gotten residents from acute care and other ltc with dangerous oral cavities...good ol'fashioned nursing care fixed most of em'..some needed meds to correct..

First of all, facilities choose to be short staffed. If you look at their HR offices, you will find more qualifying candidates then you would have expected. Often, these facilities who are understaffed contradict each other. For instance, they will say we don't have anybody to work while taking away overtimes from those who were willing to work (not me). It's one thing to work understaffed every now and then, however, if you make it a routine, it's not going to work. I used to worked for HCR Manor Care in Libertyville IL, when I first started working at Manor care, there were 6 six aides on the floor for approximately around 60 residents. The facility had 3 units which consisted of the Alzheimer's floor (30 or more ambulating residents and 3 CNA), Subacute Unit (around 55-60 residents and 6 aides), then the LTC a.k.a heavenly dependent residents (60 res and 6 aides). During night time, arcadia (alzheimer's unit) would have 2 aides and second floor 4 aides and third floor 4 aides. Let me demonstrate how the solubility of the quality care will fade and how savings will increase. On the first hand, cut down 7 aides on 1st and 2nd shift which = 14 CNA reduction, then cut down 5 from third shift which gives a grand total of 19 eliminated CNA's. The average salary of an Aide around this area is around $22,390.00 dollars, when this amount is multiplied by 19, you get savings of $425,410.00 . That is almost half a million of savings per year, now if you do this for 4 years, you save around 2 million dollars. To even make it complete 2 million dollars, the facility starts to use cheap quality products (generic drugs, less quality diapers, cheap unpowdered gloves, styrofoam cups and plates, eliminate some kitchen staff and house keeping staff as well and etc).

I am simply against this, and I believe that nothing is impossible, I think that we can all work together as a team during desperate moments, however, there is no need for a constant sturdy stimuly.

Maxs

unknown99, BSN, RN · Apr 6, 2005

You must have misunderstood my point, I wasn't only talking about oral care, I was talking about the total care and oral care being part of it. You're saying there's a direct link, and I am saying there's a solution to it. You got to understand that the residents are paying for 1:3 and 1:6 ratios, but they're getting the 1:18. If you say there's no excuse for not giving an oral care, I agree. However, I say there are no excuses for shortness of staff members.
Maxs

Yes, you are right. There is no excuse for being short staffed. Until the individual states have people who make up the ratio staff to patient laws actually see and work like the staff in nursing homes have to work, then I am afraid there will never be a change. One day, these people will want to change it when it is too late.... when they actually become a patient in a nursing home.