Survey Lessons: Resident Dignity and CNA’s

Another example of how CNA’s can have a huge impact upon the survey of a nursing home. The following are samples of a real surveyor’s findings; then we’ll look at how the CNA could have prevented these scenarios from ever occurring in the first place.

1. Interviewable sample resident #2 was admitted to the facility on 2/6/01 with diagnoses including rheumatoid arthritis and a thyroid disorder (according to the face sheet). The quarterly Minimum Data Set, dated 6/12/07, coded the resident as having mild short term memory loss.

Observations of the resident on 7/1/07 at 10:30 a.m. revealed a certified nurse aide (CNA) was preparing to transfer the resident from her bed into a wheelchair using a Hoyer lift. The resident stated she needed to go to the bathroom prior to being transferred. The CNA stated the resident experienced pain using the toilet in the bathroom, so he had her go in the trash can by suspending her in the lift and placing the trash can underneath her.

A follow up interview was conducted with the CNA at 1:55 p.m. The Unit Manager was present during the interview. Both stated the day shift and evening shift used this method to toilet the resident. The Unit Manager stated the night shift had the resident use a bedpan, and did not get her up.

And:

On 7/1/07 at approximately 1:00 p.m., supplemental sample resident #27 was heard calling for help in a loud voice. The resident was seated in a wheelchair in the Silver Key office and appeared in no distress. There was a CNA seated in the Siver Key (sic) office with the resident. The CNA stated that was her job for the day, to sit with the resident. The resident could be heard calling for help in the hall outside the office. The CNA asked the resident several times why she was calling for help when there was nothing wrong. The resident yelled for help again and the CNA stated, “You are just a problem child.”

In the first example. the staff used a mechanical lift and trash can to assist with toileting a resident. Is this normal? Is this digified? What are some options?

Commodes: They make commodes in all sizes and shapes, out of soft and hard plastics. Most CNA’s have seen these PVC models. The CNA’s are the resident’s advocate. In this case they should have (and perhaps did) ask for a comfortable commode for this resident to use.

Bed Pans: They also come in many shapes and sizes. Some are made of softer plastics as well. The CNA’s should always encourage the resident to use this before getting OOB.

In the second example things aren’t so clear. Just the name of this room suggests dignity is an issue. When a CNA is expected to be a sitter, they need to have clear expectations of what they are to do with the resident. Just sitting there and watching them often isn’t enough and is very undignified. Usually a resident who needs 1:1 supervision really needs to be occupied. To be kept busy and somewhat distracted.

The CNA’s working with this resident could have foreseen situations where 1:1 time would be needed; and anticipated the need for activities and other things to do. Seeking the help of the Activity Director or other person, puzzles, board games, reading materials or any number of other items could have been available. Smart aides know these times will come and have a box of items at the ready for these moments.

We never tell a resident they are a “problem child”. To do so is border lining on verbal abuse.

To wrap this up, when we are caring for a resident who has special equipment needs for ADLs, ask to see one of the medical supply books to see what is available. If you find something that will work ask for it to be ordered.

Plan ahead. Anticipate needs. Ask for equipment. If your facility employs the services of a physical and/or occupational therapist, seek out their input on resident comfort and equipment issues. . Ask the charge nurses to document equipment requests in the resident’s medical records. Document all of this in your personal log.

Stressed Out? Here's Help

What is stress?
Stress is the psychological and physiological response to events that upset our personal balance in some way. When faced with a threat, whether to our physical safety or emotional equilibrium, the body’s defenses kick into high gear in a rapid, automatic process known as the “fight-or-flight” response. We all know what this stress response feels like: heart pounding in the chest, muscles tensing up, breath coming faster, every sense on red alert.

There is little doubt that our job is stressful. On any given day you might be asked to take on extra residents due to call outs; you might be confronted with an aggressive resident; you might need to comfort a family member or calm down a angry co worker; the bosses might be on a very public rampage about overtime costs or some other concern. You might feel under the nurses’ gun for paperwork or some other request. These are emotionally difficult situations.

Add to this the physical part of the work- the lifting, tugging, moving of residents. The constant walking and rare breaks can and do take their toll on our bodies. So, when we’re working short and the residents are feeling OUR stress, we GET MORE stress tossed back at us. It’s almost like a vicious cycle.

TEAMWORK: The Best Stress Buster
One of the best ways to deal with environmental stress to have a good solid team to work with.
Many aides take employment at facilities where teamwork is not happening. Change is slow. Set the example. Be helpful and positive. Model the behavior you want others to follow. Some aides will reject these actions…let them be. They are threatened by teamwork. Many others will gladly accept the help and will follow suit right back. If you’re working at a facility where teamwork is a foreign concept, make it not so foreign. Just make it a part of how you work. You will be amazed at how far it spreads and how willing many others will be to this.

We should all take pains to form good working relationships with our peers. We don’t have to like the people we work with; they don’t have to be our friends. But we do have to work with them, and it’s best to remember this. When new aides join the unit, it benefits everyone to welcome them with smiles and a pleasant attitude; to train them well and correctly; and above all, to show them how the TEAM works together and not on separate paths.

When there is a strong team, stress is less a problem. People who feel supported and backed up, experience less stress. When we have others we can relate to, vent to- it makes coping with the environment easier. Strong teams trust one another. Strong teams have a common goal- and in the nursing homes for CNA’s this would be to provide the best care under any circumstance. Strong teams hold each member up when times call for it. All nursing home leaders should strive to have these strong teams on each unit.

The charge nurse should be considered a member of the team and it’s leader. The nurse leads the medical aspects of the team, of course. More than anything else, the nurse should make her or himself available as a resource to the aides. Someone they can come to when having that bad day; someone they can talk with about problems at home that are impacting work…a person aides can trust with private or personal information. Someone who will go to battle for them.

TAKING CARE OF YOU: The Other Important Stress Buster
The way we experience stress can be controlled. If you take care of yourself, it’s easier to deal with the physical effects of stress. It can’t be said enough: Eat right, exercise and get enough sleep! It works wonders. Think about it: You wake up late because you didn’t get to sleep until 3am; you’re late for work…and didn’t have time to eat breakfast…you’re tired, hungry and soon, grouchy. Being preoccupied with this, you tense up and your muscles in your back won’t be cooperating…you are at a higher risk of hurting yourself. You’re creating the factors that make for a very bad day!

The solution to your bad day? YOU. And good planning.

Create the situations that will allow you to get a good nights sleep. Only you know how many hours you need…some of us get by with 4 or 5 hours and others need 12..whatever. Plan your time so you get enough. Purchase an alarm clock- one that has a battery back up! Allow enough time to grab something to eat- even a slice of toast and a cup of juice is better than nothing. Having an empty stomach can add stress to our body in so many ways.

I’ve heard many an aide state that they don’t need to exercise because the work we do is enough. To a certain point this is true…but our work doesn’t replace a general fitness program. I’m not going to push readers to join a gym or make up some extensive workout plan (although this would be ideal), but I am going to suggest a few things that we can all do, cheaply, that will have a positive effect:

1) Stretch: EVERY DAY, several times a DAY, before you go to work…a good time to do this is after a shower or bath. Stretching leg and back muscles is very important.

2) Go out for walks. Every day. At least a mile, preferably two. Walk at a brisk pace…build up to this slowly if you haven’t done it before.

3) See your doctor on a regular basis. Get your physicals and shots and exams. And don’t hesitate to schedule an appointment when you’ve not been feeling well- especially if you’ve had a fever, a bad cold, a cough, a sore back. Your doctor can help you figure out if there’s an illness or other problem. Don’t let “things” go on too long.

Emotional Health- Another Important factor With Stress:
Our attitude effects much in our lives. Really. A good attitude will show outwards as just that. Having a positive outlook on our job, our residents, peers, bosses and others will also impact each of us. When people are generally happy and content, they manage to stay grounded during times of upheaval. When we have good relationships with the people we work with we can expect good things in return. Those with sunny dispositions are just more fun to be around. We all know this.

Be mature. This means acting like a grown up…most grown ups accept responsibility for their actions. Being mature, in regards to stress management, means doing those things that will give others reasons to respect you and want to work with you. Keep your absences and tardiness rates down to a bare minimum; offer to help your co workers with tasks they haven’t completed if you’re done. Be a person that others can rely on. Be friendly and cooperative.

At the same time, don’t allow others to walk all over you or otherwise take advantage of you. Stand up for yourself when you need to, in a friendly but firm manner. Refrain from workplace gossip! Listening to this stuff can cause more grief and stress than many realize. The culture and politics of any nursing home are usually pretty bad- don’t add to it or worse, be a part of it.

Know your limits. This is probably one of the least talked about factors. Everyone has a threshold they reach, where they are no longer able to control situations. For aides, this often involves dealings with residents. We get frustrated and angry and exasperated. We have other things to do, and time is short. So we take on a negative or demeaning manner and things escalate. The residents act out or fall or in some other way REACT to our negativity. Times like this create more stress than most others. If we know what triggers lead us to these moments, we can anticipate them. And plan for them. Count the numbers of events that cause you stress, and take an honest look at how your own actions add to the situation. Learn from this. Next time you find yourself in a similar situation, remember this self assessment and act accordingly.

Personal Notes About The Workday

In our article TIPS & TIMESAVERS, we advise new aides to keep a small notebook on their person. To write down answers to questions; to write down phone numbers and other info needed for the job.

Seasoned aides can also make use of a small notebook. They’re cheap, can be bought almost anywhere and come in so handy for CNA’s. A great resource, the little notebook.

I have one…pocket size that fits nicely in my scrub pockets. What do I do with it? A lot. When the nurse asks for VS on a resident/patient, I have paper to record the results. When a weight is needed; when a height is needed; when intake and output need to be recorded- these little pads come in real handy.

At the top of the page I write the date…day, month, year and shift I am working.

*I record the times I clock in and out- so if there is a discrepancy in my pay I can go back and check.

*I record what unit I’m working on, and the initials of the staff working with me. Even the nurses. And I note who is agency.

*I record my assignment- residents names. No need for more info; names are enough.

*Any falls or other incidents are recorded in my notebook as well…the vital stats are documented. Who. What. When. Where. Witnesses.

Some aides will go to the effort to write in certain info about their residents: BM’s, voids, showers, turning and the like.

Many aides use their assignment sheets to record all this info…and that’s fine. But I like to keep a personal record of these things. It can help you keep a clear record of your daily work and one never knows when this information can become necessary to defend one’s actions. Some aides prefer to write notes about their workday at home, away from prying eyes and nosy bosses. No matter where you do this, it’s pretty important to DO IT.

The legal environment in today’s nursing homes demand we keep clear records of the care we give. Most nursing home management can be trusted to not alter records, but not all. Aides can and have gotten into seriously hot water over issues and incidents that were not properly documented; flow sheets have been “corrected” to suit the best looking picture. Since aides are the lowest people in the chain of command, it’s way to easy to blame us for problems, issues, accidents and the like.

Who hasn’t been called at home, by the DON, demanding to know details about some incident that occurred last week? And who among us has a truly clear recollection of the events? If we had written down all the details, it would certainly help us during this call.

A little notebook can keep a lot of vital information. I wouldn’t go around telling everyone I have one though…management often doesn’t take well to such things. And we have to be extremely careful to respect HIPAA rules, but it is within our right to keep notes about our workday. I strongly advise all aides to do this.

The Residents Unit: A Reflection Upon The CNA

Hey CNA’s, did you know your residents’ units are a reflection upon you?

Sure, the resident usually gets to decide where their personal belongings go, and some of them get really mad if you tamper with anything. While we need to be respectful of our residents preferences, we can do much to keep their unit, their home, neat and organized and safe.

When you’re giving care, it’s helpful to have all your supplies ready. Basins, soap, linens, powder and lotion and all the other items should be on hand so you don’t need to leave the room once you begin giving care. Most of us use an over-the-bed-table for all these items- it’s perfect for the tasks at hand. The table can be raised and lowered to suit people of all heights, and it’s pretty portable. Often, we make a mess on this surface: water, soapy residue, wet linens are placed here. When you’re done, clean off the table with wet cloths and then dry it. If possible, use a sanitizer.

When we’re giving showers or baths, we need to think NEAT as well. Counters next to sinks, shower rails and other surfaces should be cleaned up after the tasks are finished; personal care items should be put away and not left on the shower stall rails…if a bottle of shampoo tips over and spills we have a created a HUGE fall hazard, not to mention the waste. As for the bathroom itself: Think neat and orderly. Most nursing home bathrooms now have drawers where each resident can keep their personal care items separate from the roommates’ items. Look at the belongings: are hair brushes and combs and toothbrushes and other things dated and labeled? Can you tell who owns what toothbrush? Look at the basins and emesis basins especially! Rinse them out and make sure they are CLEAN. Keeping the counters clear of clutter reduces the chances of mix ups and loss of items.

When your resident is up and out of bed, and hopefully out of the room to activities, go back and make sure the unit is neat, clean and hazard free.

The Bed: Clean linens, wrinkle free, lowered to it’s lowest position and locked. Always. Make sure the linens have no holes and are fray free. One thing most of us know but a few do not: USE YOUR BARE HAND to check sheets, pads and blankets for wetness. A gloved hand cannot always FEEL wet linens; sometimes we cannot SEE urine stains (especially when they’re wet). Sadly, we also need to check UNDER the pads…often the sheet is wet under and for the same gloved hands reason, aides from previous shifts don’t know the sheets are wet. This leads to the famous brown stain syndrome; and odors. Finally, step back and LOOK around the bed. Under the bed. Up around the headboard…look for objects, pillows, missing items (how many times have we found a set of false teeth or a pair of eye glasses under a bed?) Look for hazards- sharp objects, frayed area rugs, broken wheel parts to the bed.

The Bed Side Table: Clear off YOUR junk. That means the lotions, wipes, foam sprays, ect ect. Find a place for these items that is out of sight yet easily accessible. It is always OK to leave a box of gloves out though- we never know when we will need them. One box is good for most of the unit though. Briefs, blue chux pads and the like do not need to be laid out either. Put them all away. Show your resident some dignity. And clean off the surface with a wet cloth, again sanitizing is best.

The Dresser: Again, like the Bed Side Table, keep this area free of YOUR STUFF. This is the residents space, not yours. Remember that. If they have knick knacks and other personal items here, be extremely cognizant of this. Treat these items with the highest respect- be careful. Be thoughtful. DON’T BREAK ANYTHING! If you work for a facility that offers consistent assignment, chances are you will have the same assigned residents every shift you work. This affords you the opportunity to gently clean off the dresser top every so often, weekly if not more often. (Yes, this might be the housekeepers job, BUT, you know as well as I do that they will not do a thorough job out of fear of breaking things). To make your job easier, you might want to keep the contents of the drawers neat and orderly. Some families do this too. If this is the situation, follow their lead and keep it all the way THEY have it. Same with the closet.

Speaking of closets, we’ve all seen messy, coat hanger infested PITS known as the resident closet. The mess, like it or not, is almost always OUR fault. When we’re working short of staff we rush through cares and dive in and out of drawers and closets looking for the easiest outfits to dress our residents in…we don’t have time to go back and clean up after ourselves. A few days of this means totally out of control, awful chaos behind those doors. It’s always up to us to clean it up, to wade through the endless empty hangers and weed out the stuff that doesn’t fit. Or is in disrepair. Talk with the charge nurses, but most nursing homes box up clothing and items that no longer fit and call family to come pick it all up.

Resident Clothing: More and more we see family taking care of these items. That’s fine and it’s often a big help. But we’ll always have those residents who have no one to do this. At some nursing homes the laundry staff put clothes away; in others, the aides do it. Either way, on a day where things aren’t so crazy, it would save a lot of time for you if you organized entire outfits: In the closets and drawers. An aide I know folds up an outfit into a neat semi ball and places many of them in a drawer: Pants, shirt, underclothing, stockings. So all she has to do is grab the ball, so to speak. This can be done with closeted outfits as well: Everything can be placed on a hanger.

ODORS: A big problem in many nursing homes. Even the cleanest rooms can have strong urine odors. Once there, it’s hard to get rid of. Carpeting is a big factor here…urine soaked rugs are almost impossible to totally clean up if the accident has been left to dry…as soon as an accident occurs try to get it cleaned up. Some aides spray the foam peri cleaners directly onto the wet spots to alleviate much of the smell. Another source of odors comes from laundry: If family does the resident’s personal laundry, wet clothing placed into hampers will smell, and the scent will get worse as it spreads to the other clothes… It’s best to bag up wet clothing and tie the bag tight in an effort to separate them from dirty but dry clothes. Some facilities don’t allow urine soaked clothing to be “kept” in hampers and insist the laundry department take care of these clothes.

One final note: Usually it is up to us to report things that need repair. We’re part of the safety chain…we often see problems before anyone else. Take this seriously. When stepping back to look at your residents units, have a critical eye and LOOK for hazards, potential hazards and other unsafe things.

Check the outlets for overuse- sometimes family bring in extension cords and overload them.

Check the electric cords for fraying, loose connections

Bed: Work the siderails. Hard. Make sure they lock. Make sure they are sturdy and not loose. Check the mattresses. Headboards and foot boards. Check the side pads if resident uses them; make sure they’re usable and not ripped, torn or otherwise jeopardized of the intended purpose. (And do they need to be cleaned?)

Look up and down and all around. The privacy curtain: Make sure it’s all UP and parts of it are not down, loose, with missing links. A falling curtain can cause an ambulating resident to fall. Look at the walls for signs of leaks and other problems. Check to see if these things could use a good cleaning.

Window: Look at the locks. Test them. Screens? Holes in them? In warm months check outside for bee and hornet nests. Do the curtains work properly? Are they clean?

Lights: Are they working properly? Are the bright enough or is a bulb out?

Carpeting: Is it all tacked down tight? Any places where it’s coming up? Same with tiled flooring. And wood floors can be very hazardous if they dry out and cause slivering.

Area rugs- these are often a big risk for fall prone residents. Make sure the team is aware the resident has one of these rugs. The nurse might want to consider talking with the resident about the safety of this.

An area we tend to ignore is personal furnishings. Recliners and the like can be a real comforting thing for our residents. We want to make sure they are safe for use though: Ask your resident for permission first, then actually sit in it. Test it. See how it works and if it needs any repairs.

Getting Paid for Every Minute You Work

About being paid for the hours we work…this is an article about the LTC industry and Fair Labor Standards Act (FLSA or the “Act”):

Another minefield, as simple as it may seem to navigate, is tracking and counting “hours worked” to determine if overtime pay is due. The key words are “compensable hours,” and hours can be considered compensable even if they are not scheduled or authorized beforehand or approved after the fact if they are indeed “worked” by the employee. The time is worked for purposes of the FLSA if the employer “suffers” or “permits” it to be worked. That is, if the employer, or one of its “agents” for this purpose (head nurse, unit coordinator, department head or, for that matter, any supervisor), knows or reasonably should know that the employee has performed work, it must be counted. Rank-and-file employees should be instructed that any time they are performing work, it is “on the clock.” Supervisors must be trained to, among many other things under the FLSA, recognize that any time an employee is performing job-related tasks, be it before or after the start or end of a shift, during lunch or other unpaid breaks, or even at home, he/she must ensure that the time is included in compensable hours for overtime calculation purposes. If the supervisor “suffers” or “permits” the employee to work, it is counted toward the overtime threshold.

THIS means, simply, that if you work, you get paid irregardless of whether the DON or other supervisor “approved” the hours. Often I read at the forums that we’re not paid because the time wasn’t approved by the boss. Legally, we have to get paid.

Employers must also become familiar with what job-related activities are considered compensable activities and which are not. For example, requiring an employee to change into a uniform at the worksite is compensable, while worksite clothes-changing for employee convenience is not. Pre-shift distribution of work or assignments and, by all means, shift change meetings or “report” are compensable, as are simple things like having an employee pick up or drop off mail or packages on the way from/to home or during lunch. Performance of work during unpaid lunch periods is particularly troublesome—a huge minefield—for healthcare employers. Regulations require that the lunch break be “uninterrupted” and be at least 30 minutes for the employer to exclude it from time worked. It is not uncommon for LTC employees to eat at their workstations or with residents, and it is also not uncommon for caregivers to be called or be called back during lunch break to deal with resident issues. All of these are problematic. If the employee’s lunch break is interrupted—he/she performs any work—the entire break becomes compensable time in determining if overtime pay is due.

So…remember this when you’re on your break and get called to the unit. Check your pay stubs to make sure you’ve been paid. It helps to keep a personal log of the hours you work…a little notebook will suffice for this purpose. The date, time clocked in, out, breaks (especially) taken and clocking in/out AND, importantly, going back to the unit. I think it’s safe to say a great many of us get screwed over often, in pay because of these “little” things. We work hard and we often miss our breaks. Let’s get paid what we’re due.

Question of The Week: Falls and Responsibility

Question:
At work today I got into trouble because one of my residents' fell. This man is independent and never needs our help. He can do his own care- showers, dressing, walking, meals, toileting...the works. As far as I know he has never fallen before. I was busy with one of my other residents who requires total cares. I was in the middle of bathing her when the nurse came in to tell me the man fell and why wasn't I with him? After I finished up with my lady's care, I was told to fill out a report which wanted to know what I COULD HAVE DONE to prevent the fall; THE LAST TIME RESIDENT WAS TOILETED; THE LAST MEAL consumed- all things that had nothing to do with this fall!!

Later, I was written up for the fall. I told the DON that everyone is responsible for ALL the residents on the hall I was working. Yes, he was assigned to me, but when I am busy with other residents, my co workers should step up and cover for me. What do you think of this?

Answer:
You should not have been written up, in my opinion.

Every resident must be assigned to a CNA. It's law. No way out of that. Every aide accepts their assignment and therefore responsibility for the residents on it. Each CNA is responsible for her assigned residents and the unit, as a whole, cannot do this.

It's tough when bad things happen to good aides, though.

Did you read the man's care plan? Are you absolutely sure he is independent in his cares? If so, did you check in with him to see if he needed any help, with anything? I think sometimes we assume these residents who are able to do their own care never need ANY help- and this isn't always the case. When doing this check in, it's always a good to ask when they're planning to get up; what they're bathing plans are and the like. This way, you can have some awareness that Mr. Smith is going to be up and about around 9am, and might need someone to just peek at him.

Of course this is where team work comes into the picture. Every time an aide is going to be tied up for awhile with residents, its always a GOOD thing to let as many peers know where you're at. And include the nurse with this info as well. If you're so inclined (and I would be) I would ask peers to keep an eye and ear out for your other residents...especially if I was going to be tied up for a longer period than usual with the other resident. A good charge nurse would make sure your other residents are covered as well. It's a balancing act though: Asking every aide to cover the others' residents every time personal care is being performed is just not practical.

As for the report: It's called an Incident Report. The questions asked do indeed have everything to do with the assessment of a fall. By asking you what you could have done to prevent this fall, the answers you provide are supposed to be helpful to prevent a repeat in the future.

Did you know most residents fall because they are trying to get to the bathroom? If they're hungry they might be trying to rush out to a meal. Usually there are other questions too on these reports- about all sorts of things. Often we don't know the prior condition of any resident when they have fallen without a witness.

It's very important for CNA's to answer these things honestly...however....when we're written up it takes away the desire for CNA's to have any respect for these reports. These things should never be used as a means for punishment. When independent residents fall, it is NOT the direct fault of the aides. It was caused by something else. It IS up to management to figure out why the fall occurred- but by placing blame on the aides they are short changing this process. This is another example of autocratic management style- which isn't helpful. And, I have to wonder if nursing homes with high fall rates have these kinds of managers.

I'm sorry you got written up. Of all the things CNA's don't have control over, the FALL tops the list. The work loads alone should tell all that it's impossible to be everywhere at the same time- or even once an hour. A good fall prevention program begins with a trusting environment where no one is disciplined for falls unseen. Once that is in place, true prevention strategies can be developed AND the CNA's are the most valuable asset to this process.

CNA's And Respect

CNA’s and respect

In the LTC setting it seems that one of the most important skills we all should have is in severe lacking: RESPECT. Respect towards our peers, leaders, people who work in other departments and residents. Without a healthy amount of respect towards others we close doors upon ourselves.

Respect towards peers- other aides- is SO important if one wants to able to work effectively and in a team like manner. It isn’t hard to respect others, it just seems so. First, we have to let go of all our old assumptions about people. Start with a fresh perspective and it is easy.

People generally:
Like to be helpful
Like to be liked
Like assistance
Like “fitting” in with others
Think better of others who use manners

People generally:
Don’t like being yelled at
Don’t like being treated as though they don’t know anything
Don’t like to be gossiped about
Don’t like being ignored
And most of all, people usually don’t respond well to others who demand things rather than ask.

Using manners in all your communications is the very first thing we can all do to improve our ability to gain respect from others. Sharing our experience in a helpful and mentoring way is another step.

Saying “Thank You” and “please” and “excuse me” are things we all learned in kindergarten or early on in life. For some reason these basic skills get lost as we grow up and become members of the workforce. I respond much better to someone who says to me- “Could you please get the door for me” vs. someone who says- after the fact- ‘Why did you slam the door in my face!?” (Usually said behind my back in some gossip session and usually I had no idea the person was right behind me and needed help!) Two good things can happen with this example: The other aide feels good because he/she got a helping hand with the door and I feel good because I was able to help. So simple yet so often not done.

Since many of us have years of valuable experience as CNA’s, we have much to share with the new CNA’s fresh out of class. Many experienced aides think it is not their responsibility to mentor new aides; they feel new aides should know everything they need to know. This might be true as far as basic skills with bed making and vital sign measuring, but NOT with the other subtle skills of getting along in a fast paced environment. Skills with speed and organization need to be talked about. The way in which we choose to teach these skills can really have an impact on our profession.

If experienced aides choose to mentor the new aides with an attitude of negativity and “Just one more thing to do”- we will fail. One has to have a positive attitude and one has to respect the position of the new CNA. Remembering what it was like when we were brand new HELPS.

Respect with leaders is a harder issue. Many nurses think that because they have a degree they automatically deserve respect. This is true only so far as the fact they got their education and degree- everyone should respect others for this. But to respect someone ONLY because of their educational status is not always possible. I firmly believe that respect MUST be earned. Nurses who treat CNA’s with respect, who use manners and who seek input from the CNA’s will manage things far better than those who “demand” respect simply due to their title. I am not advocating disrespect for nurses, but don’t give it automatically. You treat them well- with manners and dignity and hopefully they will respond the same towards you. Also, when respect is handed out without any perimeters staff tend to become like the leader. This can be both negative and positive. A leader who yells and is just miserable tends to have staff with the same attributes working for them.

So, using your manners and being polite DO go along way with respect. Sharing your knowledge and skills in a positive way also help move our profession in a good path. Not handing over respect just because someone demands it makes you a better person because you have standards for respect. What about respecting the residents?

Residents should always have our respect-unlike nurses and others- simply because they have lived long lives and because they are the paying customers within the LTC setting. They are our bosses. Without them we would not be getting a paycheck.
Residents of the Greatest Generation often fought in the world wars and lived through the Great Depression. Respect for this is expected and we should all give it! And we should be grateful. Members of this generation gave much in order that we can be as we are- they sacrificed and suffered for freedom and for American way of life. Never underestimate their sense of duty to their country.

Again, as with peers and leaders, using our manners and being sincere with our efforts will go a long way towards having good relationships with residents. This generation really expects manners and they tend to have different ideas about work ethics and how to raise children. Politics and religion are often taboo subjects with the elderly. Using correct names and titles are expected and show respect. Nicknames, although cute and becoming, should always be “Ok” with the resident and they must respond well to them.

CNA’s need to respect the values of the older generations. Currently, for example, the US is involved with military operations in Iraq. Many of the current generation (younger) feel no need to get involved with this war and are very much against it. Members of the older generation, if they know about the war, probably feel quite differently about it. They most likely feel it is the duty of every American to join the military services and serve the country. These current events can lead to hard feelings between generations. No matter how strongly one opposes war or sees a need for it, always respect how the Greatest Generation feels. Remember, they have sacrificed much more than we have.