“Tired CNA” posted a comment on my blog, saying she wished there were something that could be done about alert residents who ring their call bells 30 times a day. And there is. Here are some suggestions:
- Residents who ring their call bells frequently are often anxious, needing what seems like constant reassurance. Quell their anxiety by visiting with them at the beginning of each shift, telling them who you are and when you’ll be by again next. Check in on them when it’s relatively convenient for you so they don’t have to call and interrupt you when it isn’t.
- Answering the call bell right away reduces resident anxiety and decreases the frequency of calling. Ring, answer, ring, answer, even if it’s to say that help will be there in ten minutes. Then show up in ten minutes.
- I used to wait tables and there’d always be that group of diners who would wait until I’d returned from one request to give me a second, and then a third when I returned from the second. I learned to ask “Is there anything else you need right now?” Try this.
- I provide “Call Bell Education” on the theory that the residents, most of whom have never been in a nursing home before, have no idea how much bell-ringing is considered “too frequent” by the staff (and some of them don’t use it when they should). It’s better to do this in a calm, informative manner when the residents first arrive rather than waiting until everybody is aggravated. As a CNA you could give them a ballpark figure of what’s considered reasonable during a shift, while assuring them that you’re there to meet their need for care. Part of the education process is helping them to identify when it’s important to let the staff know they require assistance (for example, they need oxygen or to be changed) and when it might be better to “group” requests (for example, if they want the window closed and the TV station switched, and meds are coming in ten minutes, they might as well wait for the nurse).
- If a resident continues to need a lot of assistance, consider moving them to a room closer to the nursing station, where staff members are more likely to pass by easily rather than having to walk all the way down the hall.
- Consider a referral to the psychologist. My residents know they will see me each week and can ask me for assistance with a wide variety of matters. This significantly reduces their anxiety. This week someone said to me, “I don’t know what I’d do without you. I really feel like you’re listening to me, taking my concerns seriously, and getting things done to fix them.” And I am. Include the psychologist on your team, and any other staff and family members you can enlist to improve the situation.
17 thoughts on “Call Bell Crazy? 6 Tips for Taming Overuse”
As always, your suggestions are excellent, I’m sure staff members and anxious residents will benefit enormously from this post.
Food for thought for “tired CNA,” have you ever stayed in a $300.00 per person per night hotel ($600.00 per room/double occupancy)? If the answer is yes, what kind of service did you expect? While a nursing home stay and a vacation at a resort are not equitable for so many reasons, I often think of how much the customer service mentality of a resort would benefit the resident in a nursing home.
Then why don’t they go to hotels, if they think hotel staff will serve them 24/7? The correct comparison should be $300/night plus 24 hour private caregiver fees.
I’ve seen both sides to this…stayed at expensive hotels and had room service- but that is totally different from being dependent upon someone to help me wash up, get dressed, eat, move around in my bed…it’s different from ordering a continental breakfast, for sure.
Working as an aide for so many years I can say, for sure, it’s frustrating to hear call bells ringing while I’m in the middle of changing someone; or showering someone. It’s difficult to have the nurse come into a residents’ room that I am providing care for, telling me my other residents are ringing bells. It’s crazy to know that nurse could not answer that bell, knowing how busy I am!
It’s annoying to walk away from Mrs. Jones who was ready for her shower, to go answer Mrs. Smith’s bell, wanting me to get the box of chocolates out of her drawer so she can nibble on them. It’s awful to make Mr. Brown sit in his wet soiled brief for another 10 minutes, just so Mr. Green can have the aides re-adjust him for the 7th time in one hour…
Working as an aide is not customer service work –They are very different types of work. Now, if we lived in a perfect world, we could wear the customer service rep hat as well. But the reality is, at 9.00, 10.00 or perhaps 11.00 bucks an hour, heavy workloads, inconsistent and often irresponsible management/supervision, you get overworked, exhausted CNA’s who can barely finish their tasks. You get smiling management that promises much more than they can deliver because they’ve often never had to do the deliveries themselves.
Call bells should only be used for emergencies. Defining emergency is the hard part…to a person laying in bed needing to use a bedpan, that is an emergency. To the aide who is changing 10, 11 or 12 residents who wear briefs, everyone gets their turn. I know it’s not perfect, but it is what it is.
I love this comment thread! Thanks, ladies! You have so perfectly illuminated the challenges in providing good customer service versus the sometimes unrealistically high expectations of the residents. I once overheard an ambulatory resident in the hallway loudly demanding, “I want tea! Somebody bring me tea!” I said, “Where do you think you are, the Ritz Carlton? Go in the dining room where they’re about to serve lunch and someone will bring you tea.” He laughed and headed to lunch. I know that the aides are overworked, underpaid, and under-supported, and yet some aides answer the call bell with a kind “How can I help you?” and others with a surly “What do you want now!” The customer service challenge for the staff is to present themselves in a pleasant, professional manner no matter what’s going on behind the scenes.
Regarding assistance from the nurse, I watched a charge nurse TRANSFORM the two units I saw her on by immediately answering the call bell using the communication system in the room. The bell went off, she found out what was needed, assured the resident someone would be coming soon, and then asked the aide to check on the room when they’d completed their current task. All calm, all reassuring, sometimes providing information that eliminated the need to disturb the aides. I saw chaos turn into calm for the residents and the aides.
I am fully aware of how hard a CNAs job is. My point is customer service. I disagree with you, ALL staff members who work in a nursing home wear two hats, one is always that of a customer service representative. While some residents will always be demanding, I think that CNAs who wear the “customer service hat” as well instill a sense of trust and ultimately be less stressed.
Some CNA’s are naturally out going, positive people who have a knack for calming others. Others, however, have no skill set on customer service. These are not bad aides, they just don’t know how to manage multiple requests at the same time. They get frustrated. Add to this the fact that many will be spoken to by the nurses, pressured to be quick and “efficient” and we have a recipe for disaster. CNA’s are not taught to be customer service orientated. They are taught skills that they need to get their job done. In fact I know many CNA courses that clearly define the resident as a patient. The aides are the professional care givers who must maintain boundaries with their “patients”…customer service skills and the overall concepts are not taught or even expected and in some cases, discouraged. Because there is always the possibility that an aide could prefer to wait on one resident over another…favoritism.
I learned the hard old fashioned way that, yes, by taking on a role above and beyond what I was taught, made my work shifts a lot easier to manage. But it took many years; it took being written up a couple times for spending too much time with a resident; it took lots of industry culture changing before I was comfortable wearing more than one hat. It’s not easy and many things need to be in place in order for CNA’s to take on additional roles. Education being the first. Acceptance from management/peers is the second. And resident boundaries are the third.
I agree, Patti, that education is primary. If the staff isn’t properly trained to provide good customer service — and by this we can start with just being pleasant and polite — then we can’t blame the staff, we must look to the management. Management can set the tone of respectful interactions, and can identify why staff members are surly: personality? lack of customer service training? understaffed? lack of tools to do their job properly? difficulty prioritizing tasks? personal crises? Many of these can be addressed administratively. With good customer service skills, the job becomes easier.
I agree with you all and I have a lot of respect for my front-line coworkers, be it a CNA, an LPN, or an RN.
Dr. El: I love #6 (OK, I may be a little biased.) The unfortunate reality is that most places don’t have a psychologist on staff and consulting psychologists may only have very limited time, and mostly with the most “problematic” residents. The other challenge is that as much as we may want to help or are able to help, there is a risk of creating “unhealthy” triangular relationships…
Thanks for your comment, C. Every nursing home should have at least one psychologist. They don’t cost the nursing home anything and they add considerably to the team, especially if they’re properly utilized. I’d say that residents who are constantly ringing the call bell to the point they’re annoying staff deserve to have a psychology consult. They are probably just as annoyed with the staff members, and the psychologist can act as a bridge to repair the relationships without triangulation. In my approach, the residents and staff are coworkers in the job of getting the residents up and ready for the day.
How’s this for a novel concept. Certified Nursing Assistants NEED assistants! If “customer service” is the trendy new “buzz” word, then we can incorporate a Customer Service Rep into the trenches/front-line, who can also act as a liaison to nursing. Bring back the concept of Candy Stripers, Hall Monitors, Call bell monitors, whatever you want to call it. Yes, this could be a volunteer position, but honestly, Hall monitors should be a paid position!!! (perhaps the State could screen/pay appropriate candidates for this position and provide nursing homes who cannot afford. them. I say this, because, after all, it is the State that has overburdened existing staff with overwhelming and unattainable standards/regulations!!!!)
What are the duties? Answer call light ASAP. Determine if the request is nursing or non nursing ( getting the “box of chocolates” out of the drawer, removing the dinner tray, assisting with making a telephone call, closing the curtain…etc etc.) and PRESTO, hall monitor disengages the light, cutting down on noise pollution, alleviating anxiety and allowing CNA’s to triage ADL interventions! If it is a nursing issue, hall monitor may STAY with the resident, assuring them that someone will be here soon.
CNA’s are the elite forces in God’s Waiting Room. They need respect. They should not be made to feel like the low men on the totem pole. They need Assistants!!!!
Genie, it would certainly be valuable to have more volunteers in the nursing home to do many of the tasks you mentioned, as I’ve blogged about in the past. Residents have many more needs than those the CNA, nurse, or social worker can provide. Who will sew on a button? Who will run to the store to buy the kind of hand lotion the resident’s used for 40 years? It would be an interesting study to measure resident, staff, and family satisfaction before and after implementing a staff position of errand-runner. I predict huge increases in satisfaction.
Iam sorry to say this but those who say it is possible to manage the non stop call bell behavior have never worked as a caregiver. Front line staff don’t even have time to eat. They don’t have time to even properly assess patients and think through if call bells ring every ten minutes from one resident when you have ten patients to look after. Telling them it is their job to manage is just nonsense. It will just result in burnout and turnovers.
K, the job of the professional caregiver is very challenging but answering the call bell is definitely part of the job. This blog post was written to offer some ways to work with residents to reduce the use of the call bell and to make the job of the caregiver more manageable, hopefully resulting in reduced burnout and turnover.
Dr. El have you personally answered a call bell even one time when you were rounding? I doubt it, typically physicians just go and tell the nurse the patient needs something. When call bells are truly “everyone’s responsibility” then things will change. You have done nothing for the patient if all you do is run and tell the nurse the patient needs help. Management needs to get off their duff’s, out on the floor, and pitch in. Then and only then will things change….
Yes, Rondo, I’ve answered the call bell many times over the years. I’m not a physician doing rounds, though, I’m a consulting psychologist.
Lol right an occasional call lighthere and there, to ask for someone to bring her coffee. Another article that gives some and I emphasize some insight into possible practical and sensible solutions that may help some reduction but not all, especially problematic call light abusers that also become chronic complainers and family members involved in complaining that we don’t respond fast enough or to every whim. But yet another typical problem that doesn’t address the real root of the problem which is willingness on administration and money holders to address and implement programs that feel it’s better to threaten or replace low paid front line CNAs soldiers than to spend time effort and money by higher ups managers or outside company to educate residents. It’s like this with nurses at hospitals too, they know running understaffed and throwing front line workers under the bus to save their own butts and cut into profit loss and potential bonuses or promotions is more easy and beneficial. Even most of the front line workers know that the long term benefits of an ounce of prevention provides a pound of cure and for them a penny spent can bring a dollar here by upping patient satisfaction rateings , potential claims and settlements and per yaps higher profitability that they may care first about or sustainability which is important for all. I’d like to see articles that stop placing more burden on frontline and those that put the emphasis on lazy underperforming non supportive administrators and money grabbers as the real root of the problem. Don’t forget care workers answer hundreds of call lights each week , week in and week out for years and for a fraction of what is earned by admins and financial stakeholders and most would never ever want to do this work for one week.
Thank you, FBGMF, for your dedication to your job and the residents! Perhaps you can bring your insights to work with the management or union within your facility to positively influence the environment there. As I commented before, if there are call bell over-users with chronically complaining families, the consulting psychologist might be of help. Also, providing my book, The Savvy Resident’s Guide, to new residents and families can help set more realistic expectations with regard to this and other issues.