What Is Here

What is here:

Educational Articles:

• Everything You Want To Know About Being A CNA
• The Nursing Process & The CNA
• Observation Skills for CNA's
• Legal Issues for CNAs
• Being Professional
• CNAs and Respect
• Horizontal Violence
• A Call For Action
• Tips & Timesavers for CNAs

Quick Reads for CNAs:

• What NOT To Wear At Work
• Making Meals Resident Centered
• Answering Phones
• Cell Phone Use At Work
• Sniffs, Smells and Odors

Advice For CNA's:

• Lifts & Transfers
• Personal Notes About The Workday
• Filling In The Blanks
• Families: Why The Battle?
  
• Pay Practices At Work
• Job Interviews Do's and Don'ts
• The Residents Unit: A Reflection Upon the CNA

SPOT LIGHT SERIES: In depth reviews of important issues

• Range of Motion: Why's It's Important
• Medical/Nursing Jargon: Understanding MedTerms
• Face, Hands & Butts?

Spot Light: Range Of Motion

What is Range of Motion? The normal movement of joints.

For many residents, a lack of mobility causes stiffness in their joints. Their muscles shrink and become weak- this is known as atrophy. Gradually, the atrophied muscles become hard and rigid. The muscles shorten in this process, and therefore joint movement is affected. Pain, discomfort and disfigurement occur. These disfigurements are known as contractures. They are, almost always, 100% preventable.

It is up to nursing staff to maintain a residents range of motion (ROM). For residents who are bed bound, wheelchair bound or who cannot ambulate, it is even more important that range of motion exercises be done correctly and often enough. Many of the activities we assist with will provide ROM for residents…bathing, dressing, grooming activities in particular offer opportunities for joint movement- SO long we we think about what we are doing. When we’re giving a bed bath for example, it makes sense to lift each leg and put it through it’s complete ROM while washing and drying it. But I’ve seen CNA’s turn the resident to the side and wash/dry them from behind, thus eliminating this opportunity for good ROM.

To be effective, ROM exercises should be performed at least twice a day, and each exercise should be done at least five times. The quick, natural opportunities for ROM are an excellent way to enhance what we do, but it should never replace a full program. The only way to fully perform all the exercises, is during AM/PM cares, with a complete focus on this one activity.

Some residents will be able to help. They can move their joints without our help-this is called ACTIVE RANGE OF MOTION. The resident can perform almost all the exercises on their own, through a dedicated program or through normal activities of daily living.

Other residents can perform SOME portion of ROM, but due to weakness, pain, paralysis and the like, they will need limited amounts of assistance. Usually they can tell you exactly what you need to do. This is called ACTIVE ASSISTED ROM.

For most of the residents we deal with, PASSIVE ROM is the norm. These residents cannot assist with this, for many reasons. It’s important to remember that these ROM exercises do not strengthen the muscles; they prevent deformity and maintain movement.

A great way to make ROM a part of AM/PM care might include applying lotion to those body parts being exercised. The lotion is calming and relaxing, and this will help with ROM. Another good time is during a bath. If you note the resident experiences pain during ROM, ask the nurse about pain medications being given 30 minutes or so before the exercises are started.

If ROM is problematic to complete due to time restraints, ask your co workers if they too are having trouble. As a group, you all could seek ways to help each other. Or, seek the advise of the charge nurses. At one nursing home I know of, the aides simply did not have time to complete ALL the ROM for each resident. The aides met with the nurses, who went to the DON to get some ideas and guidance. The DON met with the Activity Director, who implemented an exercise activity designed to provide ROM to those residents the aides could not get to in the morning. The aides marked off who received ROM and who didn’t, and the Activity Staff provided the exercises as part of special “Massages” and other aptly titled programs.

Another nursing home I know of breaks up the ROM requirements for each shift. This means third shift does some of these programs- especially for those residents who are awake during their shift.

Creative minds can ensure that vital care is provided. Dedicate TIME for this very important skill…this task…this care. ROM should not be skimped on, ever.

Staying Healthy At Work

The work we CNA’s do is HARD; some say brutal. The stress we put upon ourselves while performing our duties takes a high toll on our bodies. We have to take care of ourselves. And I mean that- especially at work.

Some of the things I do to make sure I’m ready and physically able to do my job are pretty mainstream, or so I thought. Lately I’ve noticed newer aides not bothering to do simple things that can make such a difference.

1) The usual items we hear about are par for the course: Eat right, exercise and get plenty of sleep! Easier said then done in today’s busy world. Family, friends, commitments, kids’ games and activities all keep us, at times, TOO busy to care for ourselves.

2) We use our legs, arms and backs for the vast majority of the tasks we perform. It makes sense to stretch these muscles before we use them. Before I go to work, each shift, I do some simple little stretches and exercises that really have helped me stay limber, and I believe they help me perform the lifts and other harsh aspects of this work without pain, and without injury. Please seek your doctor’s opinion before attempting these. The links take you to a site that illustrates how to do the stretches.

SHOULDER STRETCHES

UPPER BACK STRETCH

LOWER BACK STRETCH

SPINE ROTATION

HIP FLEXORS

I do three sets of 10- if you haven’t stretched in a long time, do less.

3) One thing I always have on my person is my own GAIT BELT. I don’t use the ones work provides; I prefer my own since I take care of it. Actually I have three belts- and it’s important to wash them between shifts. Think of all the germs that come into contact with these things! I have a small can of Lysol spray in my locker and every so often I use it on the belt…to kill the germs.

4) When I am working, I ALWAYS CARRY a small bottle of hand sanitizer. The stuff comes in sprays and pen form now too. I use it A LOT. I work with an aide who will rub it all over her face every so often- and she never gets sick! I use it every time I touch a door knob, or answer the phone. Some of my peers think I’m a little crazy about this- but I rarely get sick. I use it liberally and purchase several trial size bottles at Wal Mart.

5) Staying hydrated. A big one for me. Where I work it’s dry and the air is filtered, so little fresh, outdoor air comes in. I used to not bother drinking water cause I didn’t think I had time. I always felt thirsty and my throat hurt due to the dryness. I don’t care for straight water; but I do like Vitamin Water- which comes in many flavors, is very low in calories and tastes good. I get them at Wal Mart for less a dollar each and only buy them for work; I bring two or three bottles with me.

6) Eating at work can be challenging. We all know that our breaks are often interrupted, or short to begin with. It’s important to bring your own meal with you unless the facility provides them. Even then, I would opt to pack my own lunch. I know a lot of aides who skip meals altogether. That isn’t healthy. I pack a small lunch: A sandwich or pita wrap; some fruit, a granola type bar…keep it simple. Yogurt with nuts is good; a medium size salad can fill me up as well. I try to incorporate the major food groups: Meat, veggie, fruit…protein and the like.Premade pasta salads are very good as well.

7) Vitamins. A lot of people take them. Many or a few or even one. We each have our own needs and desires with this stuff. I take a multi vitamin AND lots of extra Vitamin C: We are exposed to a lot of germs and viruses every day. It’s important to stay well nourished and the food we eat should provide us with all the daily requirements…however, there are some vitamins that don’t absorb well due to medications or lifestyle habits. It’s important to seek medical advice before embarking on any vitamin regime.

Finally, I always have on my person, a bunch of things that might be needed (and from experience, have indeed BEEN needed!)…A small bottle of Tylenol/Advil/Bufferin or whatever pain reliever works; some TUMS, a little bottle of IMODIUM; band aids…all travel size bottles or packages- that fit neatly in my bag or in the glove compartment. One never knows when the headache from you-know-where will come along; it’s good to have some relief on hand.

Job Interview Do’s and Don’t's

Whether your a brand new or a seasoned CNA there will be times when you have to look for a job. We get many inquiries about this process and it’s a hot topic in the email lists as well.

For the sake of space here, this article is assuming you have located employment opportunities and have sent out resumes, made phone calls and have secured an interview at a nursing facility.

Now what?

First things first. Your appearance is absolutely vital in a successful interview. The old saying, “First Impressions can be the Last Impression” is very true.
You want to dress conservatively- you’re trying to sell YOURSELF so it’s very important to get this right.

You want to give a good first impression. You should dress neatly and appropriately:

No jeans and tee shirts; no short skirts and skimpy tank tops; underclothing mandatory
No open toed sandals or sneakers or Crocs
Limited jewelry and other accessories
Clean, wrinkle free clothing
Hair pulled up and kept out of your face
Fingernails neat, trimmed and CLEAN

While a suit is not called for in interviews for CNA work, a pair of black slacks and a blouse would be appropriate. A really nice pair of black or dark blue jeans might be alright if they are paired with a shirt that is buttoned and well fitting. Stay away from low waist style pants; stay away from dark colored underclothing as well. If possible, underclothes should not be visible to anyone. There is no other way to put it: wrinkles are equated with laziness. Iron your interview outfit!

Clean shoes that compliment the outfit and fit well are always good choices. I advice against wearing those Crocs to interviews; they are comfortable to wear at work but entirely not professional for seeking work. Sneakers are not recommended for job seeking activities of any sort.

The wearing of jewelry is a matter of personal preference. It’s a choice we all make. Other than wedding bands, most of us can go without wearing most other pieces. Keep in mind a simple bracelet and necklace are fine; stud earrings too…but ditch the spike pendants and eyebrow and nose rings. Take them out. They serve to distract people and this is the last thing you want during an interview. Also, remember that the work CNA’s do often leads to situations where jewelry can get lost or damaged (along with the earlobe or nose).

Fingernails are what patents see first- trust me. So do interviewers. You want neat, trim nails that are CLEAN. You don’t want polished, glossy shiny nails. You don’t want acrylic nails either. Okay you might want them, but infection control experts tell us germs love the long fake nails.

Now that we’ve covered WHAT NOT TO WEAR portion of the interview, lets move on to the other things:

Arrive EARLY. NEVER LATE.
If this means you have to leave your home an hour beforehand, then do it. It’s best to plan for accidents and other traffic problems. It’s best to be prepared for this and time your arrival for the interview a good 30 minutes before. Sit in your car and wait if you must. Enter the facility 15 minutes before the scheduled appointment.

Treat everyone you encounter with professionalism and kindness. That receptionist or secretary or maintenance man may offer his or her opinion of you to the boss. It will count.

Don’t let the employer’s casual approach cause you to drop your manners or professionalism. You should maintain a professional image. Don’t address the interviewer by his or her first name unless you are invited to.

Don’t chew gum or smell like smoke. In fact don’t smoke for a couple hours (at LEAST!) before the interview. Keep your cell phone in your car. You don’t need to check for calls/texts at this important time!

Sit straight, smile as often as you can, maintain eye contact but don’t stare the interviewer down, lean forward but not invading the interviewer’s space. Sit still in your seat; avoid fidgeting and slouching. Be aware of your body language.

Don’t be shy or self-effacing. You want to be enthusiastic, confident and energetic, but not aggressive, pushy or egotistic. Usually just being yourself is sufficient. Relax.

Don’t ever BAD MOUTH previous employers or bosses. Word travels fast between facilities.

Questions and The Right Answers
Expect to be asked many questions. Expect to be politely scrutinized.

When did you leave your last job and why?
How long have you been out of work?
What did you like most and least about your last job?
Do you prefer working independently or as part of a team?
Why do you want to work here?
What do you expect to experience in this job that you did not experience in your past jobs?
How do you feel about evening work? Weekend work?
Why should we hire you?
Are you considering other positions at this time?
How does this job compare with them?

Listen carefully. If you feel the question is unclear, ask for clarification.

Pause before answering to consider all facts that may substantiate your response.

Always offer positive information; avoid negativity at all times.

Get directly to the point. Ask if listener would like you to go into great detail before you do.

Discuss only the facts needed to respond to the question.

Focus and re-focus attention on your successes. Remember, the goal is not to have the right answers so much as it is to convince the interviewer that you are the right person.

Be truthful, but try not to offer unsolicited information.

Some questions YOU might want to consider asking, when the interviewer asks you for your questions: Besides the usual questions about pay, hours, benefits and other tangibles, consider these questions:

Could you explain your organizational structure?
Can you discuss your take on the company’s Mission Statement? Workplace Values? How does the CNA fit in?
How would you characterize the management philosophy of this organization?
Do you know what Horizontal Violence is, and how it applies to nursing departments?
What is the rate of turnover for CNA’s? If high, ask why. Then ask what you can do to make this better.
What condition is morale in on the unit you might be assigned to work?
How long have some of your best CNA’s been employed by this facility?
How do you define the “best CNA”? What is this title based on?
Are there opportunities for advancement for CNA’s? A career ladder, for example.
What does the facility offer for continuing education opportunities?
Why should I accept a job offer from you?
Why do you work for this facility?

…these are tough questions and perhaps only seasoned CNA’s would feel comfortable asking them. To me these questions are worthy of being asked, and answers should be frank and honest. A negative response, as in “I don’t know” or “Why are you concerned with such things” would lead me to believe this facility doesn’t respect the aides who are employed there.

Most of work because we have to. We need a paycheck. But we love to help people so we choose this special line of work- nursing. The hands on care giver is the least respected, lowest paid person in the health care field. The one thing we can do for ourselves is work for facilities that indeed respect US through actions and words and policies. Since most of us spend a great deal of our time at work, why not work for the facility that treats us best? We can find this place through the right people and by asking the right questions. We can raise the standards we’re willing to work by!

ASIDES: Enough Already, With The Cell Phone

Cell phones are a wonderful addition to our lives. Communicating quickly with family and friends is a good thing most the time.

However, at work, in nursing, they are fast becoming a nuance. I see many nurses and aides who constantly check their cells for messages; or who are texting someone. Right in the middle of patient care! Or a residents’ mealtime!

Message to CNA’s:
Cell phones no longer interfere with most medical equipment. This is no excuse to use them while we are working. Surely any message can wait until a break. Nothing is more aggravating than watching your co-worker drop everything they’re doing to TEXT someone. Or to check a call. Not only is this aggravating, it’s very unprofessional.

Message to management:
What is YOUR policy on this? Where I work we are not allowed to carry our cells with us on the units. Equipment problems are not the stated reason either. Rather, common courtesy and professionalism are cited. Cell phones take time and attention away from resident care; residents and co workers perceive the use of cell phones during care as rude (IT IS!). Staff are allowed to use their cells on their breaks only, and in the break room only- not in patient care areas.

ASIDES: Oooh That Smell

If you’re a smoker, you’ll want to read this article. If you’re not, you should still read this.

At work smokers take their breaks and usually light up. Having that cigarette often relaxes us and keeps us even keeled. Many facilities are now smoke free- no smoking on the actual grounds of the property or within certain distances from the buildings. BUT most allow staff to smoke inside their vehicles. This is a privilege and not a right. Be grateful when you can.

One thing is noticed often by smokers and non smokers alike: After you have smoked, YOU SMELL like cigarettes. It’s the natural course of events here. The smell gets in your hair, your uniform, your skin. And your breath. It’s not a nice thing to smell.

Do yourself and everyone else a favor: Clean up after a smoke…when you come back inside, WASH your hands first of all. Then brush your teeth or at least use some mints or gum. Some aides I know also do a little more: They use the hand gels to help rid their body of the scent. How? They simply rub the gel in their hands and before it dries they quickly rub it all over their arms, neck and uniform top. It works wonders. One aide actually briefly runs her gel soaked fingers through her hair as well.

Other aides wash up and then use a lotion with a light scent, to cover up the odor. At a local nursing home down the road from me the staff use the unscented Febreeze-like spray over themselves- this is probably the best thing I have seen yet, that really works.

Residents and patients can get nauseated when they smell cigarette odors. Others may become agitated because they WANT to smoke but cannot. Either way, it’s gross and no one likes the smell. So be considerate of others.

ASIDES: Answering Phones

It would seen pretty simple- at work the phone rings as you’re walking by the nurse station. The unit secretary isn’t there. You answer it. You’re polite and take messages, right?

Let’s have a better look at this. When the phone rings we should make every effort to answer it as soon as possible. This doesn’t mean we get up and leave whatever it is we are doing at the moment. It does mean, if we’re close to the phone and NOT busy with resident duties we answer it.

A good greeting goes a long way when it comes to phone calls. It shows respect and dignity towards the caller.
When taking a call, take a deep breath AND SMILE before picking up the phone. The smile will come across to the caller.

“Hello –ABC Unit, this is Suzy speaking. How can I help you?”
Such a simple sentence. Yet a lot of information is shared with the caller.

The unit is identified.
The name of the staff answering the phone is known.
And an offer to help is made.

Many times the call is for a nurse who is often busy and not anywhere near the phone. Instead of running all over the unit to locate the nurse, and keeping the caller on hold, or waiting, take a message. Ask who is calling; a phone number where they can be reached, and ask for a simple description of what the caller needs/wants.

I don’t waste my time looking for people who get calls. No matter what I always run into them eventually and usually within the hour of a call. Depending upon the policy of your employer, you may simply leave a note near the phone with calls received and it is up to staff to check. At my work we have a notebook next to the phone where messages are recorded, and it is UP to EVERY staff to check this log for calls, INCLUDING the nurses. No one runs around looking for anyone.

There are times though, when a call is very important. Anytime a call is from a spouse, a child, a babysitter, a school, a hospital or parent of a staff, we should take a message and LOOK for and relay the message to the staff. Usually these calls are of an emergency nature. Every effort must be made to get the message to the staff who the call was for. It is up to management to vet out habitual family calls during work hours that are petty and non-emergency in nature. At the time these calls come in however, each of us cannot decipher this.

ASIDES: What Not To Wear At Work

Our appearance is important in how we are perceived. When we dress appropriately, people respect us more.
Lately I’ve seen some aides come to work looking like they’ve been run over by a truck.

Wrinkled and stained scrubs might be ok to wear around the house, but please don’t wear them to work.

Thread born, tattered and ripped uniforms are another pet peeve…they present an image of laziness. Really old and faded scrubs also come across as tacky.

Scrubs can last for years with proper care and handling. Some of th newer materials are really easy to care for- wash, dry and wear…There’s no need to iron uniforms but ALL scrubs need to be FOLDED after being dried. Folding them while they are still warm keeps the wrinkles away. It’s always a very good idea to have an extra set of scrubs with you…I keep a set in my car; one never knows when an accidental spill or other event will happen, that requires a change of clothes. Better to be safe than sorry.

Old sneakers are another image buster. And do consider that these shoes probably have an odor as well, that others can smell. When you have newer shoes, spraying them daily with Febreze or a similar product works wonders to keep these odors from ever forming. Lysol even works well. Clean your shoes, sneakers too- with a damp cloth to remove stains.

Keep your hair neat. Wild hairdos just look unprofessional in our work. Make sure your hair is clean too! Greasy slick hair is nasty to look at. And very few patients/residents want your hair in their face or over any other part of their body as you do personal care. The other day I witnessed an aides’ beautiful hair fall into a brief full of feces. The hair wasn’t pulled up. It was GROSS.

Scents? Nope. Don’t wear perfume to work. Many patients/residents have super sensitive smell and these odors can nauseate them.

And one final thing: Keep the makeup off as much as possible. It runs. It makes you look like a clown. Even the mascaras that promise 12 hours of wear…smudge under your eyes and make you look more tired than you probably already are. The work we do involves a lot of running around, bathing, showering activities…perfect situations for make up to melt off our faces.

ASIDES: Making Meals Resident Centered

This is the first of a new series, “ASIDES”, we’re producing here. These will be short and sweet posts about actions every CNA can take to be more resident centered.

Meal times are not gossip hours.

At work the other day I picked up on a trend I have seen a lot of lately: During resident meals, the CNA’s chit chat about their own personal lives with other aides. I overheard an aide bragging about how drunk she got at a party over the previous weekend.

These things should never happen. CNA’s have breaks for this type of banter. When they are with the residents, it’s never appropriate to discuss personal problems or share daily briefings and updates about recent events in their lives. The resident is the focus of meals. The CNA’s should strive to make meals as resident centered as possible. Meal times are social times. We want to keep it light and relatively fun.

When we’re serving up meals, ask the residents if they want condiments such as salt, pepper, margarine/butter (if allowed); ask what they prefer to drink, and provide it . Don’t just cut up the food and slap the plate down in front of them. For residents who need assistance with eating, CNA’s should sit down next to residents, not stand. Food should be offered in a normal manner: A couple bites of scrambled eggs, then toast, then a drink…then eggs, and so on. Pureed foods should never be mixed. When offering drinks, don’t allow much to drool out. Be very aware of dignity and respect. Have plenty of napkins ready. Don’t treat the resident like a baby.

Meal time discussions should happen. Current events, the weather, the up coming holiday are good topics. Sometimes background music is appropriate. Sometimes diminished lighting can create a warmer ambiance for the meal. Find out what works for each group of residents. The goal of the CNA is make meals as enjoyable and stress free as possible.

Spot Light: Medical/Nursing Jargon

In the course of any given shift at work, CNA’s come across words and abbreviations and diseases and conditions we have never heard of before. There are hundreds of terms to learn. In this article we hope to make this task a little easier.

First off, scan this list of common medical abbreviations. We use them with charting. We read them in the medical histories sections of patient charts. Do we understand what they all mean?

Abbreviations are well known in our work; each facility should have it’s own list of accepted abbreviations used in charting/orders. Without such a list, staff can use many different abbreviations, which are accepted but perhaps mean something else to each member of the team. Confusion can arise and patients can be harmed by misunderstandings.

Some terms we read are based on the human body. Terms associated with certain sections of the body are called descriptive terms.

All references to the body are made in relationship to the anatomical position. This refers to the standing forward facing body. A imaginary line is drawn down the center from head to feet which divides the body into two equal halves.

When we read the word MEDIAL it means the part is closer to to the line/center; LATERAL mean further from the line/center.
Your thumbs are more lateral than your pinky finger…

Imagine another line being drawn- this one dividing the upper and lower body into two halves. The line is right under the navel. When we read the term SUPERIOR it refers to above the line; INFERIOR means below the line.

Further, turn the body to face sideways. A line is drawn down the center, again. We’ll see terms called ANTERIOR, which means VENTRAL, towards the front. We’ll also see terms referring to POSTERIOR, or DORSAL, which mean toward the back.

The human abdomen is also divided into four sections, called quadrants. In your work you’re apt to read notes using these terms:
RUQ= Right upper quadrant
RLQ= Right lower quadrant
LUQ = Left upper quadrant
LLQ = Left lower quadrant
It’s pretty self explanatory where these sections are located.

There are many other forms of medical jargon to decipher. Understanding word roots, prefixes and suffixes can help this process a lot.

A word root is the foundation of a medical term.Word roots usually (not always) refer to the body part being described.
A prefix is added to the beginning of the word to change or add to it’s meaning
A suffix is added to the end of the word to change or add to it’s meaning.

Some examples of root words:
aden= gland
bronch=bronchi
chol=bile
crani=skull
dent=tooth
hem=blood
hepat=liver
hyster=uterus
my=muscle
nephr=kidney
pulm=lung
ur=urine

Some common Prefixes and sample meanings:
a=without (AFebrile or without fever)
brady=SLOW (Bradycardia or slow pulse rate)
dys=PAIN, DIFFICULTY (Dysuria or painful urination)
hyper=ABOVE, EXCESSIVE (High blood pressure or hyper tension, Hypothermia or high body temperature)
hypo=LOW, DEFICIENT (Low blood pressure or HYPO tension; HYPOthermia or low body temp)
pan= PANDEMIC (flu, Black Plague)
poly= MANY (polyuria or excessive urine)
post= AFTER (Post Operation, Post seizure)
pre=before, prior (Pre menstrual)
tachy= FAST (TACHYbradia or high pulse rate)

What medical terms can you associate with the above prefixes?

Some common suffixes:
ectomy= REMOVAL (hysterectomy)
itis=INFLAMMATION (bronchitis)
gram=RECORD (electrocardiogram)
emia=BLOOD (Anemia)
logy=STUDY OF (oncology)
oma=TUMOR (Fibroma)
otomy=INCISION (tracheotomy)
plegia=paralysis (Hemiplegia)
pnea=RESPIRATIONS (apnea)
scope=EXAM INSTRUMENT (stethoscope, otoscope)
scopy=EXAM USING A SCOPE (endoscopy)

What other medical terms can you associate with the above suffixes?

For a much more comprehensive resource for medical terms and descriptions, go to THIS SITE.

This resource also lists frequently used medical terms.

THIS SITE has an excellent graphics and descriptions of human anatomy.

HERE You’ll find a detailed list of anatomical terms frequently used.

Spot Light: Face, Hands & Butts?

Much of the work we do is aimed at keeping our residents clean, dry, fed, toileted and hydrated. We focus on these things because it is OUR job. There are other things though, that often get lost in the daily shuffle. I work for an agency as a part time job (as well as a full time job at a rehab facility) and through my experiences here, I’ve seen a lot of rushed care and the results of it.

When working short, there’s a saying among aides: Face, Hands and Butts. FHB. This means that our time should be spent washing faces, hands and butts and the rest can go unattended. This isn’t ideal but it is the reality when we’re pressed for time.

Even when our units are well staffed I have seen some pretty poor quality cares that leave me wondering if some of us cannot put ourselves in our residents’ shoes…

No matter how short staffed, we must always consider resident dignity.

Complete bed baths, whirlpools and showers can be postponed.

Washing faces doesn’t mean simply wetting a wash cloth and wiping it over a face. It means using gentle soaps/cleansers. It means using another wash cloth dampened with water, to rinse off the soap. It means paying close attention to the eye areas, removing the residue and drainage we often see. It means making sure noses are clean and the area around mouths is clean as well. Shave the men.

Oral care MUST always happen- how would YOU feel if your teeth weren’t brushed???

Care must be given to underarms. They need to be washed, rinsed, dried. If needed, a light coat of deodorant is called for. Body odor is a major dignity issue for our residents.

Hands have to be washed. Period. Several times each shift. Nail care can wait, unless they are long and ragged or dirty.

Incontinent care has to happen. Buts and other areas MUST be cleaned. Period. No skimping here.

I can’t count the times I have witnessed residents being brought out with messy hair, or worse, with hair dos that are not becoming to them. Ladies like to look presentable. Imagine how you would feel with greasy, slicked back hair…it’s up to US to make hair look nice. Hair should be combed/brushed no matter what; if ladies’ hair is permed, a little spritz with some water often works wonders to bring back some curl.

Clothing choices? It usually doesn’t matter when it comes to staffing issues. Residents have clothes and we assist them with dressing. BUT what does matter is matching colors at best and avoiding clashes at worst: Striped shirts do not go with plaid pants! Just like an elegant fluffy blouse doesn’t go with sweatpants. Some of our male residents prefer to wear t shirts under their tops; and MOST of our ladies like to wear bras. Don’t skimp on this.

A quick note about briefs: For the residents who use them, we have to ensure they are correctly applied. The right size is paramount. Too big a brief is not only wasteful but a major cause of discomfort. Small briefs often lead to nasty red marks in the groin areas. Make sure the brief is centered, and the front portions are pulled up enough to allow for movement. Don’t let the brief bunch up anywhere.

Residents who use wheelchairs need special attention for comfort AND skin issues. This is a no brainer but I have seen countless times, bunched up shirts in the back and sides. Pants that are wedged up in front. We need to make sure these things don’t happen. Take the time to pull down tops once a resident is positioned in their W/C; fix the wedgies and pull down the lower parts of pants. Make sure the resident is seated properly and is comfortable.

As much as most of us don’t like providing less than ideal care, we can do so on shifts where we just don’t have time. Assignments are often increased with two or three residents when there’s been a call out. Always check with the charge nurse about your priorities when staffing is an issue. Better yet, ask the nurse for a meeting with all the aides on the shift, to plan ahead for those times.

Always consider safety, comfort and dignity. Some will say not always in that order, either.

Filling In The Blanks

I’ve read at various online forums tales of how CNA’s literally fill in he blanks of vital sign records- without actually getting them.

just need to vent about last night at work….another cna was to take vitals on resident on unit, she is not a regular, i am new cna and also to this ltcf. been there one week still on training.
well she was to get temp and bp..resident in hallway with me…she took temp and not bp but she wrote on vital board patients bp as 120/82…..rghghhhhh it bothered me being new i hate to start trouble but this patient cannot speak…but understands.

What if we we all did this? Blew off getting the T, P, R and B/P? What if the resident has developed high B/P and because we couldn’t be bothered to be honest, it went unchecked? What if a real temp wasn’t measured for a couple days, while the resident is coming down with a infection? What if the resident is on a new medication that has a side effect of changing their respirations, but this isn’t seen because no one took the time to count them??

This is very bad. And illegal. And unethical. And most importantly, dangerous. What’s a new CNA to do? Or an experienced CNA? You stand up and advocate for the resident. You MUST not allow this to happen, when you see it, witness it, hear about it or otherwise KNOW of it.

How do you go about advocating in situations like this?

It seems pretty simple to me. Here’s what I would do (and have done many times):
1) Tell the CNA involved that she is committing fraud and that she needs to get the VS in question, right now. While you watch.

2) Report the incident to the charge nurse immediately; explain what happened and leave your personal thoughts out of this.

3) Seek the DON and report the incident to he/she as well. In writing. ASAP…Make a copy of your report to keep for your own records. Even if the charge nurse says she will make the DON aware, go to the DON yourself. You’re covering yourself by doing so. Otherwise, it could come back to haunt you in the misconception that you were aware of the incident but didn’t report it…and so on.

DON’T BE ONE OF THOSE AIDES.
The CNA who fraudulently documents care is opening themselves up to numerous problems. They could lose their job; their certification/license; their chances to work in health care as a career will most likely be ruined for good. If actual harm came to the patient/resident because we slacked off, patients and their family can pursue legal remedy. The facility and the state body in charge of regulating CNA practice can turn the “case” over to the Attorney General and hence start the criminal justice process. You get the idea.

______________

Trust is big in health care.
Do we really think we can trust the aide who doesn’t measure vital signs but who writes in fictional numbers?

It’s not just vital signs. When an aide fills in the blanks in this one area, I question their honesty and integrity in all areas. The box is checked for the bed bath, but did the resident really get one? There are numbers in the intake and output record, but are they truthful?

Patients trust their health care providers to be skilled and honest. Our employers, the nursing homes and hospitals and assisted living centers trust that we’re using our skills and being honest as well. Our charge nurses depend upon our skill and honesty to assist with providing timely and needed treatments and medication administration. Our co workers trust that their peers are doing the right thing for their beloved residents.

The right things mean filling in the blanks with real, honesty measured/provided numbers/care. The right thing means when something isn’t done, it’s documented as not being done. We all know there are days when we can’t get IT all done and that’s the way of this work.

Experienced aides can prioritize their work- they KNOW what care or task needs to be completed vs what can wait. New aides should feel confident to ask for direction and HELP when they need it (which might be often the first couple weeks they are on the job!)

Charge nurses should always provide guidance to help sort through these issues. When it comes to actual skills- some newer aides really have trouble measuring blood pressure. The new aide should seek the help of her mentor, or the charge nurse to really learn this skill.

Paperwork overload is no excuse!
There is WAY too much paperwork in our work. Everyone knows this. Yet, facilities don’t get paid and pass inspections if the paperwork isn’t done. In the medical chart, if it isn’t documented it wasn’t done. Sadly these are facts.

The burden of documenting has become overwhelming. The original purpose of charting was to provide a clear record of a patients’ medical condition, where members of the health care team could go to see updates and alter their interventions and treatments as needed.

The chart is rarely used for this anymore. Now, it’s a place where endless pieces of paper are stored- and kept, in the event of a lawsuit. Nurses and others document on the defensive now. This is the world many have created and our little part in it has tremendous consequences. Those vital sign numbers better correlate with the sudden medical condition discovered on the next shift. When it doesn’t, red flags are spotted and questions are asked.

Maintaining Integrity Isn’t Easy In This Work
The CNA MUST ALWAYS be honest in the care and tasks they provide. We are the front line. The first to see and know. We are extremely valuable because of our place. If we don’t feel skilled enough in providing tasks/care, we need to speak up to this and ask for help. Those of us who hear the cry for help need to be willing and able to teach. We need to recognize when a peer is having a bad time, a bad day, and offer assistance. We do this not for the aide but for the patients/residents she is assigned to.

WHY IS THIS BECOMING MORE AND MORE PREVALENT?
In the past few years I have seen an increase in aides who graduate from these small medical-skills schools who don’t have (or are not taught) the same foundations of honesty and integrity. I’m not sure honesty and integrity can be taught either…we either have these ethics or we don’t. Better screening might be one solution.

The quick turnover rates of graduating “classes” of aides amazes me- and the fact they can pass the state tests tells me they know the basics. The basics aren’t good enough anymore.

It gets lost when these fast food CNA’s get on the units and are totally overwhelmed with their assignment. They feel pressured to get everything done and this is where I often see the cheating occur. I have to wonder if these schools are not doing an adequate job teaching the students everything they really need to know. I wonder if the new aides thought the job would be much easier.

When we see cheating happen we have to speak up. Loudly at times. We might even need to make a stink once in a while. Life and death decisions are sometimes made based upon our honesty. As I said, we’re the front line. Our words have HUGE impact upon everyone’s word, all of whom are above us. If we’re not honest, then neither are they. Yet we know it, and they don’t. Remember that.

7 Habits Of Highly INeffective CNA's

Today, we’re listing up 7 habits of highly INeffective CNA’s. If you recognize yourself, change your habits.

1) She calls out often; or is late; or leaves early. A CNA cannot be effective when they are not at work.

2) She is inflexible. She won’t alter her assignment to make things fair to all; she refuses to take on extra residents without a battle; she refuses to change her routine for the residents’ benefit.

3) Teamwork: She either belongs to a clique or is a loner. The clique is negative and spends much time backstabbing other aides. The loner never smiles or offers to assist others. She isn’t helpful with new aides.

4) She is on the phone. A lot. Either her own or the facility phone. She makes calls when the nurses are busy and away from the nurses station.

5) She spend a lot of “down” time behind the nurses station. Sitting. Doing her nails or braiding her hair. Not answering call bells; ignoring requests for help. Yet she has no problem gabbing with staff from other departments.

6) She’s a gossip queen and a rumor monger. She seeks out others to spread stories and tales true and untrue.

7) She never volunteers for anything. She avoids putting any extra effort or thought into situations that require it. Residents don’t dislike her, but they don’t favor her either. She doesn’t bring on smiles to those she encounters at work.

7 Habits Of Highly Effective CNA's

For years I have seen the books and articles titled, 7 Habits of Highly Effective People…so I thought I would come up with a list for CNA’s.

1) She is proactive. Proactive CNA’s use their resourcefulness and initiative to find solutions rather than just reporting problems and waiting for other people to solve them.

2) She has a personal mission statement. This is based upon personal morals and values- and it is almost always used as a stepping stone to make choices and decisions.

3) She knows how to balance her time between residents/patients. The CNA can set priorities based upon residents’ medical needs vs. non-medical wants. She recognizes when a needy resident truly requires some TLC and when something else is going on.

4) She isn’t interested in being in CONTROL. The CNA seeks a win/win relationship with her residents, but realizes this isn’t always possible. She will go out of her way to allow the resident to maintain control with as many choices as possible. The resident’s dignity and individuality is always respected.

5) She listens to her residents. And uses effective communication skills to make sure she understands what is being said. The CNA knows some times a resident doesn’t understand her, so she goes out of her way to make sure she is understood.

6) She works WITH the resident to overcome conflicts and misunderstandings. Instead of being defensive, the CNA will admit to her faults in the problem, and will seek to improve and correct these issues.

7) She knows when to step away. She knows she’s getting burnt out and is in need of a vacation, or a change in assignment.

Negative Aides Are Like A Virus

One reason why so many CNA’s hate their jobs is working with others who have attitudes that drag us down.

Kevincity is such a CNA:

Wow, ladies and gents, witness an example of the spin that the sucker-ups to the status quo can put on the true facts. Just when one thinks that this extravagant liar is finally gonna stick up for her own, she hops on her high horse to defend tyranny and run roughshod over us.

This is what he left as a comment to my post about Keeping Unions Out.

Sweet.

You know, no matter how hard one tries, people like Kevin will always be ready and more than willing to knock down ANY effort to make things better. People like Kevin are determined to undermine those who actually like this work, and who chose to stay in the field for a long time. Kevin assumes that people who are long term employees in this field survive this work by kissing up to the bosses. He’s wrong. And he’s a negative influence to everyone around him.

I am very hurt by his comment, and have put him on notice: He needs to start being a part of the solution instead of being a part of the problem. Of course I realize he doesn’t see himself as a problem; he sees aides like me as THE problem. I’ve been doing this work for a lot longer than he has, I have much more experience and I’m 100% sure I have seen much worse than he has. I don’t think Kevin has done anything except stir the pot. And for that I have banned him from my site. I have enough to deal with at work- the good and the bad. I don’t need his negativity here.

I’ve worked in the worst nursing homes in my area. I’ve been assigned to 35 residents by myself. I’ve been forced to stay over and work extra shifts, many times. I’ve seen neglect and abuse, and felt the impact of reporting these things. I’ve been under the fire of management who tries to cover up the neglect. I have been accused of not being a “company aide”. I’ve seen ass kissers get away with the worst care. And I’ve been hurt on the job and lost out on pay and benefits because management decided I needed to come back to work before my doctor said it was safe.

I worked for an assisted living home where a demented resident eloped in the middle of the winter, who fell down and froze to death. And wasn’t found until the next day. I have met with my state ombudsman when reporting incidences of abuse and cover ups. And I’ve lost some jobs because of this. I witnessed nurses hitting residents and withholding medications. I’ve seen a DON remove drugs from the med cart and swallow them. And I’ve been threatened to not tell anyone…as I got on the phone and called the police and the Board of Nursing.

I’ve seen more than my fair share of Nazi nurses torment good aides. Yell at them. Make unreasonable demands of them. Give them the worst assignments. And I’ve spoken up to them in their faces and demanded they be fair.

I’ve done CPR on residents who are found not breathing. I’ve removed them from their wheelchairs as they have passed out during a choking event; I’ve picked up bloodied and beaten old ladies who were the object of a combative male resident. I’e walked into dining rooms to see dozens of residents slumped over at the tables, waiting to be fed. And I’ve asked the nurses and administrator and others to help me out because I’m the only aide working.

I’ve testified before Congress on issues. I met Senators Grassley and Kennedy in Washington, to discuss wage pass thru laws and mandated ratios. I’ve attended the National Citizens Coalition For Nursing Home Reform’s yearly conferences and met many wonderful people. I’ve communicated extensively with leaders of the National Clearing House of Direct Care workers; I’ve also helped out with The Paraprofessional Healthcare Institute.
I’ve written articles for the now defunct Nursing Assistant Journal. I’ve been asked to help with books authored by Barbara Acello- the author who writes CNA educational books. I’ve met Jeni Gibson and attended her trainings on how to be an effective change agent. I’m a member of the big CNA groups. I do a lot for my fellow CNA’s. THIS site alone has been around in various forms since 1997. I’ve come to realize through my experiences that alone, CNA’s cannot change their work. But working with others, including those who have a vested interest in our work, will be far more effective. This means management. And families.

If this makes me a BAD aide, than so be it. One doesn’t have to have a dark cloud hanging over them to be a GOOD aide.

Families: Why the Battle?

One of the issues CNA’s deal with on a daily basis is interactions with resident families. Like it or not, they are the most important part of our residents’ lives. I think an admission to a nursing home is not only a shock to the person, but to their family as well.

Families deal with many feelings when they decide to place their loved one into a nursing home: guilt, helplessness, financial worries. They hear the stories about abuse and neglect. They fear these things will happen to their loved ones. Usually families have little experience with how long term care facilities work- the daily pulse and beat. The nursing home becomes HOME to the resident and the second home to many of their families.

CNA’s on the other hand work in nursing homes for a living. We punch in, do our shift and go home. We love most of our residents and do the very best we can with what we have. Often, we work short of staff and this is heartbreaking for many of us. Few of us remember our first days in this work…the shock and dismay we felt at the lack of time to do really good work. We went home feeling guilty and a little shamed of the care we gave. Soon enough, we each realize this is how it is and we also know it could be much worse than it is. I think we become immune to that SHOCK effect.

Families go through the same thing. Some come to know how nursing homes operate. Some don’t bother to learn and others just don’t care. They expect the world to halt to their demands and they could care less about who ends up being neglected because of their demands. They tend to put the heat on management with complaints and needless accusations; and they have expectations that are really not in tune with the typical model most nursing homes follow.

At the message board for this site, a discussion was initiated about this very subject. We got hot handed, a little, because I believe aides can have a huge impact on the families perceptions of who we are and why we do things the way we do.

This one is for the families of nursing home residents
You know who you are, you are the one who likes to show up a few minutes after your family member was looked after but has had an accident and then claim they had been that way for hours. You think you know our jobs, but never had a hour of medical training. You think I am your servant but I serve only god and country. My boss is the nurse, hunt her down with your bitches.

I have a real nice question for you, here it is in little words that I know you can understand:

If you think that you can do a better job then why the f—k don’t you?

Now be honest.

Understand this:

1. I am a CNA, not whipping boy or girl.
2. I am worthy of respect and you will respect me.
3. If you do not do #2 I will talk real bad about you to my co-workers about much of a moron you are.
4. Again, I am a CNA. I take of more patients that just your family member, so if you want extra special care and attention given to Sally or Fred or Ann then you going have to shell out for a private sitter.
5. O if you think I got an attitude, well think no more and now you should know.

The familes are the single worse thing about this job. Nursing homes should have stricter visiting hours.

This is an extreme view, held by more than I would care to know of. I could not work with people who hold this opinion and I can see how negative the work environment could get, surrounded by aides who are seething to the brim with these feelings. Yet I understand where Kevin is coming from…I have had days where I just wanted to toss the towel in literally at a spouse of a resident- who was caught up in the middle of this battle. The demands of one family can have a very negative effect on the other residents we are assigned to care for.

This presents a problem for us. Management always applies grease to the squeakiest wheels, and this bandaid approach never truly heals the wound- instead it makes it worse. I do place blame on management for allowing this to happen. It is up to them to deal with the nitty gritty demands and expectations that truly do take away hours of care from other residents. Dealing with these people might mean telling them how things really are. It might mean letting the families know their petty concerns over missing laundry equate to another resident getting their medications late. It might mean holding a meeting and explaining to these families that they are disruptive and detrimental to overall morale of both staff and residents.

What can a CNA do when caught up in the middle of the family/facility battle?

My best tips:
Smile!

Apologize. It may not be your fault but it is your responsability as an employee.

NEVER say that you are shorthanded!!!! It maybe true but families and patient don’t want to hear it. (I know I don’t want to here it from the bank teller when I have stood in line for 10min.)

If it is something you can’t mend as a CNA then get the RN involved- use your chain of command. Get the risk manager involved if it comes to that.

That about sums it up, nicely. Try to be upbeat and positive, and at the same time acknowledge the families concerns. If there is ever a time to pass the buck, now would be the time.

Hopefully management can do some things to make this issue better for all:
*Before someone is admitted, a good educational session about the workings of the nursing home should take place. Families should always know and understand the aides are responsible for MANY residents, not just one. Timeframes should be disclosed- it should be well known that 20 to 30 minutes is the normal expected amount of time an aide can spend with each resident.

*The family could be asked to come in and watch part of a shift. To see how things work; to learn about how nursing care and treatments; to see the food and meals and laundry service. This is a good time for families to be introduced to the dept. heads

*Get this book, several copies of it…and lend it out to families:
The Eldercare Handbook: Difficult Choices, Compassionate Solutions

*And this book:
Living Well in a Nursing Home: Everything You and Your Folks Need to Know

It wouldn’t hurt to have everyone read these books to be honest- nurses, aides, laundry staff…

Lifts & Transfers

Keeping your back healthy is very important. We all know this. And yet, at every long term care facility I have worked at, I have seen aides cheat the systems and policies and rules when it comes to LIFTING. Aides will lift heavy residents by themselves; they will also refuse to use mechanical lifts designed to save our backs.

Mechanical Lift Cheating
Most aides will cite time as a major factor when it comes to using the mechanical lifts (ML). Time involved with seeking assistance, as most facilities require two people attend a ML transfer; and time involved with setting the resident up for the transfer. The placement of the lift pad, attaching it to the machine, operating the machine…the positioning of the resident into the wheelchair or bed; removal of pad…the process takes about 4 to 5 minutes. Whereas a two person lift takes about a minute at most.

I’ve asked aides how they manage to perform these lifts, on really heavy or otherwise unsafe residents. They tell me they feel confident with their strength and ability to do the lifts. They are sneaky about it too: Many an aide will go to the trouble of getting the ML and bringing it to the room. But it just sits there, unused. The only time they will use the machine is for the extremely overweight resident, or for a resident who is with it and KNOWS they are not to be lifted/transfered by staff. Even with this, the resident sometimes insists upon being lifted as it is faster. And some residents will badger the unsure aides into lifting them.

Staff Assisted Lifts/Transfers
As for two person “human lifts”, aides will not bother getting help. They do the transfers alone, placing themselves and their residents at risk. Again, the aides have a level of confidence in themselves to do this. The aides don’t consider that these movements might hurt the resident, might be rough or terrifying. And they don’t seem to understand that a few months of doing this will result in soreness and back, shoulder and knee pain. I know aides who’ve been doing this work for years who have bad backs, who are forever complaining about being in pain…who gimp and limp around all shift…who speak of being on different pain meds all the time…it’s no wonder!

Once a facility has enough aides who prefer to transfer residents the wrong ways, it’s very difficult for newer aides to turn this around. The newer aides feel compelled to work on their own. They have asked for help but have gotten nasty looks, rolled eyes and heavy “sighs”, along with comments such as “I do this by myself!” To the defense of the old timers, they probably got stuck one time too many waiting for someone to come help them. In the nursing home environment, time is everything. Once you get behind, you cannot catch up unless you cheat. And that means cheating residents out of the care they deserve.

Fixing the Problem
How to fix this? Should management be concerned? Is management even aware of these practices occurring? Good questions and only each facility can answer. Of course the leadership should be concerned. After all, the worker comp costs are in direct line with staff compliance on lifting policies.

Should punitive steps be taken towards non compliant staff? Speaking as an aide, I say YES. Because the non compliant aide is a virus- and viruses spread. In my experience, aides who are non compliant in this area are non compliant in many areas.

Having said that, I also believe facilities should have a hard look at their policies and promotion of teamwork vs. being task and time driven. If more value is placed upon the timing, then facilities are just asking for the aides to do whatever they can to survive- up to and including cheating. If value is placed upon teamwork and healthy body mechanics, the aides relax a little and are much more apt to be compliant.

If you’re an aide who does cheat, remember you only have one back. Remember too, your shoulders and knees will only put up with so much of these bad lifting habits. It will catch up with you. If it’s in the residents’ care plans that they are to be transfered via a ML or with two staff, you are breaking rules and could lose your certification over this. Especially if you document the transfers were performed as care planned: You’re participating in fraud if you sign it off as done. And if you get hurt, how will you explain it? Worker comp claims are often denied when they find out (and they do investigate) you did an illegal lift.

Is it worth being out of work with an injury, with no pay coming in? Consider your reputation as well…you will probably be fired for not following policy and this will follow you in your future employment opportunities. And remember this: You’re teaching the next generation of CNA’s some pretty poor work ethics- and worse, you’re planting the seeds of a painful future for another person (the new aide)…and keeping this cycle alive and well.

New aides can set the standard, as can aides with more experience who decide to change their attitudes on these things. Do it right! Save your body. And think of the resident’s safety! Use the proper lifting guild lines for each resident…if a ML is called for, USE IT. Get your resident all ready for the transfer BEFORE getting help- remember your co workers time is valuable. Don’t waste it. Work efficiently and with purpose. Make teamwork as simple as possible.

Tips & Timesavers for CNA's

Tips & Timesavers- For New & Seasoned CNA’s

So, you’re brand new and a little nervous? Thats ok and natural. Being a CNA is a rewarding career, but there are LOTS to learn and lots of cover in those first few days at work! Don’t be surprised if you feel a bit overwhelmed and anxious. Someday–soon- you will be an “old pro” at this stuff. The first part of this is for the new CNA…

The Basics
I remember my first few weeks as a CNA- it was hard to get to know all the residents as well as staff as well as the facility policies and procedures. I was very overwhelmed and looking back now- there were certain things I should have done that would have made my life much easier then! Live and learn….
First, it is a good idea to bring a little notebook to work with you. In here you can write down info you need about everything from phone numbers to resident issues. Jotting down info is a way to remember it! At periodic times during the day check the little book to see if there are things you still need info about. When you think of questions and no one is around to answer them- write them down. Later you can refer back to the book.

Facility Rules/Employment Issues
OK, now onto more things every new CNA should be aware of. It’s always a good idea to know the facility policies and rules before we start a new job. Sometimes this isn’t possible. You should make it a point to find out where to go to get this info if it isn’t provided to you. Again, looking back there were things that I wasn’t clear about and I had to re-learn basic policy stuff. If I had asked in the first place:

1) Holidays/weekend pay differentials? Are there any?
2) Overtime pay: After 40 hours or after 80 hours?
3) Attendance/Tardiness: What are the exact limits/percentages?
4) Pay increases: Based on merit? Or length of service?
5) Performance reviews: When, how often, are raises included with them?
6) Uniform policy: Assistance with purchasing?
7) In service Hours requirements: Does facility offer enough hours to meet mandated 12 hours?
Phone numbers to call: For when you need to be out. Time limits?
9) Benefits: What is offered? When do they go into effect? What will cause termination of benefits?
10) Staff meetings: Times? Are the mandatory?

These are basic policy things every employee should know, and know well. Once you have this info, you can make choices about what you need to do- and when. Knowing this stuff will make your life a lot easier and will prevent surprises down the road.

Doing Your Job
For those ever important first few days, there are several things I recommend you get done, if possible. First off, find out which residents you will be working with on a regular basis. Why? You want to read their care plans as a tool to help you get to know them. Knowing what you are expected to do as far as nursing care is the reason you are there! Knowing what is in the plan will help you care for these residents in a safe and appropriate manner. You may not understand some of the things in the plan, if this happens then ask the nurse in charge of the unit. Nurses write the care plans, and they depend upon us to carry out the objectives to meet the goals in the plans. The nurse is an excellent resource for CNA’s. In your little book you may want to write down things about your residents- from the care plans. It will be awhile before you can actually place a plan with a resident! This takes time- getting to know them and what rooms they are in, never mind their care needs. Hopefully someone will be mentoring you; while being trained it is a good idea to relate what you are being shown to how it is worded in the care plan. Ask questions and learn. Your mentor has experience and can teach you much.

Watch how your mentor works- directly and indirectly with residents and staff. You should learn much just from observing. The next thing I recommend is that you check with the nurse at the beginning of the shift about what is expected of you:

Do any of your residents need VS, baths/showers, weights, or other care? When are VS needed by? Also ask about special snack/drink requirements. It is so much better to know this stuff ahead of time rather than ten minutes after they were due. Communication is vital in nursing homes- with nurses, peers, residents. Also make sure you find out where you are supposed to document your care? Ask about paperwork and where it is. It is very important that you get the paperwork done everyday.

After a few weeks, you will know which residents work well together; you will figure out how to prioritize your care to meet everyone’s needs. It takes practice and hard work. One thing that is very helpful is taking a few minutes at the beginning of the shift to plan your assignment- who gets done first, who gets showers and weights and what not. Gathering all your supplies you need before entering a room is a great time management skill all CNA’s have. Carry around a pocketful of gloves too. Check with the nurses, in most facilities you can bring in your own thermometers as long as you don’t bring them home for use. Having your own tools saves time- I have my own B/P kit too.

The next sections are what this page is really all about: Timesavers and tips CNA’s everywhere use to get their work done. Some things are pretty elementary and others are really cool. Try them.

Being Prepared:
Always be ready with a basic work kit: A waist pouch is a good thing to have- with a pen, tape measure, extra gloves, permanent marker, if possible your own B/P kit, watch and extra elastic hair things.

Keep a mental checklist of what you need before entering a room- linens, clothing, ect. Be ready.

When changing bed linens, roll all dirty linen into a ball within bottom sheet; this is easier to remove than several pces. of linen.
Type a copy of abbreviations to a little card, then get card laminated. Keep in waist pouch.

Plan your work day- check with nurse about nursing priorities and go from there.

Resident Tips:

A cool idea for shiny, soft hair: Get a little spray bottle; fill with one part conditioner to nine parts water. Spray in after shampoo and leave; this detangles as well.

Another use for little spray bottles: Fill with water and add a few drops of bath oil; after shower/bath spray a little onto residents skin. Make sure you mark these bottles with what is in them!

Bath oil can also be used in showers- small amount rubbed into your hands & onto resident’s skin. Also, add a drop or two into a wash basin during rounds….

Find residents slipping out of their chairs? A piece of rubber-type shelving liner works well to keep them upright.

For stubborn BM, a little shave cream with aloe works wonders with cleaning. Use sparingly as the cream can be drying. Apply a little lotion after.

For residents who have thickened drinks- and who don’t like the taste of the thickener, adding a pack of sugar /sweet & lo helps. Thickened water taste terrible. Some say that adding a few drops of lemon juice takes away the bad taste.

It may sound elementary, but do add salt & pepper to foods if it ok; also butter & margarine. Many elderly are used to these condiments being in their food.

If food gets cold, the wise CNA will take plate to a microwave oven to re-heat it.

Residents may eat better if they start with a clean mouth: Provide oral care right before meals.

Remember that meals are supposed to be a fun time; don’t force feed your residents; allow them time to enjoy their meal! Same with drinks- don’t force them down.

Allow the resident to determine when they are ready.

Residents who feed themselves may have trouble keeping their plates on the table. Use the rubber shelf liner under the plates.

You can build up a utensil by wrapping a washcloth around the handle and securing it with a rubber band. After each meal remove the cloth for washing.

When feeding a helpless resident- remember to tell them what you are doing, what you are feeding them- before each bite. If they constantly spit the food out, think that maybe they don’t the certain food and offer an alternative. During this feeding time, talk with the resident about current events or something like it. Don’t just sit there an stay quiet.
Foods you know the resident likes should be made known to whoever is in charge of meal planning. This is a way for you to advocate.
Documenting meal consumption is a part of every CNA’s job. Be realistic when figuring amounts eaten. Look at serving sizes and look at what wasn’t taken in- look at what was lost via drooling, spitting out…Check the clothing protector/bib!
Also, some residents like to hide their food…know this and keep an eye on it.

Remember that residents don’t always appreciate being made to wear a bib; ask them if they would like to. Don’t force it upon them.

Mentoring a New CNA
First, recall your first few days and weeks as a CNA. Have some empathy. And remember, the new CNA will watch everything you do and say. Be a role model.

Don’t expect the new CNA to know everything; yes- they have been certified but this doesn’t mean that they have hands on experience. You’r job is to teach them this!

Be respectful of the new CNA’s questions. Answer them all as best you can; if you don’t know an answer either find out or direct the CNA to someone who does know.

Allow the new CNA to observe you for a day or two. Let them see how you work; how you handle your residents. This is called role modeling. Don’t assume that it is ok to have them make your beds and get your supplies. One of the things you should be striving for is to teach them how to be prepared and how to work best to get it all done.

Plan your work and your day with the new CNA. Show them how you prioritize things. If you have questions for the nurse, bring the new CNA with you so she can see how you interact.

While you are working, explain every little thing you are doing. You want to be certain the new CNA understands why you are doing certain things in a certain order….or to please certain residents. Allow the new CNA time for care plan reading. This is vital.

Allow the new CNA break times. They might need more than you think!

If your facilty doesn’t provide one, make a checklist of things you want to teach. This way you will cover everything.

No matter what, NO SHORTCUTS should ever be shown to a new CNA! They might think these cuts are ok on a daily basis, which they are not. Show them the right way!

Peer Relations Tips:
Treat others how you would like to be treated.

Using manners can leave a positive impression to just about everyone.

If you get your work done early, offer help to others who aren’t done.

Don’t backstab, find fault with your peers. Instead find good – and offer praise.

When working short, it may be a good idea to “buddy up” with a partner. Doing things together is easier when we are stressed.

Always let your partner and nurse know where you are- even if you are only going to the rest room. This is true when you are doing care- if you know you will be awhile with a resident- say so ahead of time.

Be considerate of your peers: Don’t abuse your break times or meal breaks. Be prompt and on time.

Tell your family & friends that unless it is an emergency- not to call you at work.

Dealing With Dementia/Alzheimer’s

Keeping a sense of humor helps a lot.

Being positive is another trait that should be touted. Don’t assume something bad is always going to happen.

Once a struggle has begun, try to remain as professional as possible; don’t get into words and accusations. Don’t be the perpetrator of a power struggle. It’s not worth it. Make sure you report all behaviors to the nurse.

If a resident has become combative, your goal should be to protect the resident, other residents and of course – you. Try to act as a shield between the other residents, but don’t put yourself in a line of fire.

Sometimes it is better to walk away while a resident is having a hard time.

If you feel you might do or say something you could regret— LEAVE the room. Get someone else to take over; recognize your limits and respect them.

If you notice an increase in behaviors, ask the nurse about a special meeting to address your concerns. A team approach is always best. Now your good documenting will come in handy.

Documenting

When writing notes, be clear, concise and to the point. Be objective. Don’t write what you think happened or what you think caused an incident. Only write what you know.

Timely documentation is vital. If you take a set of VS and see that a resident has a fever, let the nurse know right away. Don’t wait until the end of the shift, or even wait until you’re done with this resident.

If your facility uses flow sheets, make sure you’re initials can be easily read.

Getting to know the particular types of paperwork you are required to do can take a little time; it is always better to ask before you sign your name to anything.

Never sign off anything you didn’t do. Never sign off something someone else has asked you to sign. Only document care YOU have given.
Being a witness to something and being asked to sign that you witnessed- this is another story.
Just make sure you write that you witnessed….

Use pens with facility approved colors. Don’t use pencils or markers. (KEEP IN MIND: Colored inks do NOT show up on copies- only B/W does)…

Taking Care Of Yourself

Don’t go to work sick. Ever. On the other hand, don’t call out over a simple hangnail either. Be respectful of giving enough notice when you call in. Also, never call to say you’ll be late and then call back to say you’re not coming in at all!!

Eat right- right is different for all of us. Make sure you are getting enough calories in daily to do your job as well as your home life.

Drink a lot of water. CNA’s don’t always think of themselves when it comes to fluid intake! Eight 8 oz. glasses a day is the least we should be bringing in; more is cool. If permitted, carry with you a covered water bottle at work. Drinking enough water may very be one of the best things we can do for ourselves!

Do some stretching before work! Really- it helps loosen up all those muscles we use and this helps prevent back injuries.

Lift people and objects properly. Use good body mechanics: Lift with your leg muscles, not your back muscles. Keep your balance and always work in conjunction with a partner during lifts.

Get enough sleep. Again, this is a personal thing, each individual has different needs. Whatever your need are, tend to them.

If you find that you are always getting upset about work, if you feel outraged at things- you need a break. Take a vacation. If this is not possible, then take a mental health day. I don’t condone taking time off that isn’t vacation – but there are those times that we all need a break. Especially right now when the nursing community is changing so rapidly.

Remember that you are a person who the new CNA looks up too; you are IT. So act it. Be professional, but friendly. Be there for those moments of self doubt and fear. Be a person who is positive and encouraging. NEVER rebuff a new CNA’s idea’s or observations: After all, they see things from a view point you haven’t seen for a long time.

The way you interact with the residents is very important during the mentoring period. Go over Resident Rights , and when the time is right use what you are doing as an example of honoring rights.

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