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Advice from CNAs and Nurses. Working in LTC, feeling confused/overwhelmed.


Hi all nurses!

So I'm currently writing this feeling a little down.

I've had my CNA for quite a while now, however, I just started a new job at a SNF/LTC and it's very overwhelming. I knew it was going to be difficult and I thought I was ready for that challenge but I was not aware of how much I'd have to go through. Most of the residents require total care, which means they can't do much on their own, a lot of them are also combative, they'll hit, kick or pinch, some also become inappropriate by touching the female CNAs in intimate places, and there's that one that'll curse you out and yell at you. Aside from the abuse I'd have to endure, I also need to provide the care they can't do on their own such as showers, feeding, making bed, everything that comes with working in SNF. So as you guys can image, I'm pretty overwhelmed, especially because I've never worked in this type of environment (ALF was not this bad).

It's difficult because I don't understand what some of the residents want, either I can't understand them or they are unable to speak. Its upsetting not knowing if I'm doing things right, and I get upset at myself for not knowing what they want.

Anyway, I wanted to hear from other CNAs or nurses who work or have worked in SNF. I just finished nursing school and I'll be a nurse soon, but I honestly don't think SNF is where I want to be which kinda scares me because I don't know what other options I'd have as a nurse, most hospitals don't need LPNs. I don't want to feel like I HAVE to do SNF/LTC and not like it. I really enjoy talking with residents and asking them what else I can do for them and they give me an answer, this is different, and they can't answer back, or I get cursed out of resident's room for not doing something right:(

I just started and already feel like I'm failing. I'm not sure that SNF is for me, but I also don't know how to find the right place for me. CNAs, nurses: How was it working in that environment? How did you guys deal with combative/verbally abusive pts.?

Nurses, how did you find the right place?

I know I'm not the only one that doesn't like SNF/LTC....right??:down:

I've worked in SNF/LTC a lot as a CNA and honestly it's a learning curve.

I thought I'd absolutely hate it at first; working in geriatrics is not glamorous by any means and I'll be honest, it took me a little bit to get over myself in that regard. I wanted to work in a hospital sooooooo bad, so for me, working in a SNF felt like I was taking a step down.

Boy was I wrong haha...

It's been one of the toughest but most rewarding experiences of my life - It's not for everyone though and I totally don't begrudge anyone for it, but I do urge folks to just give it a little extra time.

The combative patients may calm down with you a bit after a while - if you're a fresh face you can be breaking their routine. I've always talked to my patients, even if they're nonverbal; I tell them what I'm going to do, when I'll do it etc. This does help a bit on some patients - giving step-by-step breakdowns of stuff you're going to do can stem a bit of the combativeness (it's not a cure, but when those moments of lucidity and cooperation come, it's so nice!)

Understanding nonverbal cues takes time - don't beat yourself up over it. Watch youtube vids on what to watch out for - if you've got a bunch of total care patients and you're having to assist feed, make sure to offer fluids often if they're nonverbal and can't ask for them; this can reduce choking and whatnot, moist mouths make mealtimes a bit faster.

You'll learn where your boundaries are in time too with the grabby patients and you'll learn where to stand, how to direct their hands and whatnot so that they can't touch you - there's a bunch of youtube vids on that too (I would try and talk you through it, but I'm running on very little sleep so my words are failing me haha)

For verbally abusive patients - if it's a dementia patient, I give 'em a free pass. Just stay calm and know when (or if) things are going to escalate; sometimes it may be in yours and the patients best interests to step away for a moment if it's safe to do so. Give 'em a moment to calm down, and then come back acting like nothing bad had happened. Have your happy face on and see how they respond; they may not process emotion quite the same way we do, but they do respond to it. If the patient does not have dementia and is rude, don't be afraid to talk to your nurse about it - you don't have a license to be abused and sometimes it helps to have someone a little higher up ask the patient to behave a little. Sometimes it works, it's nice when it does!

As a nurse in an SNF/LTC, you won't have to do so much of the personal care stuff - depending on where you end up working you might have a pretty low patient load too (as far as SNF goes anyhow); the facility I work at now is basically a SNF/Assisted living facility for rich folk and their memory care unit has a grand total of around 8 patients, there's 2 CNAs and 1 nurse. Some assisted facilities have an lpn on hand too, so don't panic if you don't feel like you enjoy skilled nursing, there's still a decent variety of places you can work as an lpn.

I've sleepyrambled enough haha, I'm sorry! Good luck on finishing nursing school!! :) You're going to rock it :D

Missingyou, CNA

Specializes in Long term care. Has 20 years experience.

I completely agree with all of what Capa Jensen says!

I will also add:

Show no fear or frustration. They know you are new at this and if they see insecurities in you, it makes them feel insecure about your ability to take care of them.

If they are verbally or physically abusive towards you, you may have to walk away for 10 minutes or so. That 10 minutes can be a world of difference.

Your tone of voice is important too. Even those with the most advanced dementia will be able to pick up on your mood.

Most importantly, I'd say, is to never take a residents verbal abuse towards you personally. Remember they are in a difficult situation. They lost their independence, their home, ...so many things. Their frustrations (that have nothing to do with you) will be taken out on you because you are there.

You will be yelled at for what seems like the smallest of things. You really do have to let it roll off you and don't pay attention to them. Ignore it. It can be hard to ignore but, just keep thinking "it's not about me"....because it really isn't about you.

Always give your residents respect. You are a child to them no matter how old you are. SO many times I see CNA's who forget and talk to residents like they are children. Saying things like "you have to wait", or "sit down before you fall!" are things you may say to a child, not a grown adult who raised a family & lived a full life.


Has 3 years experience.

I've mostly worked in LTC as an aide. I first worked in a facility and it was a rough forst month or two. It took me a while to grt down what each pt needed and what they could or preferred to do on their own. When I first started, there was a resident who had been at the facility for a long time. She has her favorite aids and aids she would not work with. When I first worked with her she hated me. She judged my work very harshly and would scream at me almost every night (I worked mostly swing shift). In time I became on of her favorite aids and she would request me to come and help her over others. I was always calm and patient with her. I never let her get to me and especially never let it show any hint. I always ask and make sure everything is how they like it. The same thing happened with a pt I worked with when I worked in home health as an aide. She was a nasty woman and would often verbally abuse the aids. She did this to me and I let her know that it hurt my feelings, whether it actually did or not. She eventually became nicer to me. I, again, always Mae sure everything was how she liked it and asked questions about what she liked or wanted frequently. I elven came to her house, off the clock, and checked in with her after an ER visit.