Trying to Organize the Nursing Assistants Time

2-15-2012

Nursing homes have a bad rap. Sometimes it’s even deserved. You’ll get the occasional lazy nursing assistant and nurses who don’t care if the aids are doing their job. I think that’s terrible.

The first time I ran into problems with a group of aids, I worked night shift. The aids spent the night partying down in the break room, screaming with laughter. More than one call light came on from people complaining about the noise. A couple of times during the shift, they’d head out and spend 15-30 minutes on the floor, changing a few resident’s bedding and diapers, the last run spent making sure that everybody looked good for day shift.

Once I felt comfortable with the authority, I started to gradually steer the aids back to actually working. First I decreed that that rounds should be made every two hours, 10:00, 12, 02 and 04, which I had been taught at a place that got near perfect inspections. They argued. Their ringleader, “Suzy” stated that the next round should start two hours after the previous round ENDED. I told her that each person should be checked and changed every two hours and if the round takes an hour and if they waited two hours after that, it would be three hours before said resident would be changed and the aids weren’t being paid to sit around for two hours it would be neglect.

They ran to the Director of Nursing Services (DNS) and asked if they had to do rounds every two hours. She said yes, they did.

Next, I required them to turn people in bed each round who couldn’t turn on their own. I explained that this was important for preventing bedsores. I routinely ran down the halls making notes on how each resident was positioned so I could see if they were turned after the next round.

The aids ran to the DNS to complain they were being required to turn the residents. The DNS said that they were supposed to.

One by one they quit except for the ringleader, Suzy. She educated the new aids about how mean I was and how they had the right to sit around all night. Resentment continued. Screams of laughter continued to come from the break room, complaints were made by residents so I asked them to please talk a little softer, that residents were complaining.

They ran to the DNS and complained that I’d told them they couldn’t talk. At all. Despite the ridiculousness of this, (how can they do the job without talking?) I was written up as a concession to their constant complaints.

Eventually, the troublemakers quit and I had my crew, most of whom were faithful. They were an odd bunch that I called the misfits. If the work gets done, I don’t mind personality problems and do quite good balancing complaints of that nature. I have rarely ever had a patient develop full-blown bedsores where I worked the night shift, at least new ones that weren’t there when I started.

I worked one other place where the aids did much the same thing on evening shift. I guess previous nurses had tried to roust them before and were fired for being so hard on those poor, poor mistreated nurses aids. I was told to be kind since they’d had such a hard time, but when I tried to get them to use their time wisely, get vitals done and pass water at the beginning of the shift when it was slow, they acted like I was crazy. I answered lights while they had their Koffee-Klatches down the hall. After being asked repeatedly to do some work, they started to hide out in patient rooms to yak. I’d track them down and break them up, but the attitude continued. Again there was an instigator, reminding the others that I had no right to tell them what to do. Word got around that I was “mean”.

There came two new patients, both in the same room and both with looney-toone daughters. One daughter was vile, spitting filth and angry at all times, always finding fault. The other talked in the royal third person and kept cornering me to put her mom on the bedpan. I could have said “not my job”, a lot of nurses would have, but I could tell she was going to be difficult and tried hard to please. In the end, she wrote a long list of complaints about me, most of which concerned about how mean I was to the aids though she’d only seen one interaction of a minute or so and I’d been perfectly nice. I lost that round with the nurse’s aids.

Most groups of aids I’ve worked with are trying their best by their residents. They get fond of the patients and I’ve seen a few bring something special to eat for a resident who’s not eating. At one facility, the nursing assistants were just great, responsive to the residents and for the most part, working efficiently. But I noticed one problem…. the man they put to bed last wanted to be first. “Frank” finished his dinner quickly and would slowly make his way to his room. He could just make it to a standing position, but then would get stuck, unable to turn around and lay on the bed. Because he was so unsteady, he had a chair alarm that sounded when he tried to stand and a staff member would rush and urge Frank to sit down, we’d get to him soon.

I noticed, however, that the aids were being rather rigid in their bedtime routine. They would start at the end of one hall and go room to room, working their way down the hall around the corner to the end of the next. Frank was last by that system. An aid would come running when Frank set off his alarm and tell him he had to wait. Half the time, I was stuck doing the running. It made no sense to me to waste all that time running so I started laying him down on top of his bed while he waited for his aid, which irritated them into at least putting Frank to bed first.

But this got me to thinking about organizing bedtime routines and so I mandated the following: The first residents to lay down would be the loud and demanding ones, including Frank who kept setting off his alarm. The next group would be those who were tired and hurting followed by the ones who didn’t care when they lay down. This would not be a static setup, residents would move to another place in the line up when needed. I told the aids that I knew it didn’t seem fair that the noisy residents were placed first, but many of them also were ones who hurt a lot. Plus, keeping the floor quiet was less stressful on everyone, including the residents. I received more than one compliment from visitors stating that this was quietest nursing home they’d visited.

Working in a long term care facility is not easy, but sometimes thinking outside the box helps… ;-)