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

It isn’t rocket science- keeping a job. But it seems, more and more, that some people really are clueless when it comes to certain actions that will, guaranteed, send a CNA out the door via being fired. These CNA’s act all shocked and awed. REALLY??

YES.

1) Be a NO CALL, NO SHOW. Don’t go to work on any given day you’re scheduled. Perhaps you have a doctor appointment, or you need to catch up on some much needed sleep. Or your kid is sick. Whatever: This action on your part will end your employment at every facility.

2) CALL OUT MORE THAN ONCE EVERY OTHER WEEK: Believe it or not, residents/patients depend upon YOU to show up for work, to assist them with the care and services they cannot provide for themselves. When you call out, someone ELSE has to pick up your assignment. Or as more often happens, your co workers will see their workload increase. They will complain about you. Even those who say they are your friend. The complaints will be bitter if you call out a lot (more that 3 times a year).

3) Be SNEAKY WITH your DOCUMENTATION. I have known some pretty sneaky aides who do things that are absolutely appalling. Taking shortcuts that are genuinely dangerous to good health, lying about cares given, documenting incorrect or made up data…falsifying records…writing in numbers for VS, making up percentages for meal intakes- it all falls under one category. If you’re doing this, your peers will catch you. The good ones will report you.

4) Abuse and or NEGLECT YOUR RESIDENTS: WHOA everyone knows this, right? No. As many media reports show us, aides get together and partake in terrible acts towards the residents. They use their cell phones to take pictures. They don’t realize cameras are capturing every moment.
People are outside doors listening. Bruises tell stories. Residents sitting in w/c’s not being fed are stark reminders of neglect. Large open areas are also evidence of neglect. When the residents you work with start having patterns of problems, it will be noticed. You stand to lose more than your job.

5) TALK LIKE A DRUNK TRUCK DRIVER: Swearing, tough talk, threats- we see this all the time in movies. Is is necessary? No. It is ever called for in the nursing home/hospital environment? No. It may make you feel better, or make you feel important or different. But it’s a sure fire way to get fired- and quickly. Foul language also diminishes the professional image we want others to have of us. When we cuss and swear, we deserve to not work in this field.

I swear, some people just don’t have the common sense needed to keep a job. Not to be mean to them, but many of today’s younger people seem to think it is ok to not show up for work without a call; many don’t understand the concept of tardiness and how it effects work flow. Cell phones and Facebook take up much time and attention to this generation, while actual hands on attention is a foreign concept. I worked with a girl with literally broke down and cried when I told her to put her cell away for the day.  Another new staff got jittery when I told him we have no Internet access- he wanted to check his FACEBOOK. What does all this have to do with getting fired? Think about it. When you’re more concerned about who is texting you than you are with providing a bed bath…you’re asking for trouble. When you would rather check your friends’ status updates then assist your resident with eating, you’re asking for trouble. Work is work. It’s especially hard work in a nursing home or hospital. Get it together or go find a career where you can tune in to yourself vs your customers.

No related posts.

Each week we will post an article intended to educate CNA’s on OBRA regulations. Detailed articles with advice on how to view resident care from the government’s stand point will be provided. These articles will be under a new category, “OBRA INSPECTIONS”.

Regulation Number:0257

Regulation Title: COMFORTABLE & SAFE TEMPERATURE LEVELS

Regulation Description: The facility must provide comfortable and safe temperature levels. Facilities initially certified after October 1, 1990 must maintain a temperature range of 71 – 81° F

What does this mean to CNA’s? Why should we be concerned with such a regulation? After all, we don’t have any say in these things, right??

Let’s look at things we do that might make the residents environment uncomfortable.

From an actual survey:

During stage one resident observations and interviews on 3/29/11 and 3/30/11, the following information was obtained:
-On 3/29/11 at 11:24 a.m., a resident in room #26 stated his room was always cold, “every night.” Three residents resided in the room.

-On 3/30/11 at 8:34 a.m., a resident in room #14 stated the building was always cold, “especially in this room. The window is open all the time, but I don’t know who opens it. It won’t stay shut.” The resident was observed seated in her wheelchair between the bed and window, wearing her winter jacket. The window was cracked open approximately half an inch. The temperature of the room near the window was 65 degrees Fahrenheit (F). Two residents resided in the room.

-On 3/30/11 at 8:45 a.m., a resident in room #12 stated her room was very cold. She was observed wearing her winter jacket and a blanket. The resident’s window was cracked open approximately one inch. The temperature of the room near the window was 63 degrees F. Two residents resided in the room.

During the environmental tour on 3/31/11 at 10:00 a.m. with the housekeeping supervisor (HS) and maintenance director (MD), the following information was obtained:
-The MD stated the resident in room #14 had told him “yesterday” that her room was too cold. The MD stated he responded by inspecting the resident’s room, discovering her window was not completely closed, and closing and locking the window. The MD stated the staff sometimes opened windows at night and did not completely shut and lock them.

-Room #12 was observed with the window cracked open slightly. The temperature of the room was cooler near the window. The MD closed and locked the window during the tour. The HS stated the staff sometimes left the room windows open in the morning because the rooms were odorous during the night.

-On 3/31/11 at 10:15 a.m., the resident in room #26 stated the room was cold at night. He stated he asked for extra blankets and received them, but was still cold during the night.

-On 3/31/11 at 10:57 a.m., the maintenance director stated the resident in room #26 complained of his room being cold at night because staff were leaving the bathroom window open to “air it out” overnight.

Who among us has not opened windows at work? I have! Even in the middle of the winter when rooms were so stifling hot it was unbearable. Never mind the hot summer months when the AC wasn’t working. Yet it never occurred to me that the simple act of opening a window and not closing it, could cause the residents such discomfort. A couple of winters ago we lost power for 4 days and had no heat for that time. It was in February. I did NOT like that at all and bundled up in many layers. I was still very cold. I like to compare that experience to how my residents might feel if the windows to their rooms were left open. We all know older people feel cold differently than the rest of us. Now I always make sure I shut windows no matter how I feel- it’s not about me.

Related posts:

1. Survey Lessons: Resident Dignity and CNA’s

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.

No related posts.

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’ve all been assigned to cranky, demanding rude residents/patients. You know them: Mean, belittling people who have elevated themselves above all others in level of need. Not just pillow fluffers, these residents demand strict attention to minute details not because the attention is necessary but because the resident believes they are entitled to it. Resident families can be just as hard to work with. I’m not sure who is worse: The demanding resident or the demanding family member. Regardless, here are 7 tips on working effectively with the Mrs. Cranky’s of the world:

1) CHECK IN
Check on the demanding resident 1st thing: Once you know you’re assigned to Mrs. Cranky, go to her room and check with her right away. Let her know you’re her aide.

2) DISCUSS PLANS and ADJUST WORK FLOW
Ask her if she has any special requests for today: Perhaps she wants her bath later in the morning; or she isn’t feeling well and would like to skip breakfast. Or maybe she has guests coming and would like to wear the hard-to-don red dress. By asking her what her plans are for the day, you are giving her a real say in how her day will go. Based upon her feedback, schedule your workflow to accommodate Mrs. Cranky’s needs. This does not mean you neglect your other residents.

3) SHARE YOUR WORKFLOW PLAN
It is perfectly acceptable to let Mrs. Cranky know that your other assigned residents have the same needs as she does. Make it clear that you are responsible to others and that you cannot cut back on time they need. You can say all this in a polite, professional and caring manner. Even further, I would let Mrs. Cranky know the order in which you will tend to her care. Give APPROXIMATE time frames. By doing this, you are alerting her that you hold your other residents’ needs just as high as hers.

4) ANTICIPATE NEEDS
Unless she is your first resident, check in with Mrs. cranky every so often. Anticipate her needs. Use your knowledge of her demands as a tool: If you know she usually rings the bell at 10am for bathroom use, be one step ahead of her and show up in her room at 9:55am to see if she needs the toilet…

5) TALK!
When performing actual cares for Mrs. Cranky, listen to her if she speaks. If she is rude or insulting you, let her know that this offends you! Tell her that her words hurt your feelings. By doing this, you put her on notice that you won’t stand for rude remarks and the like. Try to find some common interests to talk about- this shows her that you do have a genuine interest in her. Ask her about pictures she has; ask her where she has traveled in her life; ask her questions about HER LIFE in en effort to show your curiosity. If she answers your questions positively, GOOD! Keep aiming for this positive energy. If she continues to gripe and complain, remain quiet. Don’t ignore her, but ignore the negativity.

6) ASK POINTED QUESTIONS
If Mrs. Cranky seems upset or angry, while doing her care, ask her if something is bothering or upsetting her. Sometimes people are uptight or nervous about things and take it out on the nearest person. If she expresses sadness let her know she can speak with you about those things and offer to pass on her concerns to others as needed. Let her know she can trust you. If she is angry at her family, offer to speak with the nurse to see about a family meeting. If she is mad at other staff, listen but don’t give any feedback. Give her attention for her positive words and say little about her negative words.

7) FOLLOW UP! OFTEN!
During the shift,after her care is completed, check in with Mrs. Cranky. Again, ANTICIPATE her needs! When you take a break, let her know. By doing this you are letting her know you care about her. At the end of the day, if appropriate, check in with Mrs. Cranky one last time. Ask her if she needs anything. Ask her how she thinks her day went- and what could be done to make it better. When we ask people to help us with planning schedules and work flows, it’s amazing how much feedback we get! It’s always appropriate to say goodbye and other polite remarks.

No related posts.

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.

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Yet another study has come out about nursing homes not being prepared for disasters- natural and otherwise. After Katrina, where many residents at one nursing home died due to poor planning, the government decided to do a large scale study.

WASHINGTON (AP) – Tornado, hurricane or flood, nursing homes are woefully unprepared to protect frail residents in a natural disaster, government investigators say.

Emergency plans required by the government often lack specific steps such as coordinating with local authorities, notifying relatives or even pinning name tags and medication lists to residents in an evacuation, according to the findings.

Pinning name tags and med lists to actual residents? That’s a novel idea.

“We identified many of the same gaps in nursing home preparedness and response,” investigators from the inspector general’s office of the Health and Human Services Department wrote in the report being released Monday. “Emergency plans lacked relevant information. … Nursing homes faced challenges with unreliable transportation contracts, lack of collaboration with local emergency management, and residents who developed health problems.”

The devil is always in the details: The more detail the better the plan. I recall a nursing home calling for buses to come get the residents during the Katrina event; the buses could not enter the city because the governor blocked access into New Orleans. Then as the levies broke, flooding became a logistical problem for bus companies. So the problems may not have all been the nursing homes’ fault.

The vulnerability of nursing home patients became a national issue when 35 residents of St. Rita’s Nursing Home just outside New Orleans perished during Katrina. Some drowned in their beds.

Prosecutors charged the owners of the facility with negligent homicide, saying they should have evacuated the home. But a jury acquitted them of all charges. Some jurors said afterward that Louisiana authorities should have taken responsibility for the safety of nursing home residents ahead of the monster storm.

I believe most disasters cannot be adequately planned for. There are too many variables that could destroy one important aspect of such plans.

If transportation can’t happen because the flooding is making the roads unsafe to drive on, there isn’t much to be done. No amount of planning, drills or government mandate will change this.

Having 10 days of a water supply isn’t unreasonable in my view- storing it safely is though. This could be a whole lot of water to be stored somewhere…

How about meds? What happens when they’re gone? And the streets are too flooded? And the government says we can only have so many days supply of meds in the first place? There are too many different scenarios that can occur during a disaster. It doesn’t hurt to prepare. It does hurt to assume all will go according to some neatly written, well practiced plan.

No related posts.

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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An interesting article came to my attention today. In it, a study has shown that when the ecomony is strong and jobs are plentiful, nursing home residents have much higher death rates than any other time. The study shows that staffing is directly related to resident mortality.

Loss of caregiving help is literally deadly for older folks, according to a study from the Center for Retirement Research at Boston College. Perhaps surprisingly, death rates actually rise when the economy is stronger. In researching why this happens, the Center found that when employment rises, nursing homes lose staffers who prefer other jobs.

I’ve seen this happen for sure. People who not otherwise consider working in a nursing home, will do so during tight times. A job is a job. Money is money. It’s fairly easy to become a CNA, let’s face it. The promise of a secure job, even in tough economies is a motivator for people. There’s always a need for nurses and aides. When times lighten up and better jobs are available, many people do run, as fast as they can, from this work.

Why is that? Don’t the joys of the work keep people interested in staying in the profession? Maybe. But the pay, weekend requirements, unforgiving management style so typical to nursing homes, and the HARD PHYSICAL work are huge turn offs.

What can be done to rectify this? Not much. Pay rates are determined by funding sources; when the government is the chief source of money, pay rates are low. Working every other weekend is the norm is this line of work although some forward thinking facilities do offer a M-F option and an weekend option (2 back to back double shifts Saturday and Sunday). As far as the management style- well this CAN change IF those in charge are willing to give up some of their power to the front line staff. Few health care facilities are willing to do this though. And finally, the work itself just isn’t appealing to so many. Personal care- bathing, feeding, lifting, changing briefs– it’s a lot to do and you’re not into it, you never will be.
So all these laid off teachers and money management professionals really don’t have what it takes to work in nursing.

And who suffers? As always it’s the residents.

Related posts:

1. Nursing Home Worker Injury Rates High