The CNA: From Image to Identity





Several things come to mind when we consider the image of CNAs. Stereotypes exist on both ends of the spectrum. On one end, we have the demonized version of direct care workers as presented in negative media reports. On the other, we have the LTC industry’s idealized image, the compassionate yet professional, self-sacrificing “CNA Angel.” Somewhere in the mix we find the clinical version of the CNA: a vital part of the team, but with limited scope of practice – the caregiver defined by a particular skill set and specific tasks to perform. Finally, we have the unhappy image of caregivers as the poorly trained, dispensable bottom of the totem pole, the ones who do the hard and dirty work, or in the crude vernacular of the breakroom, “Butt Wipers.”  Or even worse, “Just a CNA.”

While there is an element of truth in all of these images, none of it really gets to the essence of what it means to be a caregiver. To grasp that, we have to take a closer look at how caregivers actually experience the work and where in that experience they find meaning. When caregivers are able to express this they are defining themselves. In doing so, they move away from image and toward creating their own identity.

One approach to understanding what caregivers find meaningful in their work is to look at a typical response to the notion of “Just a CNA.”

Here’s an excerpt from a poem I often come across online:

Who are you to refer to us,
As “Only” a CNA?

We’re the ones who take the time,
To listen to them speak.

We listen about their lifetime,
In a forty hour week.

We take the time to listen,
By lending both our ears.

We listen to their worries,
Or how they’ve spent their years.

We chose to do this job,
The job did not choose us.

This from a post on a CNA Facebook page:

Yesterday a nurse put me down, went as far as saying that I was “basically just a helper.” I was VERY OFFENDED. Yes I know that a CNA is below a nurse, but when it comes down to it I’m the one that holds the patients hand when they are sad, I’m the one that they call when they just need someone to talk to, I’m the one that will sit there and engage them in a conversation for hours. I’m the one that is on call 24-7 for all of my case load

There should never be JUST in front of a CNA. We are not just CNAs. We are Family when you’re not there. We are here through the good, the bad, the ugly, and even through death. Think twice before you call us just a CNA.

This from a CNA t-shirt:

I’m Not Just A Nursing Assistant
I’m A Trusted Friend…
I’m Part Of The Family…
I’m A Comedian That Puts A Smile On A Sad Face…
I’m A Counselor…
I Listen To Stories & Share My Own…

I’m A Proud Nursing Assistant

These examples, as well as just about every response I’ve ever read or heard to “Just a CNA,” have one constant underlying theme: the meaning of our work – and thus how we define ourselves – is inextricably bound with the connection we have with our elders. If we are “Just CNAs” than the people we care for are “Just residents.” If we are “butt wipers” then our elders are reduced to just so many butts to be wiped. You cannot disparage our work without dehumanizing the people we care for. The two cannot be separated.

Our identity as caregivers is not based on the most disagreeable aspects of the job. Nor is it based on a job description, nor on our place in the LTC hierarchy, nor on how the public may view us. It is based upon how our elders experience our interactions with them. This relationship is the single most important factor in how a resident will experience life in long term care. Our awareness of the significance of this bond and our desire to express it is more than just a form of self-validation, it is also a potentially powerful antidote to much that is wrong in long term care.

How we can employ the power of this awareness is the subject for my next post.

2 thoughts on “The CNA: From Image to Identity

  1. minstrel

    This is a great post and makes an important point. We are undervalued and anything/anyone undervalued has an extra hurdle to jump to do our jobs well. Yesterday I was on a webinar about culture change (yet again) and the presenter asked, what kind of support is needed, to achieve culture change. I said, I think we need to have more staff available if we really want the aides to provide person-centered care, and we need to pay them better so we don’t have to work two jobs and double shifts, so we have the energy we need to do our jobs the way we want to. This was an excellent webinar in many ways, but at this point all the old platitudes came out. “Yes, aides are undervalued.” “Yes, they should be paid more, and we hope that will happen.” Etc. No one is really taking us seriously as people trying to do a superhuman job, while we don’t have the staff we need and are worn out. I don’t have a plan about what we can do. But just as eldercare takes a village, it takes solidarity among us to persuade our administrators that we need more staff and we need a living wage.

    1. Yang Post author

      “… it takes solidarity among us to persuade our administrators that we need more staff and we need a living wage.” I believe you have anticipated my next post, Minstrel. Although I think we are going to have to persuade more than just our administrators. This is a social problem and we need to add our unique voice and perspective to those already advocating for social change.


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