Hey you. Yes! YOU, reading this. Don’t ever allow yourself to be convinced that you are less than you are. Don’t allow anyone else to define you. You are so much bigger than your mistakes, fear, and struggles. I know you’re tired. I know you sometimes ask yourself what’s the point and I know sometimes you think your best isn’t good enough. Not one of those thoughts are true. The very fact that you are reading this post shows that you are defining your position in the world of long term care rather than allowing the system to define you. I know. That’s how this whole blog began. Two caregivers found each other online and decided it was time to let the world know what it is truly like from our perspective. We are no different than you. If we can be a part of the solution, so can you.
Step one: we have to get rid of the “I’m just” mentality. I’m just a CNA. I’m just a single mom. I’m just
a high school graduate. I’m just one person. No. You are not. You are a dynamic human being with ideas and value. Your worth is not to be measured by something as simple as a degree. You are not “just” anything. KNOWING that is the key to willingness and willingness unlocks doors you can’t even begin to imagine. Willingness produces action and action produces change.
Step two: we have to stop letting others dictate our behavior. Everyone calls out. I’m going to call out too. Right or wrong, that thinking just excuses their reasonings for our poor pay, awful work loads and disrespect. Is it fair that the best and the worst of us are treated the same? No. Hell no. But the system sees no need to change it. They treat us as disposable. We react to being treated as disposable. They use this as an excuse to continue to treat us as disposable. Collectively, we have power over this. I’ve said it before and I’ll say it again: mountains move from the bottom. Rome wasn’t built in a day. We need consistent and collective moves forward and that will not happen until we excel. Until WE define what we do and how well we do it. Until we become the leaders we wish we were provided, it’s going to be business as usual. We have to stop bullying. It’s a problem from the top down. I should not know what the office people think about the new nurse. But I do. It’s no different than the floor. The new kid on the block always has it rough. We can lead by example there. We can help the new workers, regardless of their position, rather than tear them apart. We can help other shifts instead of bitching about them. Having worked all shifts, I know they each have their challenges. We can not involve ourselves in malicious gossip like twelve year old mean girls. If we feel someone isn’t pulling their weight, we can discuss it with them like grown ups. We can speak up for one another when necessary and we can speak up for the residents. We do not have to get drawn into the drama, even when those in supervisory positions often seem to be the ones stirring it up. We can CHOOSE not to play ball, to respectfully decline to participate in bullshit. In doing so, we become examples for good. We show that it doesn’t take making another feel or look bad in order to look good.
Step three: Never give up. It may seem like no good can come from all this effort. I know I’ve felt that way. Press on regardless. Change happens slowly. It takes patience and sacrifice and even then, the satisfaction of seeing the outcome of all the effort isn’t guaranteed. Trust me, it makes a difference. Once, I was a whistle blower. My entire life was thrown into turmoil. I lost my job. Had to start from scratch and couldn’t see how any good came of it, but as it turned out, it wasn’t just their one facility that had glaring and dangerous violations that had gone unchecked, but several. By shining a light on one, all of them were on the radar. It was three years before I found out that my action had any impact. I was green in the field and naive at the time. Now I realize the most impactful change in this system is not an explosion but the slow and steady burn of passion that motivates this blog. The simple act of speaking your truth consistently will leave a mark. So leave your mark. Write your own piece. Email it to us for posting. Or reach out your hand to another person in this field. Teach with patience. And know we are all in this together and you are not alone.
I do not understand why anyone would continue in this career if they don’t have a love for what they do. It’s not the money. It certainly isn’t the respect. I cannot tell you how many times I’ve heard a nurse offhandedly tell a caregiver that being a nurse is hard, that there are so many responsibilities; The unintentional implication being that we don’t know how good we have it. And I don’t doubt that the nursing field has challenges and rewards that I haven’t experienced as a caregiver but unless a nurse has experience as a CNA in a Long Term Care facility, the reverse is true as well.
I have developed a set of ideals, skills and standards that I consider both invaluable to being a quality caregiver and highly overlooked by the system at large. None of these skills include excellent hospital corners or perfectly folded laundry, both skills with which I could use improvement. It’s not that I consider those parts of the job without value; it’s just the least important of the skills we need to provide quality care and often the first noticed when the hall is inspected by supervisors.
“Did you make the bed in room 237?”, demands an imaginary boss I created to express this point.
“No not yet. Agnes is freaking out because she thinks Ida stole her dog and she’s refusing to let anyone but me in her room…let me just…” make-believe me replied.
“Are you kidding me?! The OWNER is on his way and he wants this hall to LOOK perfect. Leave her. She’ll be fine. Go make sure all the beds are made.”
Now, I made that scenario up. I’ve never actually had anyone named Agnes or Ida in my care. But I have had countless experiences with some version of the above situation; enough for me to know that the priorities in these facilities are WAY off the mark.
The residents come first. It is up to us as caregivers to make certain that is not just lip service. And let’s be really honest here, the top of the hierarchy in these facilities view it as a business. The amount of money it costs a month for an apartment here is mind boggling. I work in a really nice place that almost no one could afford. That is the sad truth. I’m not implying that these corporations shouldn’t take in a profit and I’m not saying that the one in which I work isn’t a decent place. What I am saying is that in the ten years I’ve worked in this field, with varying degrees of severity, the issues in each facility have always been the same; have always branched from the same root. Everyone pays attention to playing their own instrument without considering what it takes to create a symphony. So we end up with a cacophony of noise instead of harmonious music.
I’ve learned through the years that I personally understand the value and necessity in what we do better than the state surveyors. The seem to have a very limited scope of what is deemed important. So I don’t limit myself to their standards, many of which seem silly and misplaced and others that do not reach nearly far enough. It’s as if they have one fixed idea of who lives in these facilities and no ability to get to know the vast array of individuals living with a myriad of challenges, both physical and mental. No interest or time to get to know the residents or those of us who care for them. So I don’t flinch when they arrive to dot some “I”s and cross some “T”‘s.
I am in this gig because I SEE people. There has been much I’ve had to learn and skills that I’ve had to improve upon. My ability to see beyond an age or disability to the person beneath is not one of them. For whatever reason, that part of the job is innate for me. I love seeing bravery in action. I love the stories. I love going to sleep knowing I make a tangible difference in the life of others. I love that I’m never bored. I love that there will always be something new to learn. With people, there always is. These are my whys. Because I know them, have defined them for myself no one can devalue my job. I am not confused why I’m in this field and that has made all the difference. It’s prevented frustration from turning to resentment. It’s inspired me to continue to try to improve the system. It’s opened the door to be both teacher and student and has saved me from becoming jaded from burn out. I defined my career. I didn’t allow someone with little knowledge of it to do it for me simply because they had a degree on the wall. So I would like to know your “why’s” readers. Whatever role you play in the long term care system, what motivates you? What keeps you coming back? And how do you think we can work together to fix what’s broken?
In my last post I talked about the value of good work partners. For a caregiver employed in LTC, working with a good crew can make even the most difficult situations tolerable. A healthy and happy work environment isn’t really sustainable without making some effort to maintain a positive working relationship with your fellow caregivers.
In this job, you really do have to take care of the people around you. This includes an awareness of your coworkers’ needs and circumstances. Yes, we are there for the residents, but when we neglect or mistreat our work mates, we are poisoning our own work environment and this will inevitably impact the people who live there. I’ve known some aides that had some great qualities as caregivers, but couldn’t keep their mouths shut when it came to what they perceived as the inadequacies of other workers. Rather than simply dismiss fellow caregivers as unworthy of the work, how much more effective it would have been had they offered their assistance without judgement when they saw a need and perhaps through their actions provide a better example of how to approach the job.
In my current daily routine with Claire, I am blessed with a great work partner: my 4 ½ year-old granddaughter, Aubrey. From a caregiver’s perspective, Aubrey would be considered a part of my “case load.” Indeed, she does demand considerable time and attention – and she can be quite a distraction for Claire. But she also assists me in ways both big and small. In fact, when it comes to Claire’s care and training, she can do some things much better that I can.
Like my old work partner Russ at the Veterans’ Home, Aubrey is very familiar with our care routines and habits, and she knows when to jump in and help. Most of the time, she’ll do this without direction from me. If I’m involved in some task away from Claire and she gets fussy, Aubrey is right there to give her sister a pacifier or entertain her with a toy until I’m able to focus on Claire again.
Whenever I’m engaged in an activity with Claire, I always make sure that Aubrey has the opportunity to participate if she chooses. Just as Russ and I complemented each other with our differing approaches to our residents, Aubrey adds a quality to the activity that I am unable to provide. Claire simply has more fun and stays engaged longer if Aubrey joins us.
Of course, I often have to redirect to keep both girls on task, but I try to do this by example and not through verbal correction. Sometimes the structure of the activity breaks down entirely, overwhelmed by sisterly chaos and mirth. That’s okay, at that point, we just move on to something else.
When Aubrey chooses to occupy herself in parallel play, she can still be extremely helpful. In our effort to correct Claire’s dominant tendency to arch her back as a means of mobility, we do a lot of floor work in which we try to keep her focus forward. Sometimes this is simply a matter of sitting her on the floor, placing her favorite toys in front of her, and having her reach for them. If Aubrey is playing nearby, I always try to orient Claire toward her sister with the toys in between. To Claire, Aubrey is the most fascinating thing in the world and she’s more motivated to sustain her forward focus when her sister is in front of her.
Like any work partnership, this is a two-way street. One of Aubrey’s favorite activities is taking care of her babies. When I’m busy with Claire, Aubrey is busy with her “group.” This consists of one or usually several “Baby Alive” dolls, most of which are capable of some bodily function.
Aubrey takes her care activities very seriously and I am obligated to pay proper respect to her efforts and assist her when necessary. Sometimes this means I have to stop what I’m doing with Claire to help Aubrey put some article of clothing on one of the dolls or take a turn feeding one of them or perhaps help search for some microscopic toy part of critical importance. Other times, it can mean turning off the music and tip-toeing around the house, because it’s nap time for her babies.
Here, I was rightfully chastised for taking a photo that happened to show in the background her changing her baby (“You DON”T do that!). I duly apologized for the indiscretion:
Clearly, it would be a mistake for me to dismiss Aubrey’s play concerns as frivolous. If I want her cooperation with what I do with Claire, then she should be able to depend on me to do the same for her group – whatever that may consist of from day to day. That is what good work partners do.
There is something else going on here. Aubrey will often use her babies to imitate my activities with Claire. She’s learning by watching and doing, developing skills that will serve her for a lifetime. In a very real sense, I’m training her as much as I’m training Claire. And while Aubrey does not yet grasp the meaning of Claire’s ACC, she is already learning some valuable lessons on how to treat it. As both girls grow, Aubrey will have more influence on her sister’s development than any of us.
In a couple months, I will be losing my valued work partner. Having recently graduated from preschool, Aubrey will be attending full-day kindergarten this fall. While this will leave me more time to work with Claire, I’m really going to miss my little work partner.
“I’ve had it! Second shift ALWAYS does this and now they want to put an extra shower on OUR shift. I’m going to the office.”
“It’s not like anything will come of it…”
“They left the bed pad in the drier AGAIN!…”
“Don’t do first shifts laundry, Alice. They’ll come to expect it…”
Sigh. Here we go again. It seems that regardless of the facility, the shift, or the home in which I work there is one constant and faulty idea that drives people: a problem can be solved by bitching at it and blaming others.
When I first started in this field, I simply tried to avoid those conversations. It’s difficult but not impossible to do. I would change the topic or find something else to do. A few years into this career, I was hit by the superhero bug. Somehow, not getting drawn into the toxic drama was not enough. I would FIX it! I felt comfortable with my co-workers and got along with all of them. It was only reasonable to impart upon them my worldly wisdom. Being “the Great Reformer”, I was surprised that my long winded and preachy speeches on the value of open communication and a sense of community were met with eye rolls rather than inspired applause and immediate action. What was WRONG with people?!
It turns out that I was asking myself the wrong questions. While blame and finger pointing never solved a problem, neither did dismissing the frustration and very real emotions that those involved in the situation may be feeling. A problem can’t be solved without acknowledging it either. So I started listening without offering solutions. I let go of what my co-workers were doing and began focusing on what I was doing. If I had an issue with a co-worker, I addressed it privately with that co-worker. If I have extra time and there is another shifts laundry to be done, I do it quietly. I know what it’s like to work first shift and any help is welcome. I make myself available to those who may need an extra set of hands when I am able. I make certain that I am consistently trust worthy. I don’t engage in gossip just to feel like a part of the group. I don’t seek approval. In other words, with varying degrees of success, I work according to my own standards. I put my money where my mouth is and let my feet do the talking. And it’s worked!
People work differently with me. They stopped bringing gossip around without my having to ask. If I need an extra set of hands, someone shows up. They know by my actions that I wouldn’t take advantage of them and that if needed, I’ll be right there with them too. The other shifts are friendly and grateful. They listen to shift report and I take my time rather than rush through it. There is a synergistic energy that stems from mutual trust.
Once I freed myself from the cage of minding other people’s business, I was better able to focus and improve upon my own. That is the simple and quiet path to actually making an impact on the world around you. Change is inspired by consistent and sometimes humbling steps forward. It isn’t about what you know and how loudly you know it. It’s about what you DO and how consistently you DO it. It’s a valuable lesson I learned from working the floor that I hope to apply off the clock. Society as a whole could use it right now.
The alarm clock cut through my dreams, it’s deceptively cheery jingle jarring my consciousness awake. I groaned, fighting the urge to hit the snooze button just once more. I had to go in early. No more time to snooze.
As I ran about the apartment in my pre-work routine of craziness, grabbing coffee, hunting my keys and making sure that I was wearing the same shoes on my feet, I mentally reviewed the day ahead. It was going to be an uphill battle.
Uphill battles are nothing new to me in this field. Both my experience in facilities and in private care have come with their fair share of obstacles. Not being one to shy away from adversity, more often than not I relish the challenges. It’s when I begin to view life as NOTHING but uphill battles that the trouble begins.
As a caregiver, I deal with a lot of loss. We all do. Death is inevitably part of our job. I’ve learned to view it not as a tragic necessity but as an inevitable conclusion. There is joy and peace in knowing that I have a part in making the last chapter of someone’s life as pleasant as possible, making certain that those in my care never feel alone. It is why I do what I do and that part of the gig I consider sacred.
As a woman in recovery who volunteers at a behavioral health center, I deal with a lot of loss as well. That kind of loss is different somehow. That kind of loss comes with a sort of survivors guilt that makes me choke on my own powerlessness. Why do I get this when others don’t? What could I have said or done differently that may have prevented another’s death or insanity or consequences? The answer is nothing. I can’t force a moment of clarity on another person. I can only share my experience.
I tell you guys this because I know we all have our baggage and we work in a field that can skew our perspective. Because I have to be vigilant, I recognize that change as it’s happening. When I start obsessing over the two people I was unable to help rather than the ten that I was, I know I need to check myself.
I cashed in all my “give up” chips years ago. Now as long as there is a breath in me, I will…I MUST keep moving forward. There is so much I want to do in life; so many people I want to reach and help. My fellow caregivers, my residents, anyone and everyone who feels lost and alone…we all have those shared experiences. I was given a second chance. I do not have the luxury of wasting it.
As a caregiver, I have the privilege of seeing the face of courage every shift. People who have survived cataclysmic and life changing events. People living with dementia, addiction, AIDS, strokes, PTSD, cerebral palsy; people of all ages and I SEE them…the very essence of who they are as individuals shine through their disorders. Their personalities, sometimes difficult personalities, may have been informed by their challenges but they are not defined by them. They laugh and cry and occasionally rage but they face their uphill battles every single day. They have no choice. Neither do I.
My keys were in hand, the same shoes were on my feet, my lid was tightly on my coffee cup and I was ready to face the day. I took a deep breath as I opened the door into the bright sunshine and reminded myself that it was uphill battles that made me who I am today. For that I am incredibly grateful.
Next week marks the 39th Annual National Nursing Assistants’ Week. “NAWeek” begins on June 9th with National Career Nursing Assistants’ Day – “a day to recognize nursing assistants who dedicated their lives to the well-being of others for 5 to 58 years” – and runs through June 16th. The theme of this year’s NAWeek is “I Choose Respect.”
NAWeek is sponsored by The National Network of Career Nursing Assistants. Longtime director of the NNCNA, Genevieve Gipson, has been advocating for direct care workers for over fifty years and is currently working with numerous National NA groups on legislation issues, promoting recognition of nursing assistants, education, research, and peer support development for nursing assistants in nursing homes and other long term care settings. We’re working to get Jeni to appear on CNA Edge as a guest contributor so that she can share her wisdom and insight with our readers and give us her take on NAWeek and the NNCNA.
Meanwhile, to help celebrate NAWeek, we will be offering a free download of the Kindle version of our book CNA Edge: Reflections from Year One from June 9th through June 12th. The book is a collection of over 80 essays originally published in 2014 as posts on this blog. We will post links here and on our Facebook page starting this coming Thursday.
For more information on NAWeek click here: National Nursing Assistants Week
Oh that’s just the way it is. It’s ALWAYS been this way. It’s never going to change. Why rock the boat? What difference is it going to make anyway? It’s impossible.
Some of the most useless reasons for inaction are the ones I have heard the most in my life. The fact is, sometimes the boat NEEDS to be rocked. Sometimes it demands it. Furthermore, if everyone bought into that logic, there would still be segregation. Women would still be expected to meekly submit to their husbands and we would have never landed on the moon.
The long term care system is crap. It does not work for the residents and it does not work for the caregivers. That is the problem broken down to its bare bones. Administrators, management, owners may argue that they aren’t getting rich. They may say that it’s the nature of the economy. They do the best they can. I call bullshit.
I understand that struggle is a matter of perception, but to compare not being able to buy a third car with having to pull doubles or work two jobs just to make rent is both insulting and shortsighted. It would be like me comparing my relatively small worries with my client who had a massive stroke in the prime of her life. There IS NO comparison.
Private care doesn’t offer much more in compensation, though I have more empathy for a family that is struggling and unable to pay a decent wage than for a facility that is at maximum capacity and hasn’t given their workers a raise in years. It should not be financially irresponsible to be a caregiver but it is.
And what happens? What happens when the majority of caregivers end up burned out, used up, angry, undertrained and underpaid? What happens to work ethic when it’s not considered a valued commodity? I’ll tell you what happens! You end up with a section of the caregiver pool that is full of apathetic, short-tempered and marginal people. Narcotics get stolen all the time from both facilities and homes. Neglect and abuse statistics go up. For every awful story you hear on the news, there are a thousand more you don’t. For every heartwarming story you hear, there are a thousand more you don’t. This is the reality. And it continues because society is more concerned about arguing politicians than the damage and the healing that we actually do to one another. The good caregivers…the smart ones who see this job for what it should be usually move on to a more lucrative field. I believe there is an alternative.
Let’s change it. How? We’re just caregivers. No one listens. Speak your truth anyway. KEEP speaking it. SHOUT it! It’s time to make our voices heard; to make our clients’ and residents’ voices heard. We have a moral imperative to stand up and speak for those who will not or cannot speak for themselves. If not us, then who? There are a million ways to be an active part of the solution. Start a support group. Write an editorial. Exchange ideas. Be involved.
Changes happens slowly, but it has to start somewhere. Why not with us?
We have received some wonderful and articulate emails from a reader who posed this question: How do we make life better NOW for those living with dementia? She went on to explain how advocacy is what drives the flow of funding and most of the funding is going towards finding a cure for Alzheimer’s disease. While vitally important, it does nothing to help those currently living with the disease in the long term care communities. Who is speaking up for them? Who us speaking up for us?
The frustration is that here on our level, there is little meaningful conversation of such things. We are expected to show up and take what is dished out. We don’t do it for the money, they say. It’s just a “stop-gap” job. If they were smart, they would have furthered their education. Treat someone as disposable for long enough and they begin to feel disposable; begin to act disposable. Is that what we want? Disposable people caring for the most vulnerable section of our society in their hour of greatest need?
Or maybe it’s an indication of something deeper. They treat us as disposable because on some level they feel that those within our care are disposable. They have aged out. They no longer contribute to our society. Wisdom, experience, history, dignity are not valued commodities in this fast paced world of “me first and the give me! give me! mentality. Old, sick people barely make the priority list and those of us who care for them don’t make the list at all.
No one SAYS that of course. I have never once seen a bumper sticker that reads Old People Suck and yet the situation in which many seniors and people with disabilities are forced to live is heartbreaking. There is no other word for it. They devalue them and by doing so they devalue us. And I’ve got news for you, folks…we allow it. Hell, sometimes we encourage it by our own behavior.
One in four seniors will suffer from elder abuse. I’m no statistician, but I would say there is a probable correlation between quality of care and treatment of the work force. One in four. The injuries caregivers suffer on the job is sky rocketing. Again, this is supposition, but I would say exhaustion due to being forced to pull double shifts or multiple jobs to barely make ends meet would contribute to this. The standards for certification is low, the wages are low, the work is difficult, and the turnover is high. Why, why, why would ANYONE choose this quagmire? Because someone has to. Because those of us in the know have a moral obligation to do everything we can to be a part of the solution. Because it’s a battle worth fighting.
How do we make life better NOW for those living with dementia? For all of those living with a disability that requires care? I have no idea. I’m winging it. I give the best possible care to my client. I write for this blog. I notice lonely people and try to make them less lonely. That’s the only way I know to make any difference that counts. I’ll tell you this though, the most meaningful changes are going to begin with us or not at all. They think we’re disposable. Let’s prove them wrong.
In my last post, I suggested that there may be something about the Long Term Care work environment that makes conflict among caregivers almost inevitable. Some – or perhaps even most – of the behaviors associated with this conflict could be described as “horizontal violence.”
Horizontal violence is a form of hostile and aggressive behavior exhibited by individuals or groups toward others within the same peer group. It is usually not a physical kind of violence, but relies more on emotional and social pressure. It includes a wide range of negative behaviors, both overt and covert. Examples include such things as direct verbal abuse, belittling gestures, threats, intimidation, gossip, “humorous” put-downs, sarcastic comments, social exclusion, nitpicking, ignoring legitimate concerns, withholding support, and slurs based on race, ethnicity, religion, physical appearance, gender or sexual orientation. In a word: bullying.
The thing that makes horizontal violence “a thing” is not a big list of nasty behaviors. These can happen anywhere and for a lot of different reasons. Horizontal violence is a phenomenon that occurs within oppressed groups. That is, groups of people who do not feel as though they have the means to adequately address the most significant problems and issues associated with their group. Some respond to this sense of powerlessness by becoming submissive and exhibiting learned helplessness. Others respond by adopting feelings and attitudes of superiority over others within their group. In a sense, both are coping mechanisms, characterized by inappropriate and self-defeating behaviors.
If a sense of powerlessness is at the heart of what it means to be an oppressed group, than direct care workers certainly qualify. Overworked, underpaid, and unsupported, LTC caregivers generally do not believe that they have the means to independently create the kind of fundamental change that would address these issues in a meaningful way. You either accept “that’s just the way it is” and learn to do what you can with what you have – or you leave.
At the bottom of the LTC hierarchy, the caregiver brand of horizontal violence plays out in one of two ways. The first way is the classic division of Older Workers vs. Newer Workers. This divide is typical in nursing in general and most of the literature I’ve come across regarding horizontal violence has to do with career RNs, but it applies just as well to nursing assistants.
New workers enter the field with a set of expectations of what caregiving is all about and are soon disillusioned by the reality of what they witness on the units. If they are unable to adapt to “the way things really are,” the more experienced caregivers have ways of putting them in their place. Newer workers are regarded as both naïve and judgmental – and perhaps even threatening – because they base their impressions of experienced workers on unrealistic expectations. They often become victims of horizontal violence, not fully comprehending why they are being mistreated.
The second situation is created by the absence of adequate and appropriate involvement of management in the typical LTC work environment. The formal rules and standards are enforced inconsistently, sometimes capriciously, depending more on personality and circumstance, such as inspections or any other time the facility is under public scrutiny. Good workers go unnoticed and poor workers go uncorrected.
By default, caregivers are left to fill the vacuum and develop their own norms and standards. These can be very different from facility to facility and even from unit to unit within the same facility. To one degree or another, they are informally enforced by the strongest personalities among the established caregivers. In the best circumstances these norms and standards are communicated through example and positive leadership, but often they are enforced by various forms of horizontal violence.
Caregivers frustrated by their inability to formally address the larger problems of the Long Term Care workplace find an outlet by dominating their coworkers. Others simply acquiesce, doing their best to keep to themselves as they struggle to find a balance between the official standards, pressure from their workgroup, and their own sense of right and wrong.
In my next post, I will share my take on how we as caregivers should approach the problem of horizontal violence in the LTC workplace.
For more information on horizontal violence:
Even in the worst work environments caregivers have the opportunity to make an immediate and positive impact on how residents experience life in long-term care. So much of what our elders experience depends upon the quality of the interactions we have with them. Whatever our difficulties, we are ultimately responsible for the manner in which we approach and respond to our residents. At the same time, how we conduct ourselves as caregivers has significance that can go beyond our ability to impact the immediate environment.
Caregiving is a practical art. Our role involves us in the details of the daily routines of our residents, but not necessarily in the larger issues of Long Term Care. While we are profoundly affected by things like poor staffing ratios, direct care staff turnover and disconnected management, the conventional wisdom among caregivers is that we simply don’t have the authority to do much about those things and the only option we really have is accept things as they are or find a different place – or field – to work.
Meanwhile, we leave the larger problems to those who we believe have the real power: the administrators, regulators, legislators and assorted LTC professionals. However, no one has greater awareness than direct care workers of how chronic understaffing and turnover rates actually impact the care and well-being of individual residents on a day to day basis. We know what it looks like and we know what it feels like to our residents in a very real way. We can give these problems texture and a real sense of the human cost. Our experience in the trenches of Long Term Care provides us with a unique perspective, a perspective that is very much needed if Long Term Care is ever to truly come to grips with its problems.
While caregivers lack formal authority, we can still influence those who do have formal authority. Our real world experience gives us something valuable to say. Our capacity to convince others that what we have to say is valid depends on our moral authority. But if we are not doing everything we can as caregivers to improve the immediate environment of our residents, then why should anyone listen to us about the bigger problems? By taking responsibility for our own behavior and conducting ourselves according to what we know by reason is right – in spite of difficult circumstances – we provide the basis for our moral authority.
And with that, we cannot be ignored.