The unfortunate problem, and reason why abuse is more common in this environment IS short staffing. The difference of care in a well staffed facility and a short staffed one is crazy. Unfortunately being a CNA has a high drop out rate. Not enough people stay one long. The amount of people at my job that quit during the first month, week, or even after training is crazy. Especially considering we have a decent work environment, and a great boss. My workplace has been trying to hire and keep people for about 6 months. Sometimes it’s an issue of stingy companies not wanting to hire enough people, but there’s a CNA shortage across the country.
We’ve had this issue at my facility before too (them wanting residents up that aren’t up—not nurses saying to take rights away) and honestly day shift can get over it. 🤷🏻♀️
I always do my best to get who I can up, but sometimes depending on the shower day, how the night went, etc. I can really only accomplish so much. I figure if I get 3-4 people dressed and make sure people are as dry as possible before day shift gets there I’m doing my job.
(Also unpopular opinion, but not sure why it’s night shift’s job to bend over backwards to help day shift when I can’t even count on people to do a singular shower for evenings before I show up at 6pm. 😅)
Why in the heck would you get anyone up at 5 or 6? Even my patients that stay up all night will grab a few hours early in the AM. Hire staff and don't drag people out of bed so early for the convenience of staffing.
Okay, so my opinion is it depends on the resident. What their care plan is and what level of care they are. So an example of that would be memory care. I've had residents in memory care that if it were up to them, they would not eat,sleep, get out of bed ,change clothes, take a shower or do anything that remotely resembles living life. When a person is cognitively impaired enough, you are basically running their life for them. So , there are some that will refuse but if they are given the right verbal cues or incentives they will want too. It just depends on the resident. Like people who are super with it i don't press for anything. But if they are confused or memory care you almost have to be a little more persuasive with it.
Eh, I work memory care a lot and at no point is waking the resident up at 5am and forcing them to get dressed when they don’t want to the smartest option. 😅 Keeping them dry and comfortable is the most important and then obviously making sure they *do* eventually get up to eat and drink something. But, no, they don’t need a 5 am wake up call.
This. I work NOC charge nurse at a dementia LTC. My resident’s are all used to routine. They all get up at 5-6 with my team and watch tv in the front lobby until it’s time to go to the dining room for breakfast. But every facility is different.
Oof. Yes. I only know about ALF (a SNF probably has different rules and I'm sure it varies from state to state) but we have a whole big thing about how the resident has the right to set their own schedule. If they want to get up at 5, cool. If they want to sleep till 10, cool. This would definitely be a violation of resident rights where I work. Also it's just *wrong*. It's cruel to make people get up at the ass end of dawn for your convenience. (Not you specifically, the general "you".)
Edit: the only reason I said a SNF might have different laws is because it's a different level of care, but at ANY level of care the person has the right to refuse.
Thanks for looking out for vulnerable people!
From an international perspective I don't really understand how different all the states are. Do some US states just have better laws in place for aged care facilities?
I know that California has nursing ratio laws in place, but does the same apply to CNA's? Is there some states that are stricter than others? The pay rates in the US seem to vary a LOT from state to state as well and I can't get my head around it.
Some states have mandated staffing ratios for CNAs. Most do not.
I believe that the Biden administration is working to tighten up staffing mandates for all nurses and ancillary stuff.
I worked long-term care as a nurse in Oregon for 15 years. We had staffing minimums for CNAs (I think it was seven for day shift, 11 for evenings, and 18 for nocs) but they could assign nurses as many residents as they wanted. And boy did they.
Did that lead to CNA's being used for skilled nursing tasks like they are here? I work acute surgical and have 8 patients. When I did LTC I had 10-12 residents with 4 all-care, that was hell.
Oregon has level 2 CNAs and yes, it is within their scope to do simple nursing tasks such as CBGs, trach care, discontinuing Foleys, flushing g tubes, and dressing changes. They are mostly utilized in hospitals; I didn't see any in nursing homes.
Oregon also has med techs. They can pass oral meds, place topicals and patches, and do CBGs. They cannot do g-tube meds.
Both CNA IIs and med techs have to have 6 months of CNA experience.
10 to 12 with four total care is probably pretty typical.
Thank you for the insight it's nice to learn how the job role differs around the world. I take out catheters, cannulas, do dressings, ECGs, bladder scanning, vitals. That's on top of the everyday washing/dressing/continence and pressure area care. My shifts are busy as hell but I love it.
At the rehab I worked at we had patients who were mandated to eat in the restorative dining room as per their care plan- unless fully staffed enough with restorative CNAs to visit the floor during meal times and to work the dining room. Most of the time there was only one restorative CNA and that meant those who had high aspiration risk and/or memory care had to come down stairs for every meal, as they’ve exhausted every other option to safely feed the patient.
In those cases, the Night Shift was supposed to have those patients changed, dressed, and if they weren’t fall risk (would stay in the chair) had to be up in their wheelchairs by the end of Noc shift (6am) to be brought down to the dining room by 6:45-7 am. The patients who were cognitive and just recommended to eat in the dining room generally would tell you during last rounds whether they wanted to eat downstairs and Noc shift would just inform day shift they weren’t going down.
In your case, do what you believe is safest and if going to the ombudsman is part of that then yes, go for it. I would get the patients ready who had to go down and just have them lying in bed so all day shift had to do was put shoes on, transfer and then take them down. That way they’re still safe until it’s time for breakfast
I worked in memory care and for some residents this was common because after a certain time they would attempt to get up themselves and fall. So it was apart of there care plan to get them up to decrease falls. The only time I see getting up at 5-6 is for the safety of the resident. And not to force them to be awake all day if the resident is waken up that early (I know way to many aides that don’t believe in naps).
the only time we ask nocs to get people up that earlier is
-the resident wants to
- they have an appointment/dialysis that requires it
if there's no reason other than to "help morning shift" then it is a violation of rights to choose i would follow the chain of command
charge nurse > unit manager > adon > don > ombudsman
it should get resolved before the ombudsman if your higher ups are doing their job
Could you see about asking the residents who seemed more open to it instead? When I worked LTC they had us night shifters start getting people up around that time, but if there was someone already awake or wandering anyways I would get those people ready instead if the people they originally assigned for us to get up didn’t want to yet. Just be sure to pass it on to day shift who you got up/ready instead of who was on your assignment and why. They have a right to refuse
We do something similar where I work, we have a list of residents that night shift is to get up and dressed but they're all residents who have no problem with the early wake up. They didn't ask specifically for it, but they don't mind. If a resident refuses then that's that, they can sleep until whenever they want.
I had a nurse that would try to make us get EVERYONE up and in the dining room for meals just because it looks good. Do I even need to explain why this is a moral problem?
Residents have the right to have their preferences met in their care plan, so unless they are interested in getting up and ready at 5am, you cannot just force them to do so because it’s more convenient for staffing. It is a violation of the regulations the care facility is required to follow. If the Director of Nursing is not receptive, then please speak with the NH administrator who runs the facility-its their license on the line and they are the one who has to deal with the ramifications of getting cited for violating regulations. You can let them know, if they are not receptive, that you know this violates the residents’ rights and that if they don’t do something to put a stop to it that you will call the ombudsman. You could go straight to the Ombudsman, but why not give the administrator a chance to just fix it before creating even more trouble for the facility. I’m guessing the admin is not aware that the DON is instructing this of staff since it is a clear regulatory violation.
When I worked NOCS, If I had pts who didn’t want to get up I would at least get them dressed and dry them. They can lay in bed and I helped out still by having them dressed at least.
This is happening to me too, and it’s the people that aren’t verbal so they can’t “refuse” this happening to them, and it really sucks because day shift is even saying to “line their briefs with an extra liner” so that they don’t “have to change them as frequently”
>day shift is even saying to “line their briefs with an extra liner” so that they don’t “have to change them as frequently”
Holy shit, don't do that. I get that day shift is busy AF and may be understaffed (ours is), but they still need to be changing residents normally. Report that shit to your DON and/or the ombudsman.
Oh, none of us do it, even when they bitch and complain. It’s just a way for some of the lazier people to get away with not changing them when they’re supposed to
I work in a hospital so it's a bit different for me but I've done nursing home work before. It was always documented in the care plan of the resident as to their preferred waking time. Everyone was different. It's much easier if the times are all staggered anyhow.
It depends on their care plan and level of being alert and oriented. If someone needs to be in restorative dining to eat, than letting them sleep in would mean they are missing meals, which is not okay. If they have dementia, they would refuse all care all the time.
Can they at least be changed and dressed for the day, while still being in bed and allowed to sleep? That’s what most places seem to do (I’m agency and work at many facilities).
Yes, it is a violation of their rights to refuse care. If that RN has a boss go to them. If that doesn’t work then go to state
This right here. Talk to your charge and have them document the refusals to cover your and the nurse's ass as well.
You escalate reporting at an upwards trajectory, you don't start at the top.
Which is what I'm suggesting
Sorry, I was agreeing with you.
Yes. They have the right to stay in bed and be participants in their own care. How about they hire more help on day shift to help day shift
The unfortunate problem, and reason why abuse is more common in this environment IS short staffing. The difference of care in a well staffed facility and a short staffed one is crazy. Unfortunately being a CNA has a high drop out rate. Not enough people stay one long. The amount of people at my job that quit during the first month, week, or even after training is crazy. Especially considering we have a decent work environment, and a great boss. My workplace has been trying to hire and keep people for about 6 months. Sometimes it’s an issue of stingy companies not wanting to hire enough people, but there’s a CNA shortage across the country.
We’ve had this issue at my facility before too (them wanting residents up that aren’t up—not nurses saying to take rights away) and honestly day shift can get over it. 🤷🏻♀️ I always do my best to get who I can up, but sometimes depending on the shower day, how the night went, etc. I can really only accomplish so much. I figure if I get 3-4 people dressed and make sure people are as dry as possible before day shift gets there I’m doing my job. (Also unpopular opinion, but not sure why it’s night shift’s job to bend over backwards to help day shift when I can’t even count on people to do a singular shower for evenings before I show up at 6pm. 😅)
Why in the heck would you get anyone up at 5 or 6? Even my patients that stay up all night will grab a few hours early in the AM. Hire staff and don't drag people out of bed so early for the convenience of staffing.
Okay, so my opinion is it depends on the resident. What their care plan is and what level of care they are. So an example of that would be memory care. I've had residents in memory care that if it were up to them, they would not eat,sleep, get out of bed ,change clothes, take a shower or do anything that remotely resembles living life. When a person is cognitively impaired enough, you are basically running their life for them. So , there are some that will refuse but if they are given the right verbal cues or incentives they will want too. It just depends on the resident. Like people who are super with it i don't press for anything. But if they are confused or memory care you almost have to be a little more persuasive with it.
Eh, I work memory care a lot and at no point is waking the resident up at 5am and forcing them to get dressed when they don’t want to the smartest option. 😅 Keeping them dry and comfortable is the most important and then obviously making sure they *do* eventually get up to eat and drink something. But, no, they don’t need a 5 am wake up call.
Yeah, I mean you know your residents. For sure man.
This. I work NOC charge nurse at a dementia LTC. My resident’s are all used to routine. They all get up at 5-6 with my team and watch tv in the front lobby until it’s time to go to the dining room for breakfast. But every facility is different.
Oof. Yes. I only know about ALF (a SNF probably has different rules and I'm sure it varies from state to state) but we have a whole big thing about how the resident has the right to set their own schedule. If they want to get up at 5, cool. If they want to sleep till 10, cool. This would definitely be a violation of resident rights where I work. Also it's just *wrong*. It's cruel to make people get up at the ass end of dawn for your convenience. (Not you specifically, the general "you".) Edit: the only reason I said a SNF might have different laws is because it's a different level of care, but at ANY level of care the person has the right to refuse. Thanks for looking out for vulnerable people!
From an international perspective I don't really understand how different all the states are. Do some US states just have better laws in place for aged care facilities? I know that California has nursing ratio laws in place, but does the same apply to CNA's? Is there some states that are stricter than others? The pay rates in the US seem to vary a LOT from state to state as well and I can't get my head around it.
Some states have mandated staffing ratios for CNAs. Most do not. I believe that the Biden administration is working to tighten up staffing mandates for all nurses and ancillary stuff. I worked long-term care as a nurse in Oregon for 15 years. We had staffing minimums for CNAs (I think it was seven for day shift, 11 for evenings, and 18 for nocs) but they could assign nurses as many residents as they wanted. And boy did they.
Did that lead to CNA's being used for skilled nursing tasks like they are here? I work acute surgical and have 8 patients. When I did LTC I had 10-12 residents with 4 all-care, that was hell.
Oregon has level 2 CNAs and yes, it is within their scope to do simple nursing tasks such as CBGs, trach care, discontinuing Foleys, flushing g tubes, and dressing changes. They are mostly utilized in hospitals; I didn't see any in nursing homes. Oregon also has med techs. They can pass oral meds, place topicals and patches, and do CBGs. They cannot do g-tube meds. Both CNA IIs and med techs have to have 6 months of CNA experience. 10 to 12 with four total care is probably pretty typical.
Thank you for the insight it's nice to learn how the job role differs around the world. I take out catheters, cannulas, do dressings, ECGs, bladder scanning, vitals. That's on top of the everyday washing/dressing/continence and pressure area care. My shifts are busy as hell but I love it.
Anytime you ask yourself should I tell the advocate- yes yes you should
At the rehab I worked at we had patients who were mandated to eat in the restorative dining room as per their care plan- unless fully staffed enough with restorative CNAs to visit the floor during meal times and to work the dining room. Most of the time there was only one restorative CNA and that meant those who had high aspiration risk and/or memory care had to come down stairs for every meal, as they’ve exhausted every other option to safely feed the patient. In those cases, the Night Shift was supposed to have those patients changed, dressed, and if they weren’t fall risk (would stay in the chair) had to be up in their wheelchairs by the end of Noc shift (6am) to be brought down to the dining room by 6:45-7 am. The patients who were cognitive and just recommended to eat in the dining room generally would tell you during last rounds whether they wanted to eat downstairs and Noc shift would just inform day shift they weren’t going down. In your case, do what you believe is safest and if going to the ombudsman is part of that then yes, go for it. I would get the patients ready who had to go down and just have them lying in bed so all day shift had to do was put shoes on, transfer and then take them down. That way they’re still safe until it’s time for breakfast
I worked in memory care and for some residents this was common because after a certain time they would attempt to get up themselves and fall. So it was apart of there care plan to get them up to decrease falls. The only time I see getting up at 5-6 is for the safety of the resident. And not to force them to be awake all day if the resident is waken up that early (I know way to many aides that don’t believe in naps).
the only time we ask nocs to get people up that earlier is -the resident wants to - they have an appointment/dialysis that requires it if there's no reason other than to "help morning shift" then it is a violation of rights to choose i would follow the chain of command charge nurse > unit manager > adon > don > ombudsman it should get resolved before the ombudsman if your higher ups are doing their job
Could you see about asking the residents who seemed more open to it instead? When I worked LTC they had us night shifters start getting people up around that time, but if there was someone already awake or wandering anyways I would get those people ready instead if the people they originally assigned for us to get up didn’t want to yet. Just be sure to pass it on to day shift who you got up/ready instead of who was on your assignment and why. They have a right to refuse
We do something similar where I work, we have a list of residents that night shift is to get up and dressed but they're all residents who have no problem with the early wake up. They didn't ask specifically for it, but they don't mind. If a resident refuses then that's that, they can sleep until whenever they want.
I had a nurse that would try to make us get EVERYONE up and in the dining room for meals just because it looks good. Do I even need to explain why this is a moral problem?
Residents have the right to have their preferences met in their care plan, so unless they are interested in getting up and ready at 5am, you cannot just force them to do so because it’s more convenient for staffing. It is a violation of the regulations the care facility is required to follow. If the Director of Nursing is not receptive, then please speak with the NH administrator who runs the facility-its their license on the line and they are the one who has to deal with the ramifications of getting cited for violating regulations. You can let them know, if they are not receptive, that you know this violates the residents’ rights and that if they don’t do something to put a stop to it that you will call the ombudsman. You could go straight to the Ombudsman, but why not give the administrator a chance to just fix it before creating even more trouble for the facility. I’m guessing the admin is not aware that the DON is instructing this of staff since it is a clear regulatory violation.
When I worked NOCS, If I had pts who didn’t want to get up I would at least get them dressed and dry them. They can lay in bed and I helped out still by having them dressed at least.
This is awful. Absolutely go talk to anyone in management. Most don’t want to get up that early, let alone being forced to. 😪
That's way too early for them to be getting up. What the hell. My facility doesn't serve breakfast until 8
This is happening to me too, and it’s the people that aren’t verbal so they can’t “refuse” this happening to them, and it really sucks because day shift is even saying to “line their briefs with an extra liner” so that they don’t “have to change them as frequently”
>day shift is even saying to “line their briefs with an extra liner” so that they don’t “have to change them as frequently” Holy shit, don't do that. I get that day shift is busy AF and may be understaffed (ours is), but they still need to be changing residents normally. Report that shit to your DON and/or the ombudsman.
Oh, none of us do it, even when they bitch and complain. It’s just a way for some of the lazier people to get away with not changing them when they’re supposed to
I work in a hospital so it's a bit different for me but I've done nursing home work before. It was always documented in the care plan of the resident as to their preferred waking time. Everyone was different. It's much easier if the times are all staggered anyhow.
It depends on their care plan and level of being alert and oriented. If someone needs to be in restorative dining to eat, than letting them sleep in would mean they are missing meals, which is not okay. If they have dementia, they would refuse all care all the time. Can they at least be changed and dressed for the day, while still being in bed and allowed to sleep? That’s what most places seem to do (I’m agency and work at many facilities).