Shift Wars
Posted by Patti on December 31st, 2004 / Print This Post
SHIFT WARS: Turmoil in the halls of the LTC facility
In my years as a CNA I have seen many a good aide leave a job because of issues between shifts. I have also seen aides become bitter and negative because of bad feelings between other shifts. This is so silly and unnecessary- really. There are ways to manage the transition between shifts. It all starts with an attitude change.
Attitude change? Why, one might ask? Think about it for a moment. If you come to work “ready” for a bad day, you’re going to get what you ask for. If you come to work in a bad mood, chances are pretty good the day will get worse.
If you assume the folks on another shift are lazy, then in your eyes nothing they do is good enough or right. No amount of “excuses” will convince you that they had reasons for not getting everything done. Of course your excuses are paramount and real when you can’t get
YOUR work done, so you have a right to expect other shifts to understand your issues, right?
Hmm. Lets look at this mindset.
Stuff happens. To everyone, on every shift, every day. Residents get sick; they have major accidents, they die. Staff work short, new admissions show up at inopportune times, room changes happen during every shift. Equipment breaks down, water turns off or gets too cold for baths. Toilets clog up, power goes out, families complain.
Each shift has it’s own set of unique problems, staffing patterns, nursing issues, demands, expectations. Residents also have their own demands and needs that are different for each shift. One of the first things to keep in mind is this. If you have worked another shift don’t think you know it all. LTC is notorious for changes happening all the time- what used to be common may not be anymore.
Managing the transition from one shift to another is a process and it involves nurses and aides from both shifts. Communication is SO important- as well as having empathy and understanding. A process should be in place to make sure each shift’s staff has clear expectations. Leaving a unit in good shape for the next shift is the goal, and here are some ways to get to the goal:
1) Identify problem areas. First and paramount should be the residents safety, comfort and well being (not staff’s comfort and convenience).
2) Once problems are identified, list ways to prevent/fix the problems. For example, one complaint that is common between shifts is the condition of bed bound residents. Mrs. Smith is always soaked. Her bed linens have brown rings! Her clothing is wet all the way up to her neck! What can we do to prevent the oncoming shift from having to deal with this? (perhaps knowing the Mrs. Smith is a heavy wetter would indicate she has a need for toileting program geared more to her individual needs. Also, look at the products being used to manage her incontinence- maybe she needs better briefs and hourly changes.)
3) Make a form called “UNIT ROUNDS”- here list everything that should be in place for the next shift. List every area of concern; place a check box or two next to each subject.
4) Implement a UNIT ROUNDS procedure. Staff from each shift assigned to do this duty- together they make rounds and check the areas. If Mrs. Smith is found wet, staff from outgoing shift need to change her, or staff from oncoming shift except Mrs. Smith’s condition and change her themselves. This procedure will take time at first- allow at least 15minutes at the beginning stages of this. Staff who makes rounds should “sign off” they have done rounds and excepted the unit as it or fixed the problems.
Another area I frequently hear about is specific to 3rd shift and 1st shift. Getting up residents. This is more than just an issue for staff- this effects the residents, the way your day can turn out, and families. Priority MUST be given to resident rights and family concerns. Never should such an issue be talked about without input from the Resident Council, families, the DON and Administrator. Residents who get up too early will not thrive, they are apt to be tired, grouchy, not able to eat well, drink well and behavior problems can result. Getting residents up before 5am should not be allowed. Many residents are from a generation where they did awake and rise early, this should be considered when developing a plan. I think the reasons for early get ups should be resident based- not based upon making 1st shift’s job easier or less hectic. DON’s should really look into the feasibility of these types of practices and decide if morally they are right. Also, think about safety. 3rd shift has way less staff than days, and having several residents up can create a safety issue. Who is keeping an eye on the residents who are up and about?
When residents do get up early, when are they toileted? A resident who gets up at 5:30am should be toileted at 7:30 am- does the staffing pattern allow for this? Is someone from day shift available to do this, or are they all getting other residents up? Quality of life must be taken into consideration.
The culture of shift wars and charge nurses responsibility
Do the charge nurses inadvertently create more of an issue with these shift wars? Tough questions that should be looked into. When the CNA’s complain, charge nurses may not respond to the issues, or think they are petty. This creates a HUGE morale problem for the units.
Nurses need to find time to listen to the CNA’s complaints and help them identify what is important and what isn’t. Help may be needed with skills of communication with each other and members of other shifts. Implementing the Unit Rounds procedure will help but not eliminate shift wars. The nurses must set and example by getting along with the next shift.
May 9th, 2005 at 9:07 am
We have a shift problem. I work evening shift and we are called the net because what ever the dont get done it falls on us. It irratates me to no end because instead of spending quilty time with our
individuals, we spend most of our time
picking up slacked work that could have been done. I can understand when there is a bad day, but everyday is not a bad day. When one shift slacks it causes a dominoe effect to every shift..the ones who suffer are the people we care for.
May 18th, 2005 at 1:32 am
i know what you mean I also worked a evening shift 7p-7a and when i get started i can’t beleive the things that are left behind or undone, I myself have never left work to be done for the day shift.. i have never left a patient undone. I pride myself in patient care especially with total care patient who can’t do for themselves. when it come to them i draw the line. they should be treated with the same respect.not just in the hospital but outside on the streets.
December 26th, 2005 at 8:41 pm
I can identify with increased workload for third shift aides. I worked for a 60 bed facility, approx. 20 residents per hall. ONE AIDE IS ASSIGNED PER HALL. They are required to do all cares alone, for easy,and difficult residents. Turning is required q2 hrs. of course, and it is difficult for one aide to do this properly for helpless, heavy, and difficult/combative residents. If you run into difficulty,illness, or diarrhea, you can really get behind. One bed-check runs into the next one, and so on. We are told, “if you need help, just ask”, well, I find that approach very impractical. Are you going to run after help to turn every difficult resident? The other aides, when they finish their hall, just sit down, watch T.V. or go out and smoke. They know that you are running behind, and you have residents that you might need help with, but no one comes down to OFFER any help.They won’t even answer the lights on someone elses hall! The charge nurse enforces the ONE AIDE PER HALL idea. If fact, another aide was told not to help, and come back to her own hall.
I believe in TEAMWORK I feel that if there are only 3 aides for 60 residents, the best way, is to work together. Start together, two aides handle the difficult residents, the other can do easy residents, and they finish together, and sit down together. I don’t believe some should be sitting while others are struggling to finish their work.
Tell me, what can an aide do, when she is new, and these practices are FIRMLY intrenched? This is a problem in almost every Nursing Home I have worked, in my 25 years of experience.
Other problems are, that aides are required to do a number of housekeeping jobs, on top of having to do resident care. Registering complaints does not help. It just makes things worse, and no changes are made. I was just told: ” we are short staffed, and everyone has to do their part to get everything done!”
On top of all this, we are required to dress, and get up 6 of our residents. To get everything done you have to start about 4am and somethimes it is not possible to get it all done, and done right. Of course, there is “Superaide” who seems to have no trouble, and can’t understand why you do! Day shift may find problems, and it’s because we have to start so early to get done, the first residents done, very likely, will be wet, or have BM by the time they get to them! they have to sit so long before breakfast, they are more than likely to be wet, too.
I believe the current way of running Nursing Homes is a disgrace. I feel there is need for sweeping changes, but, just how can this be accomplished? Anyone have a solution?
February 15th, 2006 at 9:05 am
I’ ll be starting working in a nursing home in march, I want to know what advice you have for me. My shift 2pm to 10pm. Tell me what is the routine for this shift. I know this shift is responsible for dinner, baths, toiletting, getting patients ready for bed what else. I am knew at this. Please reply.
Thank you.
Marie
March 2nd, 2006 at 1:32 pm
Marie, hello I’m responding to your comment. The second shift is a good shift. I work first and second shift. The way that I start my shift is by starting a round on my group of residents then I do my showers,vital signs and then I get up the ones that have been layed down and get them ready for dinner. After dinner I start laying them down for the night. Then I do my last round and make sure all the trash is out of the rooms and clothes are put up. Don’t forget to do personal care on each resident before going to bed like clean face and teeth brushed. You would not believe how many of my residents go to bed with dirty hands and face and teeth not brushed it upsets me when I came in on 1st shift to find my folks dirty. you can e-mail me if you want to chat more about this.sizemore182002@yahoo.com good luck to you on your new job. Brenda
March 2nd, 2006 at 5:21 pm
AMEN citizen concern!!!!! i have had that problem many times. especially when i work for the genesis corp. there were 4 aides to 72 residents. on top of that they didnt even out the assignments, so some people got 24 on an assignment, some got 13, ect. it was a bad problem.
I think it is attrocous how the aides are treated. maybe if aides were treated better then resident care would improve.
March 3rd, 2006 at 1:44 am
CNAs are the backbone of the industry, another problem that rolls down hill is micromanagement.
March 6th, 2006 at 5:26 am
Ok, so I thought I had seen it all when it came to short staffing… until today. My floor has 42 beds, 5 of which are presently empty and it has a variety of residents (ltc, dementia and skilled/rehab). I walked in to “hell” this afternoon when I realized that it was only myself and one other aide working today………. Ha ha ha ha ha, I basically said “youve got to be sh*tting me”…..needless to say I am a tired and sore puppy tonight. I read the above article though (the other day) and I realized that Im as guilty of things as the next person, so I made a conscious effort to work on my ‘attitude’….can I just say, having a positive attitude before I even got started, well it made all the difference to me this evening. I found that even though I felt severely stretched beyond my capabilities, I was still able to keep a smile on my face and I just tried to have F-U-N. It really wasnt that bad. I think that the worst part about the staffing shortage isnt how overworked I feel, but rather that I cant do enough for my residents that really need it, you know, all the little extra things that you do for people when youre properly staffed. The other thing that really sucks on these kind of days though is that sometimes the next shift coming on doesnt appreciate the fact that you were understaffed and they have 101 things to complain about that you did wrong……..so I tried to remedy this problem tonight by pointing out the things that i knew hadnt been done, to soften the blow I guess (we’ll see tomorrow wether it worked or not).
March 11th, 2006 at 9:24 pm
Is one (1) nurses assisant sufficient for 50 residents on 3rd shift?My Mother is a resident where too often only one aide is scheduled to care for 50 residents. Please advise.
March 14th, 2006 at 10:40 am
I think 1 CNA per 50 residents, even on the 11-7 shift is still a bit much, how are you supposed to get your Q2H turns done, despite anything else? Thats a heck-o-lotta briefs as well.
Guess it all depends on the State OBRA requirements.
March 15th, 2006 at 3:18 am
Ann, it all depends on what level of care is needed by those 50 residents. I worked in an assisted living facility recently and 1 aide was more than sufficient because there were only 3 check and changes the whole shift. Unfortunately, short staffing isnt a new problem and its not something that will ever go away so the aides that work just do the best that they can.
March 16th, 2006 at 9:38 pm
Blame it all on the cheapness of the nursing home maybe they are medicare fraudulant to. You are only suppose to have 12 residents according to state standards why arent nursing home administrators not held responsible for the shortage in nursing homes.
To many times I see good aides go bad because they are frustrated for the level of care they are forced to give then held responsible for not getting all their adls done for the day.
Irtt does not matter what level of care they are what happened to the companioship you share with your spare time. If all nursing homes followed the guide lines of staffing. The states need to close all the loop holes that enable the nursing homes to escape through, day after day.
and the state does not protect the aides good enough when it comes to us loosing our certification. I hope I did not say to much. But you all good aides know what I mean.
You can not efficiently take care of 50 residents on anyshift no matter the level of care 10 is questionable. GOD BESS all of us for all we do.
March 29th, 2006 at 8:45 pm
i have worked the whole building before and i did the best i could and made sure my residents were dry and clean
April 9th, 2006 at 1:16 am
Hi everyone, I was wondering if anyone has an idea about how I can get 6 residents up, washed up, changed, dressed, and in the dining room, between 7am and 8?
I need to be able to accomplish this in order to keep my job.
Kim
April 9th, 2006 at 3:17 pm
By the way, usually, 4 of the 6, at least, are continent and will be using the toilet while being washed and dressed…hmm, I truly work as fast as I can and must be missing something because I am told that other aides are able to accomplish this without any problems.
Kim
September 30th, 2006 at 6:16 pm
I truely understand the stress and frustration that is caused by working with what everyone thinks is an insufficient amount of help. But on the other hand, it doesn’t help matters when you start complaining about your job, the people you are to be taking care of, and what people expect of you before you even start your shift. There are many times that I walk into work and this is going on, all I want to do is scream!!!! Complaining doesn’t do any good to any one. Most of the time the people who are complaining, are the ones that don’t work any overtime, so it’s merely 8 hours out of their day, and if they would just think of it that way, things would go much better.
December 15th, 2006 at 12:10 pm
hi i am a 3rd shift worker me and my partner work 40 ppl all night that 20 apiece we do our rounds at 4:00 and at 5:00 we start getting ppl up we always manage 18 to 20 ppl every morning. we push each other and get it done. by the time we get done we only have 6 to 7 ppl to change. we manage very well. i think the more expereince with the resident u have the faster you go.
December 15th, 2006 at 12:15 pm
that sounded bad let me correct that we do round every 2 hours 10:00,12:00,2:00,4:00,6:00. but i agree with Erica u think positive it can be positive even though it can be pretty stressful.
December 15th, 2006 at 8:30 pm
with 28 residents on a hall assigned to you, how many cna’s should be on that hall to work. this is second shift, and most of them are total care?
December 15th, 2006 at 11:14 pm
Nancy,
You state that you and one other CNA get up 18-20 people every morning and dry six more. In what time frame is this? Two hours? The remaining 14 patients must be continent and take care of themselves I assume?
2 hours = 120 minutes divided by, say, 12 Residents = 10 minutes each at the most.
Less than that if you are answering call-lights, rinsing pads, answering bed-alarms, doing your ADL sheets, checking in one the patients that aren’t incontinent, etc.
I can’t help but wonder if you maybe work for an assisted living facility? If not… are you peri-washing these people with warm water, brushing their teeth and hair, dressing them properly, toileting them?
And you say the you manage very well. Do the patients? How long does it take you to get ready for work?
December 15th, 2006 at 11:24 pm
Marjie,
Here in Florida the state legislation states that a CNA cannot have over 20 patients. Usually that is what the 3′rd shift (night-shift) gets stuck with. In the facilities that I’ve worked, 2′nd shift (evening-shift) usually has 6 or 7 CNAs to tend to 60 Patients… but I’ve seen lousy facilities have only 3 or 4 much of the time.
January 29th, 2007 at 8:49 pm
I experience shift wars where I work. It’s frustrating to see grown people fighting and talking behind each others backs and reporting people over things that could have been resolved too easily by the people involved if only they would have communicated with each other. I feel very blessed where I work. I work on a hall of 16 early stage dementia residents, there are 2 aides (myself and 1 other aide) and 1 nurse(the nurse is split b/t this hall and an assisted living hall of 28). Things don’t get done sometimes, HELP EACH OTHER OUT. Sometimes vitals aren’t done or a room needs to be organized (after the resident has decided that “they are moving today”) or someone wasn’t able to check all the trash cans and dispose of inappropriate waste, things happen. We all need help sometimes and as long as the residents are happy, healthy, clean and dry, it doesn’t matter who gets what done as long as it’s done and we do our best.