Have YOU trained new CNAs at your facility?

Abigail612 · Aug 21, 2012

Here are a few of my pet peves...

1) Don't compare how things are done at you previous job/clinical experience as long as what the person who is orientating you is doing does not harm the patient or violate any major rules just go with it, when you are on your own you can do it your way.

2) Be willing to jump right in and get your hands dirty.

3) Don't be to cocky or brag about yourself to much that does not make friends and in this line of work you need to be on good terms with those you work with.

4) If some one tells you not to do something or to not do a certain patient alone please, please,please listen dont be a hero there is a reason!

Those are the main ones that I can think of for the moment...

mstearns09 · Aug 21, 2012

1. Listen to what the person orientating you says but don't take everything they say as gospel truth.

2. Read the care plans! Just because you're told that Resident A can do everything by herself, it doesn't mean that it's care planned that way. This will save you panic when state comes in to do survey.

3. Take your time and don't rush.

4. Don't get involved in facility gossip and politics.

SlaveHeart · Aug 21, 2012

Here are a few of my pet peves...
1) Don't compare how things are done at you previous job/clinical experience as long as what the person who is orientating you is doing does not harm the patient or violate any major rules just go with it, when you are on your own you can do it your way.
2) Be willing to jump right in and get your hands dirty.
3) Don't be to cocky or brag about yourself to much that does not make friends and in this line of work you need to be on good terms with those you work with.
4) If some one tells you not to do something or to not do a certain patient alone please, please,please listen dont be a hero there is a reason!
Those are the main ones that I can think of for the moment...

Thanks for the response. I don't plan to compare much because I did my CNA program in a different state and have only worked in home health since then. So I'm going to try to soak in and absorb as much as I can about how things are done over here. I will jump right in, I was thinking the person that is doing orientaiton is more of an observer than doing 'training' per se. Okay I won't let anyone know I have a 4.0 and loved micro and patho, that'll be our secret okay? I will consider number four a safety measure and not tackle certain residents alone. That didn't quite sound right, I won't be tackling any residents.

SlaveHeart · Aug 21, 2012

1. Listen to what the person orientating you says but don't take everything they say as gospel truth.
2. Read the care plans! Just because you're told that Resident A can do everything by herself, it doesn't mean that it's care planned that way. This will save you panic when state comes in to do survey.
3. Take your time and don't rush.
4. Don't get involved in facility gossip and politics.

Thanks for the help.

Note to self: read care plans, read care plans, read careplans.

I'm a bit worried if I don't try to rush I will be too slow and not give everyone the care they deserve. I suppose at some point quality must come before quantity and after a few weeks on the floor I'll pick up the pace.

funtimes · Aug 22, 2012

Important things to learn....

How does each person transfer? Supervised, One assist, two assist, lift of some kind? Can they be left alone on the toilet or commode(rare), can they be left in a chair or in bed without an alarm on?

How much can they do themselves and how much assist do they need? Can you just set them up and let them do their own hygiene(rare), do they need to be supervised and given a little help and prompting? Do you need to pretty much do everything for them yourself? Remember that peri care is important, even if doing it seems awkward at first. The person might seem to do it themselves but does such a lousy job that theyd end up with infection if left to do it solely themselves. When in doubt try to do it yourself, while doing it in a manner that doesnt scare or offend them, such as maybe itll be easier if I help you with that.

Another big one is how they eat and what their diet is. NDD1, 2, 3, mechanical soft, general, diabetic, etc. Do they need to be fed, supervised, or just set up. Are they thickened liquids? Dont just guess, know what it is(as someone said, read the care plans)

Remember GIT ER DONE! Old people move slow, so you dont have time to be messing or waiting around, you gotta get stuff done and multi task. If you do stuff at the same pace as your residents youll fall behind in no time. You should still always be gentle and polite and explain what your doing if they are confused and you are new to them, but you gotta move quickly and multi task. Some residents would just as soon sit on the toilet all morning or night long, so you gotta learn how to keep things moving along while letting them feel like they are in charge and you are just helping. You still want them to be as independant as possible, if they dont use it they lose it, but you also have to get them going.

Try to anticipate everything you will need before doing something and have it all there and ready before you begin. Having to leave and get something you forgot is a big time waster and could be unsafe if you need to leave the resident on a toilet to get it.

Try to have fun and enjoy your job and talk to the residents, even the ones who are totally out of it, but be polite at all times. Dont ever raise your voice or get angry, even if your being screamed at or hit or the person who can barely stand trys to get up and sets their chair alarm off every 5 minutes. In addition to not being very nice, its the surest way to get fired and possibly lose your certification.

Treat every resident like theyre your grandpa or grandma, or if its a younger person with say MS, like you would want to be treated. If you have a relatively young person with a disease that requires around the clock care they may be bitter and take it out on you, the only person they can. Just let it go in one ear and out the other if they vent or get nasty and personal.

Remember you are responsible for the well being of these people, you arent just there to be their friend or keep them company. One of the hardest parts of being a CNA is getting people to do stuff they dont wanna do. It can be like trying to herd cats.

SlaveHeart · Aug 22, 2012

Funtimes: I think I'm going to write down most of those questions in my mini notebook and make sure to jot down answers the CNA gives about each resident.

Which leads to my next question: In clinicals we had to turn in our 'notes' for the day to the instructor. Would keeping notes on residents even be a HIPAA violation? Like if I write mrs abc will ask to remain on toilet but is at a fall risk so monitor and then my notes get lost would that be a violation?

I want to make sure I know exactly what to do with whom so should i just put room numbers instead of names?

Thanks

mindyfromcali · Aug 22, 2012

Room numbers are better than names, and easier to remember. As far as I know, no one has ever gotten into trouble for their cheat sheet getting lost. Don't write down stuff so people will know what it means. Ex: I put an "I" for the incontinent patient, and a "C" for continent ones. If they toilet, and I don't have time to chart, I put a little tick mark next to the "I" or "C". If they're in a wheelchair, I put WC. If they need vitals taken (yes I know on some units all of them need them taken, mine the max is like 4 out of 14 or so Residents) I put a little V by their name. If they're total care (cannot help do any care), I put TC, if they're independent I put "ind."

If you want to put transfer info, you could put like 1P for one person assist, 2P, and so on.

Mainly, it's the toileting information I'd worry about people finding, who don't need to know.

As long as it isn't too personal, like Mr. so and so has diarrhea all the time, no one will be offended if they find it and report you.

funtimes · Aug 23, 2012

One thing I forgot to mention. Dont just rely on the word of the person orienting you when it comes to information on your residents. You should make sure you know how to look this stuff up yourself. Most of it should be in the care plan, Id try to spend some time going through them so you know where to find important things quickly, since you cant be expected to memorize everything about every resident(at least not at first).

Keep in mind the care plan sometimes is how things SHOULD be done, but reality sometimes gets in the way. For instance it may state a person is supposed to be ambulated 4 times a shift for a certain amount of time, or doing range of motion exercises, but time constraints or unexpected circumstances may sometimes get in the way of that and you might have to prioritize. Usually you can compensate by combining things, such as ambulating them on their way to or back from meals or after toileting them, or doing range of motion as you get them dressed, but its not always possible.

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SlaveHeart · Aug 23, 2012

One thing I forgot to mention. Dont just rely on the word of the person orienting you when it comes to information on your residents. You should make sure you know how to look this stuff up yourself. Most of it should be in the care plan, Id try to spend some time going through them so you know where to find important things quickly, since you cant be expected to memorize everything about every resident(at least not at first).
Keep in mind the care plan sometimes is how things SHOULD be done, but reality sometimes gets in the way. For instance it may state a person is supposed to be ambulated 4 times a shift for a certain amount of time, or doing range of motion exercises, but time constraints or unexpected circumstances may sometimes get in the way of that and you might have to prioritize. Usually you can compensate by combining things, such as ambulating them on their way to or back from meals or after toileting them, or doing range of motion as you get them dressed, but its not always possible.
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I really like your idea of multitasking ADL's I think I will need to utilize that in order to be efficient with time management. I start tomorrow night and I am sooo nervous! I've been reading everything I can and watching skills videos like I'm studying for a lab practical instead of my first day of work!

AJ_427 · Aug 24, 2012

Lately, I've trained a lot of people and worked on the floor with many new people. Things to remember:

- Not asking questions is the worst for me. That is how you get in trouble at my facility and it shows me that you don't care. Not all residents are the same and things are done differently depending on the assignment.

- If I let you do the vitals, tell me right away if something is off.

- If I let you chart, ask if you've done it right. I will check them even if you don't ask me and you will hear some harsh words if you make a big mistake.

- You do things my way and you follow my routine. I know where I'm supposed to be at what time so don't get mad because you want to do it your way. You will get to do that when you work alone.

Ask questions and get involved as much as you can. I would even ask if you can try something on your own because that's how you learn things quickly. Don't slow the person down and at least act like you care. When working alone, don't be afraid to ask for help even if the person doesn't really want to help you. You will eventually be able to do everything on your own.

fuzzywuzzy, CNA · Aug 31, 2012

I've noticed that some trainees get in this mode where they just follow their trainer around and stand there waiting to be told what to do. That can be annoying, and you're not helping yourself to learn anything. I know it can be tiring when you're orienting, and easy to kind of zone out, but try to remind yourself to be proactive. For instance, after you do care on someone, instead of following your trainer as she brings all the laundry to the bin, ask her which resident you are going to next and tell her that you'll meet her in there with towels and ask if you'll need anything else, like a hoyer. If you're helping her put someone to bed, look around for floor mats, alarms, start filling the basin with water... whatever needs to be done so you're doing more than just stepping out of the way while your trainer runs around.

I'm a really quiet person and I get flustered easily and I was totally a bad orientee at my first job because I would freeze up all the time. At my second job, I barely needed any training beyond being shown where things were kept. I got off to a much better start at that place because right from the start I acted like it was sink-or-swim, and I asked a lot of questions.

It also helps to ask about the general routine for the day. If I'm on a new wing I write down my residents on a piece of paper and ask someone, "who has to be up before breakfast? who is a shower? who needs to be weighed? What order should I see these residents?" and I make little notes on the paper. Usually the other CNA will tell me as she goes along who is total care, a hoyer, who washed in bed vs who gets dressed on the toilet, etc. Then I cross them off as I go along and put a little symbol if they are dressed but not out of bed yet. Obviously I am not in training anymore, but it still helps you to ask these questions because you'll learn a lot more if you have some context... kinda like how you're less likely to get lost if you read the map before you start the car! It's easier to see what the next step is when you know what you're working toward.