What do you do when the workload is just not doable?

[cogath]

For the first time in 3 years, I clocked out late. I am a very efficient and organized worker. My coworkers have been clocking out 30 minutes to 2 hours late. We have been yelled at by management and have tried to explain but are told that our assignments are not too tough.

We have about 25 residents. My assignment is roughly 13 residents, the residents who do not require 2 people. Of these 13 residents 3 actually do require two people for cares and I have to run around to find people to help me. 10 of these 13 residents are moderately to severely demented: we're talking about the punching, hitting, kicking, spittng in my face, playing with feces, and trying to escape the unit all night demented. These 10 residents are also essentially walking total care residents. I am part babysitter just to prevent them from hurting themselves and each other. It is also a struggle to do cares. I am also responsible for assisting the nurse in whatever she needs me for. And I give 2 baths each night. I am also responsible for answering call lights.

My other two coworkers have 12 total care residents to toilet, monitor, and get up. Most of these residents are demented too, obscenely obese, and three of them are on the call light every 20 minutes. 2 are violent. These coworkers usually have 2 or 3 baths between them.

We have gotten residents with spinal injuries that require special care and after that it's just gone downhill and we can't keep up. What can we do??

[caliotter3]

Whether residents are designated as two person care or not, you and your coworkers should be working in pairs. Work with a partner and you will learn to coordinate with each other. The two of you together will gather speed and be able to go through your combined assignment quicker together than you could do half the assignment alone. Of course, both workers need to have the same goal of getting the job done. It can't be a situation where one person thinks s/he can drag their feet while the other worker does the brunt of the work. Prioritize. Come up with a strategy. If one resident is particularly time consuming, do them first, or last, and breeze through the quick ones. Develop a routine. I used to go in one direction from room to room one day. Then the next day I started in the opposite direction. That way the same person didn't have to be the last to receive care every day. Whatever you develop for a routine, stick with it and you will get faster. If you can't get it all done, decide what will be left out, so you can clock out on time. Two hours past shift is not right. No reason why the oncoming shift can not pick up where you left off and so on. After all it is around the clock work.

[fuzzywuzzy, CNA]

^She doesn't have a partner because there are only 3 of them.

Is this 3-11 shift? I'm not sure what you do but when I worked 3-11 we weren't supposed to give our baths before dinner even though it's WAY easier. Sometimes we did it anyway (excuses: the resident asked me to do it now, the resident is FOS, the resident spilled something on their clothes, etc.) and people looked the other way.

Also, you can try throwing everyone in bed after dinner and washing them later. I'm not sure if you do that already. I know it's hard when you have picky residents who take forever, ring constantly, etc. It throws a wrench in the works but at least if you try and get everyone transferred into bed before the picky people start nagging at you, someone else can help wash/change/repo them and you won't have to worry about tracking down help.

[llg, PhD, RN]

You could ask your Charge Nurse for some guidance as to which items are of the highest priority -- and which might be left undone -- or would she rather you stayed overtime to complete those lower priority items. Do that early in the shift.

[cogath]

Yes I don't have a partner b/c the others are working together with all the pt's on lifts. I have a very well developed routine. I have been working for 3+ years.

I might just put people in bed and wash them up later. May have to forgo so basic cares. What can you do??

[CoffeemateCNA]

Partners are best, but when we used to have just 3 aides, we came up with a system. At the beginning of the shift, 2 buddied up and got everyone up for dinner, while the third person passed all waters, did the vitals (which were due by 1630), and answered call lights. Halfway through dinner, 1 would start taking residents back to their rooms one at a time as they finished eating and put their gowns on and do quick oral care (other 2 would continue feeding) and perhaps put a few super-easy people to bed, time permitting. When everyone was finished, the other 2 would buddy up and put everyone in bed, do a quick brief change, and move on, while the first would continue getting people out of the dining room, getting gowns on and doing oral care as well as answering call lights (basically going around and telling the residents that they will be put to bed shortly just as they are every single night and to stop putting their stupid bloody lights on every 5 minutes). There were just way too many people to do any p.m. washing up except for face and hands (plus we had bath aides during day, so we didn't do showers except for "emergencies"). We had time to do basics only. System worked very well. We came up with a schedule and rotated who did what job. You'd have 2 days "on" with doing most of the transfers, but then have 1 day "off" with the easier tasks. Of course our exact system probably wouldn't work for you, especially in a dementia unit, but perhaps you could come up with your own to suit your shift's needs?

[cmm4ever]

I wish people would be more willing to work together where I am for the time being. I mean once in a while they might help, but not really. It would be much easier/safe if we worked together. Maybe because its a hospital? Seriously there is not enough help!

[CNA2day]

You could take my approach and cry like I did the other night...

... but seriously I don't know what to do when you actually cant complete the work load.

I worked 4th of July short staffed. I worked on a hall of 25 residents by myself and the night was INSANE. Every resident that wasnt mentally compitent was acting deranged. I honestly cried all the way home and I have not done that in the two years of me working there.

I honestly love my job but this last weekend made me want to leave and never come back.

I have talked to my supervisor and im sure nothing will change but I felt a little better after I did that.

I think maybe taking a deep breath and saying "this to shall pass" is my best bet... I think I will try it myself.

[Hygiene Queen]

You can't forgo basic care... you just... can't.

You have to forgo something else.

Something that does not have a negative impact on the pt.

Putting them into bed and then coming back may be an option. At least the resident isn't sitting in a wheelchair for hours.

But don't forgo basic care.

That is the #1 reason why you are there.

And if management is wanked off because you can't get done in time... too bad for management.

If it happens night after night with good seasoned CNAs... that should be a CLUE that they are staffing inadequately.

When you skip good basic care for the sake of getting done on time, management doesn't know what you had to sacrifice to get it all done.

They will think your staff to resident ratio is adequate and will never staff you any better.

So the staff will continue going through the motions but not providing the basic care the residents deserve.

You go home on time and are happy.

Management doesn't pay overtime and are happy.

What about your residents?

Your residents will suffer from decubes, gum disease, contractures, odors... on and on...

I'm frustrated. That CNAs even have to have this discussion is appalling.

The facilities that allow this situation are to blame... $$$$$.

[Bbo.W]

Wow! Do you work at my facility :-) / :-( I have 22-25 residents, 3/4 of which are total cares...Sometimes I am so tired when I drive home I cry....My only comfort is that my residents (who are all dementia/Alzheimer's patients) are loved and know it. I pray and sing a lot.....

[fuzzywuzzy, CNA]

I keep telling people we need to slow down and clock out late, especially when the supervisor makes ridiculous staffing decisions, but no one wants to do that.

Why do 10 hours worth of work in 8, when you could do it in 10 and get paid accordingly? After a few times maybe they would figure out that it would be cheaper in the long run to put another person on the floor.

[CNA2day]

well to lighten up this post it has been several weeks since my post about me crying all the way home and I am happy to say that things have returned to a managable level.

I have started ******** to my manager if i have to work by myself... and she must be sick of hearing about it because I have not been by myself for several weeks.

I am back to loveing my job!