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.
there should be a state law requiring a certain cna/resident ratio!!! i get so tired of our facility running on the bare minimum (cna will have 1/2 the hall, or 28 residents). the problem really is that the cna's call out all of the time and there are no consequences. in the end though, it is the resident that pays the price. i don't care how good a cna is, with 28 resident's, corners will get cut.
We were staffed pretty well also. 4 aides for 32 residents. Now that may sound great to some, but at times, we may have only 3-4 assist/independ. patients. The rest are complete care and most are Hoyer lifts. It is time consuming! Then you have management saying not to get people dressed before breakfast on the 7-3pm shift, but it is ok to get 4 people up at 4:30am? They don't make any sense!
there should be a state law requiring a certain cna/resident ratio!!! i get so tired of our facility running on the bare minimum (cna will have 1/2 the hall, or 28 residents). the problem really is that the cna's call out all of the time and there are no consequences. in the end though, it is the resident that pays the price. i don't care how good a cna is, with 28 resident's, corners will get cut.
sadly, but 28 residents is an easy night. i had 45 on my last shift and no one called in sick. the administrator won't let the don schedule more staff.
That is so not safe!! I really feel for you and the patients
I agree w/ you 100%. All of the residents need total care and special attention is needed for each care plan as they have Alzheimer's, Parkinson's, Psych, end of life, brain injury, amputees....all mixed together. What happens if someone has an XL BM? Or someone w/ alzheimer's forgets they can't walk? A resident is having a rough time w/ psych issues. The hospice resident passes and needs post-mortem care and the family needs comforting.....Of course all those things happen at the same time.... I often feel like a failure on my drive home and I cry a lot, because they are wonderful and deserve better.
It's true. I had a problem with having to shower resident on the 11-7am shift. We had two CNA's, if one is in the shower room with a resident, the other is getting her residents up, I am doing fingersticks and meds. So much can happen and no one would be around to hear it or help!
In the facility where I work, there is usually one CNA per hall (with 20-25 residents on each hall) on third shift. There is sometimes a floater or two that helps out with the 3 halls, but generally the CNA is by herself to work the entire hall. Each hall has a list of up to 10 residents who have to be up by 7am, either because they are "restorative" or because "they usually want to get up early", or because the family requested it. Sometimes there is a 5:30 person who comes in to help get people up, but in order to get everyone up so you don't get written up, we have to start getting people dressed at 4am.
Believe me, I hate doing it. I care about my residents and hate waking them up so early to get them dressed. Those that want to get up, that's fine, I'll help them get up and generally try to help them begin their day on a positive note. Those that are restorative I will dress while I'm doing my last round, and then let them lie in bed until my 5:30 person comes in to help get them up.
Personally, I find it appalling that these poor people are forced to get up so early. When I've floated halls, I've seen CNA's who just rolled the residents around, yanking shirts over their heads and yanking their pants up and generally just treating them like sacks of potatoes. Every morning the "yellers" are having at it because some CNA is rushing to get them ready.
Yet when I get the "yellers" up, I talk to them, wake them up before pulling the covers off them, let them chose their outfit for the day, help them get dressed, and there is no yelling, no screaming. It's a good start to the day. It may take longer to get people up, and most of the time I don't get out of work until 8 or 8:30 am, but I've gotten everyone up and most of the residents are smiling and have started their day out on a happy note.
When I'm walking out the door, I have several residents who say goodbye and tell me they love me; to a few, I'm their angel. This makes my day, and that's the reason I stay in that facility, because I know that as long as I do my best to make my residents comfortable and happy and keep them smiling, I'm enriching their lives just a little bit.
I wish every facility would adopt the "open kitchen" (it's open 8am to whenever at night), and let these residents sleep. Most of them don't sleep well, and on top of that we're waking them up every two hours when we do our rounds....let's let them get at least a little bit of sleep! Those that need therapy...don't start therapy at 8am...let these people get up later. Most of them have spent their entire lives getting up early and working their butts off...now they're in their later years and they're having to get up by 4,5,6 am just to sit in the hall or the dining room and wait for 7:30 or 8 for breakfast to be served.
You know, sometimes I wonder what it would be like to open my own LTC...hire good, caring CNAs who aren't there just for the paycheck, and nurses who care about their CNAs and patients. Ahhhh if only. There's a perfect place for it where I live (an old hospital that closed years ago), but there's a monetary issue...
Specializes in Pediatric, LTC , Alzheimers, Behavioral.
The facility I work for is in the middle stages of being a Pioneer Movement facility. It is all based on what the residents choice is. They get up when they choose. Most are early risers and request to be OOB starting @ 6:30 a.m., but we have others who want their breakfast held until 11 a.m. If they typically took their showers before bed at home, then their showers are scheduled on 2nd shift @ HS. Others like their shower first thing in the morning before breakfast. All treatments and wound documentation were moved to first and second shifts to allow the residents to sleep thru the noc. And all non-essential charting such as monthly summaries and med monthy charting was moved to 3rd shift. For those residents that typically don't reposition themselves in the bed the CNA's sneak into the rooms and give the pads under the residents a gentle tug to move them an inch or two to the left or right to move them from the pressure points q2hrs. They wear nighttime briefs that are super absorbent and wick urine away from the body. These are mostly applied at HS so noc shift 1st rounds are really more about moving from pressure points and checking for comfort and not blinding the residents with bright lights in their room. Of course if the CNA's smell a possible BM then they put on a side light as to not blind the resident so they can quickly and quietly change the resident. The lights are all dimmed in the hallways to promote sleep and staff is as quiet as possible. There is great teamwork amongst the CNA's to get the residents done quickly and efficiently. Last rounds of the night usually entail checking to make sure everyone is still sleeping, and briefs are double checked to make sure they are not in need of a change since the residents may not be gotten up until after breakfast. Since we started this there are rarely ever any call lights to answer and behaviors at noc and especially during the day, are reduced to almost none, though we do still have the occasional blow up every now and then. This way of caring for the residents is awesome. When I first started we had residents screaming and threatening to pack and leave every single noc (I work on the Alz/Dementia unit). Now maybe one incident a week or less. Some nocs when I come into work I find a few male residents enjoying their western movie (John Wayne no less) while sipping on their beer ordered PRN. I couldn't imagine ever wanting to go back and taking care of the resident's the old school way. The Pioneer movement is an excellent way to care for residents. Our decub count was higher before this new way but is also almost non-existent since the change! :)
The facility I work for is in the middle stages of being a Pioneer Movement facility. It is all based on what the residents choice is. They get up when they choose. Most are early risers and request to be OOB starting @ 6:30 a.m., but we have others who want their breakfast held until 11 a.m. If they typically took their showers before bed at home, then their showers are scheduled on 2nd shift @ HS. Others like their shower first thing in the morning before breakfast. All treatments and wound documentation were moved to first and second shifts to allow the residents to sleep thru the noc. And all non-essential charting such as monthly summaries and med monthy charting was moved to 3rd shift. For those residents that typically don't reposition themselves in the bed the CNA's sneak into the rooms and give the pads under the residents a gentle tug to move them an inch or two to the left or right to move them from the pressure points q2hrs. They wear nighttime briefs that are super absorbent and wick urine away from the body. These are mostly applied at HS so noc shift 1st rounds are really more about moving from pressure points and checking for comfort and not blinding the residents with bright lights in their room. Of course if the CNA's smell a possible BM then they put on a side light as to not blind the resident so they can quickly and quietly change the resident. The lights are all dimmed in the hallways to promote sleep and staff is as quiet as possible. There is great teamwork amongst the CNA's to get the residents done quickly and efficiently. Last rounds of the night usually entail checking to make sure everyone is still sleeping, and briefs are double checked to make sure they are not in need of a change since the residents may not be gotten up until after breakfast. Since we started this there are rarely ever any call lights to answer and behaviors at noc and especially during the day, are reduced to almost none, though we do still have the occasional blow up every now and then. This way of caring for the residents is awesome. When I first started we had residents screaming and threatening to pack and leave every single noc (I work on the Alz/Dementia unit). Now maybe one incident a week or less. Some nocs when I come into work I find a few male residents enjoying their western movie (John Wayne no less) while sipping on their beer ordered PRN. I couldn't imagine ever wanting to go back and taking care of the resident's the old school way. The Pioneer movement is an excellent way to care for residents. Our decub count was higher before this new way but is also almost non-existent since the change! :)
That sounds wonderful!
My place says they want this, but it isn't happening yet
At our facility we start getting them up at 5am, if they do not want to get up they do not have to! Afterall it is their right! Only 20-25 out of 60 get up before 7am and these residents have first breakfast.
NC29mom, ASN, LPN, RN
320 Posts
there should be a state law requiring a certain cna/resident ratio!!! i get so tired of our facility running on the bare minimum (cna will have 1/2 the hall, or 28 residents). the problem really is that the cna's call out all of the time and there are no consequences. in the end though, it is the resident that pays the price. i don't care how good a cna is, with 28 resident's, corners will get cut.