The Certified Nursing Assistant (CNA) is a key player of the health care delivery team. She is the hands on caregiver and the eyes and ears of the nurse. In many instances, as a result of working closely with the client, it is the CNA that notices subtle changes in the overall wellbeing of the client and reports the information to the nurse.
Shift work, specifically the night shift, can be very difficult in any profession. The worker is fighting the normal circadian cycle of their body and often has to fight fatigue in addition to performing the responsibilities of their position. As a CNA, some of the challenges faced during an overnight shift may include:
- Minimal Staffing
- Large assignment of clients
- Higher potential of client death
- Assigned tasks such as; stocking, cleaning of equipment, bathing of clients in early am and other duties as assigned.
In preparing herself for the night shift, the CNA needs to develop a schedule of sleeping, eating and a normal life outside of work. It is often difficult to get to sleep after working the night shift because of sunlight, noise and working against the way that our bodies are meant to function. Tips that may help include:
- Turn your nighttime hours into daytime hours: Try to eat breakfast before going to your shift. Eat a well-balanced lunch midway through your shift and a light supper toward the end of your shift.
- When arriving home after work, consider this your time when you would perform your normal routine at home.
- Alter your responsibilities as needed to meet the needs of your personal and family life.
- If you have difficulty getting to sleep during the day, block out noise by using a fan or air cleaner. Assure that you have dark curtains or blinds in your bedroom or wear a sleeping mask.
As mentioned previously, working the night shift may result in working with minimal staff. Many of the responsibilities of the CNA include having additional assistance in providing safe care and repositioning clients in their beds. One of the best ways to accomplish this with minimal staffing is to use the staff that is present in a systemic and effective way. For instance; clients must be checked hourly or every two hours. Ask the nurse or another CNA to work with you to go through each of the client rooms to assure that they are safe, repositioned and free of soiled linen. Try to accomplish more than one task at the same time and be assertive when asking for assistance from the nurse. Explain that you are concerned with the safety and wellbeing of the client and that in order for you to perform your duties safely you need assistance.
Because of the potential of minimal staffing on the night shift, the CNA will more than likely have a larger assignment than those CNA’s working the dayshift. Keep in mind that, in most normal cases, the client will be sleeping or resting during the nightshift unless they suffer from dementia or another serious health problem. The CNA should utilize this time to perform the other assigned duties that she is responsible for.
Statistics show that most deaths in hospitals and long term care facilities usually take place during the night shift. It may be the CNA that discovers that the client has expired or is near death. In most cases, it is the CNA that performs the post-mortem care on the expired client. This will include removal of equipment such as: oxygen tubing, Foley catheters, dressings and other various items. The body will be bathed, fresh dressings will be applied, oral care will be performed and the expired client will be diapered and dressed for transport either to a morgue or funeral home. The eyeglasses and dentures are sent with the body. After an occurrence of death it is always beneficial to take some time to discuss the client and situation with a co-worker. Death is traumatic for the health care provider no matter how much experience he or she may have.
The stocking of supplies and cleaning of equipment can be accomplished during the downtime in which clients are sleeping and rounds are completed. The CNA should use a methodical method to achieve her assigned tasks. For instance; if she is assigned to clean wheelchairs it is easier to obtain all of the wheelchairs, line them up and perform the cleaning as needed. The CNA should be creative in making her shift productive and enjoyable.
Bathing clients can be performed throughout the shift. Never wake a client up to bath them as their sleep is very important in maintain or improving their health. If a client is normally awake during the nighttime hours then it is okay to provide hygiene to them. If the client awakens early in the morning during the CNA’s shift, this client might also be bathed. This task should be assigned, guided and assisted by the nurse if at all possible.
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