I just started a couple of weeks ago as a CNA at a LTC facility. It is a large one and considered one of the nicest ones in the area. I am applying to RN school and I am using this to get some great experience. I love all aspects of patient care. I don't mind the gross, I love being able to take care of people who can not care for themselves.

My problem is with the staff. I work on a unit that is understaffed and staffed with a lot of newbies (such as myself). Our unit has the worst bed sores and gets in trouble all of the time. This is what I walked into. I was a little bit intimidated, but I'm always up for a challenge. The challenge got to a breaking point the other day though, now I'm afraid I am going to get fired. I get rushed all of the time by the nurses and other CNAs. I actually had a nurse tell me that I need to stop washing my hands between residents because it takes to much time (I choose to ignore that request). So, I was getting ready to start my last set of rounds the other day and I made a mistake. I changed a resident who is a 2 person assist by myself. I was very careful and used proper body mechanics. I have seen a million other CNAs care for him w/o assistance. I finished changing him just fine, but then a bent down after changing him and my back went out. The nurses sent me to file an injury report, and now I am getting lectures about how you are not supposed to do patient care by yourself on a two person assist. I completly agree and I know it was my fault. I couldn't get anyone to help me though and the resident was becoming agitated at having to sit in a soaked diaper (with every right to be upset about that). So, I made a mistake. I did it for justifiable reasons. But the fact is I made a mistake and now I have cost the LTC center money. I am really afraid I am going to be fired.

I just don't know what to do when it comes down to good patient care vs. getting everything done. I seem to get in trouble either way. How do you balance it? I refuse to do shotty care, but I also understand that if I take too long with one resident the others are left waiting and suffering. I am just really confused.

You do the best you can. Personally I think if you rush with everyone, at least it's fair. I am not going to dote on someone providing amazing care while my other residents are ignored. I try to be as equal as possible.

As for you getting in trouble for doing this man by yourself, it depends on what the rules are. Did you transfer him alone or just roll him over in bed to change him? Was he hurt, or just you? Chances are nothing will come of it. Maybe you'll get written up, but I highly doubt you'll be fired.

It is not nice to leave someone is a wet sheet. If I am able to hold them with one hand and clean and change with the other, or if they can hold the bedrail and roll, then I do it alone. Otherwise, I will find somebody else, offer to help them with something if they help me to change that person.

"I just don't know what to do when it comes down to good patient care vs. getting everything done"

I hate being rushed, too. But don't hurt yourself trying to do everything. Some things NEED to be done right then, others can be finished later.

Well, first off, God bless you for wanting to take care of the elderly. And I mean that very sincerely, may God bless you for taking on this kind of vocation, because it's important needed work and it honors Him.

However, like many things in this life, when we try to do something noble and honest and decent it's crushed by the very people who are supposed to set the example. There are two kinds of nurses, doctors, CNAs, etc. in the field: there are those that genuinely want to make a positive difference in these people's lives and practice good, medically sound, authentic caregiving, and then there are those that may say they "care" or chose these professions "to make a difference" but for whatever reason, are in fact self-serving, don't enjoy what they do, and don't give decent, medically sound care. And you find of A LOT of these types in nursing facilities. Not all, mind you, but there are a lot of them. They're called hypocrites: they tell you to do something one way, but don't set the example. They look the other way when many of their "favorites" give improper care, but they'll jump all over someone who stands for integrity. They want you to chart things you haven't done yet so that that the facility can get its Medicare and Medicaid payments, but will tell you doing the activity is just as important--but in reality, they don't really care if it happens or not, as long as it's charted otherwise. Workplace bullying among staff members is very common in nursing facilities, and quite frankly, it's unconscionable.

Clearly, these problems exist at your facility, like so many others. Tons of bedsores, you said, and a nurse telling you to not wash your hands? Nurses forcing CNAs to rush, colleagues won't help, then residents fall or staff members get hurt? It's not hard to connect the dots between cause and effect, is it? I'm so sorry for you. Because the truth is, and this isn't going to be easy to hear: you are in a bind, and will get in trouble either way, because of the hypocrisy and improper care practiced by those in charge. And it's not fair, and it's not right. The bottom line comes down to this: you have to look yourself in the mirror every day. And, if you're a believe, you answer to Him before anyone else. Does it mean you might lose your job? Unfortunately, yes. But giving the best possible resident care counts for more than anything else at the end of the day. And as you gain experience, you'll learn to give the best possible care in a little bit quicker, more efficient manner. But even as you gain experience and move a little quicker, still giving good care, if everything is not done, then so be it. Just make sure you're always at work on time, have good attendance, are loving and caring to those sweet residents who SO need people like you, do nothing illegal, and keep your attention solely on your work, and you will do well. If someone needs to be moved, and they're a 2-person transfer, and fellow CNAs won't assist you, go to a nurse and say, "I need to transfer so-and-so, who's a 2-person transfer, and the other CNAs are busy so I can't get any assistance right now, and I want to properly follow the care plan. Could you help me?" and if the nurse is snotty or won't help (for one thing: document it for your own records in case something bad should happen with your job in the future), then go to the D.O.N. and say the exact same thing. And if s/he's snotty and won't help, again document it. The point is: YOU just keep doing what you know in your heart of hearts to be the RIGHT thing to do.

May God bless you and watch over you. :heartbeat

Thank you guys for the encouragement. I really appreciate it. I was just kind of freaking out. My back is okay, the resident didn't get injured, and I have learned a valuable lesson. I totally agree with Katie that I'm just up a creek either way. I am just going to do what Called2009 said and just document and keep myself out of trouble in the things I can control. I will just trust that God has a plan for me and that He will be faithful to pick me back up when I fail. Again, thanks for the kind words! :)

I really feel for you!! I am a new CNA as well and I know how it is. It really annoys me the way some of the other CNA's treat the residents. My first day one of them stood outside a resident's room and said this one is a whiny &*$#@, watch out for her. Besides the fact that every place seems to be under staffed and not very willing or able to properly train new CNA's. I just keep reminding myself that if I ever get burned out to that point, then I will quit. I don't ever wanna be like them. I really hope everything works out, because there need's to be more CNA's out there like you! Keep your head up!:)

I had my lead nurse tell me, "It's not a sprint... it's not even a marathon... it's a relay. Do what you can do and pass the rest of to the next runner."

(The LTC facility)... is a large one and considered one of the nicest ones in the area.

I work on a unit that is understaffed and staffed with a lot of newbies. Our unit has the worst bed sores and gets in trouble all of the time. I actually had a nurse tell me that I need to stop washing my hands between residents because it takes to much time

This just goes to show you that perception is not always reality.

The fact that they have such a problem with staffing means that (a) they have systematic, institutional problems and that (b) it will never get better without a change in direction coming from the top.

Honestly, your best bet is going to be to move on as soon as you're able.

You are one of the reasons I love nursing! People like you make nursing better. You care about your patients, and you refuse to jeopardize their care, even if it means getting in trouble. I love it! Never give up that attitude.

I doubt you will get fired because you got injured. You'll probably be written up for not following the care plan, but I'm sure that's as far as it will go. And if they do fire you, you can find a better job with a better company. I worked at a terrible LTC for only a month before I quit, and when I was in an interview with another better LTC I told them that I left because I refused to neglect patients the way they did at the bad place. They appreciated that and hired me! That same attitude got me a great job at a hospital later on, too. In the end good facilities want good people who care as employees. You can work with slow, you can't work with bad attitude.

We're always understaffed where I work. And since I'm new and still trying to make my own routine/way of doing the things I've got to get done, I seriously lag behind when the other CNA on the floor has to leave or isn't there. It makes me dread 3's, because the burnout comes really fast when you're racing on your feet for 12+ hours, lifting, dragging, pulling, carrying, stretching, feeding, toileting, answering call bells.

But then, I am also the oldest CNA on the floor at 37 (will be 38 in a few mos.). I am not as agile and can't get away with some of the feats of strength these 19 and 20 year old CNAs regularly do. I can't race through my day and keep everything straight in my head. I have to make notes, sit down, plot, plan, scheme, make more notes. This is just how I operate. So part of my routine is developing - the part being where I tell myself the nurses and nurse manager can lump it if I'm swamped and can't keep up. I ask for help when and where I can get it, but it's not readily available 80% of the time, and often involves a protracted hunt for available hands, during which other needs from other patients arise, and when you do finally find someone, they're in the same situation. I just do my best, work as well and as fast as I know I'm able, try and get help when I can. If I can't, and I know I absolutely cannot work a max assist by myself, I will tell the patient that, and I will apologize and let them know I'm going to get some assistance before I take on more than I can handle. I tell them straight up, "I'm uncomfortable doing that on my own, and I would like to find someone to help me first, for both of our safety", and they understand right away and most of the time will be glad to wait.

OP, I hope you continue to guard your back. I've had issues with mine over the years and I'm doing really good right now but if anyone's aware of how quickly something can go awry and change everything, it's me. Body mechanics can easily get away from you when you're rushed, or when you've got a patient that isn't able to offer any assistance. You really have to keep it in the forefront of your brain, to shift your feet, keep your back and shoulders properly angled, pull the pt up in bed correctly, etc., because it is SO, so, so, so easy to just forget your safety and comfort when someone really depends on you physically.