Category Archives: culture change

A Break before a Breakdown ; a moment to reflect


Alice
I get so tired sometimes. I want to shrink from this world that seems to subsist and thrive on anger, panic and fear. Has it always been this way and I’ve just been oblivious to the fever of it or is this some new beast fueled by everyone’s absolute certainty that they are right? The days of context and nuance seem to be gone for the moment and shades of grey no longer exist. Black or white. Right or wrong. Bottom line thinking for an end results world.
I am never very certain about very much. In my experience, that way lies madness. I have certain ethical guidelines and passions that anchor me and I try to keep my mind open to learning from others who have different points of view. Work has been vital for my sanity in this social climate where people seem to be filling some inner need by yelling at one another and coming up with shallow, half-hearted and blame-filled excuses to the deep and complex problems that our society is facing. I guess that’s easier and less satisfying than putting aside anger and wounded egos in order to come together and effectively work toward common solutions. We currently live in a world where everyone wants to be the boss but no one wants to lead.
Those of us who work in Long Term Care are no strangers to the damage such a management style causes. It’s flat out ineffective. The best supervisors are the ones who roll up their sleeves regardless of who is watching. If I only see you when state is in the building, I’m less likely to trust you around those in my care. I have more respect for an LPN who will help me calm a resident who is lashing out in fear than a career administrator with degrees on the wall who’s first solution is Ativan because she’s about to give a tour to a potential new client and wants the hall orderly. That is the difference between a leader and a boss. Because I find my own personal standards of quality care to be much higher than what is expected of us, I have no need for a boss. I learn from leaders, however, and that makes them as invaluable as they are rare.
I decided to step back from Facebook for a little while. Every other status I read is angry. Every article posted has completely different facts cherry picked to enrage or validate you depending on what side of the given position you take. They all agree that everything is the absolute worst. The only difference is who they believe is to blame…and all of that is crap. Cynical, self serving crap wrapped in a bow made of ego.
But, Alice! Aren’t you concerned about the state of affairs?! Of course I am, possibly shocked and appalled reader, but here’s the thing…this is NOWHERE NEAR as bad as it’s been. In my years in this field I’ve cared for people of color who actually lived through the civil rights era. I’ve cared for a Vietnam vet who lost his sight, and a WWII vet who lost his leg. I’ve cared for people who were children during the Great Depression and for people who lived through the Cold War. I’ve had women in my care who lived in a time when it was more socially acceptable to be an abused wife than a divorced woman. Collectively, we survived all of that. As a society, we have faced our worst behaviors and bit by bit we have grown from them; progressed step by painful step forward. I refuse to believe that this…this angry, entitled, backwards thinking reality we are all actively creating is going to stick. I have more faith in us than that.
Individuals are all more than one thing. Are my residents simply their Alzheimer’s disease? Or prostate cancer? Or schizophrenia? Are they not bigger than that? Am I not more than my political affiliation? Is it not beautiful that we are all people who bleed the same? It is a combination of different ideas and individual experiences that gives life it’s richness. When did we decide that we should only surround ourselves with those who look, think, believe and behave exactly like us? How can we possibly come up with and solutions to vastly complex issues without the benefit of diverse ideas and the freedom to dissent without fear?
So I would like to thank every single person who has ever been in my care for teaching me gratitude and perspective. Life is too short to waste on fear and anger over troubles that we create or stir up in our minds before they even occur. I would also like to thank you for living through adversity and sharing your stories so I know what courage looks like. I would like to thank my fellow caregivers who adapt to the reality on the floor rather than the one we are told to expect. We come together to make the most of what is rather than complain about what should be…ok to be fair sometimes we do both but for the most part we are about action. It is a diverse world on the floor, full of people from all walks of life with a variety of skills and reasons for being in this field. Despite what some may think, we cannot all be painted with one brush and for that I am incredibly thankful. This field has honed a strength in me that would not have developed otherwise and directed a passion for purpose toward a path where it would be put to good use. I get tired, but I’m one of the lucky ones. I get these reminders at least five nights a week. I can step back from the combative and fear filled world online and reorient myself to the world in which I live.

A Wide Movement

May

As I talk about CNA Edge more, there’s a question that keeps coming up: for whom am I writing? What is my target audience?

Whenever I’m asked, my initial reaction is always: “My audience is whoever reads it”.
But that’s a vague answer at best, and no answer at worst. There are some who tell me I should focus more on reaching policy-makers and people in positions of power. And I can follow their line of thinking and I agree with their points: there is a divide between direct care workers and those at the top. That divide hurts our residents, often badly. So yes, I would love to reach more policy-makers.
But not at the expense of also my reaching my fellow CNAs. To put it another way, I do not want to be the sole spokesperson for CNAs to policy-makers and administrators. 

Policies can change. Rules and regulations can be changed with administrations, and then swept away with the next changing wind of politics. I am not dismissing the importance of good policies and those who work so hard to affect change for long-term care. We need people fighting for good policies, and for responsible leadership. We also need people fighting to change the way CNAs think about themselves, to throw off the label of “nothing but an ass-wiper”. If I can do that, then I am not alone. One or even three CNAs speaking up can be ignored. We could even be silenced. How about one hundred CNAs? Or three hundred? How about a thousand, or a million?
That starts by letting CNAs everywhere know that they are not alone. Sometimes I think the worst affect of this broken system is that it makes people who work so closely with others feel utterly alone. We, who have the power to deeply impact the lives of our resident, are often made to feel helpless by all that we cannot change. We feel alone, helpless and burnt out. Silence and sullenness can and do follow.
But together and aloud…what can’t we achieve?
I do not ever want to talk over the heads of my fellow caregivers. I refuse to fall into the trap of thinking that I am somehow more than they are, or that they are something less than me. If I am intelligent, compassionate and eloquent, that does not make me unique among caregivers. Actually, I’d argue that makes me about average. If I stand out, it’s only because I speak out.

What we need now is change, both on a personal level and on a larger cultural one. Compassion, common sense, communication and critical thinking have got to be infused into this broken system. We have to have people dedicated to change on every rung of the ladder…including the one belonging to CNAs.
Just like a democracy cannot function without the active participation of ordinary citizens, neither can our long-term care system function without a principled and vocal base of direct care workers. CNAs who are willing and able to speak up for themselves and their residents.

Nursing-home-made

Sunflower May

In compliance with HIPAA, all resident names and identifying details have been altered or removed. 

It’s funny, how a person’s possessions can tell us so much about them. Most new residents come in with very little: just the clothes they wore in the hospital and maybe a small bag. Then, their families either start bringing in loads of stuff…or they don’t. I have seen rooms so crammed full of personal mementoes that it’s hard to care for the resident; so many clothes in the closet that the door won’t shut and every surface covered with knick-knacks.
I have also seen rooms bare weeks after the resident moved in, the only proof of occupation being the person in the bed. Only a few clothes, no knick-knacks…no decorations or pictures.

Mrs. L seems to be one of the latter category. After a week, she still only has the one bag that she had clutched so tightly on the first day, plus a couple outfits. They’re nice, but the kind of nice that has been worn for years and years. Her family comes often, but they seem more stressed each time and their visits get progressively shorter.
There’s always a learning curve, some time required to start feeling comfortable in the new environment…but Mrs. L doesn’t appear to be adjusting at all. She won’t leave the room, she hardly eats and from what I can tell, she seems to spend most of her days screaming into her phone and crying. I decide I can’t kept walking past such agony. We don’t know each other very well, but that’s about to change.
“Hey, can I sit down?” I ask, walking into her room and gesturing to the empty chair (provided by the facility) that sits by her bedside. She shrugs and I take that as permission. Good Lord, but it feels wonderful to get off my feet.
“I’m May, if I haven’t introduced myself before,” I add…although I’ve introduced every day this week. “Do you need anything?”
She shakes her head. I’m trying to decide between asking another question and telling a story about myself when she suddenly starts talking.
“You can’t help, nobody can help. Can you make me better? Can you tell the insurance company not to be assholes? Can you give my family a fortune so they won’t have to sell my house to afford ‘getting me the help I need’? Can you buy back everything of mine they had to sell, so I don’t have to look at bare walls while I wait to die?”

I can’t. I can’t wave a magic wand and sort out the economy, endow her with the money she needs to have a good life even though she is now elderly and disabled.
The only magic I have at my disposal are my imagination and my hands. I stay for a few minutes, now holding her hand as she cries yet again, then I slide off the chair and leave the room.
It only takes a few words in the right ears. When I come back, I’m not alone and we aren’t empty-handed.
We disperse over the room, laying out our various offerings. The Laundry department brought up clothes that have been donated to the nursing (usually by families of resident who have passed away in our care); Activities gave several left-over decorations from the various Arts-and-Crafts over the years. Nursing gathered personal care items from the supply room and arranged them in her drawers. Staff from every department drew pictures and scribbled down nursing-home-made Get Well cards…but the best bit came from a fellow resident. She heard of my cheering-up campaign and told me to pick out the prettiest flowers from the bouquet she got for her birthday and give them to that “poor lady”.

Small acts of kindness in Long-Term Care are not whistling in the dark. With each act of compassion, we light a candle. True, it will take a lot more candles than I can personally light to lift the shadow of greed from our broken system…but that’s the funny thing about kindness. Even when it’s not enough to turn the tide, change the culture or right the wrongs of this world––it is still appreciated and it can still mean the world to that one person.

My hope is that, one day, we will have more to give than what we can scrape up. I hope that one day, compassion will be considered along with costs, that questions of ethics will be given equal standing with questions of economics. 

Laughing together

 

Sunflower May

In compliance with HIPAA, all names and identifying details have been altered or removed to protect patient privacy.
It’s funny that we call the oncoming shift our “relief”. Funny and yet oh-so appropriate. Right now I am so relieved that I hug the poor woman as soon as I spot her on the hall.
“Oh, crap,” she gasps. “Let me go clock out if it’s that bad!”
“Some say the world will end in fire, some say in ice,” I tell her. “Clearly, they’ve never been to a nursing home or they would know it’s going to end in shit.”
We just look at each other and burst into laughter. It’s not quiet either, a soft chuckle and back work. It’s the kind of laughter that has us both leaning against the wall for support.
Just our luck, the strictest of the management team happens to walk down just then. She raises her eyebrows at our “lounging” posture and we push off the wall so fast I get a bit dizzy.
“What has you both so tickled?” she asks drily.
I glance over to my relief for some moral support, then grudgingly repeat the joke.
Our hard-ass, straight-laced management person doesn’t laugh. She doesn’t even smile, she just says in the same dry tone: “Clearly. What did they feed these people last night?”
“Corn,” I say promptly. “I felt a bit like a gold panner today.”
“Gross!” exclaim both the other CNA and office person.
“Not as gross as what else was in there,” I counter.
Then, all three of us are laughing, leaning against the wall for support.
<oOo>

Sometimes it easy to get lost in the trenches. We line up on opposite sides, slap labels over the other’s face.
Housekeeper.
Cook.
Administrator.
Supervisor.
First shift CNA.
Second shift CNA.
Third shift CNA.
New CNA.
Student.
Resident.
“Those” residents.
Labels are nifty little things, handles by which grab on to something. The trouble comes when we forget to look beyond the handle to see what it is we’ve actually picked up.
Another human being. A person who laughs and cries, the same as us. A person who laughs at your exhausted attempt at humor.
At its best, laughter is the best medicine. Laughter can connect us, transcend the labels and jump the lines.
It’s really hard to give good care all by yourself in this system. Having allies by your side, someone to lighten the load, relieve you and sometimes just not punish you for a moment’s breather…those things really go a long way. Those things are what allow me to survive long enough to have those personal moments with my residents that renew my passion for this field.

One Voice, One Vote: Why Bother?

Sunflower May

I hate election time. I’ve come to absolutely despise all the political ads, all the fear-based rhetoric and emotional responses that seem to wash away all traces of common sense from both sides of the political spectrum. Working in a nursing home, it’s hard to get away from the political reality: TVs blare from every room and, supported as the Long-Term Care system is by the political one, it’s hard to forget that election season and its results could/will have a direct impact on my work environment.
I just can’t get away from this election, not even while I am passing out lunch trays to my folks. As I enter Mr. U’s room, the first thing I see is his TV on, set on a news channel where they are, once again, talking about the election. And in the room itself, fat stacks of political ads litter the bedside table, leaving nowhere to set his tray. As I sift through faces and promises, trying to make enough room for his lunch, I have to wonder: how did my residents get on all these mailing lists?
I’m so sick of this election and I can hear that frustration seeping into my voice as I announce the presence of food to Mr. U.
“Thanks,” he replies, never moving his gaze from the TV. “Hey, little girl, are you voting on Election Day?”
I nod. Politics is always a dangerous subject, but this isn’t exactly politics, I guess.
He frowns and shifts around slightly in his wheelchair. “Are you going to vote?” he repeats, a bit louder this time, every word slow and distinct…for all the wold as I am the one with hearing loss. Apparently, he wants a real answer: the kind spoken out loud. Suddenly I am reminded of all our previous conversations, conversations that reveal his still-fierce passion for social justice. His face is lined, his skin wrinkled and his body weak…but his eyes still shine brightly, all the more intense for the rest that has been forced upon him.
“Yes,” I say. “As much as I grumble, I’m not sure it would be…appropriate for me to pass. I mean, there have been too many people who have fought, died and sacrificed for my freedom for me to just sit on my ass at home.”
“That’s right,” he says approvingly. “Ignore the noise, forget all these negative ads and remember: what is your right will always be your responsibility. I’m gonna kick your butt if I find out you didn’t vote, little girl!”

∞oOo∞

As a CNA, I often feel powerless. I am at the bottom of the food chain: in a position to see many wrongs, but not in a position that makes it easy to correct those wrongs. There’s only so much I can do, and what is within my power often seems so small: nothing more than a trickle of water seeping between the stones of a dam. Why bother? Why keep speaking out, why keep writing and trying, breaking my heart as often as not? I am only one CNA, one American with one voice and one vote. What difference can I possibly make? How can my voice and my vote make any difference whatsoever?

The worst part about the systems and mindsets that make us feel powerless: they make us forget what little power we have. When we listen to the voices that whisper “Why bother?”, when we throw up our hands and walk away with our words all left unspoken, it is not one voice and one vote that has been silenced. It is nothing less than a victory for the systems and persons who would indeed make us powerless. Feeling powerless is the first step to actually becoming powerless. Perhaps it is not so much, this freedom of speech and this freedom to vote. Perhaps I am not so very important, but I am one of many.

Silence spreads like wildfire…but so does liberty. I am an American…I have the freedom to vote, to have my voice heard in the election of my leaders. No matter who is elected, I am not powerless. I will not be silenced or shackled, either because I am a woman or because I am “just” a CNA. My voice has weight and my opinion has value no matter my socioeconomic standing. I urge you, my fellow CNAs…do not be silent. Do not forget the power that has been bought for us by the sacrifices of those who have come before, and the sacrifices we ourselves have made. Always remember: what is our right is also our responsibility. We are not powerless and we will not be made to feel so anymore.
Go out and vote. Make your voice heard. Do not be swayed by fear or fancy rhetoric. Do your research and make up your own mind about which candidates you wish to be your leaders. And never, ever forget: no matter who wins this election, it does not absolve us of our responsibility to keep speaking out for those who cannot. What is our right will always be our responsibility…what wrongs we see, we must work to right. Vote for peace and prosperity, for compassion and communication, for empathy and intelligence. Vote for the whichever candidate you feel will be more willing to embrace the qualities we have learned to value most as caregivers of the elderly and disabled.

Do not surrender your ability to think for yourself to the politicians. Our freedom to vote is our birthright, so let it be your reason and not your fear that cast the ballot. Freedom…it’s far too precious to waste on an opinion that someone told you was the right thing.

Back to the Floor

May.                          Sunflower

It would appear as though my residents missed me.
To show how much they missed me (or perhaps to convince me never to go away again), they’ve apparently decided to throw a call-light party, complete with a few alarms…you know, just to complete the experience. The party entertainment seems to be in the form of the guest of honor, aka me, running around like a chicken with its head cut off. I’m running from room to room, sweat dripping off me and breathing hard; it’s been non-stop all day long–and the day is still young. This shift ain’t over yet and I already feel as though I need another vacation. No sooner do I answer one light than five more go off.
This is getting ridiculous.
I swing into the next room, turn off the call light and ask (in a slightly breathless voice): “Whatcha need? Are you ready to get up now?”
“No,” says Mrs. H. “Not ready to get up yet.”
“Okay then, ring again when you’re ready, good to see you and bye!”
“Stop!!” she shrieks. “Come back here!”
I stop as ordered, skidding forward just a bit from excessive momentum. Thankfully the door frame is there to help me redirect back into the room. “Yes?” I ask.
“Sit down,” she says, or rather, orders. “Sit down and tell me about your vacation. I haven’t seen you in a week!”
“That’s why you put on the call light?”
“Well, duh! I heard your voice out there and figured you were back. So sit down little girl and tell me all about your trip.”
I glance out in the hall. There’s only one other call light going off and I catch a glimpse of my hall partner heading towards it…so I close the door and sit down as requested/ordered. “It’ll have to be quick,” I tell Mrs. H. She nods and settles back against her pillows, eagerly awaiting my story.
I grin. Ah, yes. The best and worst of my job were waiting for me today: everything I can’t stand and everything I love both wrapped up in this one shift, my first back from vacation. Still, it’s good to be back.

If I had to pick one word to describe the Pioneer Network Conference, I would have to go with “thought-provoking”. (Then I’d have to argue that yes, that is one word thanks to the hyphen, thank you very much, Grammar hounds.)
Over the course of four days, I had so much information thrown at me, engaged in so many conversations, asked and answered so many questions…it was a lot.
I learned new things.
I received confirmation for ideas I’ve long held without any proof.
I heard things that made me change my mind on certain issues.
I listened to arguments for certain things that did not change my mind, but showed me how other people were convinced.
I walked away with a thousand ideas for change, and 30 or so blog post ideas.

It was rather odd, sitting shoulder-to-shoulder with administrators, DONs, ombudsmen, policy makers, and other people whose spheres of influence are much larger than my own. It was odd, noticing that we took notes at the same time during a session. I guess I had rather expected to feel small, sitting with the movers and shakers, but I didn’t. Different, maybe, but not smaller. Perhaps that was the best part of the conference: hearing other people’s perspectives and actually listening. Having other people listen to my perspective.
My sphere of influence might be comparatively small, but it does have the advantage of being personal. I can’t change whole long term care facilities, or alter policies or build new facilities based on new models of care…but I can adjust my own personal style of caregiving to better suit the needs of my folks. I can take the big picture things I’ve learned and use them to make the day-to-day lives of my residents better. I can use what I’ve learned to stretch my own assumptions and perspective, use them to formulate and articulate new blog posts.
It might only make a difference to a few people, but it will make a world of difference to those few…and that’s totally worth it for me.

In the end, it’s the people who are important. The system should serve the people, not steam-roll them into molds with labels slapped on top. For me, the system will only be fixed when it empowers people to do and be their best whatever their role, whether it be resident, CNA, DON, RN, administrator or policy makers. For me, the best system is the one that encourages connections between people, no matter their social status or job title.
Systems break down, technology becomes outdated, but those personal connections?
That’s always been the thing at the heart of caregiving. It’s certainly why I do what I do.

Alice in Wonderland

The thoughts flit through my mind at a dizzying pace, a kaleidoscope of colors and frenzied impressions that dance around the idea of what could be and what already is. We are in New Orleans. The Big Easy. A city that has no shortage of whimsy and magic in its own right but to be here to present to the world our writing? To be given a platform in which we can shout our truths in the hopes of reaching others on our path to deep, meaningful and lasting change?…that’s surreal.
It wasn’t an accident that I chose “Alice” for my pseudonym. As a child, Alice in Wonderland was my least favorite fairytale. It made no sense. I much preferred Robin Hood. Now THAT was a story I could sink my teeth into. So, it came as a quite a surprise to me that after a great amount of life experience, I awoke one day in my mid thirties only to realize that my LIFE was wonderland and I am indeed Alice.
Call it fate, providence or synchronicity, I never believed it was an accident that I crossed paths with Yang and May. The odds of meeting two like minded caregivers across the country with such an amazing talent for writing and dedication to expressing truth and impacting change would be slim in any case, but the fact that we have worked together fluidly for two years without meeting one another until this week? The fact that our different styles and voices flow together in a way that is harmonious rather than clashing? The odds of us being offered such an opportunity by the Pioneer Network to speak out and reach others? No. That is more than coincidental.
Sir Arthur Conan Doyle said that if you eliminate the impossible, whatever remains, however improbable, must be the truth. The truth, as I see it, is this: We are on a path that is uniquely suited to us. We have not only the opportunity but the obligation to follow through to wherever this journey may lead and in doing so, we will impact the lives of the most vulnerable among us for the better. We will impact our OWN lives for the better and what we learn on the way will forever enrich us in ways that we cannot imagine. This I know to be true.
Lasting change may not happen on my timeframe but it does happen. I cannot properly express how grateful I am to the Pioneer Network, everyone involved and all who attended, for seeing in us the message that fits so perfectly with their vision or Yang and May for being such a vital part of my life or how much hope our collaboration has brought me these past two years. I only know that the three of us will continue to speak our truths, shouting it when necessary and as much as we can, be the voice for those locked in this deeply flawed system. We will never give up. Of that, I am absolutely certain.
As I sit outside, watching this whimsical city in all its wonders, I feel bittersweet about leaving in the morning. This conference has been the biggest and most fulfilling achievement of my life and it’s sad that it’s almost over. But in my heart of hearts I know it is but the first step of a journey that is sure to be a thousand miles and I am so excited to be a part of whatever comes next. In the meantime, we will continue to write and remind you, our readers…our friends, that each and every one of you matter and each and every one of you can and do make a difference. So don’t ever let the world convince you otherwise. Shine on, my friends!