Tag Archives: CNA attitudes

Just a CNA?

buddha

 

 

Edison Terrell

I‘m not “just a CNA,” but I’m not so bothered by people saying that’s what I am. Other people are taking snapshot judgments of my entire life stories and personality based on a glimpse when they say I’m only an aide, and I do that to them, too. It seems like an evolutionary device to tell potential friends from foes, and as we got more sophisticated, a way to determine someone’s value to you, or lack thereof. It’s deeply ingrained in the mind, passed on and perfected by thousands of generations of reinforcement. Something like this won’t go away by arguing with it. That’s literally the opposite but equal side of the thing. On one side is “You’re ‘just’ a CNA,” on the other is “I’m MORE than just a CNA, I do blah blah blah.” I’m not saying I don’t agree with either stance, but we’re just banging hammers here. You’re fighting one mindset with its equal, an unstoppable force meeting an immovable object.

I don’t know what the answer is, but it isn’t this. I honestly think it’s just to let people hate and not to give in. That’s a pill I haven’t swallowed, I’ll totally admit it. One of the reasons I’m going back for a degree is because on some level I believe that “Just a CNA” bullshit. And that’s OK, too, if you have that same thing going on. It’s just your mind. Mind is like a water glass with dirt at the bottom, and this stuff, arguing the merits of what we do, is stirring up the glass, clouding the water. There’s no taking the dirt out, though, it’ll always be there. You just have to notice when your mind get shaken like a paint mixer and understand what comes up is just a reflection of your shook up mind.

That’s a lot easier said than done, of course. I’m still working on this after almost ten years, and I’ll probably wrestle with it for the rest of my life to some degree, but I’ve found it to be the only thing that may provide some relief. I did a lot of soul-searching before I entered healthcare, fell into Zen, and I think some of the lessons like this one might be helpful for everybody, regardless of the path you’re on. The alternative from what I can see is diving hip deep in the fray, getting pushed around by forces you have no control over, people you don’t know judging you, a person they don’t know, and taking swings at everything that moves. What good will that do any of us? No—what good does that do you? Let’s not make this a global issue. Tell me when doing that has benefited you? When have you jumped into an argument like that and walked away not feeling unclean? I want to meet that person. You might feel like you one-upped somebody because you got in a few good remarks that left them sputtering or pissed off, but you still feel ugly and gross walking away, if not ashamed or mad yourself. Is that worth it?

And I know, believe me, the alternative to that sucks, too, just as bad. That guy called you worthless, but you’re supposed to not snap back at them. It becomes a question of whether you’d rather feel dirty and angry or just angry, and have to examine that anger, the stuff that arises with it, and let it come to rest while the other guy is smugly nodding in the corner like he got you. It takes everything not to verbally crank him across the jaw. After a while it starts looking like the only good option, though, even if it’s not the most palatable one.

Let the haters hate. It’s what they do. Just drop both sides, or try to anyway. Cuz otherwise it’s like thinking you can remove a bullet wound by shooting yourself again. That’s my opinion, anyway. I could be totally wrong, I’ll admit that too. 

Another Angle on Anger

DSC00999

 

Yang

Two recent posts on CNA Edge dealt with negative emotions: “Anger Management” by Edison Terrell and “Out of the Night” by May. While they take different approaches, these two posts share at least one very important idea: don’t allow your anger and frustration to become a problem for the people in your care.

In his post, Edison confronts his inner rage demon. The piece serves as more than a simple catharsis in the “confession is good for the soul” kind of way. As caregivers, we all have to deal with anger at one time or another – and if we’re honest, every single day. By his public confession, Edison demonstrates that it’s possible to have these feelings and still be compassionate and caring if we properly manage and process them. His post helps free us from the trap of denial and projection.

May’s post was equally introspective. But instead of a battle with her inner demons, she refuses to surrender to the negative influences of her work environment, in particular the perpetual listing of grievances by some of her coworkers. Instead, May makes a deliberate choice: “I stay despite the circumstances.” Through this simple act of will, she takes control and responsibility thus liberating her – and her residents – from the wearisome self-victimization displayed by her workmates.

Negative emotions are common in the work environment. Any time you put people together in a stressful situation there is going to be a good deal of politics and personality clashes. With egos on the line and blame to shift, some level of discord is to be expected. The same is true in any line of work. Due to the nature of our work, the stakes are higher and the emotion is amplified.

As we work to process our emotions, I think it’s useful to make a distinction between the routine frustrations of the workplace and the genuine anger engendered by problems that are endemic in long-term care. It’s difficult because the two things overlap so much. However, when we are able to separate them we elevate our awareness of something that is nothing less than a social injustice. We are not just workers; we are first hand witnesses to how the elderly and sick are directly affected by inadequate staffing levels, high turnover rates for caregivers and the poor utilization of resources due to misplaced priorities.

And here the rule applies doubly: the righteous anger we feel over this social justice should not become the residents’ problem. They are the primary victims. Don’t make them pay twice.

This brand of anger should instead be directed elsewhere.

 

Teachable Moments

photo

 

Alice

There will come moments when you will know that all the struggles you have faced were there for a reason, though you did not realize it at the time. Though you bled and hurt and doubted and despaired and questioned while they were ongoing. And in those moments, even if they come years later, you will realize all that you have learned from those crushing blows. You will realize that you are much stronger, more capable and more insightful than you once believed. That you can do what needs to be done. That you know how to land on your feet, regardless of how far you fall. You will be empowered. You will gain true empathy. How you choose to apply that knowledge will be up to you, but you will have a choice, because you will have learned the hard way, the messy, confusing and painful way how not to be a victim.

This truth is at the essence of our humanity. It will carry you through in this field, where we face such adversity and loss. When each moment is filled with a myriad of emotions, interwoven into a glorious and tragic fabric, it is this lesson that will remind you what to hold on to, and ultimately more important, the stuff you need to let go.

My brother Colby reminded me of a quote in Rocky. “It ain’t about how hard you can hit. It’s about how hard you can get hit and still keep moving forward.” So, here’s to all the bad days, the toughest lessons, and the worst hurts because they brought us to today. And today is a damn good day.

Daddy Don’t

 

May

Only 45 minutes left in my shift, and for first time, I’m not counting the minutes with a mix of dread and relief. I’ve only been an aide for a few weeks and I finally feel like I’m catching on. The physical stuff is becoming muscle memory and that’s freeing up energy to focus on the mental aspects. It’s the first shift in which I don’t feel like I’m drowning; the first shift in which I think: maybe this is for me.

I’m doing my nightly rounds when I hear loud voices coming from a room across the hall. The ladies who live in that room are usually quiet, so I hurry over to see what is going on. In my rush, I saw but did not comprehend the sad look thrown at me by the nurse.
In the room, one resident is awake, wide-eyed and clutching her blankets tightly. Upon seeing me, she pointedly looks over at her room mate. No words leave her lips; none need to. She looks worried, but also irritated, like this isn’t such an uncommon occurrence.
The other occupant of the room is still asleep, her eyes darting about underneath her eyelids. Dreaming, then. Or maybe not. She’s crying in her sleep, great fat drops leaking from the wrinkles around her eyes. She’s talking, too, her voice rising and falling in a mostly-incomprehensible babble.
I wish it was completely incomprehensible…because I can make out two distinct words, repeated over like a nauseating refrain to a horrific song.
“Daddy don’t.”
This isn’t something I was prepared for. In my CNA course, nobody told that I’d have to witness the nightmares of my residents, have to stand next them while they relive the worst moments of their lives. Why isn’t this something we are warned about? Why isn’t this a facet of long term care we talk about?
Before, the people I was taking care of were little old ladies and sweet old men in my head; the Greatest Generation aging gracefully.
I feel like I’ve run smack into the revelation that whatever else they are, my residents are people first. Not always cute characters from a Norman Rockwell paintings, not always caricatures from nursing home abuse commercials, old people in wheelchairs, neglected and dejected…but always people. People who lived, and yes, people who suffered.

I don’t know what to do. I feel like I should report this–but what’s the point? This lady is in her 90s, “daddy” is long dead, as are all the people who turned a blind eye to the abuse.
I do the only thing I can think of: I wake her up. She’s startled and begins yelling at me. It’s mostly for my own sake that I sink down on the floor beside her bed and hold her hand until she falls into a peaceful sleep. Or at least, a sleep that is free from screaming nightmares.
I finish my rounds late, again. But this time, it’s not because I couldn’t figure out how to roll a resident and tuck a brief at the same time. The nurse tells me I did a good job, both during the shift and during the “incident”. I suppose I should be proud of that, but I can’t get my mind out of that room long enough to think about anything else.
My notations of what being a CNA means and what a CNA does have been drastically altered. I go home and go to sleep with only one thing decided: I hate that man whose sins still have the power to torment his daughter all these years later. Once a little girl, now an old woman; always a person.

Figure it Out

photo

 

Alice

It’s pouring. And cold. And the busses aren’t running. Awesome. Figure it out, Alice. Make it work. Ok. I’ll pack my scrubs, walk in street clothes and change at work. Solution!

Third shift did not get up one resident. Not one. I was informed that she wasn’t going to risk harming herself by “lifting. She’s concerned about HER back and couldn’t care less about MINE. Figure it out, Alice. Make it work.

My partner on the floor is late. Or called out. Or maybe no one was scheduled. I don’t know. No one told me and I don’t have time to bitch. There are seven people calling my name. Where are the TED hose?! Missing again. Figure it out, Alice. Make it work.

Prioritize; desperate to desired. Fall risks first, requests for ice last. Breakfast is late. VERY late. Which means showers will be late, my residents will be “off” and my shift will be “off”; that potentially disastrous domino effect that comes from inconsistency.

New resident, ninety-five years old. Sharp as a tack. She came to us from her own home, having successfully lived independently for almost a century. Now she needs help. That’s scary. I know that’s scary. She knows that’s scary. I tell her she’s brave.

“MAKE SURE SHE GETS UP!”, says her family. Says my bosses. She does not want to get up. She refuses. She adamantly-hell-will-freeze-over-first-refuses. Figure it out, Alice. Make it work. I tell them that everything is a negotiation. I tell them she is going to need time to adjust. I tell her we will work together and try again tomorrow.

Buddy, you HAVE stop peeing in cups. I promise, I will do my very best to make sure your brother doesn’t give up. I’ll find your favorite sweat pants, they are around here somewhere. It’s not ok to dump your milk on your roommate because she got to the Rice Krispies first. Poop. So much poop. WHERE ARE MY MEDIUM GLOVES?! Small is useless when my hands are sweaty and large slide right off. Figure it out, Alice. Make it work.

“Alice. Whose drink is this? You KNOW drinks cannot be on the nursing station!”….Pause, Alice. DO NOT say what you are thinking, for once. Deep breath. Do not SAY not only do I not know who’s drink that is, but I don’t care. Why don’t you take that drink and shove it up…

“Nope. I don’t know.” Good! Restraint!

We don’t get paid enough to “figure it out”. There are days that I feel really resentful and get stuck in the “unfairness” of it all. I hate that! I’ve written previously about how I feel about that sort of mentality, but I’m human and am not immune to the occasional case of the “poor me’s”.

Luckily for me, on those days that my mind and emotions rebel and refuse to cooperate, my FEET know exactly what to do. It’s muscle memory. It’s action. They figure it out and make it happen and usually my feelings follow suit. Resilience overcomes defeatism.

 

The Gift of Adversity

photo

 

Alice

   I’m not sure when people reached the erroneous conclusion that “easy” is synonymous with “happy.” I do know that it is a societal problem and I see long range trouble stemming from it in the future. Even in the present, such a mindset inevitably breeds resentment and uncertainty when individuals don’t get what they feel they deserve.

       I do not like the word “deserve.” It’s a self-serving and superficial concept that implies the misguided notion that life is fair, when often it is not. And the truth of the matter is, that is good news for all of us.

       We learn how to do difficult things by having to do difficult things. Think about it. If life we always “fair,” we would never have to face adversity; we would never have to meet and overcome obstacles and it is by doing so that we discover who we are, as human beings and what we are capable of both surviving AND accomplishing. Life is much too big, dynamic and complex to be described by such a humdrum term as “fair.”

         I don’t have to look far to see proof of this. I see it every day at work. It is not fair that my folks ended up in a long term care facility; that some have out lived all of their families. It’s not fair that we have veterans who, after a life time of service, have to live in a place that offers lukewarm coffee, disinterested management and overworked caregivers. Cancer is not fair. A young man dying of a long illness that has resulted in dementia is not fair. Our working conditions and poor wages and lack of positive leadership; of ANY kind of leadership, is not fair. But my folks LIVE. They may have their off days, but on the whole, I complain about the unfairness of their situation more than they do. They laugh and tell me their stories and are not owned by the situation in which they have found themselves. THEIR courage gives ME courage.

           This is a difficult job. To do it well, we need a finely honed ability to persevere. There are shifts that we have to go against the system, the work ethic of others, management and the difficult days or moods of our residents.

       No one in this field for any length of time will not be changed in some profound way by it. It is through learning how to face adversity, to embrace and learn what it has to teach us, that we can ensure that we change for the better. If we accept those lessons, we become EMPOWERED. If we ignore them, we become EMBITTERED. The choice is up to us. It is not about the hand we are dealt. It’s about how we play it.

Good body mechanics

 

May 

I can feel it happening and all I can think is “how the hell did I get into this situation?”
Oh yes, I decided to become a CNA. And CNAs are prone to back injuries. I can feel it, a sharp twinge on my left side, just under my shoulder blade…unfortunately, there’s no good way to properly cradle that.
I clutch at it the best I can and hobble out into the hall where I found someone in a position of authority. (I am not going to say which position.)
“I think I really hurt myself,” I sob out.
One of my greatest faults is to get emotional when being rational would be more effective.
“What happened?” the person sighs.
I tell them what happened; when I am finished, the person is silent. 

“Well, you’ve been off your game all week and it doesn’t sound like you were using good body mechanics,” they say, finally. My back twinges, as if to echo the sentiment.
I stare at them for a long moment…the truth is no, I wasn’t using good body mechanics. I didn’t brace my back or lift with legs. I didn’t carry the load close to my body. There was definitely some lifting going on in this “no lift facility.” The reason for the bad body mechanics is that I really hadn’t expected to catch a 300+ lb person as they rolled out of bed into my outstretched arms. 
It is drummed into our heads over and over again: you do not play the hero when someone is falling, you assist them to the floor. Don’t put yourself in harms way to protect them. I didn’t obey this rule…mostly because I couldn’t see a way of “assisting them to the floor” without ending up underneath of them. So instead I had hefted the 300+ lb person out of my arms and back into bed. Honestly, it all happened so fast that I barely had time to register that “holy crap, there is a huge person in my arms” before they were back in the bed and I was on the floor.

The person is staring at me and I’m beginning to realize that I haven’t told this story very well. In fact, I know I haven’t. I should start over. I should stop crying and start from the beginning.
But the person is glaring at me in obvious frustration and my tongue is tied up in knots. I didn’t use good body mechanics and that’
s all anybody is going to hear. Sorry that you can’t think well under literal pressure but you must use good body mechanics! You shouldn’t have been changing this bariatric resident on your own! You should have gotten help! If put on paper, everything would be my fault. Because I wasn’t using good body mechanics at the time of the incident. Who in their right mind lifts someone almost three times their size–literally single-handedly?

Right?

One of my greatest faults is my tendency to back down from confrontation…and that’s exactly what I do. Suddenly I am very tired and I just want this to all go away.
“You still want to make me send you to the hospital?” they sigh.
“Let’s see if it gets better,” I sniffle and walk away, a bit stiffly, a lot slower than my usual break-neck pace.
On my way home I invest in several Icy-Hot packs. It’s not serious, I tell myself. You pulled a muscle, that’s all. Rest, stretching, Icy-Hot and Advil will make this better.

And in the morning, I do feel better. No debilitating pain, just a slightly more obvious twinge. I go back to work. There’s just a tiny bit of a twinge, nothing major. I was just overly-emotional the day before. It happens.

And for three years, I continue to go to work. I work my regularly scheduled shifts and I work extra shifts. I switch jobs and I finally find the tough skin and backbone you need to survive this field. I learn how to say “no” and I learn how to “yes”; how to stand my ground and how to choose my battles.

But I also learned something else in the years since the above incident: injuries don’t go away because you don’t want to deal them. The damage doesn’t disappear just because the person you went to is irritated. The pain remains. It makes itself known, after too many double-shifts in a row. I have to keep up a strict routine of yoga and a strict obedience to the rules of body mechanics now. I have to be more careful.

My back is not what it used to be. It is by no means broken or debilitating, but I have to be careful or it could be. I wish I had known that day what I know now: injuries and silence breed their own. If you injure your back and ignore it instead of healing it, it is that much easier to re-injury.
If you swallow the pain for fear of a hassle, it becomes a habit. “I’ve had worse happen and I didn’t say anything.”
Back injuries and silence: two problems faced by CNAs. One is more easily treated than the other, I think.

The Short-Staffed Story

 

May

It’s staring me in the face the entire time I’m getting my coat on. It’s mocking me with its very existence. I want to smash it into nothing, I want to scream insults at it. Mostly, though, I want to go home and not come back until I feel like a human being again.
“It” is a list of all the open shifts for the month…there’s enough to fill a full-time position or two. Or several.

We’re all in overtime already: we few who have stuck it out during this incredibly rough period. Every place has its bad stretches–we’re in the middle of one right now.
Every aide that leaves puts more work on the rest of us. The heavier the workload, the more aides that get fed up and leave…and when it’s like this, overworked and understaffed, it is hard to convince the new aides to stay.
Why would they? It’s crazy and ridiculous and nobody is happy to be at work. Another newbie quits and we all sigh and try to prepare ourselves for another week of 10-12 residents per aide.
When CNAs are short-staffed, they’re also overworked. It’s just the way it goes.

According to the charts in the office, twelve isn’t that much more than a standard group of 8-10 residents per aide–no big deal, right? It’s an acceptable solution to the problem of not-enough staff. Just give every CNA a couple more people, maybe three or four and there you go: we’re covered for today. Whew. Saved by simple mathematics.
But on the floor, having twelve people instead of eight means more call lights going off at the same time, it means no ten-minute breathers. It means later lunches, messy rooms, soiled pants, too-long finger nails and unshaven faces. On the floor, it becomes a problem of subtraction, not addition. What it really means is that you’re taking time and care away from all twelve residents.
What it means is I don’t have time to change Mrs. Q’s sheets because Mr. W needs to get dressed. I don’t have time to walk Mrs. E because Mrs. R’s call light has been going off for 20 minutes. I can’t spend a few minutes chatting with Mr. T because Mr. Y’s alarm is going off. Mrs. U and Mrs. I can’t go to bed yet because they are mechanical lifts and I don’t have anybody to help me right now. Mr. O has to feed himself, even though he really needs supervision because Mrs. P can’t feed herself at all. I can’t brush Mrs. A’s teeth, because I can see Mr. S coming down the hall with soaked pants–understandable, since I haven’t had a chance to touch him all shift.
Understandable to an overwhelmed CNA, that is. Try explaining that to his family. Try explaining that to him.

And while it might be “understandable” to the aides, these kinds of situation are most certainly not acceptable. Not to the good aides. We who take pride in our work, we do not enjoy seeing our residents unkempt, soaked and soiled. But what can we do? Stop time, clone ourselves, refuse to work unless safe staffing laws are passed?
If only.
What we can do is come in early and stay over late; we can skip our ten-minute breaks, we can pick up extra shifts so that our residents can get the high quality care that only comes with adequate staffing. We can take on extra work during a shift in hopes of keeping the newbies for more than two weeks.
Sometimes these measures, so wearing on us, seem like fingers in the dike. It’s not enough. It’s never enough. We go above and beyond but we still can’t reach. Bad days and double shifts stack up into a wall of weariness; the higher it gets, the harder it is to remember why we cared enough to make these sacrifices.

I’m not quite there yet. I can still feel the shame and the anger that comes from a job badly done. I’ve failed them. I’ve failed my residents, who are both my responsibility and my friends.
But it’s not my fault. I didn’t ask to have a group of 12 residents. I didn’t ask to have a whole hall to myself. This wasn’t my choice, this isn’t on me. I’m only human, I can only power through so many short-staffed shifts. I am aware that at other facilities, the ratios are much higher–up to 20 residents per aide–but this doesn’t make me feel better about the twelve people whose care has seen a noticeable decline since we’ve been short-staffed. What more can I do? What more should I do? Is it always going to be this way? How much more can I take? How much more should I take?

There’s a note on the sign-up sheet. “Thank you for all you do,” it says. “It doesn’t go unnoticed. We know it has been rough. Hang in there, we’re trying to get more staff in. Just keep being awesome for a bit longer.”
I start to tear up. They see. They see. Some would say it’s a ploy to milk more hours from us, but from the dollar signs offered next to the note, I’d say they’ve got their money where their mouth is.
Okay, I think. Between the note and the big bonuses, I’ve changed my mind. I can work nine days in a row. I can handle a double in that mix. I can do it. My back hurts, I’m always tired, I never see my friends or my family, but I can do it. I can do it again.
Next week, though. Next week I cut back. Next week I rest.
Maybe next week, they’ll have a new aide in. Maybe.
I won’t burn out; I’m not drinking that poison again. I’ll fix a smile on my face and I’ll work this week because my residents need me. My employers need me and they’re acknowledging that. They see and they appreciate me; I’ll give them one more week of my free time.
Next week I’ll cut all the way back to 40 hours and I’ll take care of myself…because my residents are going to need me in a month, a year.
I’ll damn the broken system and laugh with my residents because I chose and am choosing to be a CNA. Nobody and nothing is taking away my joy in my vocation.