This isn’t news to me, or to most aides I suspect.
We see it. We experience it. We hear all about it.
WHAT? The PANIC mode our DON and Administrators go into when it’s THAT time of the year. The biggest pony show is often put onto the stage during these times.

THE ANNUAL SURVEY.
Weeks before they expect the inspections, the leaders go crazy. Everything is painted and cleaned and polished to a high voltage shine.
Suddenly the food is much better- it’s hot when it’s supposed to be, or cold when it should be. More food is served; it looks better and smells better and….YES….it even tastes better. The nice table linens come out. The dishes are apt to be prettier. The cook is suddenly more responsive to resident requests for an alternative. The servers show some respect once again. And the aides HEAR about IT when they’re not in the dining rooms right exactly on (cue) time. The dietitians suddenly show up more at meals and actually taste the food, check it’s temp and go through the motions they’re supposed to have been doing all along.

The DON changes too at this time of the year. She or he goes on a witch hunt, scouring through employee records to see who needs to be updated for in services and background checks and all that. She might realize the nursing home hasn’t offered enough education hours so we the aides are forced to attend stupid movie in services by the half dozen for several weeks. Then we’re coached as to what to say IF the dreaded SURVEYORS ask us questions. An innocent and idealistic aide might ask why she can’t just tell them the truth? Lo and beho, the SIN this person just committed. The DON goes further into herself imposed bitchdom with the resident care plans. And the nurses are the next target of the scorn and attacks. Care plans are re-written; aides and nurses and others are asked, no TOLD, to re-sign endless pages of flow sheets and similar stuff.
The residents get the most out of SURVEY EXPECTATION ANXIETY TIME. They get brand new towels and sheets and linens. They have new toothbrushes with their names on them…and shampoo and soap and creams and lotions. Things they haven’t always had all year long. Their rooms are suddenly really well cleaned- rugs are washed, walls are re painted, much needed repairs are done. Windows might even get screens placed in them; AND, the bathrooms! The toilets are fixed so they stop clogging up; the showers magically spray hot water again. And residents have an endless supply of needed items like briefs and wipes and the likes. The scents of the home are just wonderful too, at this time of the year. Air fresheners and flowers and the smell of baking food is abundant in every nook, corner and crevice.

THE BEST PART of THAT time of the year is the increase in STAFFING. Yes. Everyone benefits now. Not only are there enough aides scheduled, often we have too many. SO many that a couple might be sent home or better yet- put to work doing special things like restorative nursing stuff, or activities. The nursing home appears to be a well oiled, well run shop. Enough staff; good food, excellent building and yards; a great activity program…and perfect care plans with well written goals and all signed off by the right people, at the right time, for the right resident.
Yep.
Too bad this isn’t how it works ALL THE TIME.

Now go this article. And consider my rant above. It’s all relative and yes, some nursing homes are NOT like this (or shall we say, some nursing home management teams) BUT many are. Hide the truth when IT’S THAT TIME OF THE YEAR. Cover up those things that are cosmetic and can be altered for a few days. And forget about the rest of the year.

Related posts:

1. THAT time of the YEAR
2. Taking Time To Find Time

We talk about it a lot. This work we do. The backbreaking physical work; the crappy pay; the low level of respect we get. Most of us stick it out because we love what we do; we love caring for people less fortunate than ourselves. We sacrifice a lot to stay in this field. How often are we thanked? I found this article and it made me think- am I ashamed of what I do? And how often am I truly thanked for my work? I say, NO I AM NOT ASHAMED AT WHAT I CHOSE TO DO FOR A LIVING…but I am rarely thanked, that’s for sure!

I work at a long term care facility in Humboldt County. One of my duties is to teach CNAs (Certified Nursing Assistants or aides) and other staff members continuing education units in order to be compliant with state regulations. Recently I did teaching on “Positive Relationships for CNAs.” I asked my aides how they felt about being a CNA. Many had positive remarks to share with my class.

My next question was “How do others feel about what you do when you tell them you work in long term care?” Many became uncomfortable and hung their heads. One brave soul stated: “I don’t like telling people what I do for a living because they look at me with a suspicious face and slowly say ‘Ohhhh’ … .”

So, hold your head up high and be proud of what you do. When people ask, tell them! And when you get thanked, rarely though it may be, treasure it and always remember it.

No related posts.

In our work as CNA’s, we see many contradictions. A lot of DO AS I SAY but little of DO WHAT I DO. We have well written care plans that, in the perfect long term care setting, would be ideal for each resident. We have leaders who brag about the “excellent” care facilities provide.

But the CNA knows the truth.

Sometimes these truths are uncomfortable.

Jeri-Kay left a comment on our post about Wheel Chair Abuse, that speaks to this, loudly and honestly:

I simply love this post. Not only is it true, but it depicts every facility that I have worked in for the past eleven years. I have waited many years to see a solution, however it just seems as though as soon as there is an idea of what to do, it ends up reverting back to the same objective which is simply this, do the “right” thing when mangaement is looking, but just forget about it after they have left for the day. Not only does this concept come to failure each time, but it ends up making chaos between the shifts in which use wheelchairs. I honestly cannot blame first shift for being angry as they are forced to walk each and every resident to and from both meals as well as in between times. Now don’t get me wrong, I am all for the perfect independence of a resident, but when you are caring for eighty residents, only have three staff memebers(when you are used to five), and the rehab nurse is barking orders to walk everyone, I believe that I would be a bit upset, not because I have to walk everyone but, when it comes to second shift, after the boss is gone the rules begin to change. Either way, I would love for there to be a solution that everyone could learn to live with. Even though I know that this article would sadly fail at my facility, it would most certainly be worth a try! Thank you for such an encouraging post!

And the truth can hurt. It hurts our residents. It hurts US. It hurts humanity when it becomes the norm. Sadly, this is how it is in most nursing homes. Staffing ratios that change from one shift to the next. But the care plan goals and objectives do not. Why is this?

I read all the wonderful programs and processes at the various nursing home trade web sites we link to. The ideas, and the thoughts behind them are based upon good nursing care practices. Much emphasis is placed upon involving the CNA’s in the programs such as eliminating wheel chair use. CNA’s aren’t stupid. We know how these things are harmful.

Much effort is put into making sure staff “understand the importance”; many hours are logged into convincing staff (namely CNA’s) that these ideas are best for our residents. Care plans are written with great detail as to exactly when and how far a resident needs to ambulate (or whatever the program demands).

CNA’s aren’t stupid.

Yet, all this “education” and “staff buy in” bulloney only goes so far.

The bulloney shows it’s true colors when there aren’t enough staff to follow through with the programs. A CNA can assist several residents with walking to the dining room, for sure. But to expect the CNA to ambulate 10, 12 or more to meals is a bit much- when we add in the meal set up, assisting with eating, cleaning up and the myriad of other tasks we’re charged with.

The bulloney shows its true colors when 3 aides are assigned a unit on evening shift that is staffed with 5 aides on days. It has always baffled me why evening shift has less aides…the claim that the shift isn’t as task-orientated is crap!

Some more uncomfortable truths:

Evening shift aides could keep all their residents out of wheelchairs IF they had enough support in the form of adequate staffing. But NO. Management cannot justify the ratios based upon the low standards of care they like to pretend are excellent.

Evening shift aides could make sure their residents are brought to the bathrooms more often and therefore decrease incontinence; which could lead to less brief use and…wow…less need to purchase all the products designed to “manage” incontinence. And a nice side effect would be less odors.

I am quite sure more than a few residents would appreciate a shower more than once a week- evening shift staff could do these. Clean residents are happier residents. They smell good, look good, feel better and often want to participate in their lives more.

Residents would not have to go to bed right after dinner, or even at 7:30pm, if there were enough aides. What adult retires THAT early in the evening? When residents are in bed, they are at risk of bedsores, contractures and all the problems associated with immobility. In the end, these problems cost far more money and time to correct than a couple extra CNA’s would cost.

I am quite sure nursing homes save money when they don’t have to keep Activity Staff on the clock past 4 or 5pm each day. Most residents would like to stay up later at night, and socialize and enjoy some activities and outings and other similar things. Having things to do is what keeps life interesting and entertaining. Looking forward to nothing is depressing and demoralizing.

I am quite sure nursing homes save money when they purchase chair and bed alarms vs. having a couple more aides scheduled. The alarms don’t require an hourly rate of and the other costs of employing an aide.

I am quite sure nursing home management can do little to change these truths. They can, however, try very hard to provide the right ratios and activity staff and other supports needed to enable carry through of these excellent (and medically sound) programs. Either that, or down grade the expectations to what can reasonably be done. In other words, care plans and programs should be, and must be, formulated and written with staffing ratios in mind.

Ideally, the residents needs should justify the ratios. The CNAs know the truth though.

No related posts.

No related posts.

An post over at the WSJ Health Blog caught my eye:

Nurses are beaten and abused, pinched and punched by deranged and demented patients.

The rough treatment of nurses by some of the people they care for isn’t an issue that gets much attention, but it should, Illinois doc Ben Brewer writes this his WSJ.com column. “Nurses get assaulted all the time at work,” he writes. “They get assaulted in small and large ways at every hospital and nursing home in the country.”

The subject comes up occasionally in the medical literature (see this study, for example), but for the most part everybody assumes it happens and there’s not much to do about it. Nurses are the infantry of the health-care system.

Brewer rolls out one example after another. The young nurse with the long scar on her forearm, where the surgeon went in to fix tendon damage after a patient violently twisted her hand and bent back her fingers. The ICU nurse with a deformed finger and nerve damage from a patient’s bite. The nurse who got punched in the ear.

He notes that patients are restrained less often than they used to be, but he suggests that more frequent use of restraints probably wouldn’t do any good. “Usually it’s the one you don’t see coming that gets you,” he writes.

Yea? Let’s talk about this rough treatment:

Nurses and aides are:
Hit
Punched
Kicked
Bitten
Pinched
Held semi captive by hair pulling
Picked up and thrown
Targets of objects being hauled across rooms- everything from a simple hair brush to entire hospital beds.

…and otherwise roughened up and abused by our patients.

On a daily basis.

Especially the nurses and aides- and other professionals- who work in long term care settings (nursing homes, assisted living, psych wards and special dementia units). I work with brain injured young adults; I’ve also worked at the Adult Brain Injury unit at my work…I’ve seen it all, experienced it all and have the scars to prove it. Many of them.

We are trained in the ways to prevent patients from getting to a point where they feel so threatened they “fight back”; we are trained in the ways to prevent a situation from turning into a full blown crisis. We have patient centered policies and procedures. And we attend expensive workshops that educate us how to handle patients who are violent, and how to keep them and ourselves safe. All this effort doesn’t always work though.

I knew an aide who was thrown across a room, and her collarbone was broken. A nurse I once worked with is now brain injured herself, thanks to a busted off side rail hitting her, hard, in her head. Broken ribs, arms, shoulders are not that uncommon. Bruises, bite marks (and the blood borne pathogen testing that must happen after), sprained and strained muscles are the hazards of this work.

Patient care itself is hazardous. Lifting, tugging, pulling and otherwise moving our patients who cannot do these things for themselves is very hard on our body. Average weight patients take a toll on us. Now we are seeing more extremely overweight patients too.

A comment left about this, at the WSJ health blog:

As far as back injuries and lifting devices, money is indeed the reason more has not been done. The priority in the healthcare industry is not nurse (or other healthcare provider) safety, or even patient safety. It is making money for the select few at the highest levels of management. Don’t believe it? Go to your local hospital and get it’s most recent tax returns and see what compensation the CEO and others make in salary and benefits.
Nurses and other staff, especially the nurse’s aids, are considered and treated as expendable resources by the hospitals, despite shortages in both fields. Despite the high rates of back and other musculoskeletal injuries, lift devices and lift teams are rare because it doesn’t cost the employer anything if an employee goes out on worker’s compensation for a back injury. And, if the employee tries to recover reasonable medical costs or financial compensation for permanent disability, the hospital will employ any means to absolve themselves from responsibility.

Well this is a little disingenuous to say the least.

The government agency in charge of protecting us from work place hazards, OSHA, doesn’t compel/force hospitals and nursing homes and clinics and other facilities to keep nursing staff safe from patient handling hazards. OSHA tip toes around the issue with standards that are fairly loose: One person cannot lift more than 50 lbs-the GOLDEN rule. This means two staff cannot lift a patient who weighs over 100 lbs…But 3 can…no matter how awkward or difficult the patient’s behavior may be during this lift. This is when so many of us get hurt. OSHA, I heard, is about to lower the limit though, to 35 lbs per person weight.

Of course when we get hurt and when we report the injury, worker comp kicks in to cover the costs of the injury. The hospitals and other facilities face paying very high premiums if the facility has a high percentage of injuries. In spite of some of the comments left about this article, Many nursing homes and hospitals are re-designing the patient care areas that incorporate lifting devices. The hospitals in my area all have patient transport teams: Specially trained staff who use many techniques and devices to lift, transfer and move patients. More and more facilities are enacting policies and procedures that support what we call the NO LIFT FACILITY. Literally this means no staff are allowed to lift/transfer patients- no matter what their weight.

I see another problem here that some don’t like to mention: many nurses and even more aides simply do not utilize the equipment provided to them. Instead, they get a buddy aide and perform a transfer themselves…Lift machines and sit-to-stand devices are not put to there intended use. Why? Because it’s time consuming- by a few minutes and nothing more. It’s difficult to explain a back injury when one was supposed to use a mechanical lift- and you bet the hospitals and nursing homes and worker comp people are going to buck at paying the costs of the injuries associated with staff non -compliance.

Those who get hurt because they refuse to use the very equipment designed for their protection deserve to be under scrutiny because it increases the premiums health care facilities must pay; and it ups the odds that every injury will come under the looking glass of worker comp claims processors. When you have even one staff who ignores safety, you’re very apt to have many. In so many ways this is self defeating: As W/C premium costs go up, the money in the pool for salary increases goes down; the loss of income resulting from an injury can be substantial; if the W/C rejects the questionable claim, legal costs must be considered too. Management must clamp down on staff abuse of No-Lift Policies.

Another comment amused me as well:

It seems to me that some of these acts hurting nurses are criminal — assault, or assault and battery. Are such incidents prosecuted? If not, why not? Are the patients kicked out, as they would be at the workplace or school for similar behavior? If not, why not? Going to a hospital does not give one license to commit mayhem.

Well for one thing the vast majority of those patients who do abuse us are not in their right mind literally. They have dementias, brain injuries, mental health illnesses and a mirage of other problems. They cannot control their actions; often their thought process is so altered they’re not aware of what they are doing. Or, the medications they are taking to help them with other problems can cause very odd behaviors.

Many of the patients will have no memory of the violence they perpetuated against a nurse less than five minutes after it occurred. It’s fine and dandy to demand that patients be held accountable for their behavior, but what do we do with those who truly cannot control it? How do you place a person with Alzheimer’s disease through the criminal justice system? Is it appropriate to charge a person with a severe brain injury with a crime that he cannot recall committing- or worse- that he committed in his own warped sense of self defense? Many people with brain injuries see the world in a very different view than we.

There are some patients who can control themselves who do harm nurses and aides. They are held accountable. The police are called, reports are taken, criminal charges are filed. The process works when its appropriate. I’ve seen patients hauled off the state medical units, where they belong; and I’ve seen really sick prison inmates be admitted to local hospitals for medical care- these patients are extremely violent- they have their own personal set of guards to protect the staff who must provide the nursing care. They are shackled to their damn beds and otherwise restrained.

Human beings are complex animals- most of us have control over who we are, what we do and how we live our lives. But there are many who are not as fortunate. Disease processes, medical conditions and psychological issues cause the most awful behaviors one can imagine. Nurses know this and aides are aware of the effects it can have.

No related posts.

I have been reading here and there about shift report.

How some nursing homes don’t seem to think the CNA needs to hear report. I think this is not only wrong, it’s bad business and a law suit waiting to happen.

CNA’s are the hands on care giver.

They are the eyes, ears, noses and hands of the health care team charged with providing care to residents. When a resident’s condition changes, does it not make sense that the first, and more often than not ONLY people who will have any direct contact with the resident KNOWS of the change?

Nursing home management, that decides CNA’s don’t need to get shift report are setting the residents AND AIDES up for potential injury, harm and distress. Physical and emotional. Nurses, going down the hall, barking out orders to the aides, AFTER the nurse has heard report is not acceptable. By then we have often done our first set of residents and it’s too late for some orders to be carried out. Or, the resident must be placed back in bed or otherwise inconvenienced. And it wastes time, that which CNA’s don’t have a lot of.

Consider this. A resident fell on evening shift. At the time no known issues resulted from the fall, but the resident needed to be observed and assessed periodically until the doctor could see them the next morning. The doctor tells the evening nurse the resident is not to do any weight bearing activities until he sees the resident. Day shift staff arrive and are given their assignments and are told to go about their job. The aide assigned to the resident who fell has no way to know that a fall occurred… The CNA doesn’t get this info and transfers the resident via a stand pivot. SNAP. A hip is broken.

Consider this. A resident’s urine is noted to be dark and foul smelling. The resident cannot speak for herself but is continent. The day shift aide assists resident to the toilet, where she voids a medium amount of dark smelly urine…the residents usual habits indicate she won’t be voiding again until sometime after lunch. A sample was needed from the morning void but that info was never passed on to the aide in time. Now the resident must endure many more hours of discomfort and pain from the UTI she has, all because of a lack of communication.

A resident was up most the night. For whatever reasons, he could not get to sleep. He is known to have behaviors, and a trigger to this is being tired…the aides don’t get report. They find him in a deep sleep and think, “Oh well, he has to get up to eat!” and wake him up…and the aide gets punched in the face. A nice black eye and broken nose are the result. And time spent at a doctors office, ex rays, pain and suffering…all on worker comp billing. Because it was never passed on in report to allow the resident to sleep this morning.

Shift report is vital to CNA’s.

We NEED the information…even when it is repetitive and mundane, it is important. CNA’s must have this information BEFORE they asked to provide care. The little details are often so helpful to us. When we know Mr. Jones hasn’t slept all night, we will allow him to sleep in, to be the last resident we get out of bed. When we know Mrs. Smith might have a UTI, we will collect a sample – many times without being asked. When we hear that Ms. Brown fall last night, we will ASK if she is able to do any weight bearing.

Report doesn’t have to be this long boring ordeal.

Many facilities only pass on information that is out of the ordinary; the typical, usual and common information doesn’t always need to be shared. Normal vital signs, BMs, percentages of meals consumed and cc amounts of fluid intake are not overly important, especially if this information is logged in a book somewhere. On the other hand, elevated temps and B/P’s DO need to be passed on; a lack of a BM in 5 days NEEDS to be passed on; consumption of NO fluids has to shared.

Part of what every CNA needs is information.
We use our training and experience to make everyone’s jobs a little easier; to make our residents comfortable. We depend upon good communication from previous shifts and nurses to provide care that is safe and appropriate. Nursing home management should always insist CNA’s take part in shift report. It should be a mandatory expectation; and, taking this one step further, if an aide shows up late for work, he or she should NOT be allowed to take an assignment until they hear report.

Related posts:

1. Shift Wars