Category Archives: new job

Worth the Hassle: the Importance of Training

Sunflower

May

“I hate training!” says my coworker. “I really, really hate it. I mean, all it does is slow you down! I can’t get my work done while somebody’s following me around like a puppy. It’s just a hassle.”

“I get your point,” I say slowly…and I do. I really do. Training slows you down. You’ve got to stop and explain everything that has become muscle memory or second nature to you. You’ve got to watch people try to do things the wrong way, the way you’ve learned is no good. You have to hear all these “new ideas” that you’ve heard a thousand times before. You’ve got to watch the shock roll through the new person, as they stumble upon the grief, the horror and the frustrations that still eat away at you.

You’ve got to be patient.

And that is much easier said than done! It’s hard to be patient; it’s hard to let go of that frantic timer inside our heads. It’s hard to take the time to explain everything the right way. It’s just plain hard to find time, period. And it’s a bit discouraging: to take all the time out for the newbies, to be patient and then to have so many newbies just walk away…often without giving notice.

All that time and energy you invested in them: gone and all for nothing. Oh well. Try again and better luck next time.

Is it any wonder that so many aides just say: “Screw the next time! Why bother?” Yeah…I get her point. Training is quite a hassle, when you put it like that. And yet–and yet, even while I get her point, I can’t agree with her.

Attitudes like that are the reason so many new aides are left to flounder. It’s sink or swim in the nursing home; if you’re not perfect right off the bat it’s out the door with you! How many potential good aides do we bury under the  never-ending landslide? How many potential good aides walk away in a fit of frustration?

How many potential advocates do we silence in our own impatience?

Yeah, training takes time and energy…time and energy we often don’t actually have. True, not every newbie I train is going to stick with it; not every newbie I train is actually going to be worth the effort of training. But for the ones that are good, for the ones who stay, the ones who will become advocates and caregivers of quality…

Oh, yeah. You are definitely worth the hassle. Please come. Please bear with me as I try to snatch the time to dance on the ropes of long term care so you don’t fall.

 

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.

New Beginnings

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Alice

This is going to be awesome. That’s the thought I kept repeating to myself as I walked up the drive way to the gigantic and imposing house of my new client. And I did believe that. At least the part of me that wasn’t filled with anxiety believed it.

       This is my second job as a home health caregiver. It comes at the heels of my first gig in home care which led to…well, it led to Long Island for God sakes. And to many many first time experiences, all of which were eye-opening and incredible, but none of which were easy.  So you can understand why my perception of home care was a little askew. I just had no idea what to expect.

         Mainly, I was incredibly grateful that this opportunity came about. I can’t be without work. I’m a CNA. We don’t have financial safety nets. We’re lucky to cover the electric bill. So, this is where I landed and I’m thankfully still on my feet.

        Still, even after all this time, I get nervous when meeting a new resident or client. It’s an awkward dance. There is no graceful way of saying “Hi! It’s nice to meet you! I will be with you in your most vulnerable moments. I hope you like me!” But that’s also my favorite part of the job; the building of a mutual trust and connecting deeply because of it. Some of my most valued moments have arisen due to the unique caregiver/client relationship. You have to learn each other.

       This is going to be awesome. I took a deep breath and knocked on the door. As my new client’s husband showed me around, I noticed a big magnet on the fridge. It read “Well behaved women rarely make history.” I smiled to myself. Oh we are going to get along just fine!

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 Dynamics of Dementia

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Alice

  Dementia. A chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning. Such a clinical and concise definition for a condition that wreaks such emotional, mental and physical havoc. I hate the disease. I hate what it does to those living with it and their families. It’s a vicious, unrelenting condition that robs people of their very essence.

        For years, I worked in facilities where the heart breaking reality for my residents living with this disease was that they either outlived or were essentially abandoned by their families. It was in this environment that I realized that I love and admire those living with dementia more than I hate the disease itself.

        It’s their courage. It never failed to amaze me, especially in the early stages, when they are aware that they are foggy. They are aware that they are losing pieces of themselves. Can you imagine the sheer bravery it takes just to live with that knowledge? Just to get up and face the day? I knew then that I wanted to do everything within my power to make their lives as full and meaningful as possible.

          My daddy used to beat my momma. I just can’t handle it. I’m too busy. He never bothered with us when he was well…I’ve heard countless reasons as to why these folks have ended up in a facility over the years. I am not discounting or judging the difficulties for the families. Sometimes a facility is the best solution. Sometimes it’s the only solution. As a caregiver, it’s very clear cut for me. ANYONE who lives with such a condition, regardless of their history or past mistakes, deserves the utmost respect and best possible quality of care. End of story. We do not pick our residents.

       Now I’m in a new environment. I have one client with a family who is very involved. Very invested. It really is an amazing dynamic. After so many years in a facility, I forget at times that the family may not know my reasonings for certain actions. My client was having a tough day. She was in her wheelchair but was rummaging and reaching for everything she saw on the floor. As a caregiver, I knew it was going to be a day that required extra close supervision. I quickly assessed potential fall risks, higher difficulty in transfers, and came up with a mental list of therapeutic redirection ideas that I could employ. All of these tools are second nature to me, almost muscle memory, so I didn’t articulate it. When a family member asked why I was staying so close by her, I told him that I didn’t want her to fall and left it at that. Later, when I was discussing her day and her mobility in more detail, I saw the light of understanding in his eyes. He then understood the potential for a head injury if she tumbled out of her chair while reaching for something on the floor. That those incidents can happen quickly if I’m not on top of it. I took for granted that “I didn’t want her to fall” was enough of an explanation simply because I was used to working in a facility where such knowledge is commonplace. These are the sort of teachable moments that I am finding incredibly valuable! In the process of explaining such situations to the family, I am reviewing the knowledge for myself. Almost like a refresher course. Muscle memory is nice, but the ability to articulate, employ and address such challenges with conscious awareness is much more valuable.

        Dementia is a family illness. There are good days and bad, but much like addiction, it affects the family unit as a whole. I stress the need for self care. I love this family’s enthusiasm and willingness. I love their honest desire to learn all they can about the nature of this illness. I love my client.

      Caregiving to me is more of an art than a science, especially when it involves dementia. With love, communication, consistency and support, we can make massive strides towards improving the quality of life for those in our care. The first step is seeing the person instead of the illness with which they live. The family unit is the biggest key to this. I value their input and opinions every bit as much as they value mine. There is gold in their memories; information that I can use when redirecting. They know her fears, taste in music, favorite foods, potential triggers. I feel part of a team effort whose sole intention is to provide the best quality of life for someone we all care about. We are united in that common goal.

       There are 7.7 million new cases of dementia every year. I am very blessed to be in the position to see how good intentions and proactive decisions from a core group of caring family members can positively impact the life of one. To be a part of such an experience is deeply enriching.

A Brave New World

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Alice

      One client. For the first time in years, I don’t have twenty or thirty people calling my name. It’s an adjustment. This new adventure comes with its own set of challenges and teachable moments.

       First, the environment is totally different. Sounds like a no brainer, right? OF COURSE it is, Alice! A home verses a facility? Duh! I expected it to be different. I didn’t expect it to be quite as challenging to maneuver around those differences. Small bathrooms. Carpets. Less space. They all require different transfers and tricks in mobility than in a facility in order to keep my client as safe as possible. And I’m learning by doing. It’s much more of a team effort too. In a facility, as much as we like to foster independence, due to time restraints, I had to do the bulk of the work for the residents. One on one care is different. I don’t have to rush and it’s an entirely new pace for me. I have time to learn what my client is capable of doing for herself and with what activities she needs extensive assistance. It’s a very different scope of expectations and I feel a bit like a fish out of water.

       I’m blessed to be working with a family who is both very invested and committed. This is new for everyone involved. It is their first experience moving an ailing loved one into their home and it’s my first experience working within a home. We are all learning this together, which is equal parts exciting and terrifying. There are physical therapy visits and occupational therapy visits. It’s a brand new environment for all of us.

       The woman for whom I am caring is funny, feisty and for the most part oriented to her surroundings. In fact, considering all of the constant changes, she has been handling the upheaval remarkably well. I attribute that to being surrounded by a family that loves her very much.

      Right now is a time of transition for me and that feels overwhelming but I am excited and optimistic about this new experience; both what I can bring to the client and her family and what I can learn from them. It’s very different, but no one ever learns from staying in one space. “Different” may be just what the doctor ordered.