Question:

My mother was a CNA for many years. My sister is a nurse. I have an interest in working in healthcare, but I’m not sure yet. Is there a way for me to try out nursing without spending a lot of money with training and/or education?

Answer:

Great question. I wish everyone who has aspirations to be a nurse could think things through a little better. Nursing is hard work. It’s not an easy way to make money. It’s not a white collar job. I see far too many people have an interest in doing this work for all the wrong reasons; once they get the training and education and degrees, they realize they are in the wrong profession. They’re left with staggering education bills. I’ve seen many RN’s practice for a year or so before realizing the work isn’t for them. Too bad! There are a couple ways to”test run” this line of work before committing to it. I would suggest applying for a job as a Resident Assistant at an assisted living facility first. Because assisted living facilities do not have specific requirements for nursing staff, the role of the RA was developed as an alternative to more costly CNA’s. RA’s so basically the same things as CNAs- and are paid roughly a dollar less per hour. Doing this work for a good 6 months to a year should give you an idea whether nursing is the right career choice. You will experience hands on personal care, assisting people with ADLs, observing nurses doing their work and perhaps work side by side with CNAs.

Second, there is no harm in taking a CNA course. Of all the options, the CNA training is the cheapest and takes the least amount of time. For about $1000.00 a person can go through the classes, get certified and work as a CNA in nursing homes, hospitals and assisted living centers. Few doctors offices and schools hire CNAs. Working as a CNA will certainly give you hands on experience you would need in order to make an educated  decision about your career. Many nurses started out as CNA’s- it really helps them understand the demands of the work throughout their careers. Good luck in whatever you decide to do!

Related posts:

1. Question Of The Week: Working With Less Competent CNAs

Question:
I work at an assisted living community- in the dementia unit. Many of my co workers are from other countries; many do not speak English well, or simply refuse to speak English. I have been a mentor for CNAs for over 15 years now and I’m having a hard time mentoring these people. They can’t read English. They can’t write in English. Trying to teach them I & O charting, for example, is very difficult. Trying to explain care plans is another extremely difficult task for them. They are all CNA’s- brand new aides with no experience. This is their first job as aides. I think this is a serious problem: How do these people pass the CNA exams?? I don’t think it’s safe to employ them but my DON said I am being biased and not open to diversity.

Answer:
You have very legitimate concerns. Your DON is a moron to be totally blunt. He or she is placing the residents at great risk by taking such an attitude. Diversity is great; we need it in today’s world. The purpose of diversity in the workplace to have a strong representation of the community our employer is part of. Diversity brightens prospects for this community and it helps keep the local economy strong. Diversity also has drawbacks. In order to work well, the people seeking jobs must match the skillsets required by employers. Sometimes, employers lower standards and hire in people from other countries in hopes that these people will learn skills and rise up to standards.

In nursing this creates professional problems. While we want to open up opportunities for foreigners who want to learn, we have to be careful with patient safety issues. When a nursing employee of any rank cannot read such basic materials like care plans, or Care Cards, or assignment sheets, they should NOT be permitted to work. Even if this employee has passed the state CNA exam and is **certified** I believe employers must go a step further in ensuring that ALL employees can function in their hired roles. So, a test should be part of the employment application process. Potential hires should be required to read a sample care plan and explain to the hiring people, what they just read and how they interpret it. The key to such employment practices is that they be evenly applied- to ALL potential hires and not just those from other countries or who speak with accents. DOing so is fair.

My advice for you is to go back to your DON and speak again to your concerns. Ask the Administrator to join this meeting. Then, keep a log book with you at all times and note when you trained who on what…and whether you believe they understand the training. Alternatively you can ask to step down as a mentor- this is a tough choice but you might go home and sleep better knowing you had no part in this unethical practice. If you know a resident has been harmed by a employee who cannot understand English and therefore provided substandard care, you have an obligation to report it.
I’m sorry that your employee chooses to place you in such a bad position.

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Question:
I’m a new CNA and cannot find a job anywhere! I’ve applied at nursing homes, doctors offices and hospitals. Either they’re not hiring or they want a CNA with experience. How do I get experience if I can’t get a job? HELP!

Answer:
It can be catch 22 situation for sure. It has little to do with the current state of the economy as well; I’ve been asked this question for 20 years now. Nurses sometimes have the same problems with gaining employment. My advice is to apply to work at an assisted living home- they usually don’t require CNA’s but it won’t hurt to be one. Another option might be to apply to nursing homes and hospitals as a housekeeper or dietary worker….don’t snub your nose at this! Once you get your foot in the door, opportunities are bound to come along much faster. Just about every health care facility prefers to promote from within; this saves tons of money on training, benefits and the like. I started my nursing career in the kitchen of the local hospital…from there I went to the Med Surg floor and then onward to another facility. It was good experience to. Working outside the nursing department can give one an objective view of the work involved. Hang in there. It might take you several months to land the job you want. Keep applying; keep sending resumes and keep in touch with hiring managers. Be persistent but not pesky. Be polite and patient. Good luck!

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Question:
I have worked at the same nursing home for 3 years now. Initially the administrator and Nurse Director were a solid team of leaders. Then one day, they were gone! They got fired because of a poorly cited federal survey. That happened in the first three months of my employment. Since then, it’s been nothing but change, change and more change! An administrator is brought in and stays for 6 months and leaves. A nurse director gets hired and lasts maybe 3 to 4 months. More than one director has resigned within their first two weeks. It seems that whoever owns the facility can’t keep a management team in place. The turnover is incredible and there is not a good place to work. I am, the staff with the longest employment. There is no teamwork because people are not together long enough to form a team. Nurses, aides, kitchen workers all come and go through a revolving door that is never closed! SHOULD I STAY at this place?

Answer:
I’m amazed that you have stayed here for 3 years given all the turnover you describe. For that, you probably deserve an award.

I’ve seen situations where nurses and aides feel obligated to continue working for a poorly managed facility because of the residents. They do so in spite of their personal dislike of a facility management team or their low pay and/or poor benefits. While this is admirable, we should really make sure we’re doing the right thing for ourselves.
When it comes to decisions about employment, I always like to make a list of PROs and CONs: side by side. Write down what you like about your current employment.

• Is the facility right in your local area so travel/transportation is not a problem?
• Is the pay good, or so good you hate to give it up?
• Are the benefits top notch? (I suspect not but could be wrong)
• Since there is no management, how to you feel supported at this job?
• Do you work with lots of agency, PRN nurses and aides?
• Do you have any relationships with peers that are worth keeping a job over?

There is something that is keeping you here…you need to seriously look at what that is and decide if it a legitimate reason for you to stay. I get the sense that you want to leave but are not sure you should. I wonder if you’re feeling some guilt about the residents and how staffing patterns effect them.

My advice would be to draw up that list and think it over for a week. You have to know what else is out there for employment. Have you worked for other nursing homes? Do you have friends in other places who are content? Are you willing and able to travel to a facility further away if needed? How about working for an agency? What are the options for you, if you were to leave?

One last thing: Personally, I would find out the name of the person who owns the facility and write them a letter; expressing how the lack of management is effecting this nursing home, it’s residents, the quality of care, etc. YOU have nothing to lose but a lot to gain IF that person really cares.

Related posts:

1. Question Of the Week: They Won’t Let Us Call Out

Question:
I work PRN at a healthcare facility. They recently hired a new CNA, full time. She is a nice person, but has no experience as a CNA. She’s been working there for a month now and still not up to speed. The problem is, I cannot work with her as my hall partner. I like her, she is a nice person! But the issue is liability if she can’t do something correctly. Other CNAs have told me they can’t work with her, either. She is very, very slow. She waits to be told what to do, instead of just doing it. She walks into the patient’s room with me and just stands there with her arms folded across her chest. I tell her “look, we have to do this together. You cannot just stand there”. Also she doesn’t know what a Hoyer lift is. She acts hesitant to touch or handle the patients. There are 30 people on the hall and I cannot do it all myself!! I need a reliable partner.

Answer:
This is a burden to experienced CNA’s for sure! Brand new, unseasoned aides seem to be more troublesome than ever before. We need good strong aides who can take initiative to get the work done as independently as possible. Unfortunately, this situation leads me to believe she had poor training in her CNA course. In this situation, I would offer her assistance during shift report if possible. Help her identify priorities. What does she need to do first? When should she ask for help? Gently correct mistakes. If possible I would meet with her after the shift ends, off the clock even. This investment in time may well pay off in terms of a smoother running unit with a capable partner. I also recommend that all of these concerns be brought to the charge nurse. She might have some options and advice as well. Another possibility is to go to the DON and ask for help with this aide. Maybe she needs more training. Maybe she needs more confidence. Maybe she needs a kick in the butt to get moving quicker…no matter what you do, don’t continue to do her work for her. You’ll burn yourself out trying. Instead, when she asks for help with lifts and transfers, tell her you will assist her when your assignment is complete. Sadly you may have to work independently from this aide if she can’t get her act together. Good luck!

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Question:
I’ve been working at the nursing home for 3 months now. More than a few of the CNAs working here are long term staff and the nurse depends upon them to get things done. I’m never asked to take on special projects or tasks. I really like this job and want to be part of the team but I believe I’m not offered the chance simply because I’m new. I’ve never called out or been late. I haven’t heard any complaints about my work. Is it too soon to ask the nurse to seek me out for more duties? I don’t think she values me.

Answer:
Good question and not one we hear too often! Many CNAs don’t stay employed long enough at nursing homes to be considered reliable staff. So those that do are indeed a valuable asset to the nurses. You say you’ve worked for this facility for 3 months now; how long have the others been employed? That might give you an idea of what the nurse considers to be “seasoned” staff. And that’s what it comes down to: The nurse knows the other aides well; she knows their skill level and quality of work; she knows when she can push them to do more and when she should NOT push them (but probably has regardless)! To begin, I would ask the nurse if she needs any help with anything at those times you have a free minute. If you hear discussions about a sick resident, offer to check vital signs- no matter who the resident is assigned to. Pick up any slack on the other CNA’s part. Offer to take on more residents to your assignment when necessary. Just show that you can handle the extra workload- AND importantly, get it all done in a timely manner. You don’t need to brag about this. Your work will speak for itself. As you grow in your job, nurses and others will take notice. Never complain! Don’t try to undermine the other aides either. Remember you’re all working as a team. Good Luck!

Related posts:

1. Question Of the Week: They Won’t Let Us Call Out
2. Question of The Week: Falls and Responsibility
3. Question of The Week: Consistent Staffing or Flexible Scheduling

I have some thoughts about performance evaluations. Annual evals should be tools for improvement. Not only should our past performance be measured, our future goals should be laid out as well. Managers and leaders, real ones anyway, know this. To often, in the nursing facility, evals are not important; they are dreaded, thrown out and disregarded and by many. We often feel under the gun and undervalued when we read our evals. Its one reason so many of us leave this work.

Specifically, are they helpful or not? Does your facility use pre made, office-supply store generic forms or their own form? Does the eval relate to the work we do, or can it apply to ANY occupation? Or, is a computer program used? Do the people who evaluate you KNOW you and know firsthand of your performance? Are your raises tied directly to the evals?

I ask these questions because our evals can make or break us. Raises and promotions are often based upon the scoring system; a weight is applied to each score as well. It’s all rather complicated for something that should be pretty simple and straightforward.

For the work we do, I think the following should be evaluated:

1) Quality of Care
First and foremost, the quality of the care we give should be the most important factor. How often do our assigned residents develop pressure sores? How do they look? Are they clean, dry and fed? Falls? Are they appropriately dressed? How do we get along with residents? Are we respectful and polite? Do we have empathy and concern for them? Are we attentive to their needs? Do we understand their rights and apply our skills with consideration to these rights?

Do we participate in any care planning? Do we follow through with specific objectives in the care plans?

2) Teamwork
How do we work with others? Are we cooperative? Do we accept assignments without fuss? How do we manage conflict? Do our co workers value our presence? Are there a lot of complaints about our behavior, attitude and ability to help? Do our co workers look forward to working with us?

3) Knowledge of Policy and Procedures
Do we know WHERE to find these documents? Do we apply them to the job? Do we follow guidelines and procedures as written? If portions are not understood, do we ask for help and guidance? Issues such as dress codes, smoking, breaks, phone use. resource use and abuse and the like should be covered under this topic.

4) Public Relations/Customer Service
IMPORTANT! How do we get a long with residents and their family? How well do we represent the facility on outings and trips? Do we smile or frown? Are we miserable most the time?

5) Attendance, tardiness, leaving early
How often, exactly, do we call out? Or come in late? Leave early? AND, how much overtime do we work? If we work no overtime, is it held against us? If we work lots of overtime, is it mentioned and given some attention? Do we attend meetings as required?

6) In services and continuing Ed
Are we up to date with our required number of hours needed each year for in services?

THEN I think there should be a section for goals and objectives for the following year.
Specific to each employee and not cookie cutter, one size fits all stuff.

For instance, CNA Sarah has problems with her demeanor towards families. She has legit concerns. However her mannerisms toward the families cause problems for all. A goal for her might be to “Improve ability to show respect and concern for resident families”.

Then, actual objectives can be listed to HELP Sarah reach that goal.

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One of the best things we’re seeing from the Culture Change movement involves how CNA’s are assigned to the residents they care for. The consistent staffing model has gained some popularity over the past few years. Research shows how this model benefits residents and aides.

Fast forward a couple years and some challenges are presenting themselves.
In my region, hospitals, nursing homes and other health care facilities have faced a shortage of nurses and aides. In order to attract these skilled professionals, most facilities up here are moving away from the standard nursing schedule model to a more flexible one. Gas prices and travel time play into this.

Instead of scheduling staff to work the typical 4 days on, one day off, every other weekend model, where I work we have staff working all sorts of different hours. Many are choosing to work two double shifts and one 8 hour shift per week. Others have opted to work three 12 hour shifts per week. Not all of these positions require weekend work either since we have a group of staff who work two 16 hour days each Saturday and Sunday.

This means different aides working every day.
So, consistent staffing is almost impossible to achieve. Rarely does an aide work two days in a row. Nurses are doing the same thing.

Many of my co workers travel from distant towns to my facility to work the weekend only; they stay at a small local hotel (paid for by my work). The benefit of this for my co workers is using far less gas which is expensive. My employer is happy knowing the units are staffed for the weekends. Other than the weekend staff, no one is expected to work two 16 hour days in a row. Nurses are offered the popular Baylor program: Work the 32 hours each weekend and get an 8 hour bonus which equates to 40 hours pay.

Facilities have to make tough choices. Either keep the strict medical schedule model and have a shortage of nursing staff, or, offer flex hours and have adequate staffing each shift.

How does this all effect residents in nursing homes and assisted living facilities? They don’t have a core staff. There is NO one CNA who is assigned to them on a daily basis.

My own schedule has changed at my request, due to the price of gas. I was spending a quarter on my earnings filling up the gas tank, just to get to work five days a week. Now I work two double shifts and one 8 hour shift, a week. Five shifts in 3 days. I have saved a respectable amount of my income by making this change.

I like the schedule in many aspects:
-I have four days a week off to be with my family and tend to home and hobbies. I’m not nearly as stressed and tired as I was when working the 5 day schedule.
-I’m saving gas, for sure- but also wear and tear on my vehicle.
-When I am working, I keep the same assignment for the long (16 hour) day. Those residents I assist with getting am cares done, I also assist with doing the pm cares as well. If we don’t get the bath done in the morning, we know to fit it in at night. My assignment is consistent for the entire two shifts and my residents and their families really like that. We haven’t seen an increase in falls or skin issues.

This week we ask the Questions:

What kinds of schedule options do others have? Is flex scheduling allowed? If so, what kinds of shifts and hours are typical?

What’s more important? Having enough staff who may be working flexible shifts, or not having enough staff who always work the typical nursing model schedule?

Related posts:

1. Staffing Ratios
2. Two Week Notices: Why It’s Important
3. Question Of the Week: They Won’t Let Us Call Out

Question:
At work today I got into trouble because one of my residents’ fell. This man is independent and never needs our help. He can do his own care- showers, dressing, walking, meals, toileting…the works. As far as I know he has never fallen before. I was busy with one of my other residents who requires total cares. I was in the middle of bathing her when the nurse came in to tell me the man fell and why wasn’t I with him? After I finished up with my lady’s care, I was told to fill out a report which wanted to know what I COULD HAVE DONE to prevent the fall; THE LAST TIME RESIDENT WAS TOILETED; THE LAST MEAL consumed- all things that had nothing to do with this fall!!

Later, I was written up for the fall. I told the DON that everyone is responsible for ALL the residents on the hall I was working. Yes, he was assigned to me, but when I am busy with other residents, my co workers should step up and cover for me. What do you think of this?

Answer:
You should not have been written up, in my opinion.

Every resident must be assigned to a CNA. It’s law. No way out of that. Every aide accepts their assignment and therefore responsibility for the residents on it. Each CNA is responsible for her assigned residents and the unit, as a whole, cannot do this.

It’s tough when bad things happen to good aides, though.

Did you read the man’s care plan? Are you absolutely sure he is independent in his cares? If so, did you check in with him to see if he needed any help, with anything? I think sometimes we assume these residents who are able to do their own care never need ANY help- and this isn’t always the case. When doing this check in, it’s always a good to ask when they’re planning to get up; what they’re bathing plans are and the like. This way, you can have some awareness that Mr. Smith is going to be up and about around 9am, and might need someone to just peek at him.

Of course this is where team work comes into the picture. Every time an aide is going to be tied up for awhile with residents, its always a GOOD thing to let as many peers know where you’re at. And include the nurse with this info as well. If you’re so inclined (and I would be) I would ask peers to keep an eye and ear out for your other residents…especially if I was going to be tied up for a longer period than usual with the other resident. A good charge nurse would make sure your other residents are covered as well. It’s a balancing act though: Asking every aide to cover the others’ residents every time personal care is being performed is just not practical.

As for the report: It’s called an Incident Report. The questions asked do indeed have everything to do with the assessment of a fall. By asking you what you could have done to prevent this fall, the answers you provide are supposed to be helpful to prevent a repeat in the future.

Did you know most residents fall because they are trying to get to the bathroom? If they’re hungry they might be trying to rush out to a meal. Usually there are other questions too on these reports- about all sorts of things. Often we don’t know the prior condition of any resident when they have fallen without a witness.

It’s very important for CNA’s to answer these things honestly…however….when we’re written up it takes away the desire for CNA’s to have any respect for these reports. These things should never be used as a means for punishment. When independent residents fall, it is NOT the direct fault of the aides. It was caused by something else. It IS up to management to figure out why the fall occurred- but by placing blame on the aides they are short changing this process. This is another example of autocratic management style- which isn’t helpful. And, I have to wonder if nursing homes with high fall rates have these kinds of managers.

I’m sorry you got written up. Of all the things CNA’s don’t have control over, the FALL tops the list. The work loads alone should tell all that it’s impossible to be everywhere at the same time- or even once an hour. A good fall prevention program begins with a trusting environment where no one is disciplined for falls unseen. Once that is in place, true prevention strategies can be developed AND the CNA’s are the most valuable asset to this process.

Related posts:

1. Question Of the Week: They Won’t Let Us Call Out

Question:
At my facility we’re not allowed to call out! Lately there’s been a lot of call outs and even more aides quitting. So we work short all the time. A couple aides have hurt their backs too cause we’re short all the time. Anyway I got the “bug” last week and had a fever, vomiting, and diarrhea. I felt horrible. I couldn’t eat anything; I couldn’t keep anything down. I called work to let them know I would be out for my shift and they put me through to the DON. who told me to come in for work, to report to her prior to clocking in so she could assess whether I was too sick to work. If I didn’t follow this directive, I would be terminated. SO I went to work and the DON took my temp (101.2)- she gave me Tylenol and a couple spoonfuls of Pepto Bismol; she told me report for duty. If I didn’t feel any better in an hour to come back and see her.

Is this legal???

Answer:
Your email tells me your employer is having a hard time with staffing. It appears that the place is going through a downward spiral of problems and management is part of that. When an aide shows up for work, sick with fever and infection, she exposes not only the residents, but her co workers as well.

It’s very likely more than a few will catch the illness. So, it spreads like a fire. As each aide comes down with the bug and misses work, management feels it has to do something to curb what it perceives to be an abuse of attendance policy. Management should be prepared for a staffing crunch knowing a virus is going around. But, this facility’s management is punishing the very people who are out in the battlefields where the germs are located. It’s old fashioned and autocratic.

Instead of being proactive, the DON is being REACTIVE and in a very negative manner. Her actions are telling her staff that she doesn’t trust their judgment on their own bodies health. She is also telling them she has no respect for them. A warm body on the schedule is all that matters, even if that body’s temp is 101.

The Legality of this:
If this is a policy, it must be written as such.

I called a lawyer friend and relayed this scenario and she gave me the following advice: Is the DON a doctor or a Nurse Practitioner?? If not, she is straying from her nurse practice laws. Nurses cannot diagnose illnesses, diseases, disorders and the like. Perhaps she is sending staff to a doctor who is legally licensed to perform a medical assessment. She would be smart to do this. She should NEVER give staff ANY medications without a doctors’ order. She is putting her license on the line by doing so. She knows this. And is counting that you don’t know this.

Legally this practice is not advised for management. They are risking a discrimination lawsuit if this “policy” doesn’t cover ALL employees of this facility- so, when the dietary aide or the cook or the maintenance man calls out, the DON/Management must apply this same requirement towards them. They too must come in, be assessed, and determined if they’re “healthy” enough to work or not. And this would mean doing so 24 hours a day, 7 days a week. Even on holidays and weekends.

What To Do?
If you find yourself too ill to perform the duties of your job, you can and should call out. However, you should also make every attempt to get better or try to reduce your symptoms so you can work. In other words, do take Tylenol/Advil to get the fever down. Immodium will end just about every episode of diarrhea. After this, if you still feel too sick, call out. Make sure you follow the policy- most facilities require 2 or 4 hours notice.

Have your spouse or a friend make the call for you if you’re concerned with being harassed by the DON. Instruct your spouse/friend to take a message but to be firm: You will not be showing up for work. Make sure your reasons are given: Details- fever, vomiting, ect. and the actions you have taken to try to make it better. Then call your doctor and make an appointment. You’ll need to be assessed and diagnosed properly; and the MD will need to write you a note excusing you from work. Often, this note will include actual dates you are not recommended to work.

A doctors note will not protect your job.
We need to know this and not rely upon it. The note does give credibility to you though: You’re putting the effort into seeing the doctor to find out what is wrong and get better; you’re paying money to do in most cases; you want to show your employer you weren’t goofing off, ect.

You can still be terminated unless you’re a member of a union which has rules on this.

I would not wish to continue employment at a facility where this practice occurs. I would leave on my own free will and seek employment at another place with more enlightened management.

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