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.