“What the f***!” Ms. Webster was red in the face, shouting at the nurse who’d just arrived for the evening shift. “The day nurse told me I was moving to the third floor — now you tell me I’m not? You people better get your s*** together!” She began hurling onto the bed the belongings she’d gathered into a giant trash bag earlier in the day. She muttered profanity as she did so.
“I’ll make some phone calls and find out what’s happening,” the evening nurse said nervously and then rushed out of the room.
There’s been a lot of attention paid recently to transitions in nursing care: moves between the hospital and nursing home, and moves between home and the hospital or nursing facility. Another transition that deserves attention is room changes within the nursing home. The importance of this passage is often overlooked, resulting in confusion, anxiety, and distress. Properly handled, room changes are an opportunity to create a positive customer service experience within your facility. Here are some points to consider:
- Prepare the resident (and family) for the change by informing them as far in advance as possible.
- Attend to the emotional reaction to the move, especially if it signals a shift from being a short-term resident to becoming a long-term resident. Consider a psychology referral to facilitate adjustment to the new floor rather than waiting until problems become entrenched.
- Try to make room changes early in the day so that one shift handles the entire transition.
- Do an “idiot check” to make sure all property is transitioned to the new room.
- Label clothing quickly and make the resident aware of the reason the clothing is missing.
- Provide an introduction of staff and a pleasant welcome to the new unit to reduce anxiety.
- Introduce the transferred resident to another resident or two with whom they might get along.
- Ask a long-time resident on the floor to welcome the new resident.
- Create a policy that guides transitions so that “short-term” floors stay short-term, avoiding the resentments that crop up when one resident is reluctantly moved while another resident who has been there longer remains on a supposedly short-term floor.
What a great opening! So vivid, and then the practicalities of how to help. You rock Dr. El!
Dr. El,
I would like to add to your comprehensive list: if the resident is to move in with another resident, it is important to prepare the new roommate as well. Also, if not already involved in recreation programs, floor changes may provide a new opportunity to get the resident more involved in the life of the facility.
This is a touchy subject all around. Even the staff can be upset by a resident moving. While one group is losing a favorite resident, the other may feel that they are being “piled on” by having to take on another person. It sounds petty, but I hear it all the time.
I work in a relatively small nursing home, so even if a resident is moved, we still get to see them. I imagine in a large nursing center moving a resident from one floor to another is like having them move to another country.
Thank you, Maggie!
Good point, Sue, about preparing the new roommate in advance. It helps for them to know someone is about to enter their space, especially if the previous roommate had been a good friend. And you’re right, a floor change is a great opportunity for a resident to start afresh and perhaps take advantage of recreational activities they might not have previously tried. A good way to do this is to have one of their new neighbors accompany them.
K. Tree, thanks for your perspective. Resident floor changes can be a big adjustment for everyone, including staff. I know when CNAs move, residents can talk about their old CNAs for months afterward. And you’re right, because of limited mobility — physically for the residents, and practically for the staff due to time limitations and job duties — traveling between floors is a monumental task.
Thank you for writing this!
This is what we do at our facility: Let the resident “visit” the new unit with a staff from his/her current unit a day or two before the move and discuss his/her concern.
Here is what I would like to see, if staff don’t tend to work across units and residents on different units don’t tend to see each other often: Allow resident ample time to say goodbye and discuss ways to stay in touch with residents and staff they are close to.
Here is another one: Reintroduce unit policies and explain that things may be different on different units, but it’s not intended to be a “punishment” of any kind.
Thanks for your comment, C. You’re so right about discussing the different unit policies, because staff styles can be dramatically different from floor to floor. Also, residents’ perceptions can have changed between their admission and a move to another floor: their cognitive ability might have improved or worsened and their knowledge of the facility might change the way they hear the information now.
Recreational activities are a good way for residents to stay connected after a move. It would be nice for friends to plan to meet at events and be able to sit together.