The following is a transcript of an average day for an aged care staff member who wrote this article.

The following is a composite of an average day for me in a brand spanking new, state of the art, aged care facility I went to with rose coloured glasses. I have since learned the hard way, that any facility, be it old or new, is only as good as the management and staff employed there! I worked permanent evening shifts, from 2.45pm to 10.51(!)pm.

You may also be interested to know that I am hearing impaired. I was alone in a 16 resident, combined high/low care dementia wing for the first 4 months. I was then given a second staff member from 5pm to 9pm (occassionally), then 3.30 to 9pm (occassionally, when staffing levels permitted).

The rigorous timetable below does not include palliative care that is often expected of us due to 'ageing in place'. Two hourly turns, bed baths, trying to 'push fluids'. Often there are showers after residents are incontinent and a wipe over with a washcloth simply isn't enough. This is manageable if there are enough staff on board, but, despite my constant asking for help, I was told it was a 'one person wing'. Ludicrous.

2.45pm Handover, often interupted by residents.
3pm

Check on the whereabouts of all my residents, I need to know where they are and that they're safe.

Afternoon teas for everyone, resident's family members also, if they are there.

Residents from the high care wing wander over and go into the rooms of my residents causing behaviour issues. These issues can take the form of either verbal, or physical aggression, which I, alone, have to deal with. I cannot take the residents from the other wing back, as we cannot leave the wing unattended!!

I can only hope that the EEN (Endorsed Enrolled Nurse) on duty will come in to see how things are and take them back for me.

3.30pm

I attempt to carry out regular toileting programms, but I have a lady who is shadowing me constantly, she just wants to be with me, holding my hand and feeling wanted. I want to give this to her, but can't, as I need to toilet a male resident. I sit her gently down then move very quickly away, hoping she won't find me. She doesn't understand about 'personal space', and will follow me into the male resident's room unless I'm quick enough.

One toileted, but as I leave his room, I see another female resident, who is a compulsive eater, going into another resident's room looking for food. She does this constantly and has to be redirected. She is often not happy about this and can become aggressive.

I move onto the next person to toilet, but my 'shadow' has found me again, and another resident is shouting because another resident is in his room using his bathroom, they come to blows and I have to separate them. He has a lock on his door, I ask him to please use it.

I also have a family member wanting to discuss an issue with her husband. I tell her I won't be a moment, I have to sort out the yelling.

While going to do this, I notice that one of the residents is very wet, far more so than would be expected if the morning staff had toileting them prior to the end of shift(!!).

So, sort out the yelling, try to 'lose' my shadow, toilet, clean and change the wet resident, then go talk to the family member.

4pm

The EEN comes over to see how things are progressing, great, ask her to take the high care people back to their wing, and please lock the door so they can't come back. Take this opportunity to clean up the afternoon tea things in readiness for dinner. Go around the rooms and put out the night pads and pyjamas in readiness for bed preparation. Redirect a resident back to his room as he 'was just going to get his car'.

Toilet 2 more residents, one of whom has been incontinent for faeces.

Throughout all of this, I am trying to redirect my shadow. This is what I really hate about the job, she needs attention, which I would gladly give if I had the time. But all I can do is constantly sit her down and offer her drinks, at least she is getting a good 'fluid intake'!!

There is nothing for her to do, the television holds no interest for her as English is her second language, she is rarely taken to 'activities' as she will wander off and the activites are held in an open area.

4.30pm Ask the EEN if I can have a 15 minute break, sometimes possible, sometimes not, depends on how busy she is. Assuming I manage to get it, I go, with great relief, and have a coffee.
4.45pm

Start taking residents to the dining room for dinner at 5pm. Low care are fine, but high care need to be taken by the hand, or guided with their wheelie walkers to the table, sat, and pray they will stay sat.

During this time the kitchen is unlocked, so I must watch our compulsive eater constantly or she will go into the kitchen and eat anything in sight. Care has to be taken as to where residents are sat as some simply don't get along.

5pm

The meal trolley arrives, cutlery, serviettes, and drinks are placed before each resident. Soup is served, our compulsive eater is presently happy, but our shadow is verbalising loudly, and upsetting the other residents, I don't have time to placate her as the meals need to be served, I can't do two things at once (amazingly), some residents need to be encouraged to eat, some need to be fed. I make a pot of tea, clear the tables, then serve everyone a cuppa.

During all this, I have residents trying to leave the table before eating their meal, I have to try to keep them there, some finish sooner than others and want to go back to their room, they need assistance, meanwhile the shadow doesn't want her meal, you take it away, then she wants it, you return it (you may be interested to hear that I am getting palpitations just writing this, remember, I am alone).

The EEN comes over to give out medications, a little relief for me. I am able to take residents to their room knowing there is someone there to watch the others.

6pm Load the dishes into the food trolley, clean up the kitchen, check all residents are safe and clean, toilet where necessary, ask the EEN if I can go on my meal break.
6.30 Blessed relief, half hour break, do the wee I have been hanging onto. (Incidently, I had several UTI's due to the fact that there was no one to relieve me (pun not intended), when I needed to go to the bathroom).
7pm Back on duty, the EEN leaves and I get supper for everyone, clean up the kitchen after, then starts bed preparation. The first is a male resident who is unable to weight bare, so I use a stand up lifter, toilet him, night pad, change him into his pyjamas, brush teeth, then settle him into bed. Assist my shadow to bed, get hit, spat at and scratched for my trouble. When I leave her room, she is content, comfortable and happy.
7.30pm

Buzzer goes, it's a resident who needs assistance with toileting, assist him, then get him into his pyjamas, and brushing of teeth, settle him in bed.

Take another male resident to his room, he is to be an evening shower, manage to divest him of his clothes, get him under the shower, he then, for reasons known only to him, becomes extremely aggressive and has me baled up in the bathroom (I am alone, no support). I stand mute, and wait for the blows I expect to follow. Fortunately, he contains himself, but I am unable to rinse the soap off his body, he goes to his room, dries himself and then puts his day clothes on again, despite me having put his pyjamas on his bed and folding his clothes up, placing them on the chair. I am not going to argue with him at this stage! (I, again, have palpitations).

8pm

Assist 3 lovely ladies with bed preparation, p.j's, pads, teeth cleaning, and settle them into bed.

EEN comes over to do medications, she is busy and unable to offer me any assistance.

8.30pm

Assist a male resident, who has a very set bedtime routine or he becomes extremely confused. Toilet, teeth cleaned, pyjamas, settled in bed.

8.45pm

Buzzer goes, it is the first male resident I put to bed. Go to check on him and he is distraught. He says he has 'just fallen off the wall'. This is a very real issue for him, so I take 45 minutes to talk him through it, make him a cup of tea, then settle him into bed again.

I hear screaming!! Rush out and a male resident has a female resident in a headlock and is dragging her along the corridor. I have no idea what set this off, other residents are aggitated and also start exhibiting behaviours....prioritise.... first, and foremost, is to stop the female resident being strangled, I approach them and tell the male resident that's it's fine now, everything is OK. He says 'are you sure?', I reply yes, and he (thank God), lets her go, then allows me to take him and sit him in front of the communal television.

I then go and check the female resident, take her to her room and calm her.

I then go to the other unsettled residents, gently redirect them to their rooms.

I then run like the clappers, through the courtyard, into the high care dementia wing, and ask staff to come over. I am a mess, shaking, palpitations. Staff come over and tell me to go have a break for 10 minutes, I do, happily.

9.30pm

Back on deck, now I have to attempt to get our aggressive male resident to bed, I never know if he will be compliant, or become aggressive. He is still sitting in the chair I sat him in and dozing. I approach him gently and ask him if he is tired, would he like to go to bed now, he says yes. I take him to his room and verbally encourage him to put his pyjamas on, he refuses, all I can manage to do is get him to take his shoes off, then he gets into bed and settles (Thank you, Lord).

10pm

It is now time to attack all the paperwork and computer work. I start, but a male resident gets up and is wandering, I take him to his room, toilet him and settle him back in bed, Go back to the paperwork, but he is up again within 5 minutes. I, again, try to settle him, and while I'm in with him a female resident gets up and goes across the hall to another residents room and uses the bathroom, waking her up as well.

I now have 3 to settle, meanwhile the paperwork is waiting.

The buzzer goes off!!! I attend the resident who needs toileting, settle him, settle the other three, then try the paper work again.

10.35pm

I manage to get the bowel charts done, everything else must go begging as night staff is here for her handover. The male resident gets up again. Settle him, quick check through the wing to make sure everyone is in bed and comfortable.

Give handover and leave at 11pm, 9 minutes over my allotted day.

I am exhausted, I do this 5 nights a week.

Comments  

#1 Pippa Matthews 2019-11-03 12:55
Thank you for this report! I am a voluntary pastoral worker in several nursing homes. i follow my people from their home situation to the home their family has chosen. This means that I am familiar with a lot of homes.

Your report does not surprise me. Homes are often understaffed. I wonder why there is not a realistic mandatory staffing ratio for homes - just as there often is in childcare situations.

Your report is entirely consistent with what happens every day/night in every home - and of course our clients get more confused and frustrated as the day progresses.

It is obvious that you care about your job. Please take care of yourself, so that you don't 'burn out'.
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