Tag Archives: CNA attitudes

Kindness Doesn’t Cost a Thing


Alice
In all my years in this field I have never had a person in my care who did not respond better when approached consistently with kindness. Never, not one single time. My most resistant residents have been more willing to be an active participant in their own care when they didn’t feel invisible. My most confused residents had less anxiety clouding their minds when I have been able to coax a laugh from them. Kindness doesn’t cost a thing. It takes no more time to be kind than it does to be resentful and impatient and it takes far less energy.
“You’re going to spoil them”.
“Now they’re going to expect that from everyone.”
“Don’t get that one going. She’ll talk your ear off if you let her”…To which I politely smile and go about doing my job exactly as I see fit. Treating my folks the way I’d want to be treated is not “spoiling” them. It’s being good at my job. I give my best effort regardless of what it causes other people to expect. Quite frankly, I don’t care if that raises the bar or not. My work ethic does not include doing less for those in my care so they don’t expect it from other workers. And I don’t mind having my ear talked off. Why should my night owls feel lonely? If they want to talk and I’m not in the middle of a task, I have no problem listening.
The idea that the people in our care are tasks to be minimized and tackled begrudgingly has to be changed. Not every caregiver treats the job with such apathy; not even most, but there are more than enough that do. Rightly or wrongly, the majority of hard working and dedicated caregivers are stigmatized by the behavior of those who are not right for this field.
We are the frontline of Long Term Care. We are the faces most seen. When something goes wrong, we are the easiest to blame. People see the bad behavior of the caregiver and not the broken system that spawned it.
There is grace, value and purpose in this field. We are needed and trusted by those in our care. There is something sacred about that. If the system has beaten you down to the point of resenting those in your care and basic human kindness is too much to ask, then maybe it’s time to consider another field. As workers we don’t like to feel disposable or invisible so why would we treat our residents as little more than a burden? We can do better. We HAVE to do better…any lasting change that matters will begin with those of us who work the floors. We are the closest to the residents and we have a deeper understanding of the world through their eyes. All improvement begins from within, though, and before we change the system we have to change our attitude toward those who live within it.

Powerless?


Alice
It will get better. I promise… I must have said that a hundred times to our new resident. She didn’t sleep at all. She searched for her mother, father, friend, a child and a pair of shoes that she must have left in England. She paced the floor for hours on ends. She changed her clothes eight times. She knocked on the doors of my other residents and asked me a garbled series of questions to which I had no good answers. In short, she did absolutely everything BUT sleep.
It was an unusually hectic night and by the end of the shift, I was emotionally tapped out. My new resident was so scared, hurt and anxious and eight straight hours of trying to soothe her in between my other tasks left its mark on me. In the end, I walked with her as she paced, rubbed her back when she cried, and made promises that I can’t possibly keep when she frantically asked questions based on the reality within her mind.
It will get better. I promise. I say it all the time. I redirect and calm and search for pets or loved ones that exist only in my residents’ memories. And yes, more often than not using those skills in those moments will bring a measure of short lived relief. But that doesn’t mean it will get better for them. Not in any lasting or impactful way. I can’t stop the loss of her memories. I can’t take away her confusion and unfamiliarity at her new surroundings nor the sense of abandonment and anxiety that comes from being pulled from one reality and placed into different one. I. Am. Powerless.
Normally I am good at compartmentalizing this awareness. It does no good to let those thoughts dance around in my mind. Such thinking only robs me of space in my head that is better used for what I actually can do to make life better for those in my care…normally. There are moments though when I am struck by a wave of such sadness that it robs me of my breath and I feel crushed; paralyzed by the weight of it all. Usually they hit me when I’m feeling powerless in my life outside of work or have been dabbling too long in my mind for my writing. My mind can be a fun place to be, but there are roads in there better left untraveled. The fact is, both on and off the clock, I deal with some pretty heavy shit. It’s kind of what I do. And acceptance of that, even joy in it, is so hardwired into me that I forget sometimes that it takes a toll if I’m not careful. Those short lived crashing waves of momentary despair are my wake up call. HEY ALICE! You’ve been playing too long in the deep end again! Come up for air!
So how do I stick with it and keep the faith without losing the ability to feel? Without becoming hardened? I get out of the problem as quick as I can and get back in the solution. Can I cure Alzheimer’s? No. Can I make someone living with Alzheimer’s laugh hard? More often than not. Can I force someone to get sober? No. Can I offer numbers and resources to someone who is in desperate need of help? Yes. I can do that. There are many aspects of life over which I have no power at all. Some but not all. I can DO. I can consistently and relentlessly keep moving forward. I can brighten another person’s day. I can do my job to the best of my ability. I can be kind and I can never give up. Even when it sometimes feels like the world is begging for it. That I have power over. That is my choice. Powerless and helpless are not the same thing.

Beneath the Surface

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Alice
The longer I am in this field the more I realize that in order to truly change the culture of Long Term Care, we must change the way those who are living within the system are viewed. Regulations can be changed. Environments can be improved upon. Staffing levels can be reasonable, but until society begins to see through the physical disabilities and age to the person underneath, such changes, though important and well meaning, is like treating the symptoms rather than curing the disease. This point has become so much clearer to me since I began working in private care.
As an independent caregiver, I have the freedom to do the job as I see fit within very wide margins. Being pretty terrible at setting work boundaries, I find myself in many roles throughout each shift; CNA, housekeeper, family confidant, driver, personal shopper, cook…the list goes on and on and each shift brings new surprises. There is only one client and yet for me it’s every bit as challenging as working in a facility. Working one on one with my client has opened my eyes to how people view those living with disabilities outside of the four walls of a facility. Sometimes, it’s not very pretty.
My client loves baubles. She loves bright colors, and make up and having her hair done professionally. Her appearance matters to her. It always has. Religiously, once a month she goes to a particular salon and has her hair washed, colored and styled. She has been doing this with the same stylist for five years. Now, this particular stylist knows that my client suffered an immediate and life altering change to her health sixteen years ago. She sees the effort it takes for her to transfer from her wheelchair to the shampoo chair and back again. She knows that on my clients tougher days, when it takes all she has to get dressed, it is the idea of her beauty days that pushes her through that pain. I’ve told her that myself.
It’s a splurge. It’s not a cheap salon and this hair stylist is always tipped well. Getting beautified is one of the few good things that has remained a constant from the time before my client fell ill. It takes her more effort, but it is well worth it. So you can imagine my fury when I received a call from my co-worker informing me that this hair stylist would no longer be taking appointments from my client because she was fifteen minutes late. This hair stylist to whom my client had formed an attachment, despite what I considered to be her snarky attitude, who had NO problem gushing over her tips and taking her money, was put out. She did not bother to tell this to my client. No. She told it to my co-worker who, like myself, does not have the heart to tell her.
Look. I understand that we all have lives and a client being late for an appointment can cause inconveniences to whomever is providing a service but if you are incapable of taking on those with physical challenges, then DON’T TAKE THEM ON. When my client is going to be late for appointments, we call. After so many years, the very least she could have done was have enough respect to have a conversation with her about it.
It was such a clear example of apathy. I realize that it’s not cruelty that causes such slights, but the damage done from it is the same. It’s an example of the self-centeredness that we all have within us in one form or another. Even those who are closest to my client are subconsciously guilty of this thinking. How much is my client going to slow them down if they take her with them? Is there room in the car to pack all of her necessities? Is it worth the effort when she will be so exhausted the next day?…they see all the obstacles and none of the opportunities and in so doing, they diminish her humanity and reduce her to little more than “person with disability”.
I look at people through the lens of a caregiver. There is not a single person on the face of this earth who doesn’t have obstacles or challenges. Most have the luxury of wearing them on the inside. The downside to that is that too often, they forget those wounds exist and begin to convince themselves that they are a part of a group lucky enough to be normal. Allow me to disabuse those of you in that category of that notion. There is no normal. It’s imaginary. The only thing that separates you from those in my care is circumstance or age.
If I had to pick one lesson that I would like people to learn from my posts, it would be this: We are all human. Separating yourself from the way you view those in our care may make you feel safer or more comfortable but you do yourselves a disservice. One day, you will age out too, if you’re lucky enough to maintain your health. Ask yourself this: How would you want to be seen? As an “invalid”? A burden? As someone who has “outlived usefulness? As a bed filled to keep census up? As a cause? As part of a group to be pitied?…I wouldn’t. I would want to be seen as a person first. As Alice. And I would hope that all of those who were fighting for my rights would take the time to actually ask me my opinion of the system and what I think would be an improvement. I would hope my loved ones would see me before my disability and I would hope that an overpaid hair stylist would have the decency to tell me to my face that she no longer wants to do my hair.

See No Evil, Hear No Evil … Fix No Evil

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Minstrel

As aging impacts physical and cognitive health, many of us will eventually live in long-term care homes.  Thanks to poor standards of care, most people dread this prospect.  To improve care, experts advocate a person-centered model of care as an alternative to the traditional medical model.  Moving from one care model to the other calls for culture change.  Last year I visited the website of a leading culture change organization for information on their annual conference.  It was discouraging to see that among their many events, none included one of the critical elements of culture change, CNAs: our workloads, wages, and caregiving standards.  Hour after hour, day in and day out, CNAs are key caregivers.  Without us, there can be no culture change.  Yet CNAs aren’t heard.  Here is one CNA voice.

I first became familiar with LTC homes when a family member needed care.  I explored many places to find him a good home, then visited him frequently.  Since then I’ve worked in LTC homes and gone into others as a hospice volunteer.  When my uncle moved to a memory care home, I saw the aides who cared for him as angels: they did for my uncle and the other residents what we family members no longer could.  They did this with magical skill and saintly kindness.  And for wages that were obscenely sub-standard.  I was enormously grateful to them.  But in these years of being in and out of long-term care homes, this is what I’ve also seen: aides who sit talking to each other or texting while residents sleep in front of TVs or sit staring into space, alone.  I’ve seen a resident fall because an aide was busy texting.  Aides spend mealtimes noisily socializing with each other instead of engaging with residents, most of whom (at least in memory units) need some level of assistance.  Some aides announce, by their behavior, “Once she’s bathed and dressed and in the dining room, once he’s fed and toileted: once the ADLs are completed, it’s my time.”  Sometimes instead of interacting with residents, aides simply take time apart to rest.  It’s not that aides are intentionally mean or abusive.  And comradery among aides isn’t a perk; it’s essential.  But on every shift there are failures in attentiveness to residents, failures to engage them in an enriching way, lost opportunities for Creating Moments of Joy, as Jolene Brackey has written. 

Some will object, “Not in OUR facility!  We have awesome aides who go out of their way every day to make life better for residents.”  Yes, aides are often inspirationally caring.  But too frequently the quotidian reality is lackluster care, not the person-centered care promised.  Tellingly, the administrators who dispute this picture are often conspicuous for their absence from the daily fray.

Here’s something else I see: thanks to abysmal wages, many aides work two jobs.  Where I live, starting wages are $9 to $12 an hour.  Self-employed aides can earn more, but have no benefits.  Full-time aides are sometimes scheduled to work only 32 hours a week, to avoid overtime when an aide is asked to work a double shift to cover for someone who calls out at the last minute.  Many aides have children at home to care for.  By the time the aide starts his or her shift, which typically involves caring for six to ten residents, she is already tired in body and spirit.  How can this aide bring to work the physical and emotional energy needed to care for the chronically ill, the elderly frail, the cognitively impaired?  Is this what you want for your parent or spouse, or yourself?

How to improve care?  Administrators provide innovative training programs.  Workshops offer state-of-the-art information and creative care ideas.  Two questions not examined:  1. How do we get aides to buy into culture change and embrace person-centered care, once the trainer leaves?    2. Where do we find the money to increase staffing and pay direct-care workers a living wage, one that honors the physical and emotional demands they meet every day?  

Culture change seems focused primarily on training of direct-care workers and renovations to the physical environment.  A more effective approach might come from a change in what we expect of leadership.  Once upon a time, ‘Management-by-Walking-Around’ was the mantra.  An effective manager was expected to circulate on the factory or office floor, paying attention.  Not spying on employees, not micro-managing, but noticing things.  Sensing conflicts and stresses before these undermine performance.  Offering feedback when needed.  In care homes, how often do you see someone on hand whose role is to encourage, compliment, coach or critique?  To see that necessary supplies are on hand.  To offer an on-the-spot performance suggestion, transforming a moment of poor care into an opportunity to reinforce good care skills, per Teepa Snow’s  coaching model.  And at times, with a chronic slacker, to go down the road of discipline.  How much do managers engage with direct-care workers? 

Today’s code word for good care is engagement: aides need to engage with residents.  If administrators aren’t modeling this by meaningful interactions with direct-care workers, will aides believe that engagement is to be the ethos in their workplace?

We can’t improve what we don’t see.  If administrators don’t see the problems, it might be because they are buried in ‘CYA’ paperwork, medication management, marketing efforts, and time-stealing meetings.  Sometimes their offices are in some distant realm of the facility.  Culture-changing organizations might hire a clerk for paperwork and scheduling, freeing the front-line manager for a more constructive presence among staff.  Give this manager a mandate to convert ‘person-centered care’ from a slogan to a fact.   

Can LTC homes provide person-centered care, without the personnel?  Staffing levels are egregiously low.  They may meet states’ woeful requirements but we all know they are inadequate to ensure patient safety, let alone the person-centered care everyone espouses.   Inadequate staffing also leads to on-the-job injuries and CNA burnout.  Are any of the culture-change conferences addressing these issues?  Are leaders lobbying for better staffing and better wages for their CNAs?

Ah, wages!   One is tempted to wonder whether managers tolerate poor performance out of guilt or shame for what they pay their aides.  Even compassionate professionals don’t want to mention the issue of wages in public.  It may seem too daunting and discouraging a challenge—and an embarrassment.  Compensation levels reflect the fact that the job doesn’t require high-level academic or technical credentials.  But aides shouldn’t be thought of as unskilled.  Our skills lie in meeting the global needs of residents who are sometimes completely dependent on us.  A good aide needs to excel in kindness, patience, gentleness, flexibility, effective time management, communications creativity, appreciation for the diverse ethnic, racial, religious, cultural backgrounds of those in our care.  We care for residents regardless of their illnesses or diseases.  We don’t need to describe here the physical tasks we perform, sometimes difficult, often unpleasant.  When the person has dementia, the challenges are doubled, tripled.  We’re accountable to employers, to families, and to our residents.  Not everyone is up to the job.  Wages should reflect the importance of this work and the competencies it requires.  We need a mindset conversion among executives who still think it’s acceptable to sustain their LTC organizations by reliance on a bare-boned staff of underpaid workers who need public assistance to supplement their wages.  Care homes charge their CNAs to respect the dignity of residents.  What about respect for the dignity of CNAs, starting with a living wage?

“Where will we get the money to raise wages and increase staffing?” ask horrified LTC operators. The question is valid.  However, it begs the further question: How much are you spending now, and for what?  Until there is budget transparency (another piece of culture change), the industry’s position that these proposals aren’t affordable, isn’t credible or convincing.  Their question should be not the end of the discussion, but the beginning.  Reviewing the content of culture-change workshops, we don’t see these issues on agendas.  No one wants to touch staffing or wage issues.  Could it be that the profit motive plays too big a part in the culture of some LTC organizations? 

This isn’t rocket science: Be as zealous about improving supervision, staffing, and wages as you are about upgrading the chandeliers and countertops and holding conferences.  Put your assets where you claim your values are.  (Make your budget transparent!)  Invite CNAs to be co-leaders in culture change.  Then we might see culture change that leads to transformed care, transformed lives.  

The Big Picture

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Alice

  See past the disorders. See past the challenges. See past the constant reminder of our own mortality. Look beyond the dysfunction of the broken system and the day to day gripes we all face in this field. Look beyond the bad mood of that one particular resident who seems to have it in for you for no reason at all. Work around the apathetic owners of these facilities and you will learn some truths about yourself as a person through your work as a caregiver.

       We can’t fix the broken or heal the sick, but we can comfort the hurting and add a spark for another going through a day of despair. We can support and teach each other in a system that fails us in that area so often. We can reach people when we look beyond the surface. When we do not allow how we are viewed by others to define us; when we refuse to do the bare minimum in our workplaces, we set the example. We set the standard. The powers that be do not understand the nature of our work. They don’t know and many don’t care. They want the most cost efficient option and are willing to sacrifice standards of care in order to increase profit margin. I get it. They view it as a business, but they are not selling shoes and burying our collective heads in the sand is not going to work.

       Are we going to accept this? Are we going to allow those within our care to be forced to settle for apathy and neglect? Are we going to allow this system that is designed to fail convince us that we are disposable and worth very little? We have choices here. We have numbers and we have a voice. We have to stop getting stuck in the minor irritations that so often distract us from the essential truths that all caregivers share: we are the protectors. We are the comforters. We are the voice of the most vulnerable among us. That is a sacred responsibility and that doesn’t change because it goes unappreciated or noticed by others. If we embrace this, if we are motivated by this consistently, then together we have the opportunity to fight for the changes that only us and those in our care really know are needed. We need to collectively look at the big picture and then get on with the business of doing what we can to improve it. It’s in our hands.

The Simple Things

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Alice

How many moments do we waste away worrying? How much time is wiled away as we stew and fret over missed opportunities? How much of our lives do we willingly hand over to resentments and anger and fear?

The people for whom I have cared throughout the years remind me of that in a million ways, both with words and by action. Many of them have survived cataclysmic events that forced them to redefine what exactly it is to live, and yet the sheer joy they derive from the simplest things is truly a sight to behold. It humbles me.

The scent of freshly brewed coffee, the comfort of a familiar routine, a well-timed joke, a large bowl of ice cream, a certain song; the small, simple joys that I so often take for granted transcend those in my care from their current situation to the time “before”. 

They don’t know they’re brave, but I know. I see it. I see it in their strength to live and love and embrace what moments bring them happiness in the face of overwhelming challenges. How could I NOT be changed by such quiet courage? How could I NOT be motivated to embrace my own moments? They inspire me. I’m slowly learning how to get out of my own way. I have a daily reminder to never take the moments for granted and that life is for living and to not waste my time with regrets. That is a hell of a job perk.

The CNA: From Image to Identity

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Yang

Several things come to mind when we consider the image of CNAs. Stereotypes exist on both ends of the spectrum. On one end, we have the demonized version of direct care workers as presented in negative media reports. On the other, we have the LTC industry’s idealized image, the compassionate yet professional, self-sacrificing “CNA Angel.” Somewhere in the mix we find the clinical version of the CNA: a vital part of the team, but with limited scope of practice – the caregiver defined by a particular skill set and specific tasks to perform. Finally, we have the unhappy image of caregivers as the poorly trained, dispensable bottom of the totem pole, the ones who do the hard and dirty work, or in the crude vernacular of the breakroom, “Butt Wipers.”  Or even worse, “Just a CNA.”

While there is an element of truth in all of these images, none of it really gets to the essence of what it means to be a caregiver. To grasp that, we have to take a closer look at how caregivers actually experience the work and where in that experience they find meaning. When caregivers are able to express this they are defining themselves. In doing so, they move away from image and toward creating their own identity.

One approach to understanding what caregivers find meaningful in their work is to look at a typical response to the notion of “Just a CNA.”

Here’s an excerpt from a poem I often come across online:

Who are you to refer to us,
As “Only” a CNA?

We’re the ones who take the time,
To listen to them speak.

We listen about their lifetime,
In a forty hour week.

We take the time to listen,
By lending both our ears.

We listen to their worries,
Or how they’ve spent their years.

We chose to do this job,
The job did not choose us.

This from a post on a CNA Facebook page:

Yesterday a nurse put me down, went as far as saying that I was “basically just a helper.” I was VERY OFFENDED. Yes I know that a CNA is below a nurse, but when it comes down to it I’m the one that holds the patients hand when they are sad, I’m the one that they call when they just need someone to talk to, I’m the one that will sit there and engage them in a conversation for hours. I’m the one that is on call 24-7 for all of my case load

There should never be JUST in front of a CNA. We are not just CNAs. We are Family when you’re not there. We are here through the good, the bad, the ugly, and even through death. Think twice before you call us just a CNA.

This from a CNA t-shirt:

Front:
I’m Not Just A Nursing Assistant
Back:
I’m A Trusted Friend…
I’m Part Of The Family…
I’m A Comedian That Puts A Smile On A Sad Face…
I’m A Counselor…
I Listen To Stories & Share My Own…

I’m A Proud Nursing Assistant

These examples, as well as just about every response I’ve ever read or heard to “Just a CNA,” have one constant underlying theme: the meaning of our work – and thus how we define ourselves – is inextricably bound with the connection we have with our elders. If we are “Just CNAs” than the people we care for are “Just residents.” If we are “butt wipers” then our elders are reduced to just so many butts to be wiped. You cannot disparage our work without dehumanizing the people we care for. The two cannot be separated.

Our identity as caregivers is not based on the most disagreeable aspects of the job. Nor is it based on a job description, nor on our place in the LTC hierarchy, nor on how the public may view us. It is based upon how our elders experience our interactions with them. This relationship is the single most important factor in how a resident will experience life in long term care. Our awareness of the significance of this bond and our desire to express it is more than just a form of self-validation, it is also a potentially powerful antidote to much that is wrong in long term care.

How we can employ the power of this awareness is the subject for my next post.

Rise Above

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Alice

       One of my all-time favorite comedians, the late great George Carlin once noted that most people work just hard enough not to get fired and get paid just enough money not to quit. As much as the eternal optimist in me wants to rail against the cynicism and believe that hard work and dedication will be properly rewarded when applied consistently, the realist in me recognizes truth when I see it.

        I have worked in the same facility through three owners and five administrators. Other than the faces, not much changes. I gave up on the idea of good leadership with strong problem solving abilities long ago. The office is the world of what things appear to be. The floor is the world of what actually is. Because of that, I don’t hold a lot of faith in their ability to employ the solid and positive changes that are necessary to keep the floor running smoothly, enhance the quality of life for my residents and promote a healthy work environment for my co-workers. They do not attend the in-services, they are not engaged with the residents and they don’t listen to those of us who are. As frustrating as that can be, I’ve learned to accept and work around it.

      It’s a tougher pill for me to swallow when I see my family on the floor allow the poor pay and lack of structure to erode their work ethic. It’s a little heartbreaking to see caregivers come in so full of potential, talent and skill and watch as the low pay, drama and daily frustrations dissolve their drive until it is the negative atmosphere that is dictating how they perform their job.

      I GET it. I do. An excellent caregiver and a terrible caregiver are treated exactly the same, the only incentive, at least on paper, is to not get fired. Why break yourself in half when it goes unappreciated? Why run yourself ragged trying to make sure the hall is in tip-top shape before you leave when no one bothers to do it for you?

        The answer is simple. Because our job is important. Not in the “looks great on a resume” sort of way but in the “we are making a direct difference in the lives of others” kind of way.  We take care of the broken people. The lost and scared and forgotten. That is our job. That is our calling. People who are sick and angry and scared are not always the easiest to handle, but easy is not in our job description.

     I wish I could find the words to properly express to my co-workers how amazing I think they are and that I KNOW they have the strength not to be defined by the bullshit. They are smarter than that. I wish I could convince them that if we come together as a team; united and dedicated to our residents and to each other, we could do better. We WOULD do better. If we spent less time pointing fingers and more time finding solutions, we could be a force of good to be reckoned with; that I BELIEVE in them and their potential…but I am one person. I try very hard to speak through my actions. Maybe 1 in 10 caregivers there hear me. But those that do, those that don’t tune this message out give me hope enough to continue on in this field. In this facility in particular. Those that rise above and soldier on give me the strength to do so as well. They remind me of another one of old Georgie’s quotes,

“I like it when a flower or little tuft of grass grows through a crack in the concrete. It’s so f&$king heroic.”

The Queen and I

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Lynn

There is always at least one in every long-term care facility. You know, the one.  No matter how many residents you are responsible for, the one sincerely believes they are the only one in the building, demanding precious minutes of your shift.  The one.   Mine, I secretly call the Queen. I have 25 residents on my wing yet I spend more time answering her numerous call lights than any other resident on the wing. I tried to count how many times she used the call light in one shift but when my count was up to twenty after two hours, I stopped counting before I got depressed and resentful.

The Queen cannot walk or transfer herself requiring a two person transfer with the sit to stand.  She cannot see very well, even though she always seem to know what time it is, if her bedspread is too close to the floor, that her wastebasket is getting full, when her window shade is crooked and when my name tag has flipped upside down.  She usually spends most of her time in her room, by choice.  She does not go to the dining room choosing to eat in her room instead.  It takes at least five minutes to fill out her supper slip. Sally from the movie “Harry met Sally” was a novice compared to the Queen when it comes to ordering food.  The Queen does not take to waiting very well. She will not hesitate to let upper management know how much she is ignored, that the “girls” never answer her light promptly and she is the only one who has to wait all the time.

I can’t help but release a really deep sigh as I type this out and I know that I sigh deeply several times during my shift while caring for the Queen.

Yesterday the Queen was in rare royal form, throwing verbal jabs at everyone she could; “threatening” to have our jobs, complaining about supper, demanding her medications NOW and ranting about the length of time it took us to finally start getting her ready for bed.  When she acts like that my best offense and defense is to keep my mouth shut.  I don’t respond to her sarcastic, belittling remarks. I keep my body language as neutral as possible and do the work needed; only speaking to politely give one or two word directions to help prepare her for bed.  She starts her rant over when the nurse comes in with her medications.

We’ve had a stressful week on our wing and this nurse was on the last shift of four days working double shifts.  The nurse, tired and out of patience, responds to her royal tirade by firmly replying, “You are not the only resident here. We have other residents who need our time too.”  ‘Oh no, oh NOOOOO!’ I silently moan to myself. I shut my eyes while crouching down to put on her night time socks and start doing deep breathing exercises knowing full well what is about to occur.  And it comes, the royal Queen verbal hurricane.  The nurse plays the nurse card and walks out on her mid-hurricane tirade.  My partner and I still have to get her in bed. We can’t walk out. We are stuck to weather this storm.  My partner starts to open her mouth to say something and I glare “NO!” at her.  She snaps her mouth shut and we silently start getting the Queen into her bed.

Our silence has sucked the air out of the Queen’s hurricane.  She tries a few more jabs at us (“Giving me the silent treatment, huh? Your boss will hear about this!”) and when those comments didn’t net the response she was looking for, she too became quiet.  We finish tucking her in and as I approach the door, turning off the light, she calls my name.  I cringe; steeling myself for what may come next.

“Yes?” I say with outer calm but inner apprehension.

“Thank you,” she replies in a soft, sincere, non-Queen-like tone.  And I exhale in relief.  All that transpired during the last 45 minutes evaporates like morning dew in the sunshine.

I don’t want to talk about the psychology behind her behavior.  Instead, I want to share the gifts she has given to me.   The Queen has taught me how to be patient when confronted with impatience. She has taught me that silence can be more powerful and calming than words.  Because of her I have learned how to tune out the hurtful and sometimes cruel spoken words while tuning into the unspoken reasons behind them.  She has taught me what it means to truly care for another human being unconditionally.

This fussy, demanding, insistent, bossy woman makes me a better CNA, a better person. And I can’t help but adore her.

It Ain’t About the Money, Honey

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Alice

$2.83. That is the balance of my checking account. Two dollars and eighty-three cents to last me for the next five days. I checked it repeatedly, as if money would magically appear if only I willed it…It didn’t.

“Well, Alice, rent is paid. Nothing is going to be shut off this month, you have plenty of ramen, cereal and milk that is only mildly questionable”, I thought to myself as I laced up my sneakers, strapped on my back pack and headed out to work.

I always chuckle to myself when I hear other caregivers say that someone is only in this field “for the paycheck”.  WHAT paycheck? Honestly, you could make more money and have more room for advancement and growth in the fast food industry than in the long term care system. Anyone who takes on this gig hoping for a lucrative future either has bad business sense or is delusional.

Our world is not the neat confines of the office. Our language is not the detached, clinical observations of the doctors or nurses who visit occasionally. No. Our place is on the floor, with the people. Hands on.

It is a gritty, raw, deeply emotional reality filled with equal amounts of devastating loss and bodily fluids. It requires a unique skill-set; an adaptability and stamina that few are able to maintain for long periods of time. If done well, this job will break your heart every day. If done correctly, it will test your limits in every way. It is not for everyone.

So why are there “bad” caregivers? Why do some seem to phone it in? My best answer, in the most simplistic of terms, is that it is an emotionally, physically, mentally exhausting job that usually goes unappreciated by those in charge. Often, the only incentive we have is to not get fired. We are underpaid and overworked by people who do not understand what we do. Many caregivers burn out because they cannot see past that wall.

Well then, what makes “good” caregivers? Simply put, they do not give up. They do not let the deeply flawed system define them. They reach down and discover their own personal reasons for their commitment to this field and hold on to it when everything else seems to fall apart. They find their own leadership and they never stop learning and growing. It is an emotionally fulfilling, physically challenging and mentally stimulating job that never goes unappreciated by those for whom we care. Even if they don’t or can’t say so. The truth is in the moments and the moments on the floor are abundant.

As for this caregiver, I never lose sight of the fact that having money and being rich are not synonymous. I do not underestimate the value in what we do or the depth it has added to my life. For me, it far outweighs the difficulties we have to face in order to do it.

Good, bad or indifferent, it isn’t about the money. It’s about the perspective. We make an impact on the lives of other human beings, sometimes breaking ourselves in the process. There is no way to put a price tag on that; no adequate way to measure the give and take required to do this job the way it should be done. I only know that it is so very worthwhile.  $2.83 in my checking account and I wouldn’t trade places with an heiress.