Resident Rights Week and Refreshers for CNA’s

The week of October 5th- 11th is Resident Rights Week. Mark your calendars.

These are Residents Rights, with info and guidelines for CNA’s to follow when caring for residents after the first few.

The right to be fully informed—by word and in writing—of the policies and procedures that protect the person’s other rights

All of the rights of citizenship the person has in the United States
This includes voting in all elections.

The right to know all of the services available at the facility, including whether it is certified for Medicare or Medicaid residents, and the right to assistance in applying for those benefits

The right to be fully informed about the person’s own health condition
Believe or not, some residents do not know what their medical conditions are. Some families wish to keep this from the resident. Or, residents are not informed of disease progress (such as a cancer spreading). While the CNA should never disclose this information to ANYONE, we need to be extra careful when discussing it at the Nurses’ Station and other not-so-private areas.

The right to choose one’s own physician

The right to refuse medication, treatment, or care
Indeed. A resident can refuse to be medicated, to have dressings changed, to be weighed, bathed, fed, dressed- we cannot force them to do these tasks or allow us to assist them. When we do, against their wish, we are violating their rights and in some cases it would be considered abuse. It is very important to document these instances. Make sure the nurse is aware of the refusals.

The right not to be forced to perform therapeutic activities
These include PT or OT sessions, activities, special baths and the like.

The right to be free from punishment and involuntary isolation
THIS IS A BIG PROBLEM. CNA’s often take it upon themselves to remove residents from dining and other rooms and place the resident in their room. This is involuntary seclusion and in some cases is considered abuse. Don’t do it. Wait for the nurse to direct you on this. It is never within the scope of a CNA’s practice to make decisions like this. Withholding food, drinks, delaying care, when used to punish a resident is abuse.

The right to be free from verbal, physical, sexual, and mental abuse
For some residents, the sweet little nicknames we have for them is a form of verbal abuse. Others love to tease and tell jokes- but for some this is mental abuse.Yelling includes raising your voice. Or using short, sharp words- it’s all verbal abuse. Many aides don’t understand the varieties and the subjectivity of this. If it offends a resident, often it can be called some form of abuse.

The right to be free from chemical or physical restraints except on a doctor’s order and as a last resort for the person’s safety
This includes being put to bed against the will. It also includes placing residents into recliners and other furniture that they cannot freely get up from. Being tucked into a table so close movement is not possible is a restraint as well.

The right to be treated with courtesy and respect
Manners. Use them. All the time. Please, Thank you, Excuse Me, I’n Sorry. Referring to Sally Smith as Mrs. Smith until she asks you to use another name…

The right to privacy when receiving treatment or personal care

The right to get and send mail and to make and receive phone calls without anyone else’s interfering

The right to associate with anyone the resident chooses, in private if the resident requests privacy

The right not to be sent to a new room without a good reason, advance notice, and sufficient preparation

The right to keep medical and personal records confidential (except as needed to evaluate the facility and follow up on complaints about your care)

The right not to be transferred or discharged without good cause, advance notice, a discharge or transfer plan, and the right to a hearing to stop the proposed change

The right to make suggestions and complaints and to have the staff act promptly in response, and the right to be free from retaliation of any kind for making complaints or suggestions

The right to inspect the person’s own records, and the right to purchase copies of all records

The right to participate in any social, religious or community activity the person chooses

The right to keep and use personal clothing and belongings, as space permits, and to have lockable storage space for personal belongings

The right to be reimbursed for belongings lost or stolen by facility employees

The right not to sign any contract or agreement that claims the person agrees to give up any of these rights

The Nursing Process, And The CNA

The Nursing Process, And The CNA

In my experience working as a CNA in a nursing home, I rarely heard the term “Nursing Process”; I often heard about care plans- but that was about as descriptive as things would get. I remember asking a nurse- “Just what is a care plan, anyway?”- and she didn’t know how to answer me! So I have spent a long time researching this elusive term- “Nursing Process”- and trying to figure out exactly where the CNA fits in with it.

First, the medical team is broken into several layers. At the top is the patient- who has an illness, or condition requiring on going care. The Doctors are next- we all know they are well educated and have spent years learning how to diagnose and treat problems, illnesses, disease ect. Doctors are the only person within the medical team who can actually diagnose. Nurse Practitioners- in reality- cannot DX anything without checking with the MD. Physician Assistants often will see a patient and DX simple problems such as ear infections, but an MD will always go over the PA’s notes to make sure nothing has been missed. Same with Nurse Practitioners- the MD always double-checks the work.

So this brings us to the next point: A patient, client, resident is admitted to a nursing unit. This can be in a hospital, nursing home, rehab center, even to the patient’s own home. Nurses are called upon to perform several steps to assist with the healthful and positive outcomes for these patients. The nursing process is a relatively new thing; in the 1960’s team based nursing came into fashion, but nurses had no way to let other team members know what to do with patients.
A process, based upon what scientists use, was developed. Over the years this process has been refined to what we know today.

The nursing process is divided into five steps.
1) Assessment
2) Nursing Diagnoses
3) Planning
4) Intervention
5) Evaluation

Where does the work of the CNA fall here, you may ask yourself? Let’s see if we can find some pretty common things CNA’s are asked to do, that are a part of helping the nurses with this process. It is assumed here that the patient/resident/client has a top level diagnoses from an MD, and a treatment plan is in place from the MD. This plan would include medications, treatments, special diets, procedures ordered by a doctor.

Step One: Assessment
Assessment involves continuous data collection to identify a patient’s actual and potential health problems. This data should be as objective as possible, and nurses should be as non-judgmental as possible as well. To perform the assessment, nurses should:
· Get Nursing History from patient
· Perform a physical examination
· Review lab and medical information

The nursing history is mostly subjective data. Often, the patient’s perception of his health problems makes up a large portion of the health history. Nurses should find out how the patient coped with a similar illness, what interventions worked, didn’t work ect.

A physical exam is the next step. This is where the CNA often assists the nurse. When we are asked to get heights and weights, vital signs, record food/fluid intake and output, it is almost always for the purpose of assessment. Although CNA’s do not make assessments, nurses depend upon us to report timely and accurate data. Things we see, smell, hear, feel and touch should be reported.

Nurses should perform a thorough exam by doing the following:
· Body Inspection- observation of patient- direct and indirect
· Palpation- feeling body regions for masses, smoothness, muscle tone
· Percussion-using fingers in a tapping motion to feel for abnormal sounds over body regions
· Auscultation- listening for sounds over body regions such as lungs, bowels…

Nurses are taught skills to perform a physical assessment in their schools.

Step Two: Nursing Diagnoses
Nurses are licensed to identify and treat certain human reactions and potential health problems associated with the illness, disease ect.
As we see, nurses have a huge responsibility when it comes to giving accurate diagnoses of a health/potential health problem. All the care given is based upon the proper Dx, the proper plan of care being written and the right interventions.
Based upon all the data collected- both subjective and objective, the nurse next will form a nursing diagnoses drawing from the above list of possible problems.

It is these terms in the list that we will often see when we look at a care plan. It isn’t something that comes lightly for nurses- this is one of the big reasons they need a college degree. Assessment is a big part of being a nurse, and it is an even bigger part of what we, CNA’s, do. It is absolutely vital that we report back accurate information. The care a patient gets, and hence the outcome of his health, depends upon good sound information.

Step Three: Care Planning
The Care Plan is a term we should all be familiar with. We all should know that the care plan is the bible for nursing care of patients, but what else should we know about this document? It is a legal document promising care being delivered as written; the nurse can get into huge amounts of trouble if her care plan isn’t followed. The care plan is designed to assist team members in delivering high quality, consistent care that is needed. Time spent performing tasks and care that is not needed results in wastes of money, resources. Effective care plans take into account unit staffing patterns, patient wishes and abilities, and should reflect who the patient is. A good nurse will seek the opinion of the CNA when writing the care plan. CNA’s can offer invaluable insights into the patient’s abilities and desires. All facilities should encourage CNA participation in care plan conferences.

Cookie cutter care plans are easily recognizable:
· They have the same nursing Dx
· They have the same interventions for all patients (seen often in nursing homes, where all residents have been known to be on a two hour bladder program)
· They don’t work!

A good care plan will be specific, realistic, clear and brief. It doesn’t need to be a long novel.
Anyone who is expected to deliver care from a care plan should be able to read the plan and understand it, including the patient when applicable, as well as the patient’s family.

Step Four: Interventions
This is where the CNA really comes into play! Often, the interventions are WHAT we do. All that turning, repositioning, toileting- are all interventions listed in the care plan. Also, a great amount of the documenting we do is designed to assist the nurse with evaluating these interventions. So it really makes sense to document accurately- in time- if an intervention IS NOT working, it will be noted (and perhaps removed from future care plans). Interventions can be anything from special baths to back rubs to repositioning, to toileting, to using special creams and lotions, to offering certain supplements. Often, an intervention must have an MD order along with it. This is kind of strange I think- if nurses are allowed to formulate their own Dx then they shouldn’t need an MD’s order to carry out some of the treatments to reach the goals. The most important part a CNA can play in this intervention stage is to accurately report all reactions to the interventions. Be as specific and objective as possible.

Step Five: Evaluation
This is the final step in the nursing process. This is the time when nurses look at their care plans and check to see if the plan has “worked” in solving the patients’ health issues, concerns, ect. As stated before, a good plan will work and a poor plan will not. Nurses will check to see if the interventions have been effective- they look at subjective as well as objective data. This is when they will see your good documentation! For example, if a patient were incontinent, and the patient wasn’t so until recent illness, the nurse might try a timed program approach to help the patient gain control again. IF the initial voiding assessments, done by the CNA, were not accurate (i.e.- CNA just wrote in times she guessed patient voided)- and the nurse put the resident on a two-hour program…when patient actually needed to go every hour- you can see how this intervention would fail.

The nursing process doesn’t end here- it continues until the patient is discharged or passes on or whatever. Sometimes a patient goes home with a care plan, and this is especially challenging for staff. If the nurse never saw the home environment, then chances are good that the care plan won’t work. Usually home health nurses do the plans for this population.

Some thoughts to Ponder…
As I said in the beginning of this page, I never knew what the nursing process was. I still have my books from my CNA classes, and I have several newer additions. It wasn’t until very recently that CNA’s were taught this process. This is too bad. I fear there are too many CNA’s out there who do not have a clue how important their work is. All the work, the documenting- would certainly take on a new meaning if CNA’s really understood their role, within the nursing process, as a whole. It would make a good in-service for any facility to offer: Nursing Process- What Is it?

Even of greater concern for me is the apparent lack of concern on the part of nurses who are charged with this process. Never mind those who don’t seem to know what it is, but what about those who DO know, yet follow their own approaches to deliver care. Hmm. I challenge all CNA’s to hold their nurses up to the standard when it comes to the Nursing Process. After all, if our work is to have any meaning at all, then the Process should be the standard. When a new patient is admitted onto a unit you work on, watch to see if a complete physical assessment is done by the nurse; see if any of the things you are asked to do may have a part in the assessment. Ask questions. Expect answers that make sense to you. A lot is at stake here, the patient’s well being. See if all your good documenting is worthwhile. Ask the nurses what will become of the notes you have written- those flow sheets should become a tool, not some paper put into a chart.

See if the system really works, or if it is just another process that is meaningless.

© 2006. All Rights Reserved Nursing Assistant Resources On The Web
This material can be used freely for educational purposes.

Survey Lessons: Resident Dignity and CNA’s

Another example of how CNA’s can have a huge impact upon the survey of a nursing home. The following are samples of a real surveyor’s findings; then we’ll look at how the CNA could have prevented these scenarios from ever occurring in the first place.

1. Interviewable sample resident #2 was admitted to the facility on 2/6/01 with diagnoses including rheumatoid arthritis and a thyroid disorder (according to the face sheet). The quarterly Minimum Data Set, dated 6/12/07, coded the resident as having mild short term memory loss.

Observations of the resident on 7/1/07 at 10:30 a.m. revealed a certified nurse aide (CNA) was preparing to transfer the resident from her bed into a wheelchair using a Hoyer lift. The resident stated she needed to go to the bathroom prior to being transferred. The CNA stated the resident experienced pain using the toilet in the bathroom, so he had her go in the trash can by suspending her in the lift and placing the trash can underneath her.

A follow up interview was conducted with the CNA at 1:55 p.m. The Unit Manager was present during the interview. Both stated the day shift and evening shift used this method to toilet the resident. The Unit Manager stated the night shift had the resident use a bedpan, and did not get her up.

And:

On 7/1/07 at approximately 1:00 p.m., supplemental sample resident #27 was heard calling for help in a loud voice. The resident was seated in a wheelchair in the Silver Key office and appeared in no distress. There was a CNA seated in the Siver Key (sic) office with the resident. The CNA stated that was her job for the day, to sit with the resident. The resident could be heard calling for help in the hall outside the office. The CNA asked the resident several times why she was calling for help when there was nothing wrong. The resident yelled for help again and the CNA stated, “You are just a problem child.”

In the first example. the staff used a mechanical lift and trash can to assist with toileting a resident. Is this normal? Is this digified? What are some options?

Commodes: They make commodes in all sizes and shapes, out of soft and hard plastics. Most CNA’s have seen these PVC models. The CNA’s are the resident’s advocate. In this case they should have (and perhaps did) ask for a comfortable commode for this resident to use.

Bed Pans: They also come in many shapes and sizes. Some are made of softer plastics as well. The CNA’s should always encourage the resident to use this before getting OOB.

In the second example things aren’t so clear. Just the name of this room suggests dignity is an issue. When a CNA is expected to be a sitter, they need to have clear expectations of what they are to do with the resident. Just sitting there and watching them often isn’t enough and is very undignified. Usually a resident who needs 1:1 supervision really needs to be occupied. To be kept busy and somewhat distracted.

The CNA’s working with this resident could have foreseen situations where 1:1 time would be needed; and anticipated the need for activities and other things to do. Seeking the help of the Activity Director or other person, puzzles, board games, reading materials or any number of other items could have been available. Smart aides know these times will come and have a box of items at the ready for these moments.

We never tell a resident they are a “problem child”. To do so is border lining on verbal abuse.

To wrap this up, when we are caring for a resident who has special equipment needs for ADLs, ask to see one of the medical supply books to see what is available. If you find something that will work ask for it to be ordered.

Plan ahead. Anticipate needs. Ask for equipment. If your facility employs the services of a physical and/or occupational therapist, seek out their input on resident comfort and equipment issues. . Ask the charge nurses to document equipment requests in the resident’s medical records. Document all of this in your personal log.

Stressed Out? Here's Help

What is stress?
Stress is the psychological and physiological response to events that upset our personal balance in some way. When faced with a threat, whether to our physical safety or emotional equilibrium, the body’s defenses kick into high gear in a rapid, automatic process known as the “fight-or-flight” response. We all know what this stress response feels like: heart pounding in the chest, muscles tensing up, breath coming faster, every sense on red alert.

There is little doubt that our job is stressful. On any given day you might be asked to take on extra residents due to call outs; you might be confronted with an aggressive resident; you might need to comfort a family member or calm down a angry co worker; the bosses might be on a very public rampage about overtime costs or some other concern. You might feel under the nurses’ gun for paperwork or some other request. These are emotionally difficult situations.

Add to this the physical part of the work- the lifting, tugging, moving of residents. The constant walking and rare breaks can and do take their toll on our bodies. So, when we’re working short and the residents are feeling OUR stress, we GET MORE stress tossed back at us. It’s almost like a vicious cycle.

TEAMWORK: The Best Stress Buster
One of the best ways to deal with environmental stress to have a good solid team to work with.
Many aides take employment at facilities where teamwork is not happening. Change is slow. Set the example. Be helpful and positive. Model the behavior you want others to follow. Some aides will reject these actions…let them be. They are threatened by teamwork. Many others will gladly accept the help and will follow suit right back. If you’re working at a facility where teamwork is a foreign concept, make it not so foreign. Just make it a part of how you work. You will be amazed at how far it spreads and how willing many others will be to this.

We should all take pains to form good working relationships with our peers. We don’t have to like the people we work with; they don’t have to be our friends. But we do have to work with them, and it’s best to remember this. When new aides join the unit, it benefits everyone to welcome them with smiles and a pleasant attitude; to train them well and correctly; and above all, to show them how the TEAM works together and not on separate paths.

When there is a strong team, stress is less a problem. People who feel supported and backed up, experience less stress. When we have others we can relate to, vent to- it makes coping with the environment easier. Strong teams trust one another. Strong teams have a common goal- and in the nursing homes for CNA’s this would be to provide the best care under any circumstance. Strong teams hold each member up when times call for it. All nursing home leaders should strive to have these strong teams on each unit.

The charge nurse should be considered a member of the team and it’s leader. The nurse leads the medical aspects of the team, of course. More than anything else, the nurse should make her or himself available as a resource to the aides. Someone they can come to when having that bad day; someone they can talk with about problems at home that are impacting work…a person aides can trust with private or personal information. Someone who will go to battle for them.

TAKING CARE OF YOU: The Other Important Stress Buster
The way we experience stress can be controlled. If you take care of yourself, it’s easier to deal with the physical effects of stress. It can’t be said enough: Eat right, exercise and get enough sleep! It works wonders. Think about it: You wake up late because you didn’t get to sleep until 3am; you’re late for work…and didn’t have time to eat breakfast…you’re tired, hungry and soon, grouchy. Being preoccupied with this, you tense up and your muscles in your back won’t be cooperating…you are at a higher risk of hurting yourself. You’re creating the factors that make for a very bad day!

The solution to your bad day? YOU. And good planning.

Create the situations that will allow you to get a good nights sleep. Only you know how many hours you need…some of us get by with 4 or 5 hours and others need 12..whatever. Plan your time so you get enough. Purchase an alarm clock- one that has a battery back up! Allow enough time to grab something to eat- even a slice of toast and a cup of juice is better than nothing. Having an empty stomach can add stress to our body in so many ways.

I’ve heard many an aide state that they don’t need to exercise because the work we do is enough. To a certain point this is true…but our work doesn’t replace a general fitness program. I’m not going to push readers to join a gym or make up some extensive workout plan (although this would be ideal), but I am going to suggest a few things that we can all do, cheaply, that will have a positive effect:

1) Stretch: EVERY DAY, several times a DAY, before you go to work…a good time to do this is after a shower or bath. Stretching leg and back muscles is very important.

2) Go out for walks. Every day. At least a mile, preferably two. Walk at a brisk pace…build up to this slowly if you haven’t done it before.

3) See your doctor on a regular basis. Get your physicals and shots and exams. And don’t hesitate to schedule an appointment when you’ve not been feeling well- especially if you’ve had a fever, a bad cold, a cough, a sore back. Your doctor can help you figure out if there’s an illness or other problem. Don’t let “things” go on too long.

Emotional Health- Another Important factor With Stress:
Our attitude effects much in our lives. Really. A good attitude will show outwards as just that. Having a positive outlook on our job, our residents, peers, bosses and others will also impact each of us. When people are generally happy and content, they manage to stay grounded during times of upheaval. When we have good relationships with the people we work with we can expect good things in return. Those with sunny dispositions are just more fun to be around. We all know this.

Be mature. This means acting like a grown up…most grown ups accept responsibility for their actions. Being mature, in regards to stress management, means doing those things that will give others reasons to respect you and want to work with you. Keep your absences and tardiness rates down to a bare minimum; offer to help your co workers with tasks they haven’t completed if you’re done. Be a person that others can rely on. Be friendly and cooperative.

At the same time, don’t allow others to walk all over you or otherwise take advantage of you. Stand up for yourself when you need to, in a friendly but firm manner. Refrain from workplace gossip! Listening to this stuff can cause more grief and stress than many realize. The culture and politics of any nursing home are usually pretty bad- don’t add to it or worse, be a part of it.

Know your limits. This is probably one of the least talked about factors. Everyone has a threshold they reach, where they are no longer able to control situations. For aides, this often involves dealings with residents. We get frustrated and angry and exasperated. We have other things to do, and time is short. So we take on a negative or demeaning manner and things escalate. The residents act out or fall or in some other way REACT to our negativity. Times like this create more stress than most others. If we know what triggers lead us to these moments, we can anticipate them. And plan for them. Count the numbers of events that cause you stress, and take an honest look at how your own actions add to the situation. Learn from this. Next time you find yourself in a similar situation, remember this self assessment and act accordingly.

Personal Notes About The Workday

In our article TIPS & TIMESAVERS, we advise new aides to keep a small notebook on their person. To write down answers to questions; to write down phone numbers and other info needed for the job.

Seasoned aides can also make use of a small notebook. They’re cheap, can be bought almost anywhere and come in so handy for CNA’s. A great resource, the little notebook.

I have one…pocket size that fits nicely in my scrub pockets. What do I do with it? A lot. When the nurse asks for VS on a resident/patient, I have paper to record the results. When a weight is needed; when a height is needed; when intake and output need to be recorded- these little pads come in real handy.

At the top of the page I write the date…day, month, year and shift I am working.

*I record the times I clock in and out- so if there is a discrepancy in my pay I can go back and check.

*I record what unit I’m working on, and the initials of the staff working with me. Even the nurses. And I note who is agency.

*I record my assignment- residents names. No need for more info; names are enough.

*Any falls or other incidents are recorded in my notebook as well…the vital stats are documented. Who. What. When. Where. Witnesses.

Some aides will go to the effort to write in certain info about their residents: BM’s, voids, showers, turning and the like.

Many aides use their assignment sheets to record all this info…and that’s fine. But I like to keep a personal record of these things. It can help you keep a clear record of your daily work and one never knows when this information can become necessary to defend one’s actions. Some aides prefer to write notes about their workday at home, away from prying eyes and nosy bosses. No matter where you do this, it’s pretty important to DO IT.

The legal environment in today’s nursing homes demand we keep clear records of the care we give. Most nursing home management can be trusted to not alter records, but not all. Aides can and have gotten into seriously hot water over issues and incidents that were not properly documented; flow sheets have been “corrected” to suit the best looking picture. Since aides are the lowest people in the chain of command, it’s way to easy to blame us for problems, issues, accidents and the like.

Who hasn’t been called at home, by the DON, demanding to know details about some incident that occurred last week? And who among us has a truly clear recollection of the events? If we had written down all the details, it would certainly help us during this call.

A little notebook can keep a lot of vital information. I wouldn’t go around telling everyone I have one though…management often doesn’t take well to such things. And we have to be extremely careful to respect HIPAA rules, but it is within our right to keep notes about our workday. I strongly advise all aides to do this.

The Residents Unit: A Reflection Upon The CNA

Hey CNA’s, did you know your residents’ units are a reflection upon you?

Sure, the resident usually gets to decide where their personal belongings go, and some of them get really mad if you tamper with anything. While we need to be respectful of our residents preferences, we can do much to keep their unit, their home, neat and organized and safe.

When you’re giving care, it’s helpful to have all your supplies ready. Basins, soap, linens, powder and lotion and all the other items should be on hand so you don’t need to leave the room once you begin giving care. Most of us use an over-the-bed-table for all these items- it’s perfect for the tasks at hand. The table can be raised and lowered to suit people of all heights, and it’s pretty portable. Often, we make a mess on this surface: water, soapy residue, wet linens are placed here. When you’re done, clean off the table with wet cloths and then dry it. If possible, use a sanitizer.

When we’re giving showers or baths, we need to think NEAT as well. Counters next to sinks, shower rails and other surfaces should be cleaned up after the tasks are finished; personal care items should be put away and not left on the shower stall rails…if a bottle of shampoo tips over and spills we have a created a HUGE fall hazard, not to mention the waste. As for the bathroom itself: Think neat and orderly. Most nursing home bathrooms now have drawers where each resident can keep their personal care items separate from the roommates’ items. Look at the belongings: are hair brushes and combs and toothbrushes and other things dated and labeled? Can you tell who owns what toothbrush? Look at the basins and emesis basins especially! Rinse them out and make sure they are CLEAN. Keeping the counters clear of clutter reduces the chances of mix ups and loss of items.

When your resident is up and out of bed, and hopefully out of the room to activities, go back and make sure the unit is neat, clean and hazard free.

The Bed: Clean linens, wrinkle free, lowered to it’s lowest position and locked. Always. Make sure the linens have no holes and are fray free. One thing most of us know but a few do not: USE YOUR BARE HAND to check sheets, pads and blankets for wetness. A gloved hand cannot always FEEL wet linens; sometimes we cannot SEE urine stains (especially when they’re wet). Sadly, we also need to check UNDER the pads…often the sheet is wet under and for the same gloved hands reason, aides from previous shifts don’t know the sheets are wet. This leads to the famous brown stain syndrome; and odors. Finally, step back and LOOK around the bed. Under the bed. Up around the headboard…look for objects, pillows, missing items (how many times have we found a set of false teeth or a pair of eye glasses under a bed?) Look for hazards- sharp objects, frayed area rugs, broken wheel parts to the bed.

The Bed Side Table: Clear off YOUR junk. That means the lotions, wipes, foam sprays, ect ect. Find a place for these items that is out of sight yet easily accessible. It is always OK to leave a box of gloves out though- we never know when we will need them. One box is good for most of the unit though. Briefs, blue chux pads and the like do not need to be laid out either. Put them all away. Show your resident some dignity. And clean off the surface with a wet cloth, again sanitizing is best.

The Dresser: Again, like the Bed Side Table, keep this area free of YOUR STUFF. This is the residents space, not yours. Remember that. If they have knick knacks and other personal items here, be extremely cognizant of this. Treat these items with the highest respect- be careful. Be thoughtful. DON’T BREAK ANYTHING! If you work for a facility that offers consistent assignment, chances are you will have the same assigned residents every shift you work. This affords you the opportunity to gently clean off the dresser top every so often, weekly if not more often. (Yes, this might be the housekeepers job, BUT, you know as well as I do that they will not do a thorough job out of fear of breaking things). To make your job easier, you might want to keep the contents of the drawers neat and orderly. Some families do this too. If this is the situation, follow their lead and keep it all the way THEY have it. Same with the closet.

Speaking of closets, we’ve all seen messy, coat hanger infested PITS known as the resident closet. The mess, like it or not, is almost always OUR fault. When we’re working short of staff we rush through cares and dive in and out of drawers and closets looking for the easiest outfits to dress our residents in…we don’t have time to go back and clean up after ourselves. A few days of this means totally out of control, awful chaos behind those doors. It’s always up to us to clean it up, to wade through the endless empty hangers and weed out the stuff that doesn’t fit. Or is in disrepair. Talk with the charge nurses, but most nursing homes box up clothing and items that no longer fit and call family to come pick it all up.

Resident Clothing: More and more we see family taking care of these items. That’s fine and it’s often a big help. But we’ll always have those residents who have no one to do this. At some nursing homes the laundry staff put clothes away; in others, the aides do it. Either way, on a day where things aren’t so crazy, it would save a lot of time for you if you organized entire outfits: In the closets and drawers. An aide I know folds up an outfit into a neat semi ball and places many of them in a drawer: Pants, shirt, underclothing, stockings. So all she has to do is grab the ball, so to speak. This can be done with closeted outfits as well: Everything can be placed on a hanger.

ODORS: A big problem in many nursing homes. Even the cleanest rooms can have strong urine odors. Once there, it’s hard to get rid of. Carpeting is a big factor here…urine soaked rugs are almost impossible to totally clean up if the accident has been left to dry…as soon as an accident occurs try to get it cleaned up. Some aides spray the foam peri cleaners directly onto the wet spots to alleviate much of the smell. Another source of odors comes from laundry: If family does the resident’s personal laundry, wet clothing placed into hampers will smell, and the scent will get worse as it spreads to the other clothes… It’s best to bag up wet clothing and tie the bag tight in an effort to separate them from dirty but dry clothes. Some facilities don’t allow urine soaked clothing to be “kept” in hampers and insist the laundry department take care of these clothes.

One final note: Usually it is up to us to report things that need repair. We’re part of the safety chain…we often see problems before anyone else. Take this seriously. When stepping back to look at your residents units, have a critical eye and LOOK for hazards, potential hazards and other unsafe things.

Check the outlets for overuse- sometimes family bring in extension cords and overload them.

Check the electric cords for fraying, loose connections

Bed: Work the siderails. Hard. Make sure they lock. Make sure they are sturdy and not loose. Check the mattresses. Headboards and foot boards. Check the side pads if resident uses them; make sure they’re usable and not ripped, torn or otherwise jeopardized of the intended purpose. (And do they need to be cleaned?)

Look up and down and all around. The privacy curtain: Make sure it’s all UP and parts of it are not down, loose, with missing links. A falling curtain can cause an ambulating resident to fall. Look at the walls for signs of leaks and other problems. Check to see if these things could use a good cleaning.

Window: Look at the locks. Test them. Screens? Holes in them? In warm months check outside for bee and hornet nests. Do the curtains work properly? Are they clean?

Lights: Are they working properly? Are the bright enough or is a bulb out?

Carpeting: Is it all tacked down tight? Any places where it’s coming up? Same with tiled flooring. And wood floors can be very hazardous if they dry out and cause slivering.

Area rugs- these are often a big risk for fall prone residents. Make sure the team is aware the resident has one of these rugs. The nurse might want to consider talking with the resident about the safety of this.

An area we tend to ignore is personal furnishings. Recliners and the like can be a real comforting thing for our residents. We want to make sure they are safe for use though: Ask your resident for permission first, then actually sit in it. Test it. See how it works and if it needs any repairs.

Getting Paid for Every Minute You Work

About being paid for the hours we work…this is an article about the LTC industry and Fair Labor Standards Act (FLSA or the “Act”):

Another minefield, as simple as it may seem to navigate, is tracking and counting “hours worked” to determine if overtime pay is due. The key words are “compensable hours,” and hours can be considered compensable even if they are not scheduled or authorized beforehand or approved after the fact if they are indeed “worked” by the employee. The time is worked for purposes of the FLSA if the employer “suffers” or “permits” it to be worked. That is, if the employer, or one of its “agents” for this purpose (head nurse, unit coordinator, department head or, for that matter, any supervisor), knows or reasonably should know that the employee has performed work, it must be counted. Rank-and-file employees should be instructed that any time they are performing work, it is “on the clock.” Supervisors must be trained to, among many other things under the FLSA, recognize that any time an employee is performing job-related tasks, be it before or after the start or end of a shift, during lunch or other unpaid breaks, or even at home, he/she must ensure that the time is included in compensable hours for overtime calculation purposes. If the supervisor “suffers” or “permits” the employee to work, it is counted toward the overtime threshold.

THIS means, simply, that if you work, you get paid irregardless of whether the DON or other supervisor “approved” the hours. Often I read at the forums that we’re not paid because the time wasn’t approved by the boss. Legally, we have to get paid.

Employers must also become familiar with what job-related activities are considered compensable activities and which are not. For example, requiring an employee to change into a uniform at the worksite is compensable, while worksite clothes-changing for employee convenience is not. Pre-shift distribution of work or assignments and, by all means, shift change meetings or “report” are compensable, as are simple things like having an employee pick up or drop off mail or packages on the way from/to home or during lunch. Performance of work during unpaid lunch periods is particularly troublesome—a huge minefield—for healthcare employers. Regulations require that the lunch break be “uninterrupted” and be at least 30 minutes for the employer to exclude it from time worked. It is not uncommon for LTC employees to eat at their workstations or with residents, and it is also not uncommon for caregivers to be called or be called back during lunch break to deal with resident issues. All of these are problematic. If the employee’s lunch break is interrupted—he/she performs any work—the entire break becomes compensable time in determining if overtime pay is due.

So…remember this when you’re on your break and get called to the unit. Check your pay stubs to make sure you’ve been paid. It helps to keep a personal log of the hours you work…a little notebook will suffice for this purpose. The date, time clocked in, out, breaks (especially) taken and clocking in/out AND, importantly, going back to the unit. I think it’s safe to say a great many of us get screwed over often, in pay because of these “little” things. We work hard and we often miss our breaks. Let’s get paid what we’re due.