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I am currently working as a nursing assistant in a nursing home. At 3:00 pm I am assigned 12 patients who are all incontinent and wheelchair bound.


I am assigned to change their diapers and pants, transfer them alone and by hand from the bed to the wheelchair and place all of them in their place in the dining room by 4:00 pm.


Wheeling a patient from the bedroom to the dining room takes a minute.


This allows on average 4 minutes for each diaper change and transfer. The patients have little to no mobility, little to no awareness of what’s going on and I am doing this manually alone.


Is this abusive?


I have heard that this nursing home has been flagged for having an abnormally high number of injuries.


If I would arrive a half hour earlier the this would increase the time to 6.5 minutes.


Personally 15 minutes sounds reasonable to me.


Any opinions are welcome.

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By the way often a CNA will push two patients at once between the dining hall and the bedroom to save time. I am just astounded.
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Reply to jacobstein1960
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It sounds like abuse to me and I would report it. The expectations you speak of explain why nurses get impatient, even neglectful. If the facility you work for only allows 4 minutes for these tasks, nurses should be working in teams. You need another person working with you to meet these unrealistic time constraints. I wish you luck and thank you for the work you do. T. 🌷
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Reply to tctredwell
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They have some cookies and tea at 4:00 pm. I think that the main issue is just getting it done fast so the CNA’s can all get a break.
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Reply to jacobstein1960
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I don’t believe that NY state regulates the resident to CNA ratio, because I checked on that on the Medicare/Medicaid website when mom entered her NH in upstate NY. If I recall the wording basically said “whatever is safe”. Her NH had 38 residents, per floor, and on 1st shift there were 5 CNA, on 2nd shift there usually was 3-4. They worked in teams of 2. 2nd shift began at 3 and dinner was 5:30, so they had 2.5 hours to get everyone changed and over to dinner. No way in the world would they have been able to do what you’re attempting. And she was definitely not in the Taj Mahal, but in a pretty well run facility that accepted Medicaid. Also worrisome to me is the lack of mechanical lifts, and only having 1 CNA for transfer, but the assist level must be specified on the residents care plan. If a plan says 2 assist, but you are asked to transfer on your own, this is definitely a violation that needs to be brought to the attention of your charge nurse, or union rep if you have one.
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Reply to rocketjcat
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No way is that load safe or providing patient centered care. Unfortunatly it sounds like it is expected and I have to wonder if the fellow coworkers who are saying "just do it" are indeed NOT doing it and making it look like they are. I would say it may be time to look for another position where the safety of the residents as well as their wellbeing and the safety of the CNA is the focus.
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Reply to sandy1955
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Sorry for my earlier reply, I wasn't paying attention🤔.

If you are rushing through only to have the residents sitting waiting for an hour for their dinners then I'd simply work at your own pace. This sounds like a toxic workplace where management turns a blind eye and your coworkers have gotten used to slacking off, it's why good aides either burn out or quit. Thank goodness for people like you.
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Reply to cwillie
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Jacobstein, does that mean that you can give yourself more time to do these services?

I would be concerned if everything is done in a big hurry, that is usually when accidents happen.

Thank you for caring enough to change this behavior.
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Reply to Isthisrealyreal
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There are laws. In each state about the patient ratio you can have. I would imagine 12 to one is against the law.
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Reply to Grandmaofeight
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The transferring from bed to wheelchair sounds horrendously risky for residents and CNAs alike.

If I may say so, you don't write like the kind of person who wouldn't know how to report risks and poor practice if you need to. What do you plan to do?
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Reply to Countrymouse
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Actually I’m looking over the nursing home schedule and there isn’t any really important reason to do it this quickly.

The real reason seems to be that the CNA’s just want to get it over with and have a smoking break.
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Reply to jacobstein1960
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cwillie Jul 22, 2019
I'm not sure what you are trying to say - the OP starts work at 3:00 and is expected to have those in her care seated in the dining room by 4:00. We don't know why they should be in the dining room by 4:00 since that seem early for supper but that is what she is expected to accomplish. If she really didn't give a s**t then she wouldn't have posted.
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Even assuming that some of the diapers won't need changing, you are

checking their clothing and any continence pad
moving the resident from the bed to the wheelchair. Is there a Hoyer lift? How is this usually done?
wheeling the resident to the dining room
returning to the next resident

I don't see how you could do that in a total of five minutes per resident without, at best, making the resident feel like a battery chicken. Where's the explanation of each step, pause for permission, individual interaction?

Even when I got quite good at it, I couldn't have changed a soiled diaper - and cleared up, and washed my hands - in five minutes. Fifteen, I think you're right, is probably good going.

When you say you're "doing this manually" - if a resident is unable to bear weight, you shouldn't be doing this without proper equipment and/or on your own. It isn't safe.

What does your line manager have to say about any of this?
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Reply to Countrymouse
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jacobstein1960 Jul 22, 2019
There is no equipment involved whatsoever and no assistance from another person.

I would describe what I see being done as “sack of potatoes” treatment.
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We need another CNAs opinion. On the whole, 12 patients doesn't seem a lot, in an 8hr shift. But trying to get them all ready to go to dinner...an impossible task. I would question if day shift is responsible for getting the ball rolling. You need to ask your supervisor how are you suppose to accomplish the task. I have heard said on this forum that in transferring two people are needed.
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Reply to JoAnn29
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As an in home caretaker for my mom who is cognizant and helpful, I have to stop myself all the time and mentally tell myself, “Slow down..., be patient...”

You are not allowed to do this! You are being required to “Hurry up! Get moving!,” TIMES TWELVE!

It is unreasonable in so many ways! You have too many patients. You’re given too little time. You’re not given any help. Your not taking in account your patient’s disabilities. You’re not given any leeway for mishaps.

Yes! It is a formula for abuse! How else can you get the job done by the standards set forth?

Not only are you doing one of the hardest jobs there is but you are being set up to be a total failure doing it!

It isn’t like a production line where you will work faster the more experience you get. No matter how good you are at your job, you have extenuating circumstances every way you look at it!

I feel sorry for you, yet I’m very glad we are doing well at home.

Charlotte
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Reply to CharK60
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I don't think it is in and of itself abusive, but I can certainly see how the impossibility of your task could lead to shortcuts which could lead to neglect and injuries to both the people being cared for and to staff. With a little bit of forethought the previous shift could be starting changes well before you arrive rather than leaving it - no doubt that is what management expects to be happening🙄. I have no words of wisdom for you other than to look to your coworkers for guidance and seek ways to work smarter - perhaps some of the residents could be changed after supper, or they could be lined up together in the halls before you take them to the dining room.
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jacobstein1960 Jul 22, 2019
One coworker suggested that I arrive a half hour early, on my own time, to get an earlier start.

The other advice I’ve gotten is “JUST HURRY UP AND DO IT!”
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I think it is abuse. Not only for the residents but those care givers like you who have to hurry them through like cattle. It is not right. The states pay for the care of the individuals, who are people and to assign 1 person 12 people all on the same need level is negligence. It is so sad that the fast food industry is more important than caring for people. And if no one speaks up for these people who cannot even speak, then it will only get worse. One day they may just lock them up in cages and throw them food. Or more than likely consider them useless and irrelevant and put them down. I have worked in nursing homes and the care has never been what it should be. No one will take care of your loved one like you would.
It is so very sad, the priorities of the world. People care more about animals than humans. I think what you speak of is abuse. But bless you for what you do.
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Reply to smeshque
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It doesn't sound like nearly enough time for the job required, do it well and do it safely.

Is it an abuse of the patient? That depends on the staffer. If you are rushing, rough handling them, putting them in dangerous situations, in order to meet that deadline, then you are at risk of tilting into what would be considered abusive. If you are taking the amount of time you need regardless of how long it takes and taking the heat for being late from your boss, then there is no patient abuse going on.

Is it abusive to the staff? It could be seen as mental abuse of a staffer to force them to choose between providing what they know is their very best patient care and meeting required deadlines in order to keep their job.
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Reply to faeriefiles
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jacobstein1960 Jul 22, 2019
“If you are rushing, rough handling them, putting them in dangerous situations, in order to meet that deadline, then you are at risk of tilting into what would be considered abusive.”

That’s exactly what’s happening and they’ve found a gang of workers who don’t care.
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