Category Archives: CNA

Do the right thing, part 2

May

It’s my supervisor.

She immediately launches into a speech.
“May, what is going on? I’ve got an aide saying that you let a woman soil herself because you didn’t feel like transferring her, I’ve got a pissed off family member who is literally screaming at me because my workers are too damn lazy to do anything. And you’ve got six call lights going off, not counting yours.”
She pauses and looks at me, giving me a chance to explain my side of the story. There’s just one problem.
My patience, I realize, is completely gone. It up and left and I have this horrible feeling that if I try to defend myself, I’ll end up crying…because I’m mad. It’s a bit confusing for others, but I usually cry when I’m just so mad I can’t see straight.
I step back and nod to the resident sitting on the commode. She’s still crying.
“You try. If you think I’m lazy or whatever–”
My supervisor gives me an odd look, but to her credit, she does what I, er, ask. For a split second, I’m afraid that the resident will just hop up…that would certainly be a perfect way for this to end. And, in a way, this is what happens; she stands up. But the supervisor is straining and clearly doing more than just assisting. I jump in and help–between the two of us, we manage to pull up Mrs. A’s pants and get her in the chair. It’s…not easy.
“My God, how did that girl get her on by herself?” the supervisor gasps. “She’s got to be really strong.” There’s a note of almost admiration in her voice.
I shrug. “I’m strong,” I say quietly.
It’s true, not a boast. I might be petite, but I am strong. I can do bed check of the most difficult residents by myself, I can get residents on the hoyer in their chairs pretty darn good. I could have picked up Mrs. A by myself.
The supervisor nods. “I know,” she says apologetically.

It’s not a question of physical ability. It’s a question of survival and longevity in my career. I’m still a young person with the majority of my life ahead of me. If I blow out my back because I was too impatient to wait for help, that’s it. I’m done. Not only would that possibly be the end of my career as a CNA, it could very well be the end of my independence and mobility. I don’t want to end up in constant pain just because I’m a CNA. I refuse to believe that’s just the way it is.
CNA is a rough job. Sorry about your luck and here’s your pain pills.

The problem is that I do understand where my partner was coming from. Letting a woman urinate on herself rather than put myself through a bit of discomfort seems like a selfish choice. I did, after all, just rank my wellbeing above hers. Not only that, getting help ate up precious time, time I could’ve used to help another resident. Seems like a selfish choice.
Or was it? If I’d have bear hugged her, she could have slipped out of my arms. She could have fallen. Probably wouldn’t have, and didn’t when my partner transferred her. However, I weighed the options and decided that the possibly of hurting myself or Mrs. A outweighed the probability that she’d soak herself. Hard choices, as they say.
Unfortunately, staffing situations make these kinds of scenarios an almost hourly occurrence.
It’s a judgement call, deciding how much we can handle. Can I roll this person on my own? Should I roll this person on my own? Is there anyone even available to help me? There are those who abuse this judgement call, demanding help with the easiest of residents (one girl once asked me to help her change a walkie-talkie resident!). Some people never want to make this decision and do more than they can handle. It’s never easy when the “right” choice is to let someone soil themselves rather than put yourself at risk.

My supervisor washes her hands slowly and leaves the bathroom. I hear her talking with the son and when I come out with Mrs. A, he doesn’t say a word to me. Doesn’t even look at me, in fact.
My hall-partner shoots me a dirty look the next time we pass each other. I later hear that she got in trouble for leaving a resident on alarms in the bathroom by themselves, but not for the one-assist transfer. Apparently, Mrs. A’s inconsistent transfer abilities make it hard to say for certain that the aide did an “illegal lift”, as I’ve heard them called. Mrs. A is made a standing lift PRN, and at our next meeting, we are reminded that this is a no-lift facility. Use your best judgement and don’t hurt yourself. Now get back to work.

A Start

May

It sits in front of me, wrapped in gray paper with the words “Happy CNA week!” scrawled across it. It was given to me by my supervisor, along with the words “thank you”.
I don’t know what’s inside…I haven’t had a chance to open it until just now, hours after it was given to me. Too many call lights going off, too much to do. Some would say that this is the prettily-packaged perception that the facility wants to present going smash against the reality of what a nursing home is really like.
It’s just a small gesture, after all, doesn’t change anything…right?
It’s just a gesture, offered once a year, doesn’t balance the scales…right?

Except…the last place I worked never celebrated CNA week. There were no gifts, no cookouts, no free candy. Nothing. No gestures.

I start ripping the paper off like a little kid at Christmas. Gestures can’t be measure by how large they are, but by how genuine they are…and this one feels pretty damn genuine. The “thank you” was sincere. It’s not my supervisor’s fault I’ve had a lousy day on the floor; it’s not my facility’s fault that the rules are stacked the way they are. We’ll never win the fight if we fixate on the wrong bad guys. We’ll never get anything more than small gestures if we don’t say “thank you” too.
My place is trying. That’s enough–or rather, that’s a start.

Tough love

This has got to stop, I think. My mental voice does not sound firm enough, so I try it again. Firm and un-arguable–that’s what I want to sound like.

I stride up to the bed and say in a loud, hopefully firm voice: “Good morning! It’s time to get up! The nurse says I need to get your weight.”
“Sleeping Beauty” is good, but not good enough to fool me; watching intently, I catch the split second when her eyes crack open, focus on me and then snap shut.
“No, you are getting up today,” I say sternly. There’s a fine line here between insistent encouragement and forcing her; residents have the right to refuse, after all. On the other hand, Sleeping Beauty’s been in bed for five days now and she’s growing more depressed and withdrawn. Enough is enough, I decide, time to break out the tough love.
“Look, I have to get your weight. They have to have it for your medical records…I mean, you’ve barely eaten in the past week and the last time you did this, you dropped five pounds. So, we’re getting up to get your weight.”
I’m interrupted by a suspiciously well-timed snore.
“Tell you what,” I continue, “after I get your weight, if you want to go back to bed, I won’t stop you. I won’t be happy, but I won’t stop you. Deal?”
“Fine!” she grumbles. “Long as you be quiet. Always talk, talk, talk. Why don’t you ever shut up?”
I ignore this and go about gathering her clothes.
“No,” she says.
I raise an eyebrow and my hands settle on my hips in a fairly good imitation of my mother–funny how easily we revert back to childhood impressions of Authority. “You want to go halfway across the building in a hospital gown?” I inquire.
A string of grumblings, but no clearly stated refusal answers me, so I proceed with my plan. She doesn’t try to stop me, but she also doesn’t help me in the slightest. Clearly, she thinks that since this is all my idea, I can do all the work; if she’s trying to punish me, she is succeeding. I’m sweating buckets by the time the erstwhile Sleeping Beauty is dressed and in the shower/weight chair.
She’s silent on the trip to the scale in the way that only a passive-aggressive person can be. I slid her and the shower chair on the scale, deduct the weight of the chair and inform her of her weight. She has the right to this information and I want her to know that her most recent episode of playing possum has made her loose four and a half pounds.
She’s silent on the back, but a different kind of silent: thoughtful, reflective. Still withdrawn, but not belligerently so.
I go to put her back in her bed and she stops me with a hand on my arm.
“No,” she says, “wheelchair.”
Quit while you’re ahead, I think and I don’t comment on the change of attitude. I do, however, strip the sheets from the bed once she’s in the wheelchair–it does need to be changed and if it takes me a while to remake it, well, it wouldn’t be the first time.

I don’t see Sleeping Beauty again until much later in the shift. She’s sitting in front of the dining room windows, face tilted up and sunlight pouring around her. She looks peaceful and happy.
She cracks an eye open and focuses on me; a huge smile lights her face up.
“Hi,” I say, a little surprised.
“Thank you for getting me up,” she tells me. “I’ve been in bed so long and wouldn’t get up but you didn’t give up on me. You can make that bed now, I’m not going back in it until bed time. You didn’t give up on me, so I’m not going to give up on myself,” she finishes with a determined nod and turns back to the window.

As a CNA, I always have so much to do that sometimes it’s just easier to go along with the refusals, to mark an “R” in my charting and walk away. I’m glad I made the time today.

The Best of Times/ The Worst of Times

photo    Alice
       Ah, life on the floor; messy, rewarding, difficult, frustrating, chaotic, painful, endearing, hilarious, and so worthwhile. Sometimes you pick a calling and sometimes a calling picks you. I’d be lying if I didn’t say that I have my love/hate moments with this career, but even on my worst days, I wouldn’t trade places with anyone.
The lessons I’ve learned from working as a caregiver have transcended into all areas of my life, the most profound of which I picked up from the toughest aspects of the job. It is a career that fosters self-reflection and deep insight, if we as caregivers, allow it.  With this is mind, I came up with three of my favorite lessons and three of my biggest challenges. I will start with the positive.
                                        The Best of Times
1. The relationships.  Everything that I do as a caregiver revolves around my relationships with others. From the dynamic, vital and loving connections with my residents, to the cooperative partnerships with my fellow caregivers on the floor, to communicating effectively with those    in other departments, the relationships, even those that are occasionally contentious, are the glue; the underlying pulse that connects us to the long-term system at large.  These relationships both enrich us AND empower us. I have found it mutually beneficial to form connections with visiting family, house doctors, ombudsman, nurses and anyone else who comes into the facility regularly. Often, WE as caregivers, have to be the ones to initiate such relationships, but once formed, they open the doors to effective communication that is so desperately needed in this field. We all learn from one another if we are open to it.
2. The ability to adapt. In May’s last post, she explained the challenges, frustrations and powerlessness of constant short-staffing with perfect eloquence. Every word she wrote was spot-on. Unfortunately, until the system evolves, there is very little chance of this issue being solved. The silver lining is that such conditions force us to adapt; to assess quickly and think on our feet. We HAVE to adapt because if we don’t, our residents suffer for it. It has been one of those life lessons that I learned through experiences at work, almost without realizing that I was learning it. I can not overstate the impact it has made on my life, both on the floor and off.
3. The ability to overcome. No one can survive for very long in this field without developing the ability to persevere.  We face any number of obstacles and challenges on a given shift. From loss of loved ones to supply shortages; From dealing with shoddy work ethics to ill-timed mandatory meetings put in place by management who has no working knowledge of the routine on the floor, we keep moving through it all. We HAVE to. The people for whom we care depend on us to be as consistent as possible, come what may. And, if I’m honest, the intoxicating mixture of pure joy, relief, and sense of accomplishment that comes from making it though and impossible shift gives me a feeling of temporary invincibility and for just a moment, I feel like Wonder Woman.The Worst of Times
1. Loss. It is inevitable. It is heartbreaking. It is a part of the job that never gets easier. It also comes in many forms. Clearly, death is the most obvious. When it is expected, it brings with it the peace that comes from knowing that I  had the privilege of walking hand in hand with a vital human being in the end of their story on earth. Even when it’s unexpected, I know in the back of my mind that I’m caring for sick people and it is part of the job. Acceptance of death is a difficult part of the gig.
Far more surprising and ultimately more difficult is the loss of hope. And make no mistake, I have my fair share of “those days”. Those days when I question if what I do is nothing more than tossing pebbles in the ocean; the days when I question my abilities, when the system seems so impossibly flawed that I ask myself why I bother; the days that I think I’d be better off selling shoes or  waiting tables. I’d definitely make more money. Those days scare me. They pop up after long stretches without enough sleep or when I neglect self-care.  They always pass.
I am blessed with a great love for what we do. It doesn’t mean I don’t get burned out or question this calling, but it does mean that at the end of the day, I am not confused about what we caregivers are and why we do what we do. We develop tools to handle the emotional baggage in this field. One of mine is writing about it. It’s my way of never giving up. After all, it may be a big ocean, but there are a lot of pebbles.
    2. Lack of communication. Ideally, long-term care facilities would run like a body in motion. The legs, arms, and mind cooperating and moving in synergy. Ideally.  The reality of it is, each department in my facility fends for itself, with little or no guidance from the office…until there is an inevitable mess to mop up. It is such an ineffective way to run a ship that I find myself constantly baffled as to why the powers that be choose to continue on that course.  Simple things, like informing 1st shift that their cover is going to be late BEFORE it’s time to clock out, or letting us on the floor know ahead of time that there are major changes in the works so we can prepare our residents or letting us know more than ten minutes in advance that we have a new resident arriving would do wonders to PREVENT resentments from forming rather than having mandatory meeting on anger in the workplace AFTER those resentments inevitably spill over.  Good communication is a sign of respect. We all owe each other that.
  3. Sometimes, it’s frustrating when people do not understand. Death, the elderly, broken systems, and body fluids.  Not everyone will see the humor in a resident who decided to use his own poop as a new art medium. Even I only saw the humor in hindsight. Not everyone wants to understand the devastation on a Vietnam vet stuck wasting away alone in a facility. No family. A ward of the state as his mind slowly erodes. People don’t understand the bond that forms between partners on the floor; two people who may be completely different working together to make the day as smooth as possible. Very few know the difference between the reality on the floor vs. the public perceptions of long-term care facilities and even fewer care. It is NOT first date conversation material. Learn from my mistake on THAT one. Because of this, it can sometimes feel very lonely in this field. It can be frustrating to have to explain why I’m “only” a CNA. But then I think, that’s EXACTLY the problem. And either I’m going to be a part of redefining what it means to be a caregiver or I’m going to die trying. That is a lofty goal and it isn’t one any of us can achieve alone. But it is so very important. After all, nothing ever changes without first recognizing the problem, and then attempting to be a part of the solution. The problem ISN’T with the job title. It is the with the descriptor “ONLY”.

The Short-Staffed Story

 

May

It’s staring me in the face the entire time I’m getting my coat on. It’s mocking me with its very existence. I want to smash it into nothing, I want to scream insults at it. Mostly, though, I want to go home and not come back until I feel like a human being again.
“It” is a list of all the open shifts for the month…there’s enough to fill a full-time position or two. Or several.

We’re all in overtime already: we few who have stuck it out during this incredibly rough period. Every place has its bad stretches–we’re in the middle of one right now.
Every aide that leaves puts more work on the rest of us. The heavier the workload, the more aides that get fed up and leave…and when it’s like this, overworked and understaffed, it is hard to convince the new aides to stay.
Why would they? It’s crazy and ridiculous and nobody is happy to be at work. Another newbie quits and we all sigh and try to prepare ourselves for another week of 10-12 residents per aide.
When CNAs are short-staffed, they’re also overworked. It’s just the way it goes.

According to the charts in the office, twelve isn’t that much more than a standard group of 8-10 residents per aide–no big deal, right? It’s an acceptable solution to the problem of not-enough staff. Just give every CNA a couple more people, maybe three or four and there you go: we’re covered for today. Whew. Saved by simple mathematics.
But on the floor, having twelve people instead of eight means more call lights going off at the same time, it means no ten-minute breathers. It means later lunches, messy rooms, soiled pants, too-long finger nails and unshaven faces. On the floor, it becomes a problem of subtraction, not addition. What it really means is that you’re taking time and care away from all twelve residents.
What it means is I don’t have time to change Mrs. Q’s sheets because Mr. W needs to get dressed. I don’t have time to walk Mrs. E because Mrs. R’s call light has been going off for 20 minutes. I can’t spend a few minutes chatting with Mr. T because Mr. Y’s alarm is going off. Mrs. U and Mrs. I can’t go to bed yet because they are mechanical lifts and I don’t have anybody to help me right now. Mr. O has to feed himself, even though he really needs supervision because Mrs. P can’t feed herself at all. I can’t brush Mrs. A’s teeth, because I can see Mr. S coming down the hall with soaked pants–understandable, since I haven’t had a chance to touch him all shift.
Understandable to an overwhelmed CNA, that is. Try explaining that to his family. Try explaining that to him.

And while it might be “understandable” to the aides, these kinds of situation are most certainly not acceptable. Not to the good aides. We who take pride in our work, we do not enjoy seeing our residents unkempt, soaked and soiled. But what can we do? Stop time, clone ourselves, refuse to work unless safe staffing laws are passed?
If only.
What we can do is come in early and stay over late; we can skip our ten-minute breaks, we can pick up extra shifts so that our residents can get the high quality care that only comes with adequate staffing. We can take on extra work during a shift in hopes of keeping the newbies for more than two weeks.
Sometimes these measures, so wearing on us, seem like fingers in the dike. It’s not enough. It’s never enough. We go above and beyond but we still can’t reach. Bad days and double shifts stack up into a wall of weariness; the higher it gets, the harder it is to remember why we cared enough to make these sacrifices.

I’m not quite there yet. I can still feel the shame and the anger that comes from a job badly done. I’ve failed them. I’ve failed my residents, who are both my responsibility and my friends.
But it’s not my fault. I didn’t ask to have a group of 12 residents. I didn’t ask to have a whole hall to myself. This wasn’t my choice, this isn’t on me. I’m only human, I can only power through so many short-staffed shifts. I am aware that at other facilities, the ratios are much higher–up to 20 residents per aide–but this doesn’t make me feel better about the twelve people whose care has seen a noticeable decline since we’ve been short-staffed. What more can I do? What more should I do? Is it always going to be this way? How much more can I take? How much more should I take?

There’s a note on the sign-up sheet. “Thank you for all you do,” it says. “It doesn’t go unnoticed. We know it has been rough. Hang in there, we’re trying to get more staff in. Just keep being awesome for a bit longer.”
I start to tear up. They see. They see. Some would say it’s a ploy to milk more hours from us, but from the dollar signs offered next to the note, I’d say they’ve got their money where their mouth is.
Okay, I think. Between the note and the big bonuses, I’ve changed my mind. I can work nine days in a row. I can handle a double in that mix. I can do it. My back hurts, I’m always tired, I never see my friends or my family, but I can do it. I can do it again.
Next week, though. Next week I cut back. Next week I rest.
Maybe next week, they’ll have a new aide in. Maybe.
I won’t burn out; I’m not drinking that poison again. I’ll fix a smile on my face and I’ll work this week because my residents need me. My employers need me and they’re acknowledging that. They see and they appreciate me; I’ll give them one more week of my free time.
Next week I’ll cut all the way back to 40 hours and I’ll take care of myself…because my residents are going to need me in a month, a year.
I’ll damn the broken system and laugh with my residents because I chose and am choosing to be a CNA. Nobody and nothing is taking away my joy in my vocation.

The Unexpected Loss


photo

       

Alice

Accepting and coping with loss is part of the package in our field.  It can be very painful, but often it is the final chapter of the relationship between caregivers and those for whom they care.

There is peace and a kind of beauty in knowing that we have been given the gift and honor of walking with others at the sunset of their days.  For me, it is incredibly special and, while often difficult, I feel blessed to have been a part of their journey, however briefly.

For the most part, such loss is not shocking. I work with people who have been living with long illnesses or who have slowly declined. Usually there is time, however fleeting, to prepare. To say goodbye.  The unexpected loss, though, is a very different beast.  I lost a resident this week. A funny, spunky and relatively healthy resident. A woman so full of humor and life that nothing could keep her down; the very definition of survivor.

“I didn’t see it coming. This makes no sense. I never saw it coming.” The thought looped through my head for the remaining seven hours left to my shift on the day I found out. It repeated so often through my mind, that by the end of the day, the words ceased to have any coherent meaning. It is the sort of loss that sucks all the air out of you.  I saw my shell-shocked disbelief mirrored in the eyes of my fellow CNA’s and knew they were feeling the same way. But there was work to be done, and life on the floor does not stop for grief, unexpected loss or not.

The way we cope with such loss, as caregivers, is varied, individual and personal. Some hold onto gallows humor, some of the greener ones simply fall apart for awhile, some get angry. As for me, I find it best to stay busy. I compartmentalize, but I also make sure that those who are gone are remembered.

I didn’t see it coming. That means my residents didn’t see it coming either. If I am struggling with this, then so are they.  It is through helping them accept and find peace with such a painful situation that I find peace and acceptance for myself.