The nursing care is provided by a RN, LPN (LVN) or Certified Nursing Assistants (CNA) and nursing standard of care must be followed. Nursing care duties are very time consuming. A RN, LPN or CNA will typically work a minimum of one shift a day, 7.5 (or 8.0) hours. There is an allowable labor break for a 30-minute meal and two 15-minute breaks per shift. This allows 390 (420) minutes for resident care in each shift. Often a CNA will work a double shift at the facility or have another job at another nursing home. Frequently, the CNA holds down two jobs due to low wages, resulting in many days of 16 hour work days. Additionally, the CNA will often work 6 or 7 days per week.
The following are examples of resident care responsibilities a RN, LPN or CNA1 may have on a single daily shift:
Shower…(whirlpool is at least 30”): 10 – 30 min.
Bed bath: 10 – 15 min.
Personal hygiene care (each time incontinent): 5 – 10 min.
Partial baths (face, oral care, hands, peri-care) on each resident: 10 min.
Foley catheter care: 5-10 min.
Empty and measure catheter bag at end of shift: 5 min.
Oral care / dentures: 5 – 10 min.
Groom / shave resident: 5 – 10 min.
Dress resident: 5 – 15 min.
Nail care to resident: 5 – 10 min.
Body / hand lotion to skin: 5 min.
Toilet resident: 10 – 15 min.
Vital sign’s (temperature, pulse, respiration’s & blood pressure): 5 -10 min.
Set up meal tray, document food / fluid intake each meal: 5 – 10 min.
Total feed the meal to a resident: 20 – 60 min.
Each CNA may have a minimum of 2 residents to feed: 40 min.
Serve and feed nutritional supplements during the shift: 1 – 10 min.
Handwashing between resident: 30 sec. – 2 min.
Bed making – unoccupied: 5 min.
Bed making – resident in the bed: 10 – 15 min.
Resident unit organization: 5 – 10 min.
Documentation & observations on the resident care records: 3 – 5 min.
Passive range of motion (5 – 10 repeats) to resident: 10 – 15 min.
Ambulating resident to dining room or other areas: 10 -15 min.
Assessment of pain, depression and behavior: 5 – 10 min.
Turn, hygiene care or toileting assist & reposition a resident: 5 – 10 min.
If a nurse or CNA has nine (9) residents in her/his group for the day shift, the following minutes could be needed to complete the resident care responsibilities:
Four showers to give (15” each): 60 min.
Five bed baths or partials (15” each): 75 min.
One catheter to empty, measure and document: 5 min.
Four incont. res. to clean / change (3 times x 5” each): 60 min.
Document on the resident care and observations (3” each): 27 min.
Make at least 9 beds, including clean linens (5” each): 45 min.
Set up 7 meal trays (2 meals on day shift – 5” each): 70 min.
Toilet five residents (3 times on day shift – 5” each): 75 min.
Groom / shave / oral care 9 residents (15” each): 135 min.
Total minimum minutes needed to provide the care: 552 min.
On a 7-3 shift, if a RN, LPN (LVN) or CNA has 9 residents on her / his team and completes the necessary care tasks following the standard of care, an additional 162 (132) more minutes are needed to perform the resident care responsibilities. However, many CNA’s or other caregivers have between 10 & 15 residents on 7-3 shift. The CNA may have more residents if a staff member calls in sick. On the 3-11 PM shift, a CNA may have between 15 & 25+ residents. Handwashing between residents & care needs as required for infection control is not included in the above time figures.
1. How many residents are total-care for ADL’s?
2. What happens when a nurse or CNA calls in sick or does not show for work?
3. Was there assessment for pain control, anxiety and depression?
4. Does the resident have a dementia process and need additional time?
National Pressure Ulcer Advisory Panel: www.npuap.org
Agency for Health Care Policy & Research: www.ahcpr.gov
Center for Medicare & Medicare Services: www.hcfa.gov
Nursing Home Compare: www.medicare.gov
Good website for understanding LTC: www.wwa.com/~conda/aging
Better Government Association – Chicago: www.illinoiscare.org
National Citizens for Nursing Home Reform: www.ncnhr.org
Nursing Home Monitors: www.nursinghomemonitors.org
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