Category Archives: teamwork

Looking back and forward

May

Life is funny, sometimes. And it’s strange, always it is strange.
For almost three years, I have been writing for CNA Edge. Three years…it hardly seems possible. I must be getting older, because it feels like just yesterday that I was writing my very first post for this blog (Perception, now found in CNA Edge: Reflections from Year One).

But three years have passed, three wild and crazy years. Life marches on, bringing new responsibilities and opportunities. Just to be clear, I’m not leaving CNA Edge for good. I’m just stepping down to part-time contributor. Instead of once a week, I’ll be writing once a month. I’ve learned so much about the world and myself here on this blog; become a better writer and caregiver because of CNA Edge. Now it is time for me to take the lessons I’ve learned and apply them to new challenges.

Long-term care is a crazy corner of a strange world. We form deep bonds quickly with our residents and with our fellow caregivers. We have to: there’s too much work to do and too much stress to bear on our own. The relationships we form lighten the load, making it possible to bear. Not easy…but possible. Something we can struggle through, together.

The human cost of our long-term care system is something that is not counted enough. When it’s easy to justify making a profit off broken backs and burned-out hearts, you know there’s something screwy in the system. Something broken.
If I am proud of one thing I’ve accomplished in these last three years, I’m proud that I helped to empower other CNAs. My words and my stories touched people, helping them remember that they are not alone. Maybe I’ve helped to alter the perception of CNAs…that we aren’t poor, uneducated ass-wipers who can’t do any better than a crappy job. That many of us are intelligent, compassionate and hard-working people, just trying to do our best in a system that is set up against good care. We caregivers fight the clock every shift, just trying to give good care that we can be proud of…and trying to do it in five-minute windows. Drive by care, that’s what we’re forced to give. And it hurts us, to have to offer scraps and band-aids.
For so long, CNAs had no recourse but to swallow the hurt. Not anymore.
We’ve always had thoughts and feelings, voices and stories. Now, we have platforms to speak them from, safe spaces to tell our stories.
And CNA Edge has been so good to me, giving me that platform to write down and share my stories. Carving out time for good care is hard, but it’s easier now, knowing that change is possible. Knowing that there are those among management and policy-makers who do care, and try to implement lessons they’ve taken from my stories. Knowing that there are other CNAs who, like me, process feelings through writing stories.
I’m so grateful to CNA Edge, to Yang and Alice and the friendship we’ve forged here on the Internet.
Guys, you are the best and even though I’m stepping back, just know that I’m not leaving. I’ll still be here for you, even as I embrace new roles and opportunities.

To all my readers, thank you so much for all the likes, shares, comments and support. Your loyalty and support mean so much to me.

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.

Enabling Exploitation

Sunflower May

Times like this, I can really see the connection between nursing homes and haunted houses. Both have claims of being the abode of ghosts and, more relevantly, both seem to have innumerable nooks for people to hide in. Well, maybe not hide in, but it does seem like every time I need help, there’s no one there to help me.
I peak around another door, finally finding the person I’ve been looking for.
“Hey, do you have a second?” I say, panting just a bit. It’s been nonstop all day and I’m exhausted. Perhaps if I was only working one shift today, it wouldn’t be so bad, but it’s another double I’m working today. I swear, even my bones ache tonight.
My hall partner looks up from bagging up a brief. “What do you want now?” she grumbles. She’s been a bit…less than friendly with me and looks like she’s running out of patience.
“I need your help to get Mrs. H to bed,” I tell her, glancing at the clock hanging on the wall and immediately wishing I hadn’t. It’s much later than I thought and we still haven’t started our lunches. At this rate, I’ll be clocking back in from lunch just in time to clock out for the shift.
“Mrs. H is a tiny woman,” she says crossly.
“Yeah, but she’s not standing right now. I’m going to have to use the lift to get her in bed and I need a spotter.” Seeing the hesitation on her face, I hasten to add: “I just need help putting her to bed, I can handle the rest from there.”
My partner does not look happy, but she agrees to come help me…although she takes me at my literal word, standing in the doorway while I hook up Mrs. H to the standing lift and maneuver her into the bed. Before I even have the chance to unhook Mrs. H, my partner turns to leave.
“Go to lunch when you’re done,” she calls over her shoulder.
It takes me a few minutes, but I get Mrs. H finished up and head off to the break room. I haven’t had a chance to sit down since my first shift lunch break…many, many hours ago.

Oh, but sweet mercy, it feels good to sit down! I’m too tired to eat, so I just sit back and attempt to become one with the chair. I feel like all my bones have turned to jelly; like I’m going to have to be poured out of this beautiful, gorgeous, wonderful seat.
It’s entirely possible that my brain has checked out for the night, long before my body can. I fish my phone out of my pocket and open Facebook. Even if I can’t eat, I need to do something or I’m going to fall asleep.
It’s sitting there at the top of my newsfeed, only twelve minutes old.
Worst night ever. Partner is so damn by-the-book and can’t do anything by herself. Seriously, if you’re so lazy or weak, you’re not cut out for this job.”

Twelve minutes old. She must have posted this right after she left Mrs. H’s room. It isn’t until the phone starts to jump in my hand that I realize I’m shaking with anger. What the…I mean, come on! Facebook! By-the-book? Not cut out for this job? Weak because I asked for help with a resident who, while normally one-assist, needed lifting tonight? Would she have rather I took the chance of injuring myself or Mrs. H?

<oOo>

CNAs have one of the highest rates of back injuries among any other profession. Why in the world would we continue to solo-lift residents who are either require two-assist transfers or a mechanical lift?
Minstrel hit the nail on the head with her latest post. There is a “Macho” culture that has sprung up among CNAs—borne, no doubt, from the chronic short-staffed circumstances. Asking for help (and waiting for help) eats up time…time we quite honestly do not have. Every aide is therefore left with a choice: lift and take a chance on hurting yourself or go get help and fall even more behind.
You can start this job with good intentions, decide you’ll never lift a two-assist. That decision wavers the first time you see another aide lift a resident and walk away—apparently unharmed. It crumbles some more when you hear other aides rank each other by their toughness: so-and-so can lift the heaviest resident on her own. Now that’s a good aide!
That decision is left by the way side when you realize that you do not have time to things the “right way” and you take a short-cut. You lift a resident who is explicitly a two-assist. You don’t raise the bed up to change someone. You change the bariatric resident by yourself.
Now you are a good aide, a tough aide. Now you’ve earned the respect of your fellow CNAs.
And when your body succumbs to the strain, when you feel something pop or pull, when you can’t straighten your back without gasping in pain…you pick yourself back up and continue on. You grumble about the conditions that led to this injury, but you are still a good aide, a tough aide and no injury is keeping you down. You don’t have time to be hurt. You’ve seen other CNAs work injured and sick and you applauded them for their toughness. Time to prove your own.

There is, shall we say, an expectation of injury and an attitude of invulnerability at play among CNAs, two ideas that should be contradictory but are held together nonetheless. There is this mentality among Long-Term Care aides, a mentality that says by allowing ourselves to be injured, we have shown ourselves to be weak. Perhaps this is not the right phrasing. Maybe a better way to say this is by allowing ourselves to be affected by our injuries, we have shown ourselves to be sub-par CNAs, weak and “not cut out for this work”.
It’s a tough job, but we’re tougher. Those CNAs who refuse to lift, or who ask for help…these CNAs are mocked and, dare I say, bullied for their caution.

Very little of this, I’m sure, is intended to be malicious. Solo-lifting, after all, ensures that our residents are toileted when they need to be and put to bed when they ask. It ensures that they do not suffer from this broken system. Refusing to solo-lift can be construed as placing your wellbeing above that of a resident…and that’s just selfish.
Isn’t it?
Whatever the reasons and justifications of any party, the fact remains: the health of CNAs is not treated as a priority…not by management, not by the policy makers and not by the CNAs themselves.
This is a problem. True: the conditions of Long-Term Care are stacked so that injuries among CNAs are high. Yes, the resident to aide ratios are so high that doing things the right way slows you down, very often to the point that you are the last of your shift to leave every single day.

I am a CNA and I do not find it acceptable that I live in expectation of injury. I do not find it acceptable that I have to make a choice between harm done to a resident and harm done to myself. Being “by the book” is my quiet protest of the over-worked conditions of Long-Term Care. If we cut corners and finish on time, but document that we did things ” the right way”, then our complaints of being overwhelmed can be shuffled to the side. “What do you mean, you can’t care for 12 residents? You do it just fine according to my spreadsheet and your charting!”
By solo-lifting two assists, we are not proving our toughness as CNAs: we are enabling the system to exploit us.
Take care of your health. No one else is going to do it for you. This system is not set up to treat the health of CNAs as a precious resource, anymore than it is set up to treat the CNA as a valuable member of the team.
I do not solo-lift and I try to cut as few corners as I can. It is not because I am lazy or weak or not cut out for this job. It is not because I like seeing my residents wait for care. It is because this gesture is one of the few resources at my disposal to show why culture change in Long-Term Care is needed. It is my defiance of a system that exploits me and will throw me away if I break beyond repair.
As an individual, I am easy to ignore and my gesture of defiance easy to overlook. Strength comes in numbers. If every aide refused to cut corners and committed themselves to being “by the book” when it comes to lifting…well, now that would be hard to overlook.
I’d go so far as to say that would be impossible to ignore.

Top Ten Things To Remember While Training

Sunflower

May

I started training other aides by default–by that I mean, I was trainer by default of being the aide with the most experience that day. Six months after I started my first aide job.
To say I was a little startled would be an understatement. I was not at all certain that I knew enough to be training other aides, and I probably was right. However, I fudged my way through, with missteps and mistakes but apparently doing enough right to asked to do it again. I guess my constant mental refrain of “Be like A, not V!” was indeed helpful. I’ve been training ever since. It has been a good experience for me, and I sometimes think of it as the first step towards writing on CNA Edge, because the thing about training is you have talk somebody else through the job.
I learned slowly, one trainee at a time, what works and what doesn’t. Here’s my Top Ten Things To Remember While Training:

  1. Slow down.
    This one is hard for me, even to this day. I talk fast; I’ve got a long stride and move like Speedy Gonzales…or so I’ve been told. One day I was explaining the fire policy to my trainee and all of a sudden I became aware of this wheezing behind me. Naturally I thought a resident was having difficulty breathing–but when I spun around, there was no one around except my trainee. Her hands were on her knees and her face was bright red. “Do you think you could slow down just a bit?” she gasped. “I can’t make out anything you’re trying to show me beyond the human-shaped blur.”
  2. Show and tell.
    “How about you take this one?” my trainee laughs, nodding at the next resident in our rounds. “I’ve done almost all the changing today!”
    “Correction,” I say, “you’ve done almost all the work today. I believe in hands-on learning: think of me as your training wheels, there if you need me, but meant to be phased out. If all you did was watch me do the work, all you’d learn is how I do it. I want you to learn how you do it.”
    Normally, I show once or twice, then I talk my trainee through it step-by-step. As the training progresses, my verbal instructions become verbal cues and then, on the last day, simply confirmation or critique.
  3. Encourage initiative.
    To survive in long term care, you’ve got to think on your feet. The earlier you learn creative problem solving, the easier it will be to take the pressure without breaking. I try to give my trainees first go at a problem, encourage them to think how bend so you don’t break.
  4. Take the time to explain “why”.
    I noticed pretty early on that people would respond better if I could tell them why they needed to do something a certain way, instead of just telling them that I knew best and they needed to do as I said.
  5. Don’t swoop in and finish a job you set them unless it’s an emergency.
    This one was hard for me: I like things done right. Also, there’s always a clock ticking instead my head, reminding me of much time is slipping away, how many more residents I have to do. However, I had to learn not to swoop in and snatch the job away from my trainees…especially if they were struggling. All that did was reinforce the feeling of “I can’t do this”.
  6. Don’t sugar-coat the reality.
    I was terrified the first few times I trained–not of training, but terrified they would think it too hard and leave. We were extremely short-staffed at the time and I was terrified of losing these new aides before they even finished training. I tried to make everything run smoothly, busted my behind to create a good day around them. The first time they worked without me, they were shocked and horrified to learn that things didn’t run so well outside my little umbrella of forced calm. I learned the hard way not to sugar-coat things; let the newbies see the reality of what they were getting into before we were dependent on them to pull their own weight.
  7. Set realistic expectations and be patient.
    “Faster, faster, faster,” was V’s constant refrain while I was with her. “Come on girl, you’ll never make it if you don’t speed up. 15 minutes per shower, come on, let’s go.” Sadly, V was not the only aide from whom I have heard this. Many newbies, like myself once upon a time, find this extremely frustrating: to be brand new at a job and expected to keep up with the most experienced aide in the building. It feels like you’ve been set up to fail and nobody likes that. “Slow down, learn it the right way,” I say. “Speed will come with experience. It’s a lot of information being thrown at you all at once, but don’t worry. Give it a few weeks and you’ll get it. I don’t expect you to be Superaide right out of the gate.”
  8. Set a good example.
    I hope that I’m a fairly pleasant and polite person to begin with, but I’ve learned to keep a cheerful demeanor while training no matter what my personal emotions are that day. Like it or not, I am the face of my nursing home while I’m training…the face of long term care even, when I’m training brand new aides. Constantly griping or focusing on the negatives is setting a bad example of what is acceptable from a caregiver. Constantly freaking out about all the work we’ve got left…doesn’t quite inspire confidence, either in you or their own ability to do the job. Grace under pressure is the goal, I tell myself. Grace under pressure and show these new initiates how to handle a bad day.
  9. Follow the rules.
    This one hurt a bit to learn. Look, any aide who has survived for any length of time in this business has probably bend (if not broken) a few rules. Unfortunately, that’s the way the system is set up: doing it the “right” way is always difficult, if not impossible. At first, I cut corners in front of my newbies. That stopped the first time one ratted me out to my supervisor–over a minor infractions, but whatever. Lesson learned. Follow the rules, be friendly but don’t assume this is your new best buddy at work.
  10. Draw your line in the sand and stick to your guns.
    There’s a few important things you cannot budge on. For me as a caregiver, these are body mechanics and how you treat my residents. My trainees learn quickly that I’m strict when it comes to good body mechanics and treating my residents with respect and empathy.
    I warn them about the statistics on CNA back injuries; I tell them not to be a number on that graph. I remind them constantly to talk to resident during care, to remember that it’s not the dirty brief that is important: it’s the person who wears the brief.
    Protect your back.
    Remember: residents are people too.
    Simple to say, not so simple to practice. As a trainer, I try not to let newbies start any bad habits. There’s no “just this once” for bad body mechanics and being mean to residents.

You inspire me

Sunflower

May

She looks shocked.
I really don’t know why: all I said was “You inspire me.”
“Oh, no,” she replies, laughing a little, but it’s a nervous little laugh. “You’ve been a CNA for years, I’ve only been one for a few months–”
“So? You handled that situation better than I did,” I say. It stings coming out–but it is the truth. I didn’t handle that situation very well. I lost my cool and she didn’t. Sometimes I think I’m told too often that I’m a great aide; it’s true I’m good at my job but there’s always room for improvement. Today, I was shown in area in which I need to improve by this new CNA. It’s a bitter pill to swallow–but I believe in giving credit where it is due.
“I’ve never been told that before,” she tells me. “Mostly I’m just told ‘Don’t tell me how to do my job’ or ‘Listen here I’ve been doing this for far longer than you’.”
“Well, I have been doing this longer than you,” I reply with a laugh. “That doesn’t mean I know everything and I’ve got nothing to learn. Today I learned how to keep my cool. Tomorrow maybe I teach someone how to make a resident laugh. We’re a caregiving team: we either make each other better or we make each other worse.”

God knows I’ve got my flaws, but I hope the day never comes when I was “too good” to learn something. I never want to be of those aides you can’t say anything to.

Suffering the consequences

MaySunflower

“I just can’t believe it!” my supervisor rants. She’s red in the face, her breath coming in quick and angry. “I hope you all know you’ve done this to yourself! Why do you keep shooting yourself in the foot?”
It’s a typical: something’s happened and we’re in a meeting. The supervisors are informing us of our mistakes and we are silent on the opposite side of the room. Typical. Happens a lot in long term care.

But don’t jump to conclusions. This isn’t a story about the problems of leadership of long term care (that’s for another day). My supervisor might be angry, but she’s got reason to be. This situation is, maybe miraculously, exactly as she’s said.

Anyone who’s set foot in a nursing home knows exactly what I’m talking about. Gossip. Older aides being mean to new staff. Working in cliques. Aides refusing to a call light because “it’s not my resident”. Saying, in the middle of the hall way with residents around “I hate my job!” Acting like it’s an inconvenience to take care of a resident.
You know, shit like that.
My supervisor is asking a valid question when she demanded “Why?”
Why do CNAs shoot themselves in the foot? I’m not saying every aide does it, but I’m not going to deny it happens…more often than it should.

I think, in part, it’s because this is a hard job and so personal in every detail. I was trying to explain to a friend how long term care was a different beast from other kinds jobs. Without belittling the importance and value of other jobs,
“Imagine every mistake you make at work. Now imagine that mistake happened on a human being. Now imagine that mistake happening on someone who has lost the ability to do anything for themselves.”
Is it any wonder we aides get stressed? But it’s not just stress. It’s also guilt. I got in a hurry and tore the skin from this human being’s arm. I walked past that call light because I was so hungry and that human being soiled himself. I got frustrated and the human being, whose wellbeing is my responsibility, heard me say how much I hate this place.
That’s a lot of guilt and you’d better believe it stings.
At the same time, every aide knows all too well that feeling of helplessness. It’s not a good situation and who knows when it will get better. Some days, it feels like it never will.
I did my best today. It wasn’t enough. My residents still went too long between changing. I haven’t brushed their teeth in so long. I did my best today, but it’s not enough. It’s never enough. My personal passion can never cover the flaws of the system.

Guilt combined with helplessness and pure stress turns into frustration. Frustration spills out.
Even worse, frustration can turn some people numb. It’s a losing battle anyway, so what’s the point? Why exhaust myself when the effort doesn’t change a thing?
Have you ever seen a caregiver turn numb? Have you ever seen a caregiver lose their sense of empathy for the resident? When their perception of the resident shifts from “human being whose welfare is my responsibility” to “nuisance in the way of getting my work done on time”.
It’s not good. It’s also not rare.
In this state of mind, it’s easy to lash out, say things we shouldn’t. It’s easy to exude a toxic atmosphere when there’s so much resentment, guilt, helplessness and other negative emotions built up inside us.

I get it. I really do: I’ve been an aide long enough to be familiar with both the guilt and the helplessness. When your best isn’t enough, when nothing you do seems to make a difference, when exhaustion sinks its claws into you…I get it. We’re only human; we aren’t infallible angels. It is too much to ask of us, at times. How can we be positive and cheerful with new aides when we’re just so damn tired?

The flaws of the system do not absolve me of my personal responsibility to take care of my residents. Proper care means proper staffing…means not running off new aides with a toxic attitude. I’m the one who chose to fight this battle…so either I keep fighting for their dignity or I quit. No other options, no other door.

Simply put, CNAs do not have the luxury of shooting ourselves in the foot because it is not just us who suffer from the consequences. Other human beings, whose welfare is our responsibility, suffer as well.

I Get By With a Little Help from My Friends

photo

Alice

I miss my co-workers. I miss sharing rueful smiles over our resident’s antics and commiserating over management’s ineptness. There is a bond between caregivers forged from shared experiences. Everyone may not get along but we all speak the same language. I didn’t realize how much that comradery added to my whole caregiving experience until it was gone.

The joy of working together as a team can get lost amidst the gossip, frustrations and general bitchiness that is often a by-product of short-staffing, poor communication, low wages and mismanagement. I am as guilty as anyone of bemoaning the poor work ethic of others when I was working in a facility. Laziness of others takes its toll on those who are not lazy in our field. On the best of days, it’s hard work and when I felt “saddled” with a caregiver who was not invested, I adopted an attitude of either help me or get out of my way. I took for granted the peace of mind that comes from working with someone else who GETS it, even in the most basic ways.

This jaunt into private care has taught me that caregiving can be lonely business. Or, to put a more positive spin on it, I know now not to take for granted my co-workers in whatever future facility I may find myself employed. I’ve written in previous posts about some of the more positive aspects of working one on one with a client. There is much that I am enjoying about this aspect of caregiving but I do find it lonely. If my client is tired, or cranky or has a day when she just doesn’t want to be bothered with me, I have to take a deep breath and make it work. There is no other option. Like it or not, I’m what you’ve got for the next twelve hours. I have been lucky on that front. There have been very few bad days with either of the clients that I’ve worked with so far but I do know that it is an inevitability. Working so closely with people in a vulnerable state is a dance and sometimes we accidentally step on each other’s toes. In a facility, if a resident doesn’t want to work with you, there are other caregivers who can step up to the plate and vice versa. It was often a flawed team but it was a team nonetheless and one way or another, the work would be completed before the end of shift.

No one can fully understand what it is like to walk with someone through their most difficult days unless they have done it themselves. We see the humor in body fluids. We see the end results of a broken system. We see the people in our care fight their way forward despite that. We see death, but more importantly we see LIFE. Sometimes I wonder if our most important job is to remind those in our care that although they think they are headed towards death, they are not there yet; to remind them that as long as they are breathing, they have value in this world. The family members usually can’t see this because they are too close to the situation. Until I started in private care, I thought it was selfishness. It’s not. It’s an inability to detach from the mental image of how it “used to be”. It’s thoughtless maybe, but it’s human. I do miss working with others who get that; who understand the heart of caregiving even if they don’t express it in words. This shared core of experience between caregivers has been an incredibly valuable tool for me in the battle against cynicism that often muddies my vision of what I believe caregiving can and should be. It took being away from my co-workers to realize how big a part they played in helping me develop as a caregiver and on the occasions when I would fall, it was they who helped me back on my feet. On the tough days, it’s good to know that there is power in numbers and we are not alone.

 

That it is the question, part two

Sunflower

May

Being an aide, I’ve decided, is a bit like throwing yourself at a brick wall, thinking that either the wall is going to come down or you are going to splatter yourself all over it.
Unfortunately or not, what actually happens is you come away bloody and for all your pain, all you’ve done to the wall is put a couple hairline cracks in it.

“If I don’t do it, who will?” This question might feel like it is being asked out of a lack of faith in our fellow aides…like nobody but myself is capable of doing it.
Unfortunately, it is a honest question. Anyone who has been around Long Term Care for any length of time, for any reason, can attest the chronic short-handedness that plagues so many facilities.

“If I don’t pick up that shift, who will?”
The answer might be nobody. Everybody is exhausted and everybody has lives outside the nursing home. They’ll go short that day and frustration will increase.
“If I’m not here in a year, who is going to be there for these people?”
Very possibly, a stranger who will put in her two-weeks notice the next day. The staffing coordinator didn’t tell her she was signing up for a tour in hell, after all. There’s got an easier way to make a living.

The system, as it is set up today, depends on sacrifice. It relies on dependable aides who pick up shift after shift, who will stick it out for little money and little hope of relief. And that’s a problem…and CNAs are not the only victims. The residents suffer too, often feeling like it is their fault. The elderly often feel themselves to be a burden and it is horrible that the current system only enforces that feeling, as they watch the parade of faces come and go.

Perhaps the answer lies in the middle. Set your own boundaries because your supervisors certainly won’t. There’s no ceiling on overtime and if you’re willing to do it, they aren’t going to stop you.
Know how much you are willing and able to give. Stick to your story: if you’ve got plans, you’ve got plans you can’t reschedule. The pathos is palpable in the nursing home and it is so very, very easy to give more than you have when surrounded by desperation. Remember your own needs while you take care of others. There is something in the make-up of a caregiver that wants to make things better. Watch that instinct and don’t be the hero all the time. You can’t give from emptiness.

Give what you can, but know when you can’t. Our only responsibility is to provide high-quality care and compassion while we are there…however long that is. Picking up is (or should be) optional. Pace yourself.
That wall isn’t going to come down all at once and I’ve seen aides break their hearts and shatter their compassion trying.
Hairline cracks are progress, no matter how insignificant they feel.
Don’t burn yourself out.

Caregiver versus Caregiver

DSC00999

 

 

Yang

For a CNA, working with other caregivers you can trust and depend upon can make a bad shift tolerable and a good shift even better. In an environment where workers often feel like they’re under siege,  maintaining a positive relationship with the people you work with can take the edge off the worst aspects of the job and can provide a sense of security and comradery. It is not unusual for caregivers who work with one another for an extended period of time to develop close personal relationships, sometimes lasting a lifetime.

But it’s not always that way. Right?

You don’t have to work direct care very long to realize that caregivers do not always get along.  A brief survey of caregiver related social media will support this. One of the most common rants in the CNA Facebook groups is about other coworkers. These describe fellow workers as “lazy, whiners, cliquish, back-stabbers, know-it-alls, butt-kissers, bullies, wimps, rude, inconsiderate, uncooperative, mean,” and – of course – “judgmental.”

To be sure, social media rants tend to be motivated by the emotion of the moment and they only tell one side of the story. Also, some of the discord among caregivers can be attributed to the ordinary conflict that occurs in any workplace. There are politics in every organization and at every level. Personalities clash, agendas conflict and sometimes people with good intentions simply don’t agree.

And yet, there just seems to be something about the nature of Long Term Care that makes worker on worker conflict especially prevalent – and harmful. Almost as if it’s woven into the very fabric of the system itself.

I’ve often thought that the LTC brand of coworker friction was a product of the nature of our work. Since we work hands-on with residents, almost everything we – or don’t do – has a direct impact on the well-being of another human being. The moral element is immediate and powerful and when someone implies that you’re not doing your job, it doesn’t just mean they’re calling you a bad worker; they are also saying something about you as a person. Even the slightest hint of criticism can be taken as a personal attack. On the other hand, LTC management is often disconnected from the day to day realities of caregivers and workers in genuine need of correction do not always receive it. The injustice and unresolved resentment grind on people daily and sooner or later, there’s going to be trouble.

However, there may be much more to caregiver vs. caregiver conflict than hyper-defensive workers and disengaged management.  I recently received a request from a reader who asked if we could do a post on “horizontal violence.” Not being entirely certain what that phrase means, I did a little research. What I found was pretty interesting and may provide some additional insight to why caregivers don’t always get along.  In my next post, I’ll give a brief summary of horizontal violence and how I think it applies to the LTC workplace.