Clinical concerns

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I just started my clinicals for my CNA course and I have some concerns that I was wondering how common they appear. I realize that this work is tough, and I expected nothing less, but I also believe that we should always place the well being of the residents that are under our care first. We are here to improve health were we can, not make it worse.

Throughout the day I noticed that the majority of CNA employed at the facility were quite rough and impersonal with the residents. In class I was taught that we needed to greet the residents and state our business, what we were going to do for them, before we began any process. Yet, I saw none of this happen. The caregivers just walked in and began their duties, not once did i see anyone greet the resident before starting. While offering care there were little, or no, words spoken to the residents. It was very mechanical, and harsh.

I noticed during the range of motion exercises the aides were moving the limbs in rapid and rough manners. One resident had a stiff knee, and the aide forced the leg to bend in a very harsh fashion. It appeared that there was alot of over stimulation to the resident that could make their condition worsen. Often I noticed that the residents that could not speak showed obvious pain during these exercises, and that the aides bluntly ignored their groans and moans of discomfort.

I saw that perineal care was rushed and incomplete, leaving fecal matter on the resident. At some points I noticed aides ignore a plea from a resident to go to the restroom. Even their dining was rushed and forced. By "force" I mean that exact wording, it was as though the aide crammed huge spoon fulls into their mouth. It was such a risk for aspiration and choking.

My first day at clinicals had me heartbroken, I went home that evening and cried for those residents. Many of them had cried when my class had to go. Just in that one day I feel that I have made many friends of those residents, and it hurts me to see that their care is so disappointing. I did speak to my instructor about these concerns that I observed, and hope that they will be brought up to the DON. Keep in mind that these are just a few of the things that I noticed wrong..

Is this activity of care a common thing? Why do people that are so unconcerned for a persons well being involved in providing care in a medical facility? I appologise for my rants, but I had to get this off my chest, it is so sad for me to see this occur.

Thank you for your time in reading this.

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Specializes in LTC.

That does sound bad. The ROM and the dirty butts and ignoring requests for the bathroom, that is.

As far as the other stuff goes... you don't need to go through the greeting and explanation of what you're going to do with every resident. If they're alert, they know the drill and they don't need you going through all the steps. I do usually tease them or make small talk though. I don't just do through the motions without speaking or smiling. I only tell the residents who are nonverbal or just heavily confused what I am going to do. When you're feeding most people, you have to shovel it in. Putting a spoonful up to their lips will get you nowhere, otherwise most of them wouldn't need help in the first place. Tiny little bites don't usually work either... they stay at the front of the mouth or get pocketed in the cheeks. You have to do things like push a big spoonful right in, coach them to swallow, stroke the throat if needed, maybe add milk to the food to thin it out or sugar (even if it seems disgusting to you, adding sugar to everything incl meat sometimes works).

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Specializes in LTC, Rehab, CCU, Alzheimers, Med-Surg.

Unfortunately a lot of homes are like this PURELY because of the resident load they have. It's scary, but some nursing homes have 18-20 residents per CNA. When this situation happens you can only do so much for your residents :cry:

As far as the people who cry out, to go to the bathroom for example... There are some residents who put on their callbell every 5 seconds for something. The same resident will have to go to the bathroom 10 times in an hour. And the CNA's know this, they aren't ignoring, they are giving the other residents who NEED care, care first. There was a lady at a nursing home I worked at who would yell "I wet my pants!" constantly, just so someone would take her to the bathroom, and when we did, her pants weren't wet, she wasn't wet at all, and she would pee 1 cc of urine :bugeyes:

You just have to learn the routine! It is heartbreaking, but you do as much as you can with the time you have. Unfortunately for the residents, we cannot give them great care all the time.

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Specializes in Alzheimers and geriatric patients.
Unfortunately a lot of homes are like this PURELY because of the resident load they have. It's scary, but some nursing homes have 18-20 residents per CNA. When this situation happens you can only do so much for your residents :cry:

As far as the people who cry out, to go to the bathroom for example... There are some residents who put on their callbell every 5 seconds for something. The same resident will have to go to the bathroom 10 times in an hour. And the CNA's know this, they aren't ignoring, they are giving the other residents who NEED care, care first. There was a lady at a nursing home I worked at who would yell "I wet my pants!" constantly, just so someone would take her to the bathroom, and when we did, her pants weren't wet, she wasn't wet at all, and she would pee 1 cc of urine :bugeyes:

You just have to learn the routine! It is heartbreaking, but you do as much as you can with the time you have. Unfortunately for the residents, we cannot give them great care all the time.

I agree. Sometimes things that we criticize in class turn out ot be misunderstandings. Once you get on a floor with 15 residents to care for, you might find yourself rushing through things! I do always try to talk to the residents even if im busy, but thats because a lot of them dont have the best families and we are the only people they see for weeks sometimes.But since i wasnt there with you and you really feel as if the standard of care isnt what it should be, then you had every right to mention to your instructor. even if she just explains why certain things were done like they were, at least you know now.

Good luck in your class!

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thats why we need good cna's like you!!

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Specializes in LTC.

Yeah it's totally true about certain people trying to monopolize you. I forgot to say that. We have some people who do the same thing- go to the bathroom 10 times just to pee a couple drops (literally). This comes at the expense of others who legitimately need your help, and sometimes you do end up blowing them off.

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Specializes in LTC, Memory loss, PDN.

Being a compassionate, efficient CNA is truly an art. When mastered, it will yield the love of the patient's and their families and the respect of your coworkers, even the ones with more seniority. It takes a daily comittment and lots of visits to the what I'd really like to say thread. It also takes experience, because you have to know when and how to be firm and how to go about it in an appropriate manner. Be true to yourself. Don't change your ways, because a bunch of senior CNAs say their way is the only way. Recognize not everyone has the same capabilities. Don't judge, try to lead by example. If you can do all this and more for whatever little pay you get, you'll be tired and achy, but deeply satisfied.

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Unfortunately these things occur, largely due to understaffing/overwork. Some of these aides are burnt out, and some of them are probably so stuck in their routine that they stop thinking of these residents as people to greet and start thinking of them as steps to check off in their day. I always talk to residents while caring for them, with the only exception being at night when I change them (if they are sleeping), then I keep it to "Hi *insert name*, I'm going to check your brief" or something similar.

Now, it's never okay to leave a resident dirty or be rough. I imagine that its not intentional, just caused by stress, but that still doesn't make it excusable. Remember how much this upsets you now - once you are a seasoned CNA, that will help you avoid going this route.

I will echo what a couple of others have said though - when it comes to requests to go to the bathroom, you will soon learn who actually needs to go and who wants to get up and go to the bathroom every ten minutes (and doesn't actually go). You will also learn about time budgeting - there are some residents you need to get to RIGHT AWAY (fall risks, etc) and some who can generally wait for a few minutes.

No matter what, use your distress to become a GOOD aide. Don't let yourself get calloused and burnt out as so many have and do.

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Oh, and I forgot to say that many of these residents who are oriented and have been there for a bit KNOW the routines. FOr those residents, you aren't going to state the routine every time. For example, in time, they will know that when you come into their room at 8:00 with towels and washcloths, you're there to get them ready for bed. You should still talk to them, of course, but don't worry about naming your steps, instead ask about their day or something.

Now, confused residents are a different story. SOmetimes you need to tell them what you're going to do before you do it...but some of them, you need to distract otherwise. I have one resident currently who will kick at and fight you when you try to get her dressed, but if you get her singing, she won't think about it.

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And the real world comes into play, after years of caring and overworking for low pay without respect or acknowledgement of the time and effort you put forth to give these patients. Years later, it now seems useless and pointless because even though you care so deeply for your patients, the ones around you no longer care because they don't have the time and are so burnt out because 1 employee rather than 5 employees saves the company sooo much money. I am like you, not understanding because I have not been there and tell myself often that my patients would never be subjected to such disgrace and lack of disregard that they too are humans that desire and need a kind hand to help them with what they can't help themselves with any longer. So, I can't explain why people allow themselves to close their eyes to the abuse they leave behind for all to see. I hope I never forget the reason I came into this profession and turn into the uncaring servant only there for the little money they get. And may I never have a boss or company that allows it to continue each day as they walk to the mailbox and pick up their medicare checks.

To those who have found a way around the typical scene described, congrats and may you out number the ill ones some day....the people need more like you.

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This is to the OP...your thread had me in tears! This is why these places need people like you and me...I absolutely 100% agree with you on how cruel people can be. Good god...I know people are overworked and underpaid and get burnt out but GOOD GOD these people deserve more respect! Whatever happened to respect your elder's???? If I ever have to live in a nursing home when I'm older...I sure hope the government can change things! This is just sad. And like I've said I KNOW people work their butts off and don't get the credit they deserve but some just don't give a crap either way. I will always treat my elder's with respect even when their being difficult because put yourself in their shoes and literally think about what they must think...they didn't ask to get older or be put in a home...they probably just feel violated. And the ones that have their call light on all the time are just probably bored and want company...its their way of letting people know "Hey I'm still alive in here...come talk to me!". Anyway...you show everyone that you care and I hope you continue doing a great job. I know it takes more than one person to change things but our help puts it one more notch above what it use to be!!!!

God Bless

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I just want to clarify something.

I think all of us know that the people who are always pushing their call lights are doing it out of boredom and loneliness. We understand that and sympathize. However, the fact is, you don't always have the time to sit in there and talk. I'm sorry if that sounds cold, it's not. On a busy day, if I sit in a resident's room and chat, in doing so I am neglecting someone else or something else that needs done. You can't keep someone company when you have a hall full of people who need toileted and changed, several people with bed alarms who keep trying to get up, confused residents to redirect, and a ton of other tasks.

I'm not by any means saying that you shouldn't take the time to sit and converse with a resident when you have the time, just that being a CNA means having more work than you have time to do, and all you can do is try your best.

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