Paul's Passing Thoughts

Revised and Updated: Should Aides Split a Unit or Work Together?

Posted in Uncategorized by Paul M. Dohse Sr. on July 18, 2020
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Nurse aides in nursing facilities will typically work on long halls with 20-30 residents or in units with two smaller halls. This article is about skilled nursing units, behavioral units, or Dementia units. In most cases, assisted living units would not beg the question as to whether or not two aides should work together on a hall or unit. However, some assisted living units are only that by name and require a lot of total care.

Among aides, working a unit together rather than splitting it up and working the two halves solo is not a popular notion, but for some reason, that is changing. In the last two months I have worked units together with another aide three times, but before that, only once in my entire career as an aide.

In all three cases, it was young aides that were very experienced and also very good. I was surprised that they were so readily open to working together. Most of the activity in the rooms was automatic. I paid close attention to time, which most aides, including myself, give too much concern to, and found that tasks do get done faster. The other day, the two of us got three people up with Hoyer lifts and did one shower in well less than an hour. That’s pretty good and brings me to my next point.

Facilities have gotten really good about abiding by laws that require two aides to transfer a resident with a Hoyer. So, let’s think about this: if you divide a hall and work separately, the other aide has to stop and spot you on a transfer anyway. Usually, the other aide is in the middle of something and you end up waiting for them. Secondly, beyond that, you may have residents that require two aides anyway even if they are bed ridden. Some residents can lend little help with bed mobility.

Then, there is the whole issue of accountability. Two heads are better than one. Since you are not in such a rush, being by yourself, you are thinking more about safety issues and other care issues. One aide may be turning the resident while the other one is making sure catheter tubes and other lines have plenty of slack. Many needs can be done separately at the same time. One aide can be helping with oral care while the other is making the bed and straightening up the room. And yes, being in the room and ending up without everything you need happens; so, the other aide can go fetch what you need while the other aide keeps the tasks moving along. In addition, having to leave the room to get something or find a nurse in the midst of a task can be a safety issue.

This is for certain: even if the time is about the same, quality of care is greatly increased. In addition, the residents like two aides in their room instead of one; it’s additional personal contact that aides usually avoid because of time constraints.

Let’s also discuss resident preference regarding the gender of the aide. That cuts all the different ways that you can think of; some male residents don’t want male aides etc. Again, one aide can do the personal care while the other aide does the other tasks.

Another issue is residents needing to be “pulled up in bed” and having to go find the other aide to help you do that using a draw sheet. The point here follows; as mentioned prior in this article regarding other care items, the aides have to work together on a lot of tasks anyway. Let’s also add the possibility that one aide is unfamiliar with the residents; not only is that a safety issue, but you don’t have one aide looking for a nurse or aide to ask questions about resident care.

When an aide is going to get charting done can be a stressful issue, especially if the day is not going well. The two aides might want to split up for that. One aide can start second rounds while the other one charts and then rejoin the other aide after charting is done, or they can do the charting together. Break times are more likely to happen if you work together as well.

There is something unfortunate in aide work that is much more likely to occur if a hall is split: walking past a call light. “Not my room, that’s your room,” right? Only problem is, an aide should never walk past a call light for any reason. During meals, residents needing assistance can’t be evenly divided for several different reasons, so there is some crossing over in assignments for that as well. You can add these to the list of things that invariably lead to the assignments being intermixed anyway. In other words, splitting a unit is somewhat of a fallacy to begin with. I am convinced that it leads to a reduction in care quality.

COVID 19 is also an issue. While quality of care is increased, time exposure in each room is less, and there is a decreased possibility that a single aide that is behind schedule will cut corners on standard precautions. Two aides working together wash their hands more etc.

lastly, aides are the eyes, ears, and nose for the nurse. When aides work together, that perception is doubled.

Paul Dohse STNA/ MA-C

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