I did two weekends of clinicals so far, it's really hard because during the diaper change for one lady she who could
speak only a little bit, she was crying and mumbling "I am not here, I am not here". i feel alot of empathy for people and I can understand how extremely hard it must be to have someone help you with you ADL's. I don't like
or understand why some CNA's don't even bother to cover the bottom part of a resident while cleaning the top
part, and vice versa. I understand that we don't have alot of time with 7 or 10 to get ready, but it's doesn't take
extra time to cover someone up in one area while you are cleaning another area. We are running around and probably feel hot, if they are bed bound, old they probably have poor cirulation and will be colder. DUH.
... Just because someone is "used to" poor treatment doesn't mean one should provide it. One should make the effort and if the resident prefers it differently (not to be covered) that is up to them- they can throw off the cover or throw their clothes off if that is their preference.
Oh, I certainly wasn't trying to say that "poor treatment" is okay. I realize how poorly worded my reply was, and I'm sorry for that.
I didn't mean that you should just leave your residents hanging out naked. But some of the stuff you learn in class when it comes to draping (like covering one side when you put the other arm in a shirt, etc) just isn't likely to happen when you only have so much time to get people dressed. When I dress or change my residents, I uncover what needs to be uncovered, do what i need to do, and go on. I leave the top half covered while I dress the bottom half and vice versa, etc., but I do not cover every individual body part while I am dressing or cleaning others, and I don't think I've ever seen anyone else do that, either.
I guess my point was just that, it's really easy when you're new or in clinicals to see a rushed CNA do something like forget to properly drape a resident and think "Oh that's terrible, I'd never do that". But it's just a fact that in most facilities, each aide has more people to care for than they should, and sometimes when you have so much to do in so short of a time, you just might not think about it.
I'm not saying that's okay or a good thing, just that I understand it. It's one of the reasons that I am currently looking to get into home health care - staffing levels at the facilities around here are such that you can't possibly get everything done without cutting corners, and I don't feel good about that. You're so busy you start thinking of your residents as something to check off on a list and not the living, breathing individuals they are. It wears on you, and that's why you see so many experienced CNAs performing their jobs so impersonally. I'm sure many of them were a lot like the OP when they started, but over time, they got so used to their routine that it became just that - a routine.
Oh, and I will agree - one of my biggest pet peeves is how so many aides will go in and dress or change a resident without so much as saying "Hi *insert name here*, I'm going to get you dressed/change you/bathe you/whatever".
I can understand rushing. I can understand cutting corners. But I can't understand why you wouldn't at least greet the resident first, even if they can't answer you.
In regards to talking to the resident, I found that silence with the exception of a greeting ect, can be very comforting to them. Its embarassing what you're doing in many cases, they hate it, they don't want it and often times like dry runs it happens many times a day. I would greet them, do my job as fast as possbile let them know I was available if they needed me, smile and get out of their room so they could enjoy some privacy. I think alot of ltc residents don't want to hear 'now i'm going to put you on the lift' time and again. They know whats going to happen, they just want to get it over with. And my personal pet peeve, cnas who are fake to the residents. In the room its all "i love you, I care for you, you're so sweet' and when they walk out of the room and hopefully but often times not out of earshot "such and such in room whatever is such a pain in the, I can't stand such and such". I believe in always being professional kind, caring but never lying to them. I saw many residents latch onto the I love yous and turn it into if you truly loved me get me out of here. Thats tough for them to deal with.
... Just because someone is "used to" poor treatment doesn't mean one should provide it. One should make the effort and if the resident prefers it differently (not to be covered) that is up to them- they can throw off the cover or throw their clothes off if that is their preference.
I agree with you.
But. Just try to do everything the way you are taught too when you have 16 patients that are all hoyers or 2 person transfers, half are trachs, all are incontinent, half are over 300 pounds, most have dementia, some bite, some hit, some play with their poop, some are on the call light every 2 seconds, some have families on the call lights every other minute, your nurse want X Y and Z done right now, the nurse has 30+ patients and twon fell so no help from her, the other aides laugh at you when you need help because they have more people than you, and the resident you are on right now just knocked the wash basin over and threw BM at you, the nurse has spilled 2cal on at least 3 of your patients and the beds, the daughter of Mrs. Princess is yelling at you IN the room even though it's NOT her mother's room and she won't leave, the DON is mad because no one has had a shower yet and expects them all to be done, along with making all the beds, oh and you are already 30 minutes late for breakfast!
Did I mention that you don't even work the floor but were pulled 10 minutes before breakfast because someone didn't show and oh by the way, you still better get your OTHER job done!
THEN try to do everything by the book.
I'm just saying. HEHEHE
And then, after all of that the CNA/nursing student in clinicals says 'They told us to do it differently in class...'
But. Just try to do everything the way you are taught too when you have 16 patients that are all hoyers or 2 person transfers, half are trachs, all are incontinent, half are over 300 pounds, most have dementia, some bite, some hit, some play with their poop, some are on the call light every 2 seconds, some have families on the call lights every other minute, your nurse want X Y and Z done right now, the nurse has 30+ patients and twon fell so no help from her, the other aides laugh at you when you need help because they have more people than you, and the resident you are on right now just knocked the wash basin over and threw BM at you, the nurse has spilled 2cal on at least 3 of your patients and the beds, the daughter of Mrs. Princess is yelling at you IN the room even though it's NOT her mother's room and she won't leave, the DON is mad because no one has had a shower yet and expects them all to be done, along with making all the beds, oh and you are already 30 minutes late for breakfast!
Did I mention that you don't even work the floor but were pulled 10 minutes before breakfast because someone didn't show and oh by the way, you still better get your OTHER job done!
THEN try to do everything by the book.
I'm just saying. HEHEHE
And then, after all of that the CNA/nursing student in clinicals says 'They told us to do it differently in class...'
:::SMACK:::
Stop It - you are making me laugh so hard I am getting stomach cramps.
Of course, the days ends perfectly when you walk into the last room of your bed check with the on-coming shift and the patient there has painted their best rendition of Van Gogh's 'Starry Nights' on the wall...
I agree- many don't want the play by play- but that doesn't mean one can't make small talk to distract them from what's going on. Granted, one needs to keep that empathic pulse to see how that is received- one person may prefer silence, another likes knowing what to expect step by step- another might prefer chatting about the weather/their great grandchildren- whatever... It's all about getting to know the residents and giving them the respect to offer them what they prefer. MHO.
And yes- definately agreed- talking about the residents in OR out of earshot is unprofessional and. as far as the situation you describe- unkind as well.
In regards to talking to the resident, I found that silence with the exception of a greeting ect, can be very comforting to them. Its embarassing what you're doing in many cases, they hate it, they don't want it and often times like dry runs it happens many times a day. I would greet them, do my job as fast as possbile let them know I was available if they needed me, smile and get out of their room so they could enjoy some privacy. I think alot of ltc residents don't want to hear 'now i'm going to put you on the lift' time and again. They know whats going to happen, they just want to get it over with. And my personal pet peeve, cnas who are fake to the residents. In the room its all "i love you, I care for you, you're so sweet' and when they walk out of the room and hopefully but often times not out of earshot "such and such in room whatever is such a pain in the, I can't stand such and such". I believe in always being professional kind, caring but never lying to them. I saw many residents latch onto the I love yous and turn it into if you truly loved me get me out of here. Thats tough for them to deal with.
There is a difference between not doing things "by the book" (which yes- reality gets in the way of that- I certainly don't deny) and that of forgoing basic human respect, dignity and niceties alltogether. You have to be in there anyway- being respectful and kind doesn't take any extra time. (It might be more difficult depending on the person- but doesn't take more time )Throwing a bath blanket over the resident and working around it also doesn't take extra time. Well- half a second- but that's hardly relevant :) Frankly- they can yell at me all they like and they can fire me- I'm OK with that because there are always other places hiring. I'm not going to compromise on aspects of care that deal with safety, infection control or respect and human dignity. Period. One can save alot of time by shaving it off from other areas... Like learning to hustle between rooms rather than meandering. Making sure equipment is collected ahead of time. Managing ones time efficiently. Keeping those gloves in ones pocket. Skipping the social chit chat with coworkers. etc. etc. etc. Yes- there are going to be days like you describe below- it happens. But that's not the daily grind- and if it is- you need to find a different facility. MHO. They may be harder to find- (facilities with lower resident/staff ratios, realistic expectations, respect for staff, good working environment etc.) but they do exist... :)
I agree with you.
But. Just try to do everything the way you are taught too when you have 16 patients that are all hoyers or 2 person transfers, half are trachs, all are incontinent, half are over 300 pounds, most have dementia, some bite, some hit, some play with their poop, some are on the call light every 2 seconds, some have families on the call lights every other minute, your nurse want X Y and Z done right now, the nurse has 30+ patients and twon fell so no help from her, the other aides laugh at you when you need help because they have more people than you, and the resident you are on right now just knocked the wash basin over and threw BM at you, the nurse has spilled 2cal on at least 3 of your patients and the beds, the daughter of Mrs. Princess is yelling at you IN the room even though it's NOT her mother's room and she won't leave, the DON is mad because no one has had a shower yet and expects them all to be done, along with making all the beds, oh and you are already 30 minutes late for breakfast!
Did I mention that you don't even work the floor but were pulled 10 minutes before breakfast because someone didn't show and oh by the way, you still better get your OTHER job done!
THEN try to do everything by the book.
I'm just saying. HEHEHE
And then, after all of that the CNA/nursing student in clinicals says 'They told us to do it differently in class...'
I agree CNA is hard work and just because it is - it isn't a reason not to properly care for patients- so I am on your side. I have not observed many privacy issues about a patient being covered-probaby because of room curtains being pulled. As for poor care - I have seen the results in facilities mostly where on a good day CNAs have 10 patients. I think in general all CNAs start out with the best intentions and most quit, ones who stick with it a few do the min job-most still try thier best.
My pet pea is hand and foot care. When doing clinicals one woman had toenails - not exageratting - atleast 2inches long if not longer. I never saw anything like it in my life. I told the instructor - the instructor basicly brought up the unspoken code of silence between health care workers. It still agrivated me so he told me it is a issue for the DON-Director of Nursing. So I told the DON of the facility - she said we don't have a padiatrist (sp?) here. This was a bit of a upscale nursing home - nursing students were also doing clinicals there. I did not know what to do - was scared to report. One of my regrets. - About a year later the facility was shut down, I never did find out the official reason.
)Throwing a bath blanket over the resident and working around it also doesn't take extra time. Well- half a second- but that's hardly relevant :) Frankly- they can yell at me all they like and they can fire me- I'm OK with that because there are always other places hiring. I'm not going to compromise on aspects of care that deal with safety, infection control or respect and human dignity. Period. One can save alot of time by shaving it off from other areas... Like learning to hustle between rooms rather than meandering. Making sure equipment is collected ahead of time. Managing ones time efficiently. Keeping those gloves in ones pocket. Skipping the social chit chat with coworkers. etc. etc. etc. Yes- there are going to be days like you describe below- it happens. But that's not the daily grind- and if it is- you need to find a different facility. MHO. They may be harder to find- (facilities with lower resident/staff ratios, realistic expectations, respect for staff, good working environment etc.) but they do exist... :)
I have not observed many privacy issues about a patient being covered-probaby because of room curtains being pulled. As for poor care - I have seen the results in facilities mostly where on a good day CNAs have 10 patients. I think in general all CNAs start out with the best intentions and most quit, ones who stick with it a few do the min job-most still try thier best.
yousoldtheworld
1,196 Posts
Oh, I certainly wasn't trying to say that "poor treatment" is okay. I realize how poorly worded my reply was, and I'm sorry for that.
I didn't mean that you should just leave your residents hanging out naked. But some of the stuff you learn in class when it comes to draping (like covering one side when you put the other arm in a shirt, etc) just isn't likely to happen when you only have so much time to get people dressed. When I dress or change my residents, I uncover what needs to be uncovered, do what i need to do, and go on. I leave the top half covered while I dress the bottom half and vice versa, etc., but I do not cover every individual body part while I am dressing or cleaning others, and I don't think I've ever seen anyone else do that, either.
I guess my point was just that, it's really easy when you're new or in clinicals to see a rushed CNA do something like forget to properly drape a resident and think "Oh that's terrible, I'd never do that". But it's just a fact that in most facilities, each aide has more people to care for than they should, and sometimes when you have so much to do in so short of a time, you just might not think about it.
I'm not saying that's okay or a good thing, just that I understand it. It's one of the reasons that I am currently looking to get into home health care - staffing levels at the facilities around here are such that you can't possibly get everything done without cutting corners, and I don't feel good about that. You're so busy you start thinking of your residents as something to check off on a list and not the living, breathing individuals they are. It wears on you, and that's why you see so many experienced CNAs performing their jobs so impersonally. I'm sure many of them were a lot like the OP when they started, but over time, they got so used to their routine that it became just that - a routine.