Alone on Nights With a Resident Trying to Stand
You are the only CNA on a 14-bed unit at 3:00 a.m.; the second aide called in sick. Mr. B, 79, has moderate dementia and a fall two weeks ago. His care plan says "high fall risk - bed low, call light within reach, check every 30 minutes, bed alarm on." At your 3:05 check he is sitting on the edge of the bed with his legs already over the side, pushing up to stand, saying he must "get to the bank before it closes." The bed alarm is switched off and the bed is at waist height. Two call lights are on down the hall, and Mrs. T is calling out that she needs the bathroom. You are alone on the unit.
1. What is your immediate priority, and exactly what do you do in the next minute?
Read the worked answer
Priority: Mr. B. He is mid-fall, not a fall risk - a call light is a request, but a resident already standing with dementia is an active emergency.
In the next minute:
- Stay with him. Do not leave to answer lights.
- Lower the bed and get down to his level; speak calmly and use one simple instruction at a time ("Mr. B, let's sit down together first").
- Do not grab, pull, or physically force him back - that is a restraint and risks injury to both of you.
- Ask what he needs. "Bank" is likely a cover for "I need the toilet" - offer the commode or urinal instead of the hallway.
- Once he is safe in a chair or on the commode, use the call system or phone to bring the nurse.
Reasoning: the standard is to match the response to the immediacy of the risk. If he does start to fall, guide him down to the floor rather than trying to catch him, then don't move him and get the nurse.
2. How do you handle the two call lights and Mrs. T while you are managing Mr. B?
Read the worked answer
Use the intercom, not your feet. Answer each light from the room you are in: "I'm with a resident right now; I'll be there in a few minutes - are you safe?"
Triage:
- Mrs. T needing the bathroom is the higher priority of the two - an unmet toileting need quickly becomes a fall or an incontinent episode. Ask her to stay seated and wait, and go to her as soon as Mr. B is settled.
- The other light: ask what it is for. If it's a request for water or a reposition, it can wait a few minutes; if it's chest pain, shortness of breath, or a fall, it becomes the top priority and you call the nurse immediately.
Reasoning: you are not ignoring the lights - you are answering them and sorting by risk. Leaving a confused, standing resident alone to answer a non-urgent light creates a foreseeable injury.
3. What do you report at the end of the shift, and what should you avoid doing to "solve" the problem?
Read the worked answer
Report to the nurse in charge, before you leave:
- The bed alarm was off and the bed was high at the 3:05 check.
- Mr. B repeatedly tried to stand and was redirected to the commode.
- The staff shortage - this is a safety issue and belongs in the record, not just in conversation.
Document: time, what you observed, what you did, his response, and that the nurse was notified.
Avoid:
- Raising all four side rails, tucking sheets tightly, or tying a lap belt - these are restraints and require an order; they also increase injury risk when a resident climbs over them.
- Sitting outside his door for the rest of the shift and abandoning the other 13 residents.
- Promising the family "it won't happen again."
Reasoning: fixes that restrain the resident trade one safety problem for a bigger one; the correct response is supervision, environmental correction, and escalation.