Jump to content

Advice for a new CNA

Posted

I have only been working as a CNA for a month. My biggest struggle stems from me not being a very assertive person. I work in LTC and have always been raised to respect my elders, so it is very difficult for me to convince residents to do things that are important to their care (toileting, showers, going to bed, drinking more fluids, etc) because it feels bossy for me to tell my elders what to do, even though some residents have some stage of dementia and are not of sound mind.

I just want to do the very best that I can for all my residents who I love and care about very dearly, but sometimes don't feel like what I do is enough. All I want is to take the best care of them all, but it's difficult to be good to each and every one of them without feeling rushed, even though I realize that it's a fast paced work environment.

Will it get better with time? Or would I be better suited for something that offers more one on one time with residents where it doesn't feel like you're always heading them up and moving them out? I just wish I could do something more that would put some joy into peoples' lives. I would hate to have to give up my independence just as much as my residents hate giving up theirs. I just want to give them all a better life or at least bring them some joy and hope to them every day.

I have also thought a great deal about getting into hospice.

Any thoughts, pointers, words of wisdom, or experiences would be greatly appreciated.

You nailed it in so many ways how I feel about my CNA job. Especially about the respecting your elder part. But I just try to keep reminding myself when I am starting to feel that way that if I was not reminding them and being a little bossy about important things to do something may happen to them that will be even worse. Though sometimes you can only push things so far as well and if they still refuse there really is not much more you can do about it either. You also have to remember that many residents even though you want to give them the dignity and respect they so richly deserve are sometimes like little children...and like little children they do not always know what is best for them anymore and they need guidence to help them figure it out.

Will it get better with time?? I think to answer this question you need to literally take this DAY by DAY. You will have your good days and bad days. We can only hope that there will be a point that the good days out number the bad, or at the least the good days will out weigh the bad.

I am torn about what to say to you next about getting a one on one job for you... On one hand I'd say if you want that then I think Hospice or Home Care would be perfect for you. That is one of the reasons why I love being a Home Care CNA so much, and I know you might be happier and feel you are making that differance that you are hungering for. BUT on the other hand I can see you are one of the Gold Star CNAs that actually care and give a resident the compassion and respect they deserve. Then I think to myself those residents need CNAs like you so much!! TLC enviroment is so dark sometimes and because it is such hard work you get CNAs that are burned out, crabby, hate their jobs, and even though it is not right sometimes the residents have to suffer for it. They need CNAs like you that are going to WANT to make a differance in their day. That truely care for their whole well being not just going through the motions.

Whichever path you decide to take as a CNA the people that you are going to be caring for will be lucky.

Thank you for the encouragement. I know that I'm in the right field as a caregiver. I've been called to the field for a reason. I'm sure that I will find a place where I belong and can feel like I make a difference every day. Whether it be working in a home care setting and possibly just volunteering in a LTC environment. I just wish there was more time to do the fun parts of the job (painting fingernails, giving back rubs, taking residents for walks, giving long whirlpool baths, etc.) I am very thankful that I work in a facility where the resident to aide ratio is about 7:1, which is FAR better than most places. I know that I provide good care, but I want to provide the BEST care. It's tough to do when you're with someone and want to take your time with a resident and do everything right, but have call lights going off because everyone wants to do things all at the same time and want to get to everyone as soon as possible. I'm sure that gaining more experience will help me and I should just hang in there for now. I don't want to leave LTC, but question whether I would be better as a volunteer or in the activities department and do private care as well. Endless possibilities in this new career choice....

I commend CNAs, CMAs, and nurses for all their hard work and dedication! It's absolutely amazing what they do! I think it is very important that we, as caregivers, stick together and give one another encouragement and emotional support. I thank you for that! It means a lot!

Missingyou, CNA

Specializes in Long term care. Has 20 years experience.

Think of it this way: You have to pick and choose your "battles". If a resident is fighting you about having their brief changed when they've had a BM, that is a battle you must "fight" for their own good, but not if it could cause physical harm during the "battle"...sometimes reapproaching in 10 min or so helps.

If the resident refuses to go to bed (or get out of bed), then leave them be. They have a right to refuse!!! Some CNA's feel the need to enforce the bedtime at "before 3rd shift arrives". Third shift will have to get them to bed when the RESIDENT is ready. Same for getting up...they can eat in their room or have a lite breakfast later.

....and yes, you usually don't have the time to do all the "fun" things...but if you're caring for someone and doing it in a patient and dignified way, that is priceless! I would say it is even more valuable than being able to have time for the "fun" stuff with them, because it is harder to do and not everyone has that skill. There are many CNA's and only some of them do it because they WANT to.

The resident's need someone like you.

If you decide to go with homecare or hospice, there will be other ,different, challenges.

Chin up! It's for the good of the residents.

Very good advice. Thank you. It is such a new experience for a greenhorn like myself to encounter adults who don't always have the capacity to make decisions about their health and well being. Biggest example is getting told no when asking if a resident needs to use the bathroom. I should think more about the way I phrase things. "Let's try to use the bathroom before dinner or bed" is probably a much better approach. I'm learning more every day that choosing my wording is important!

Another question I have is how to pick up speed, without seeming impatient, to get things done in a timely fashion. I know that I'm still slow, which is bad for my co-workers and residents, particularly when everyone is wanting to do something at the same time. It's not due to laziness, because I'm always the first one to jump in and help someone when I can. Things just take me a little longer, having only been an aide for a month. Does speed just come over time with better planning and with getting to know residents and earning their trust so they're more willing to participate in cares and establish a routine with me? I think I may have just answered my own question there.

I think I may worry too much and put too much pressure on myself, but I just want to do right for both my co-workers and residents. I realize that I can't please everyone all the time, but I can come darn close, right?

Jeniele, ADN, RN

Has 2 years experience.

Missingyou made very good points in their post, you have to pick your battles. Just be sure to notify your nurse and chart, chart, chart. One month is still very new, especially if you're also a new grad. I found that three months was the clicking point at which things got easier. By then you typically have everyone's care plan memorized which saves you back and fourth time because you forgot to do something. Also, by then you will have learned the individual resident's routine as well.

Once you know what you have to do (care plan) and the how to do (resident routine) then you can develop a game plan to attack it and develop your own routine to meld it all together. Being assigned the same residents helps as well. They get to know you and your routine and will have confidence in your ability to meet their needs within that routine.

By six months, I found it was golden. I could have res A (capable of sitting alone) in the toilet taking his 10 min morning routine, while I was just outside the door with roommate res B getting dressed. By the time I got res B dressed and at the sink for him to brush unassisted, res A was done toileting and ready for my assistance. It doesn't always have to have A-Z with res 1 then onto do the same with res 2. Look for your down times and see if it's possible to multitask safely. Probably the only benefit to multiple bed rooms... Some residents can sit on the edge of the bed and start dressing/undressing while you help a roommate into or out of their bed.

When I was working second shift, I learned who my night owls were and got them settled (changed/toileted/etc.) right after dinner into their evening activity (TV, etc.) which then left me free to get those who were early birds into bed with fewer interruptions. You're always going to have something pop up during your shift that will derail your routine. But if you have one fully established, it will only take a few seconds of mental calculating to figure around the interruption and get back on track.

Ask other aides and nurses for info on res routines. If they've been there for any length of time they can really help out identifying the idiosyncrasies of each individual as well as the things that will gain you "points" with them. Positive points come into play when you have those episodes of resist. I don't mean this as blackmail or extortion, but knowing that a resident has a special spot at the table can help get things moving if your remind them they might not get there in time to get it. Also knowing a sweet tooth can help out on those very difficult times when you can offer a piece of candy (with nurse approval) or something as a reward. Again, not in a disrespectful manner like "Be a good girl and I will give you candy" but maybe something like "if you let me help you take a shower right now, I'll check with the nurse to see if there might be some candy you can enjoy with your favorite TV show after". Having a good bond with your res will lend you credence when compromising. Redirection is also a very valuable tool to have up your sleeve. Find out what's available to offer and use it judiciously.

Also the small things can really mean a lot. Knowing that a resident likes putting on their glasses and then their watch, or knowing that they like a certain necklace with a particular dress, or that they shave after breakfast or always wear cologne or makeup as the case may be goes a long way in providing that type of "special care" you're looking to provide. Does any of those really make a difference in their care? Generally no, but to the resident it makes all the difference in their world and for you it takes less than a minute typically. It's the little things which they still have control over and allowing them that shred of independence makes all the difference in their perception of the level of care you provide. I had a res who just had to have her blanket a certain way in her wheelchair and another just a certain way under her right leg, and I really mean certain indirection of fold and how the seams lined up. This irritated CNAs to no end and they'd go round and round with her on how it made no difference. I learned it was way easier to just fold it her way when getting out her clothes before getting her out of bed. I could get her in her chair and the blankets just the way she wanted in less than 5 minutes without any complaint and/or tears and her thanking me when all was said and done which took way less time than arguing over it. Pick your battles, saves time in the long run.

Sorry for the book, but wanted to let you know that I have been in your exact position and it gets better. Give yourself six months and see where you stand then and learn all your can about your residents in the meantime. They may not remember that back rub you were able to give yesterday but they'll know that you remember how they like their hair styled every day, or how you always talk about their favorite topic during shower time; and be sure to tell all their visitors how you're the best aide they ever had.

SeattleJess

Specializes in None yet..

...

....and yes, you usually don't have the time to do all the "fun" things...but if you're caring for someone and doing it in a patient and dignified way, that is priceless! I would say it is even more valuable than being able to have time for the "fun" stuff with them, because it is harder to do and not everyone has that skill. There are many CNA's and only some of them do it because they WANT to.

The resident's need someone like you...

So very, very true! Some of my fellow CNAs are economic refugees who feel trapped in work that is beneath them. They give technically competent care but it can be mechanical and rough - things like slapping ice cold lotion onto a resident, bumping toes, failing to explain what they are doing, using harsh tones to people who mostly understand only tones and touches now. (Thankfully, there are only a few of these.)

They're called basic needs for a basic reason! Give yourself credit for meeting them with a loving heart and leave perfection to the higher power in the Universe.

Meanwhile, do what little extras you can. Sing a favorite song while you're changing a brief. Quickly put a little lipstick on a lower lip and ask a woman to blot it. This took 30 seconds the other day and I wish you could have seen the radiance on that woman's face! She was thrilled to be wearing lipstick to dinner.

We don't have time to do everything so it helps to ask, "What can I do to make your day better?" You could be surprised and delighted. One patient, in considerable pain, responded, "Dance!" I hummed a little waltz music and danced a few steps at his bedside. Who knew?

Focus on the good you are able to do and it will grow. And please, acknowledge your skills and your good heart.

Edited by SeattleJess
Grammar

SeattleJess

Specializes in None yet..

Very good advice. Thank you. It is such a new experience for a greenhorn like myself to encounter adults who don't always have the capacity to make decisions about their health and well being. Biggest example is getting told no when asking if a resident needs to use the bathroom. I should think more about the way I phrase things. "Let's try to use the bathroom before dinner or bed" is probably a much better approach. I'm learning more every day that choosing my wording is important!

Another question I have is how to pick up speed, without seeming impatient, to get things done in a timely fashion. I know that I'm still slow, which is bad for my co-workers and residents, particularly when everyone is wanting to do something at the same time. It's not due to laziness, because I'm always the first one to jump in and help someone when I can. Things just take me a little longer, having only been an aide for a month. Does speed just come over time with better planning and with getting to know residents and earning their trust so they're more willing to participate in cares and establish a routine with me? I think I may have just answered my own question there.

I think I may worry too much and put too much pressure on myself, but I just want to do right for both my co-workers and residents. I realize that I can't please everyone all the time, but I can come darn close, right?

All the good aids tell me it just comes with time. Repetition, repetition, repetition. Better to do it slowly and correctly, then build speed, than to do it quickly and unskillfully to get a head start on doing something poorly AND fast. I'm in my third month and can tell I've picked up speed already. Give yourself time.

Also, remember that your employer had enough confidence in you to hire you and still has enough confidence to keep you employed as your grow in experienced. Trust that you're on the right path.

SeattleJess

Specializes in None yet..

Jeniele, that was an AWESOME book and so very true! Thank you for sharing your observations, experience and wise ideas!

I wish you'd repost it as a separate thread with a title like "Remember This, Scared New CNA!"

Thanks again.

Edited by SeattleJess
Typo

The "scared new CNA" thread would be great! The great thing about being new is that you get along so much better with the bossier residents who like to tell you how to do everything step by step because I know that things are being done THEIR way which makes them happy and feel more in control of things. One particularly bossy resident is always very thankful and appreciative to have me give her shower and put her to bed at night. She always tells me "oh, I'm so glad it's you!"

I actually had another resident remember me from when I was there for clinicals. She remembered when I told her I was wearing all white when she asked how long I have been there. She says "yeah I remember when all the whites were here from school" This was from someone who has a hard time remembering things! Made me feel really good! Having extra time last night, I was able to give her a really good backrub and lotion her arms and legs really well. Last day of clinical was rough because of her. She held my hand for the longest time and didn't want to let go after I told her I didn't know when I'd be back. I immediately went to my car and cried after saying goodbye the last day. Now I'm working at the facility and get to see her and other residents I had bonded with then every day. I had such a good experience from clinicals because I saw that most of the residents were generally happy, as well as the staff. I'm thankful to be a part of the organization now

Jeniele, ADN, RN

Has 2 years experience.

Jeniele, that was an AWESOME book and so very true! Thank you for sharing your observations, experiecne and wise ideas!

I wish you'd repost it as a separate thread with a title like "Remember This, Scared New CNA!"

Thanks again.

When I get a chance I'll expound on the ideas and post something along those lines.