Category Archives: changing employment

The Wheelchair Test


May    Sunflower

 

The first time I went job-hunting as a CNA, I didn’t have a clue what I was doing. But that was then and now? Now I at least have a clue. Two years experience has at least given me that.

“Hello, this is _____ Healthcare, ____ speaking. How may I help you?”
So far, so good. The woman’s voice is pleasant and friendly and she doesn’t sound like she ready to rip somebody’s head off.
“Hello, my name is May and I was wondering if you could tell me what your base pay is for CNAs? Um, on first shift?”
There’s a small silence on the other end of the line, then the other woman says, “Give me just a second and I’ll find out for you. Are you looking for a job?”
“Yes,” I respond, still marveling at my decision. It’s been a long time coming, but it still doesn’t feel real. This isn’t an “I’m so fed up I’m reminding myself I have options” kind of call, such as I’ve pulled in the past…no this is the genuine article. I’m leaving. On some level, it feels like a betrayal to feel so relieved.
The receptionist’s voice cuts across my thoughts, pulling me back to the present. The figure she names is decent, slightly below average national pay, but more than my current pay…especially since my current pay includes shift differential! Hello savings account, you might not remember me! I force myself to calm down. The other place I called offered similar pay and a crap-ton of stutters and excuses instead of an answer to the next question on my script. Speaking of…
“And can you tell me what your resident-to-aide ratios are?”
The other woman laughs. “At the risk of repeating myself, give me a second to check.”
This time, the pause is longer. I can’t help but spring to my feet and start pacing the room. My thoughts pound out in rhythm to my steps: please, please, please. For years now, I’ve heard the same mantra thrown at me, “If you leave, you’ll never find as good a place as this.” At first it was reassuring. Then it was annoying and now I’m praying that it’s not true. I don’t want to have to decide between the money it will take to have a good life and ratios that allow me to take pride in my work. Please, please, please.
“Well, our staffing person is not answering the phone, but I just talked to one of the CNAs and she said she’s got eight people today, if that helps.”
“That’s very helpful, thank you,” I reply, trying and failing to keep my glee out of my voice. “Just one more question: are you hiring?”

It’s dangerous to accept a job sight- unseen, so I continue to check my rising excitement until I actually walk through the doors of the facility the next day. To my surprise, the receptionist recognizes me from our phone conversation as soon as I ask for an application. She’s seems as friendly in person as she did on the phone. That’s good.
As I fill out the application, I take time to look around me. It’s not quite as opulent as my current place, but there’s a friendly functionality at work. There’s also no odor that I can detect, no harsh scent of ammonia and urine. I can see aides moving quickly on the halls and some nod at me or wave. They look busy, but not hassled. A few residents are lined up by a nearby nurse’s station and I examine them closely. Men and women both are neatly shaved and groomed, there are no food stains on their faces and they all appear engaged with their surroundings. Quite a few of them are looking at me quite as intently as I’m looking at them. I hand in my application, wondering if I’m about to become their caregiver.
The receptionist asks me if I want to schedule my first interview for today, warning that it might be a bit of a wait. I say yes. I want to get this ball rolling, get this transition over with.
As I wait, I do the last thing on my list. It’s not something I’ve pulled off the Internet or asked other aides about, unlike everything else on my list or script. This is something I came up with on my own, a pattern I’ve noticed in my own experience. I like everything else I’ve seen and I almost don’t want to look. But as I wait, I walk up to a resident and start talking to them. Our conversation is mostly an exchange of names, but it gets me close enough to the wheelchair that nobody looks at me like I’m crazy when I squat down to put myself more or less on eye-level with the resident in the wheelchair. Nobody even notices when I duck my head down for a quick look at the underside of the wheelchair.

See, when you’re short-staffed or overwhelmed, somethings slip through the cracks–things like washing wheelchairs, for example. As an aide, I’m…not exactly okay with this, but I understand it. You can only do as much as you can, and when you’re running late on time and short on energy, primary care comes first. Better to make sure your people are clean than to make sure the wheelchair looks nice.
We’ve all had those shifts. Everyone, no matter how good the facility, has had that kind of day, and a good facility can rally. If one shift slips, the others can still catch up around it. The wheelchair gets washed the next go-round and all’s well.
But if that facility is in crisis mode and has been for a while, if every single shift is short…there’s no catching up. That wheelchair goes unwashed shift after shift, week after week. There’s a big difference between a bad day once in a while and a string of bad days; I’ve learned to tell the difference in the state of the wheelchairs.
And this one is mostly clean. There’s a bit of grime and dust on it, but it’s only a single layer. There aren’t layers upon layers of bad days coating the underside of the wheelchair.
Okay, I can work with that. I don’t expect perfection, but I’ve come from a place that’s been in crisis mode for almost a year and I can’t take it anymore. I’ve learned too many bad habits, too many shortcuts and there’s a bitterness in the air I just can’t breathe anymore. I need a clean break, a new place to make a stand…and I think I’ve found it here.

The Tale of Two Trainers

Sunflower

May

Training new aides is an important link in the chain of long term care. Unfortunately, it’s also a link that is neglected. Today’s post starts a three-part series on my experiences with training and my own experiences on either side of the problem. First up: it’s my first day and I’m as green as green can be!

There’s something daunting about a parking lot on your first day of a new job. Most people are creatures of habit: they’ll park in the same general spot every time. I’m rather convinced that I’m in someone else’s spot…and then tell myself not be stupid. This isn’t a club, this is a job and as far as I can see, there’s no assigned parking. I walk in the side door, trying not to show my nerves. It’s my first job as a CNA and I think I’m as green as green can be. I did my clinicals in an assisted living facility and I just know that this is going to bite me in the butt. The day I did my tour of this facility…my facility, I didn’t recognize any one of the mechanical lifts the DON pointed out. Or any of the other equipment she showed me. The other girl in orientation with me had known the names of the equipment and had seemed to know what to do with them. I push aside my nerves and approach the nurse’s station. There’s a nurse there, and another young woman in scrub pants and a blue tee shirt. She isn’t wearing a name badge, so I’m not quite sure who or what she is.
“Hello,” I tell the nurse on duty.
“What do you need?” she asks gruffly.
Well, I think, that’s a great start. “I’m May,” I tell her, “I’m new here; it’s my first day. Could you tell me who–” I check my paper–“A is? I think she’s my trainer.”
“That’s me,” says the young woman in the blue shirt. “Nice to meet you, May; have you been an aide before?”
I shake my head.
“Well, we’d better get started,” she says briskly. She turns and walks away; I scramble after her. She shows me where to put my stuff and we’re off. By the end of the shift, I’m quite impressed with A’s jaw muscles: she’s kept up a steady stream of talk all shift. She introduces me to the other aides and all the residents. Resident introductions are strange, I think, as she tells me not only their name but also their transfer method and other pertinent details of care. Hoyer, standing lift, two person, one assist. Contractures, she hits, this one’s not ours, very confused, steals other residents shoes. Don’t give her your hand.
That instruction comes a bit too late as I pull back my hand, trying not to gag at the sticky, shiny layer of saliva now covering it. The resident, a woman with curly white hair and an innocent expression, had nonchalantly used my hand as a hankie, bringing to her mouth and spitting in it.
My head is spinning and I feel like I’m drowning in information. How on Earth am I supposed to remember all the details I’ve been told. On the other hand, while I feel like A has practically buried me in names and details, she isn’t as thorough with the physical side of the job. I follow her from room to room, watching while she does all the work. Whenever I try to help her, she’s just too fast to keep up with. I couldn’t tell you how she did it, let alone how to do it myself. Oh, well, I tell myself. It’s only the first day and maybe I’m just meant to shadow on the first day. I’ve barely seen H, the other new girl, all day long and whenever I do, she is trailing J, her trainer. J is also keeping up a steady stream of instructions. J also doesn’t seem to like me very much, hardly speaking to me and shaking her head whenever she overhears one of my many questions. Apparently, I should already know this stuff. First day and I’m already falling behind. Darn clinicals held at assisted living instead of nursing homes! But then, that wasn’t exactly my fault.
At the end of the sift, A tells me she wouldn’t be my trainer on the next day (as it’s her day off) and says I will be with V…then she had added, her voice full of scorn, to watch out for V and not to pick up any bad habits from her. J scoffs, rather loudly, upon hearing that V has been selected as my trainer.
Well that’s not worrisome at all, I think, before gratefully climbing in my car and driving home. I’m utterly exhausted and my head is still spinning from all the information thrown at me today…unfortunately, the only resident whose name and information I can clearly remember is Mrs. R and that’s because it’s hard to forgot that sweet little lady who spit in my hand.
The next day starts the same as the one before. I get to work, park in the same spot, notice that all the other cars are more or less parked in the same spots too and go through the side door. The same gruff nurse is there, but this time she’s alone.
“Hello,” I say again.
“V is always late,” she tells me. “Just wait here for her.”
So…always late and don’t pick up any bad habits from her. If V is the kind of employee I’m getting the idea she is, why is she the one training me today? H and J arrive and get straight to work while I’m still standing at the nurse’s station, waiting for V and trying not to get testy with impatience and nerves. At last a tall blonde sweeps in through the door. The nurse jerks a thumb at me and says: “This is May. She’s with you.”
V greets me warmly. Ok, then, I think. Maybe J and A just don’t like her. Maybe she’s not actually a bad aide. This comfortable idea last until the first room we go in, whereupon V begins to change the resident without putting on gloves.
“Um,” I say, my own gloves halfway on.
“Oh, don’t worry about it,” V says airily. “If you’re a good enough aide, you won’t get anything on your hands.”
Excuse me? What? I stare at her, a sinking feeling in my stomach. Then I snap my gloves on with a bit more noise than strictly needed. V points to the other resident in the room. “Get her dressed,” she says. Ok, then, I think.
It’s the first time I’ve ever gotten a resident dressed on my own and I’m not quite sure what’s the best way to go about it. V isn’t helping. She’s finished her own resident and is now just standing against the wall. She only speaks to tell me to hurry up…eventually she does unfold herself from the wall, only to push me aside and finish the resident herself.
Well, I guess that J and A have good reason to dislike V. I don’t think I’m too fond of her either.
The rest of the day is just more of the same. V sets me a task without telling me how to do it, mutters impatiently while I try to accomplish it, then pushes in to finish it herself. There’s no talk of hoyers or standing lifts or two assists–V insists that if you’re a good enough aide, everyone is a one assist. I’m always back from our breaks long before she is and so spend a good bit of the day waiting. The gruff nurse is still at the nurse’s station and she also doesn’t seem too fond of me, so I take to waiting on the bench outside the clock-in room. If I had a clue what I was doing, I’d go ahead and start working without V. But I don’t, so I just sit and wait.
J and H pass by; J slows down long enough to ask me: “How’s it going?”
People have called me timid before…and I know I’m shy, uncertain. I’m also young, in a strange new job and terribly frustrated. “V is hard to keep up with,” I say shortly. “And I thought you always wear gloves when providing care.”
“V!” snaps J and I turn around to see V glaring at me. Great. Just great. “While you are training new aides, you will wear gloves or I’ll tell the nurse. Got it?”
What? While you’re training? Shouldn’t that be something more along the lines of “while you are changing briefs you will wear gloves”? V just glares at me and ignores J. The rest of the day goes worse. V’s still upset with me, but she’s decided to talk to me now. She talks non-stop the rest of the shift, like A did the day before but I don’t even bother trying to remember anything she says. It’s just the same thing repeated over and over. “There’s the way you do things for your test and there’s the way you do things on the floor. You don’t have time to do things the right way. You’ll see.”
I’m quite glad when the shift is over. I ask the nurse, quietly, if it can be A that trains me next. She goes too fast, throws too much information at me and doesn’t show me how to do things as thoroughly as I’d like, but at least she wears gloves. At least she doesn’t disappear like V does.
The next day it’s A. I’m so happy I completely ignore V, who is still glaring at me.

A Glance Back

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Alice

  It was such a surreal feeling, driving into the parking lot of my old facility. Like being a visitor in my old home. It was Christmas day and I had promised the residents that I’d spend the afternoon with them. Truth be told, it was as much for me as it was for them. I missed them. These past few weeks have sent me adrift and I needed the reminder of what started me on this caregiving path in the first place.

      “ALICE! You’re BACK!” Shouts and greetings that warmed my heart and healed my spirits from residents and co-workers bounced from the walls. I felt at home, as if I never left.

      In that moment, I remembered how much I once loved working in that facility. The challenge of having to solve problems in a moment’s notice, the constant testing of my every limit, the ability to look at someone I’m training in the eye and tell them that this is a tough gig if you do it correctly but if you’re open to it, this will be the one of the most worthwhile experiences in your life. I loved all of that. I found it endlessly challenging.

         My greatest joy are the people. These interesting, difficult, demanding, funny, people who became my friends over the years; who have more wisdom in one pinkie than the rest of us have combined. How I’ve missed the stories. It’s safe here.

      Suddenly my reasons for leaving seemed so remote; the pain and financial struggle and inability to blindly accept the status quo seemed a dim memory compared to the joy I took in my work. My etch-a-sketch mind quickly erased the rough edges of the actual working conditions and replaced it with a smooth and calm mental image of a reality that never existed.

      In this time of upheaval, the familiarity of my old job is appealing. I know my residents, their preferences and routines. It would be so easy for me to just turn back. As tempting as that thought may be, I know it’s the wrong answer. It broke my heart to walk away the first time. It would just be harder to do it again in a year. Or two. Or three.

      No. There is no going back. I don’t know where this new experience is going to lead me, but I have to believe that it’s not back to the starting gate. I have to believe that it’s leading me forward. Besides, my residents are what bring my life a deeper depth; a wealth of experience. That connection can happen just as easily over a cup of coffee as it can by punching the clock.

The Long Goodbye

      photo   ALICE
       I’m calling in sick. I can’t have “the talk” anymore. I just can’t. It’s ripping my heart out. After all, what are they going to do? Fire me?…These were my thoughts as I was lacing up my sneakers and getting ready for work. Even as they floated through my head, I knew the words were a hollow threat. I would not call off. I would not ruin nearly eight years of perfect attendance at work while finishing out my notice. As gut wrenchingly painful as it may be, to cave in because facing this is difficult would be like throwing the game in the last inning. THEY would win. I would lose. And far more importantly, my folks would suffer.
       You can do this, Alice. It’s the right move. After all these years, three owners and five administrators, you know that this facility is never going to change. They will never invest in competent management and because of this, you will always be stuck. Now is the time. Opportunities like this don’t fall on your lap everyday. Take it and run and start moving forward with your life. This has been my mantra, played on repeat, for the week. And it’s true. I know it is. I know that I have to get out of this particular facility. I know that I’m no longer comfortable working under questionable conditions and bosses with very questionable ethics. So, I’m moving on. My resignation letter, worded carefully to not offend so that I may visit my folks without interference from the office, is in.
       I’ve explained the situation to my residents. And explained. And explained. I’m not leaving YOU. I’m just leaving the JOB. I’ll be here to visit at least once a week. It will be different but it will be good! I’ll have time to sit and visit instead of running here and there. You will be fine…over and over again. They are scared and feel like I’m abandoning them. I know this because they tell me and that just shatters me. The average length of employment for a caregiver in this facility is six-eight months and that is being generous. The turnover is ridiculous because the wages are insultingly low and the work conditions are terrible. Because I have been there so long, this is traumatic for them and for me.
       I am letting them down. There is no getting around that. I’m making a choice that is both right and necessary but to deny that it will impact those around me would be dishonest. It is a truth that I can accept and live with, but for the moment it is incredibly difficult and painful. I really can’t discuss it without crying. This decision has turned me into a blubbering mess. I love what I do. I love many of my co-workers and I have been deeply committed to my residents. I resent having to make this choice. I am furious at the administration for not investing and paying a living wage for quality caregivers. I resent the dishonest, inept, incompetent and unethical woman in charge of coordinating care. She has not eased my residents’ stress or discussed with them the upcoming transition. She has not comforted them. She is quite honestly only concerned with how events affect her. Such apathy in this field never fails to boggle my mind.
       A few more days. That’s all I have left there. I will continue to reassure my folks that they will always be a part of my life. After so many years, they are more friends than residents and it will be nice to explore that dynamic. I know that nothing I can say will prove that to them. I will have to show them with action. And I will. Until they see me visit them, I have to accept that emotionally, they are not in a trusting place. Often, the best decisions are the most difficult to make. I know that underneath all of these deeply felt emotions that I am walking through, there is excitement at what’s to come. New opportunities will open up from this very difficult decision. For now, I have to trust the process. After all, life is change and transitions.

Leap of Faith

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Alice

You know you have to take this leap, Alice. You KNOW you do, not only for your financial responsibilities but also for your mental and emotional well-being. Sigh. I knew this. And I was excited about the opportunity that practically landed in my lap. Excited, yes. But scared and sad too. After nearly eight years of working with my folks, I am taking another job. Instead of taking care of more than twenty people, I will be caring for one. I’m so accustomed to running and routine that this is a big change for me.

         My ability to get to know and connect with my residents is where my strength lies. I look forward to actually having the time to spend one on one with someone; to get to know her on a deeper dimension than the facilities can provide due to time constraints. I’m excited to put into use much of the training that was a lost cause working in a facility that was often short-staffed. I can actually use music therapy and appropriate forms of redirection. Together, this client and I can plan our day; I can actively encourage her to engage in the development of a routine that suits her rather than trying to get her to follow one that is easiest for me.

       It is a wholly unexplored area of long term care for me and I think there is much that I can learn from the experience. It will be trial and error as we get to know one another and I adjust to the different pace. That is actually a benefit though. This will be a new adventure for us both.

       Ah, but I am not overstating it when I say that it breaks my heart to leave my folks. I know logically that they will be ok. I also know that I’m not actually LEAVING them. The facility is only four miles away and I’m already making plans for fun visits. It will just be a new dynamic to our relationship. We will meet as friends rather than caregiver/residents.

     My difficulty stems from love, but also from my reluctance to let go. My reluctance to trust such a broken and flawed system to care for them properly. It’s MY issue, not theirs. It is true that I need to take this leap. To deny that would be a disservice to myself. It is equally true that taking this position affects more than just myself. To deny that would be a disservice to my residents whom I’ve formed such close bonds with these past several years.

       Change is the one constant in life and I’ve been walking through my fair share of it lately. Though most of these changes have been very positive, it is my nature to cling tightly to the familiar. There is no room for growth in holding on to fear.  Letting go is never easy, but that doesn’t mean it’s not the right move and I look forward to exploring and sharing this new chapter with all of you. I believe this period of one on one caregiving will hone my abilities and help me become more well-rounded, both of which I will be able to use for future endeavors in the world of Long Term Care.