ok, here's another gripe. In the LTC facility that I work at, which has 42 residents, the aides start getting residents out of bed and into their wheelchairs and out into the halls at 4am starting on one wing. I have asked the DON what is an acceptable time for this and she skirts around the issue. She really won't state what time the residents should be getting up.
We have residents that can get up on their own and usually around 5-5:30am I see them moving around in their rooms ready to start the day. I saw a nurses aide take a spray bottle of water and spray it at the faces of several of the residents who were already in their wheelchairs in the halls. I almost blew a gasket. This is outright abuse. DON fired the aide because she had been looking for some reason to get rid of that aide for months because of the constant bruises, skin tears and other complaints, but she could never catch her doing anything.
Anyway, just another rant from me. I am currently looking for a different job. Working in LTC is just not for me.
at our facility night shift will begin to get them up at around 6am. Most of the time residents are dressed and left in bed until the am crew gets there, so they'll sleep at least until 8am. It takes a little of the load off the day shift, especially since they never know how much staff they'll have to get through the day.
The place I work they get up generally when they want to. However, is it common to have a lot of the treatments, like patches, dressing changes pt/inrs, ect done on the 10p-6a shift? It seems like we wake our residents up a awful lot, but it is to spread out the work load.
The place I work they get up generally when they want to. However, is it common to have a lot of the treatments, like patches, dressing changes pt/inrs, ect done on the 10p-6a shift? It seems like we wake our residents up a awful lot, but it is to spread out the work load.
You're right; it does spread out the workload, but who wants to be awakened at 3 AM for a dressing change or pain patch? Also, with the medication patches, I'd be concerned about applying them at that time of noc because you want to get it done quickly---and there's a much greater risk of not removing the old patch, hence giving the resident an overdose of medication.
IMHO, on that facility's practice. The facility should hire a treatment nurse if there are so many treatments that the day and evening shifts can't do them.
We start about 5..but then they have breakfast from 7:30-9:30 now..and we have some residents that get up on their own at 3..*shrug* But I agree...get the h e double hockey sticks out of there...weird place.
Here's my question for those embracing culture change: all the residents get up when they want. They get their meds when they want. So the regulation is still medications will be given an hour before or after the scheduled time. IF there are NO scheduled times, how do you get around the regs?
One of the groups from my nursing class did their clinicals at an Eden facility. Their med passes are set up differently... meds are BID (or TID or whatever) and you just start whenever they wake up and go from there. It all sounds like a nice idea. I interviewed at that facility before I accepted my current position but I didn't think I could be so fly-by-the-seat-of-my-pants.
I would write them all up for getting anyone out of bed and dressed at that unGodly hour! We have several residents who have always gotten up and dressed before sun rise. Mostly they were fishermen and have been getting up this early for decades. If it it THEIR choice to get up at 5:30 or 6 we get them up. Otherwise they sleep till 6:30 or 7. One facility I worked for got cited by the DPH for having the lab tech come in at 5 am. The residents complained that 5 was way too early to have some stranger stick a needle in their arm!!!
Here's my question for those embracing culture change: all the residents get up when they want. They get their meds when they want. So the regulation is still medications will be given an hour before or after the scheduled time. IF there are NO scheduled times, how do you get around the regs?
About the regulations concerning medications; I too am at a loss. The new program is supposed to allow residents to keep their medications in their rooms in a locked cabinet. If a resident has a 7am med and doesn't get up until 9 or 10, then it would seem to be a med error because it wasn't given. But..the state wants the residents to have their own say about when they take their meds, have meals, etc. It's going to be a real change for many of the staff.
Specializes in Gerontology, Med surg, Home Health.
Most of my residents wouldn't be able to self medicate safely. It would take more time and energy for us to chase them around and remind them than it would to go the med pass ourselves.
This is exactly what the facility tells me. We have to start getting them up at 4am or they won't be ready for breakfast at 7am. There are between 43-47 residents depending on if there is someone in the hospital/out with family, etc. The DON gave the night shift aides a list of residents whom she expects to be up by 6am. We have 2 halls and it just seems so unfair to start waking up someone at 4am, throwing their clothes on them and then pushing them into the hallway. Of course half the time they aren't even awake. They are sleeping in their wheelchairs and it's really sad.
Yep, this is the same reasoning that the LTC facilities I've worked in and heard about used. I know CNAs who have had to get up as many as 5 residents before 7 am. If the CNA has 30 residents to care for on the 11 to 7 shift, she has to start that early. Plus, we all know about the tremendous understaffing that LTCs have, so it would be harder on the 7 to 3 shift CNAs to have to get up wash, shower, feed, and dress 12, 15, sometimes 20 residents before, say, 10 am. (Or whatever time a facility requires residents to be ready by.)
This just goes back to the crappy CNA (and nurse) to resident ratio that many LTC facilities have (by choice in some places I've seen), which leads to improper care of residents.
My LTC has 4 wings with 17 residents on each wing... Each wing has a Kitchen that all meals are served out. (steam cart from main kitchen) the cart stays from 7 to 9 if some one sleeps in we can make eggs and toast. and we have a pantry with cereal...each wing is staffed with 2 NAR's 1 LPN and a homemaker. who serves out in the am. and then cleans that wing. and washes laundry (personal clothing). every person that works in the building is a NAR. even the Maintance men. we are very well staffed.
and yes we have a few resident that get very restless in the early morning. Night shift will do AM care and dress as it is a safty issue,
My problem is with the rest of your staff, it is reasonable to believe that the CNA had the spray bottle before you caught it, did others look away?
Yes 4am is a ridiculous hour to be pulling these residents out of bed, but you have to blame the DON who is obviously aware and doesn't provide the staffing to ensure her pts get proper care.
Truth is we start waking them at 6am but we have CNA's come in at 6 to help the night CNA who is alone. They all want baths before breakfast at 8am- 8:30 so the staff have to work quickly. This doesn't allow for the leisurely shower that the patients dream of, but unfortunately this is how it is done.
Place the blame squarely where it belongs, with the DON and management, the staff are just following protocol. Chances are the families are aware and if they dont complain, you dont have a leg to stand on.
You also should take into account what hour they go to bed - in our facility they start putting them into bed at 7pm and that is with a midday nap (1pm -3 or 4pm) so the early hour balances out a bit.
About the regulations concerning medications; I too am at a loss. The new program is supposed to allow residents to keep their medications in their rooms in a locked cabinet. If a resident has a 7am med and doesn't get up until 9 or 10, then it would seem to be a med error because it wasn't given. But..the state wants the residents to have their own say about when they take their meds, have meals, etc. It's going to be a real change for many of the staff.
when you have a situation like that,where a pt rises at 9 and misses her 7am...just ask the doctor to change the order to reflect the pts requested schedule. Thereby the 7am becomes 9 and the rest is adjusted accordingly. We have some pts self medicate and it goes well, when they are no longer capable, they happily hand over the reins to us but it helps that they have built up trust with us from before. One pt gets all his daily meds in the morning every morning as we are afraid he will take too many, most get meds for the week and we keep count. I sign on the count.
on that facility's practice. The facility should hire a treatment nurse if there are so many treatments that the day and evening shifts can't do them.
dulcemorena
26 Posts
at our facility night shift will begin to get them up at around 6am. Most of the time residents are dressed and left in bed until the am crew gets there, so they'll sleep at least until 8am. It takes a little of the load off the day shift, especially since they never know how much staff they'll have to get through the day.