Category Archives: supervisors

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.

Bad Boss Part 2: Consistent or Crazy

Sunflower

May

I tip my chair back, enjoying this. I had to take my lunch late due to craziness on the hall and it appears as though I wasn’t the only one. The break room is packed; everyone is eating and enjoying this chance to relax. Conversation is flowing smoothly–we’ve hit on a great topic, one with legs that could run around the world.
“Oh, I’ve got one and it’ll top May’s story!” T says between bites of her casserole. “So I had this supervisor once, who decided she was going to ‘whip us into shape’. She started disciplining people up over rules that hadn’t been enforced in so long that we’d forgotten what they were. So here she is, a holy terror over everything…until one day she asked why we were so short every shift. Then we had to remind her she’d fired half the staff.”
I choke on my baked potato. “Yeah, I’d say that tops mine.”
“You’d think she would have noticed,” mutters A.
“At least she was trying,” says P, a new aide. I haven’t known her long enough to decide if she’s optimistic or naive.
“The problem,” I sigh, “is consistency. At some point, even a crazy boss is tolerable…as long as they are consistent. If I’m allowed to do something on Monday, I’d at least like to know that I’m not going to get in trouble over it on Wednesday.”
“Only for the boss to decide that the next aide can get away with it on Friday,” T finishes.
“Hard to toe the line when it keeps shifting under your feet,” A agrees. “So which do you all think is better: the boss who never comes out of the office and lets the staff get away with anything or a micromanager?”
“I don’t know about better,” P says, “but based off your stories, I’d rather deal with an absent boss than one who is all up in my business.”
“Yeah, second that,” I say. “I’ve had enough bad bosses to learn it’s best if I just take personal responsibility for my own work ethic.”
T shakes her head slowly, like she’s thinking really hard. “That works for you–and everyone in this room–but what about the bad aides? The ones who don’t care about the quality of their care?”
Three voices rise in unison: “Then they shouldn’t be CNAs!”
“Which,” I add drily, “means that either we step into the gaps they leave or the residents go without.”
“Those kind of aides should just go flip burgers,” A spits out. “They’d make about the same and our folks wouldn’t suffer from their apathy,” P agrees.
There’s silence for a few minutes. Everyone goes back to chewing their food. Thoughts are churning ceaselessly around in my head and, from the expressions on their faces, the others are thinking just as hard. Eventually P breaks the quiet, an almost desperate look etched on her face. “Please tell me you’ve all at least had one good experience with a supervisor.”
I smile at her. “Of course. Matter of fact, we’ve got a pretty good one now.”
“Yeah,” T agrees. “He’s doesn’t do the drama, doesn’t play games and he helps.”
“He’s looking pretty stressed out lately,” A sighs. “I hope he’s not on his way out.”
All four of us look at each other in horror. Truth is, as much as we boast about our ability to self-direct and self-discipline…it’s nice to have a supervisor who can take up the slack. It’s nice to have someone who will listen when we speak, pull us aside when something needs to be addressed. It’s nice to have rules that don’t change with the wind, nice to have someone who doesn’t play favorites and isn’t afraid to be stern when he needs to be. Who isn’t afraid to joke with us when he doesn’t need to be stern. Who we can trust to be fair.
“Oh, God I hope not,” I say fervently. “Let’s go write him Employee of the Month recommendations before we get back to the floor!”

<oOo>

What makes a bad boss? If only I knew. As it is, I have only guesses…thoughts inspired from seeing events from below, glimpses into Management through cracks in the floor. I can only assume it’s the same stresses that make a bad aide. There’s too much to do, not enough time to do and precious recognition or thanks. It’s an impossible job. Only instead of taking care of far too many people for far too many hours, they are juggling the constantly changing demands of Medicare, Medicaid and the Health Department–and keeping the floor in some semblance of function.

There’s also disconnect between the care plans and the living people they represent. It’s a disconnect that in some ways can’t be helped in the current system. Charts can’t convey the reality of long term care, not alone. Accurate documentation of my shift as a CNA would mean writing a novel each day before I go home–there’s just no way to communicate the reality on a glorified spreadsheet.

And in some ways, it’s a disconnect that can very much be helped.

There’s a culture of enforced silence among direct care workers, learned in the dark hours of neglect when speaking up meant losing your job. It’s a habit we’re still trying to break, to speak our truths and tell our stories. There’s a culture of enforced deafness among managers, learned in the dark hours of greed when listening meant being mocked by your peers. It’s a habit we’re still trying to break, to listen with wisdom and compassion.

If all you look at are care plans, then you haven’t seen the person. If all you look at are numbers on page, then you haven’t experienced the toll those ratios take on your employees and residents. The best of bosses know the people they are responsible for, both residents and caregivers. They are the ones who can read on my face when I’m about to break down, who care about me enough to step in and say: “What can I do to help?” But that takes time. That takes energy.

That takes a real dedication and devotion to the art of caregiving. To all good managers and bosses–thank you from the bottom of my heart for all you do and risk for me. It does not go unnoticed and, I hope, does not go un-thanked.

Bad Boss Part 1: “Work Harder”

Sunflower

May

Note: This, like most of my posts, does not tell the story of recent events. I try to chose stories that are a few months (or years) old, although I am usually inspired by recent events or conversations which remind me of the story in question. 

All I get is a whispered warning in the hall: “Watch out for so-and-so [a person of unspecified authority in the nursing home who shall henceforth be called VIP]. She’s on a bit of a power-trip today.”
“Great,” I sigh back. This bit of information has two possible meanings:

  1. The other aide is having a Bad Day, very possibly got talked to about some deficit of care and now thinks everyone’s out to get her or
  2. VIP is actually on a power-trip and I’m going to have to try to be invisible as in addition to being everywhere at once.

We’re already working short today, and seeing as how the next shift is also short, there’s a good possibility I’m going to either be asked or ordered to work a double shift. Again. I really don’t have the energy for any more drama, I really, really don’t.
“May!”
I swing around, startled and resist the impulse to shout: “Speak of the devil!” However applicable the phrase, I fear the wording would not go down well.
“I need to see you,” VIP says. She’s dressed to the nines today, I notice and mentally calculate the cost of her outfit and accessories to be roughly a month’s worth of my wages. With, you know, the usual amount of overtime thrown in.
“Okay,” I say, bracing myself for anything.
“May, I don’t want to hear anyone saying that we are ‘short-staffed’ today or any iteration of it,” she says. “We are not. We are still within acceptable and legal ratios.” Well, technically, in our state there’s no safe staffing requirements for direct care workers/CNAs…that might very well be legal, but it’s no help on the floor…no requirements that I can find, any way. She might as well say “It’s after breakfast” when asked for the time; it’s perfectly true and very little help in figuring out if you’ve missed your favorite show. “If I hear anyone saying ‘we are short today’, or any iteration thereof, or even a mention of how difficult it is today, I will be writing up that person. Understood?”
“What am I supposed to tell my residents when they ask why I’m taking so long to get to them?”
“You’re just going to have to do your best and not let them even notice,” she says. “We do not need to be adding to their burdens because you have a few extra people today. They shouldn’t even notice a difference, it’s only four people more per group. Understood?”
I nod. Well, I’ve only been forbidden to say a few phrases: how rough can it be?

As it turns out, the only thing worse than working short of staff is being forbidden to mention this factoid.
“May, I put on my call light half an hour ago, where have you been?”
“May, this person is soaked. Why haven’t you changed him?”
“May, why isn’t this person up for the meal? What do you mean, there’s nobody available to help you with the hoyer?”
“May, why can’t you help me right now?”
“Where the hell have you been, you lazy bitch? I’ve been waiting for my shower for an hour!”
It’s chaos. I rush through my shift, begging for understanding from my folks and unable to explain why it is taking me so long to get to them. Words have always been my best weapon and I suddenly feel shackled, having been forbidden to use my words to coax or cajole patience and empathy from my folks. And I really don’t think just coming out and saying “we’re short today” would be a great shock to the increasingly frustrated and soiled residents. They’re not stupid and (for the most part) they can still count. They can see how quickly I’m running between rooms, that I haven’t stopped for a break yet, that nobody has shown up to help me. Oh, trust me, they know and my refusal to admit the truth is making some of them angry.
They aren’t the only ones. I’ve always been emotional and today has strained my control. I’m running myself ragged, haven’t had a chance to stop and breathe and for my efforts I’ve been screamed at, insulted, cussed out all day. I can’t even blame them, sitting in soiled clothes for almost an hour while I try to take care of everyone who has put on their light first. In a rather disturbing turn of events, I’m apparently having the walking-talking kind of melt-down…perhaps because I don’t have time for the actual sit-down variety. That is to say, tears are leaking from my eyes, but I haven’t stopped working and, rather bewilderingly, I’m still speaking in a semi-normal voice. I’m rushing around, doing my work in fast-forward and all the while, my sweat and tears are mixing on my cheeks. This day can’t get much worse.
I really should know better by now.

I round the corner and VIP is waiting for me. “May,” she says without preamble, “what’s going on? Why is it such chaos today?”
“…” I stammer. What can I possibly say in explanation that won’t get me written up? “I can’t keep up when it’s just me on the hall, okay? There’s just too many of them and I can’t do everything at once. Which is when they want it.”
Her eyes flash…but I never actually used the words “We’re short-staffed today.” This feels so unfair. How can I explain myself after she tied up my words and laid threats against my job?
“May, these residents deserve to have a good day without having to deal with all of our troubles. They’ve earned your best, even under challenging circumstances, so calm down, put on your big girl boots, dig a little deeper and work harder.”
Work harder? What the freaking hell does she think I’ve been doing all this time, sitting on the bathroom floor and crying my heart out? I wish! Oh, how I wish. I’m about to say something that will get me written up for sure, when a call light goes off in the room behind me. Seizing upon this gift from the heavens, I blurt out “Excuse me,” and dart in the room before VIP can say anything else. The resident in the bed looks extremely grumpy.
“May, I asked to get up an hour ago.”
“I’m sorry,” I start to say, but she doesn’t let me finish.
“May,” she says in a very different tone, “are you okay? What’s wrong? Are there not enough of you girls to take care of us today?”
“I’m running behind, but I’ll be okay,” I reply, conscious of VIP on the other side of the door. It’d be just my luck today if she had her ear pressed against the door! My resident doesn’t look like she believes me. I can’t say I blame her: faced with the evidence in the mirror over her sink, I don’t believe myself.
“You’re not okay,” she says firmly, but kindly. “You need to take a break.”
“Don’t have time.”
“Did I ask for your opinion? Did I call for a vote? Now sit down and take a minute to pull yourself together. If anyone asks, we’ll say I had to shit really bad.” That sliver of concern, of human compassion breaks the last of my control and I start to sob in earnest, out loud and quite noisily. I sink down to the floor, half-hidden by her bed, bury my face in my arms and proceed to rage and storm at the injustice of it all.
Who the hell does she think…no, that’s not it. VIP isn’t wrong in what she said. She’s actually got a good point about what my folks deserve…but under these “challenging circumstances” I don’t know how to give them what they deserve. Does she think I want my folks to soil themselves? Does she think I like having my residents sit in their own urine for hours? Does she think I’m not trying my damnedest to push through these challenging circumstances?
She isn’t wrong. She’s got a good point…and yet, it’s hard to hear the words “Work harder” from someone who is calm and collected while I’m weeping silently and uncontrollably. It’s hard to accept criticism from someone who is wearing roughly a month’s worth of my wages on her person, when I’m decidedly not looking my best. I looked at her, then I looked at myself and all I saw were the differences that divided. And I hate that. I hate thinking in binary terms, us and them, the powerful and the powerless. I hate looking at her and seeing only the wealth she’s wearing, the power she holds over me. It shouldn’t be like this. We’re both persons. Everything I believe in says we are equals…but I’m so stressed I can’t even hear my own beliefs in my own head. I hate that the only words reverberating in my mind are those that scream: “She’s on a power-trip and I’m the pavement she’s pounding.” It comes down to trust and right now, I don’t trust VIP to have my back.
Okay, calm down. Breathe in, breathe out. I’m not thinking straight and it’s likely I’m misconstruing her motives or projecting my turmoil onto her. I can’t do that. She’s got a good point, the residents shouldn’t have to bear our burdens…it’s just her approach to the problem was a bit half-baked and she didn’t consider how an overwrought CNA might take her words or choice of expensive accessories.
Calm down. Pull yourself together, if not for her than for your residents.
Because if there’s one thing in this whole mess that I have reason to be upset over, it’s that between a staff member with [unspecified] authority and a resident, it shouldn’t have been the resident who made the sacrifice to give me the time I needed to pull myself together.
When my ten minutes of rage and tears are over, I rise and splash cold water on my face. My resident still looks concerned, but she allows me to get her up and together we leave the room. Back into the chaos, but this time, I am master of myself.

<oOo>

I have been blessed: while I have had experiences with bad bosses (as detailed above), I’ve also had good bosses and, more frequently, decent bosses who were neither great nor terrible. It’s not all horror stories. It’s even mostly horror stories.

But what makes a bad boss? What combination of stresses and personal flaws combine to make a nightmare experience for those who work under these people? Sometimes it’s hard to remember, especially in the moment, that a bad boss is still just a person and not evil incarnate…a flawed human being, same as yourself. It just so happens that their flaws have the power to make your life a living hell while you labor under their authority.

The definition of “unhelpful”

Sunflower

May

I wish I could turn invisible. I wish I could turn back time and shove a washcloth in the nurse’s mouth. I wish she could read minds so she would have caught my frantic thought of “oh, God, please don’t say it”. I wish all these other people weren’t clustered all around. I wish they’d go back to glaring at her and leave me out of it. I wish she’d leave me out of it.
Perhaps she thinks it was a nice thing to say. Perhaps she thinks it was helpful.

It was not. The dictionary definition of “unhelpful” ought to include a picture of this moment, I think savagely. Perhaps it’s true, perhaps it’s not; I have a razor-sharp feeling this is question I would do well to avoid answering. Or thinking about much.
I certainly hope it’s not true. If I am the best aide ever as this nurse suggested…out loud and in front of several other CNAs…well, that’s not a very good sign, is it? I know my flaws as an aide better than anybody except the residents who suffer from my shortcomings. I do try, but I would hate to think that my efforts are the pinnacle of CNAdom.

It’s not that I object to being appreciated and valued for the quality of care I provide. I work hard to overcome my shortcomings and the flaws of the system to provide compassionate and competent care. Appreciation is nice, and I do better work with a pinch of it. But I prefer my praise like I prefer my criticism: done in private. No audience. Most particularly, no audience of slighted fellow aides. Please don’t praise me in front of my coworkers without having something good to say about them too. Even if they aren’t quite as…how shall I say this without sounding arrogant…doing as well.
The absolute only thing this singling out does is surround me with unhappy coworkers. Actually, let me restate: the only things this singling out does is surround me with unhappy coworkers and give them an outlet for their misery. Trust me, if the difference between work ethics is apparent to a supervisor, it’s obvious to the workers as well. Pointing it out is not necessary.
And the resulting, um, situation is not conductive to a good work morale. At least, my morale tends to bottom out after a shift of cold shoulders and whispered remarks behind my back (often while I’m still in the room). It’s very hard to work with people who think you’re either a suck-up or a spy.
Being forced to work on your own because a badly timed bit of praise has given your coworkers the impression you think you’re too good for them…that is not going to result in high quality of care for the residents. And the residents are supposedly why we are all here. Well, I’m certainly not here for an ego-trip (there have got to be more socially acceptable and higher paying jobs for that).

Unfortunately or otherwise, the current system is best worked as a team. On my own, it’s hard to push past all the obstacles erected in my way by bottom-line obsessed bureaucrats. With hard-working and stubbornly compassionate CNAs beside me…well, I can conquer this world, defy the system.
Care for my residents. Figure out how to fix long term care.
That’s a more important question than “Who is the best aide of them all?”

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.

Do the right thing, part one

May

It’s the middle of the lunch rush and I have a problem. Mrs. A needs to go to the bathroom.
Well, that’s not quite right. My problem is that Mrs. A desperately needs to go, but she’s having trouble standing up. I’m having trouble supporting her; between the two of us, we can hardly get her bottom off the chair. I seriously don’t know how I’m going to her fully upright, or on the pot.
Again, that’s not fully true. The solution to my current problem is obvious…and right outside the door: the standing lift. Unfortunately, it’s a solution that just brings more problems: in my work place, all mechanical lifts are two-person devices. Using one by yourself is considered unsafe and grounds for immediate termination; we’re also a no-lift facility. If a resident requires lifting, we get the lift and someone to help us. It’s a policy designed to reduce CNA injuries, a policy I applaud.
But right now I have no help and a resident who desperately needs toileting. To make matters worse, her son is in the room, impatiently waiting…he’s never been particularly sympathetic or empathetic to us caregivers. I get the impression that he regards us as little more than vending machines of care. Press C5 for toileting needs, B3 for pain pills. Never mind that I’m not a nurse and can’t give out pills.
“All right, Mrs. A,” I say, “let’s try this one more time.” I’m hoping that she’ll stand up just fine, that my last attempt was a fluke or a test of patience, or something.
It’s not. This woman isn’t going to stand up without strenuous help from me. I know that I can do it, physically. I can pick her up in a bear-hug, wiggle the pants down and get her on the commode. It’s not her fault I have no help and she shouldn’t be punished for something she can’t help.

I do the right thing. I take her back out of the bathroom and explain that I’ll need to go get help. I explain that it might be a moment before I find that help and then I leave, avoiding the son’s irate glare.
After five solid minutes of looking, the first person I find is my nurse, hurrying off the hall.
“Hey, can you help me for a minute?” I ask.
“Can’t. Someone just fell in the dining room. Gotta go.”
Well, darn, I think. Just then a chair alarm sounds and I take off. Mr. W is attempting to put himself on the toilet…at least he can transfer, I think. He’s not very trust-worthy about pulling the call-light when he’s done, so I have to stay with him until he’s done.
Ten minutes later, I emerge back on to the hall, just in time to see my hall partner come out of Mrs. A’s room.
“Oh, good,” I sigh. “I’ve been looking for you. Mrs. A…”
“Is already taken care of,” the other aide interrupts.
“Oh, she stood up okay for you? I was having trouble–”
“So am I, working with a damn by-the-book aide. When are you going to learn, May, that you can’t be such a rule-follower if you expect to get the job done? If you have to pick somebody up, you pick them up. By the way, she’s soaked.”
With that, she walks off and I’m left with another problem. Mrs. A is on the toilet, sure, but I very much doubt that the other aide is going to help me get her off.

I’m right again. Not only is Mrs. A’s son visibly furious with me, Mrs. A is just as weak as she was fifteen minutes ago. And in tears. And soaked with urine.
Damn.
I change her clothes and pull the call-light for help. If I’m honest, I’m furious myself: angry at being called “by-the-book” when I was only trying to protect myself and Mrs. A. I did the right thing, not the selfish thing, as the other aide was implying.
Seven minutes pass before the bathroom door opens.

It’s my supervisor.

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.

Excuses and reasons

 

May

Every time I’ve got gloves and…other stuff…on my hands, my face starts itching.

I’ve no idea whether it’s simply that I notice the itching more when I’m unable to do anything about it, or whether it’s fate playing a cruel joke on a poor CNA. Most days, I’m inclined to suspect the latter.

I suppose that it doesn’t matter, either way. Even the persistent, annoying itch in my eyebrow is small potatoes compared to the fact that I have five minutes before I am “officially late” to the meeting (I’m “actually late” already). I try to hurry as best I can, though I’m rather thinking that a cork, rather a wipe, would be appropriate for this situation.

Eventually, there comes a time when you stop wiping and call it enough. I fasten the new brief, turn her on her side and pull the covers over her.
“I’ll be back soon, okay?” I tell her as I snap off my gloves and turn on the water to wash my hands. This resident hasn’t spoken in weeks, but I swear she doesn’t need to power of speech to express her doubts about the “soon” part. Her eyes continue to bore into my back until I leave the room.
Two minutes later, I’m quick-marching down the hall in that not technically running that I’ve perfected in my time as an aide. It’s one of the ways I got over my green-aide days, by cutting down the time it took me to get from one resident to the next without invoking my administrator’s distaste for “running around in an unprofessional manner”.

Despite my not-running, I’m one of the last to enter the meeting room. I hope for a minute that this at least means I’ll get a seat in the back of the room, but no. Seating is first come, first serve and apparently, we started in the back today. Lucky (late) May gets to sit in the first row, right in front of our special guest. And the DON and administrator, who both raise their eyebrows over my late appearance. I shrug in a half-meek, half-cheeky manner and slide into my seat.

Our guest today is a middle-aged man, dressed in an impeccable fashion. Well, impeccable if he were attending a board meeting; here, he rather sticks out. His suit fits him perfectly and nothing about him is out-of-place. Under his blazer sleeve, I see the glint of a gold watch and his brown shoes are so shiny that I can see my reflection in them. I wince.
In the sleek, expensive leather, my reflection is not flattering. My scrubs are old and faded; my shoes cheap and scuffed. I’d actually done my hair and makeup this morning, but you can’t tell now. Sweat has washed off the makeup and revealed what I was trying to hide: the pale skin and large bags under my eyes, courtesy of two doubles this week. I don’t look professional; I just look tired.
I can’t help the thought: I’d have to work a lot more doubles before I could afford a similar outfit. I try to stop the thought: I know better than to judge someone based only on appearance…but I also know that you dress for who you are trying to impress. Everything about him screams that this man is not really here for the CNAs. In this setting, his clothes do not so much impress and set him apart from us.
I glance around me and I know I’m not the only one who’s noticed. Grumbles sweep the room: there are a lot of us who hover on the poverty line, lots of single mothers working themselves ragged to provide a good life for their children, a lot of us trying to scrape enough to save for school and pay the bills.

Resentment is an ugly thing, but hard to shake…prejudice, even more so.

He clears his throat and begins to talk. I try to stop thinking. He’s here to discuss “time management and job efficiency”. Apparently, ours suck. He doesn’t say it quite like that, of course. He starts with a story about how his office is cluttered and how this ‘negatively affects’ his job performance. Somewhere along the way, he makes the connection between offices and time: how a cluttered office is like misused time. Just like we need a well-organized office to properly do our jobs, we need to manage our time.

Office? I work on the floor–closest thing I have to an office is a bathroom. I shift in my seat, stifle a yawn and think his examples are a bit odd, considering his audience. I’ve never had an office in my whole career. I’ve never had a desk, or a filing cabinet or even a chair. I do have scrub pockets, though.
He goes on at length, citing studies and tying them back to time management policies. He tells us how much room for improvement he sees for us “on the books”.
But that’s all he does: cite studies and tell us what we are doing wrong. He doesn’t give any relevant examples or any insights on how to apply these principles to the world of the floor–where residents crap a ton, tumble out of wheelchairs, slap us in the face, get confused as to we are and where they are. All he does is stand there in his fancy suit and offer us generic slogans and cookie-cutter criticisms.

Oh, crap. I forgot to lay down Mrs. T. I can see her in my mind’s eye, leaning over the right side of her wheelchair, leaning towards a tumble. How did I forget her? Oh, yes, I was dealing with the never-ending squirts. Now there’s a time management conundrum: if you only have ten minutes, do you change the soiled resident or do you lay down the fall-risk? Suddenly, I am all impatience for this meeting to be over, so I can lay down poor Mrs. T.

My attention is jerked back to the meeting by an aide behind me speaking up.
“All that is well and good,” she says drily, “but it ain’t practical. How’s it my fault that I got six people to get up and only an hour to do it in? And you want me to be doing all this other stuff in that same time? Ain’t gonna happen. If that’s mismanagement, it ain’t mine.”
“Well, you will just have to try harder,” he says. “You just need to stop thinking it can’t be done. All this can be done…I’ve been to hundreds of facilities and you’re telling me that this one is so different from all the others I’ve been to?”
Resentment flares up from all corners of the room. Come again? She made a valid point, I thought. At least valid enough to be discussed instead of being dismissed out of hand.
I’m speaking before I’ve half-made up my mind to say.
“Some days, you’re right and we do have time. But she’s also right: good quality care takes time. You can’t tell us to only provide the highest quality care–but be snappy about it. It just doesn’t work that way; especially on the days when we are short-staffed–“
“So you’re telling me that there’s nothing you can do to improve your time management?” he interrupts. “Nothing at all? You are perfect? Because this isn’t going to reflect on me; it’s your job performance that is going to be judged. And being short-staffed is just an excuse, young lady. Just an excuse to not do your best.”

I’ve got so much I want to say that they all get wedged in my throat. Of course there’s stuff I can to ‘improve my time management’. I could not sit with Mrs. W. while she cries–that’d save me ten minutes at least. I could just randomly check boxes when charting instead of accurately recording my shift–that’d be huge time saver! I could cut out the part of my day when I wash everyone’s face…I could not pee for eight, twelve, sixteen hours, whichever one I’m told to work on any given day.
A higher-up clears her throat. “I think what May means is that we do have really crazy shifts and it’s hard to focus on how else we can be doing things when we’re already so far behind. And May, he’s not trying to be mean or harsh. You’re just…tired.”
Tired?
Behind my back, I can feel the heat of resentment washing up from my coworkers. Tired? We’re all tired! And yes, exhaustion does affect our job performance. Sorry about that.
Maybe we shouldn’t be talking about time management. Maybe we should be attending a seminar on how aide fatigue affects the residents’ quality of care and what we can do about it. How we can resolve the problem, in this facility and elsewhere. But according to this expert, these are just excuses, not reasons. Complaining, not cause-and-effect.

I glance at the clock and I don’t say any of the things that are boiling inside. I need to get back to the floor and I’d be wasting my time trying to argue my point. This man is not open to listening to me and honestly, I’m not open to listening to him right now, either. Anything I say is going to get tossed in a box with the label “tired”. Funny things, labels and boxes. “Tired”, “disgruntled”, “angry”, “uneducated”: easy ways to categorize statements without sifting through the bath water to find the baby. I guess it’s easier to treat the symptoms than to cure the disease. Truth is almost always messy and multifaceted: it never fits into a neat little box.
Though, that cuts both ways. I wish this meeting had happened at some other time than during my hectic shift, some time where I had the mental energy and actual time to listen and weigh his words. I still don’t appreciate his attitude.

The last thing I hear as I leave the meeting is another higher-up talking to the special guest.
“I think a softer approach might have been appropriate. I mean, didn’t you see how tired they all are?” Her voice is quiet but hard. Displeased.
Well, they’ve noticed. No, not “they”, I remind myself as I slowly walk back to the floor…sitting still for so long in the middle of my shift has sapped my energy. The people in the offices aren’t one collective being, no more than aides are a faceless mass of cheap scrubs. At least two of the office-workers have noticed how exhausted I am, how exhausted we all are.
It’s a start.

Do CNAs Make the Best RNs?

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Yang

“CNAs make the best RN supervisors.”

I see some version of that statement a lot on the various CNA Facebook pages. The idea behind it makes sense: in order to properly supervise caregivers, you have to be familiar with the work they do and the best way to achieve that is to have done it yourself.

For me, this raises two questions. First, from my perspective as a caregiver, what are the qualities of a good supervisor? Second, did I find this true in my own experience? Do the supervisors I admire the most have CNA experience?

Everyone has their own ideas of what qualities make a good supervisor. These are what I like to see in mine:

1) Caring and compassion for the residents as demonstrated by their actions, not by what they say.

2) Technical competence – both medical and managerial. I want to have confidence in their ability to address problems in a practical way – whether it’s an issue with the residents, the staff or the administration.

3) Awareness of what is happening on their unit. Not just the stuff at the desk, but what’s going on down the halls. Especially what’s going on down the halls.

I thought about all the supervisors I’ve had over 25 years and which ones best demonstrated these qualities. I came up with three. Then I considered whether or not they worked as caregivers at some time in their career.

Of the three, I knew that two did indeed have experience as direct caregivers. The third, I wasn’t sure about. And of the three, she best exemplified the qualities I listed above. She was amazing.

Since I wasn’t sure, I asked her if she ever worked as caregiver.

Make it three out of three.

Of course, this is a pretty slim database and my criteria are subjective, so it doesn’t really prove anything. And I’ve had several good supervisors that have had no caregiver experience. And I’ve had some lousy ones who did.

I think it’s important that we don’t discount those RN supervisors who haven’t worked as caregivers. There are other ways to develop the qualities we like to see in our supervisors other than working direct care.

But maybe there is something to the idea of making CNA experience a required part of RN training.