Shocked with my CNA clinicals.

Nursing Students CNA/MA

Published

I am shocked with the quality of instruction during my CNA clinicals. One incident is particularly poignant of the lack of heart that residents/patients have to deal with from health care administrators. I am new to nursing and would like to work as an RN for a few years before receiving my NP but am absolutely horrified at the attitude I've encountered from the teachers and even my student partner. Is this how it REALLY is?

My partner and I were instructed to give a shower to Diane (name changed). Diane has alzheimers and is very unhappy. She is obviously severely depressed and apathetic and completely exhausted all of the time. I have never seen her smile. Since it is clinicals the instructor accompanied us to the shower. My partner has been a resident assistant for a couple months so I am doing most of the work (no problem there since I want to because the more experience the better). Our patient, Diane, is very difficult to work with as she is so unhappy that everything makes her even more unhappy and she HATES showers. So we tried to make it as fast possible for her.

After I washed her hair I got a towelette to scrub her body and was handed a bottle of conditioner by my partner. I said "this is conditioner" and my partner said it doesn't matter, we just want to get this done with. I look over at the teacher and she said the same thing, to just "hurry up". Diane was in no danger to herself or us at the time, she was moaning and complaining. I asked if there was soap and they prodded me on to just do the job, and I told them to give me the shampoo since it was still nearby.

I cannot believe that the student and teacher who were working with me in the shower would use conditioner to wash Diane's body. Am I missing something? Perhaps conditioner is useful for cleaning? I'm not being sarcastic. Maybe they thought it's a soap anyways. But my partner is extremely intelligent (the "get the right answer" type of intelligence) so I don't think she thought it could be used as soap as well. I really think they were trying to cut corners to the point where the conditioner was just an excuse to get the "act" of washing done so that we could get the shower skill done. Might as well be slapping on butter to clean skin...

It made me feel uncomfortable, as if we were putting a dirty depend on Diane. I told them that I didnt' want to use conditioner because it would take longer to wash off instead of being upfront and saying, "I'm not going to play along with pretending to shower Diane".

Then today me and my partner were pushing her in her weelchair and asking Diane to raise her feet (no footpads... not the best nursing home I know). I kept having to press behind her knees to get her to elevate them since her feet kept dragging on the ground and getting pushed behind. Diane kept saying her feet were too heavy, which is porbably true, Diane has Alzheimers and her muscles are atrophying. Anyways, I told my partner that "poor Diane doesn't get it" to which my partner replied, "she's just being lazy". I seriously don't think Diane was being lazy, I don't see why she wouldn't raise her legs up to make things easier for herself but that she just doesn't "get it" and that it actually does require strength to raise them. My partner insisted that she was just being lazy.

What concerns me more is the conditioner incident. The wheelchair thing I mentioned because I needed to vent. But the conditioner thing????? What is up with that? Am I possible missing something (please please let it be that).

Thank you.

Specializes in Neonatal Nurse Practitioner.

If that's the worse you come across, you're doing pretty well. The nursing home I did CNA clinicals at frequently ran out of towels, and we had to get creative sometimes. And conditioner can be used as a cleansing agent. Things don't have to suds up to be able to cleanse.

I've never had any problem with supplies at the hospital I work at or do clinicals at.

I think conditioner can probably actually be good for elderly skin to help condition it. My friend uses conditioner on her skin daily and swears by it.

Would I have taken the time out to find some soap? Yeah probably, but thats assuming they had some handy. However the reality is that every extra minute you take means others are waiting to use the BR, or sitting in the dining room waiting to get to bed, or is lying in their bed incontinent, etc. It all adds up and as you will find out, you have a hundred things to do and enough time to do 50, thats just the way it is, almost no matter where you work, although some places are much worse than others.

Inevitably during clinicals someone posts about how horrible it is that a CNA didnt take the time to properly brush someones hair or whatever, then a few months later that same person is commenting about how horrible it is trying to keep up with everything as a CNA and how they have been written up or fired because their residents were not taken care of properly, which can happen if you spend too much time on less important things while the important things are delayed or neglected.

wow i can't believe how some people who replied did not take the time to read my post carefully. it appears that some of you must have formed judgements after reading bits and pieces of my post without understanding where i was coming from. it also strikes me as annoying that people who read my post haphazardly have the harshest remarks. i notice that people like to POUNCE on this forum.

i'm not going to clarify the "missed points" here, actually read over my post if you're interested. thanks though to all who took the time to read over my concern and who gave an honest answer. HONEST answers people is all i was looking for.

Specializes in Neonatal Nurse Practitioner.
wow i can't believe how some people who replied did not take the time to read my post carefully. it appears that some of you must have formed judgements after reading bits and pieces of my post without understanding where i was coming from. it also strikes me as annoying that people who read my post haphazardly have the harshest remarks. i notice that people like to POUNCE on this forum.

i'm not going to clarify the "missed points" here, actually read over my post if you're interested. thanks though to all who took the time to read over my concern and who gave an honest answer. HONEST answers people is all i was looking for.

At the end of the your post, you specifically said what bothered you the most was the "conditioner thing." Several of us have claimed that conditioner is just fine for cleansing skin.

As far as whether this is "how it really is?" Your mileage will vary. Sometimes you work with people who don't care as much as you. Sometimes you have so much to do, you don't get everything done to your original standards (like using conditioner in place of soap). Both of these leading to less than glowing moments in healthcare.

I've read over the thread, and I'm failing to see the presumed dishonest answers that you've gotten in reply to your original post. I also don't see where posters pounced on you, but sometimes tone is hard to interpret through written word.

At the end of the your post, you specifically said what bothered you the most was the "conditioner thing." Several of us have claimed that conditioner is just fine for cleansing skin.

As far as whether this is "how it really is?" Your mileage will vary. Sometimes you work with people who don't care as much as you. Sometimes you have so much to do, you don't get everything done to your original standards (like using conditioner in place of soap). Both of these leading to less than glowing moments in healthcare.

I've read over the thread, and I'm failing to see the presumed dishonest answers that you've gotten in reply to your original post. I also don't see where posters pounced on you, but sometimes tone is hard to interpret through written word.

^This

I will add that I had similar thoughts when I first did CNA clinicals. When I actually became a CNA, I took on a different perspective. I wouldn't say that I ever neglected any of my Residents. Everyone was always checked/turned/changed every 2 hours. When I first started, I did try to do everything as taught. Sometimes, you just have to do the best with what you have in the time provided. I got yelled at by a nurse because I didn't have everyone up by 10am. Doing stuff the Red Cross way will yield that type of result.

^This

I will add that I had similar thoughts when I first did CNA clinicals. When I actually became a CNA, I took on a different perspective. I wouldn't say that I ever neglected any of my Residents. Everyone was always checked/turned/changed every 2 hours. When I first started, I did try to do everything as taught. Sometimes, you just have to do the best with what you have in the time provided. I got yelled at by a nurse because I didn't have everyone up by 10am. Doing stuff the Red Cross way will yield that type of result.

As long as you dont harm the patient.

As long as you dont harm the patient.

That's obvious.

At the end of the your post, you specifically said what bothered you the most was the "conditioner thing." Several of us have claimed that conditioner is just fine for cleansing skin.

As far as whether this is "how it really is?" Your mileage will vary. Sometimes you work with people who don't care as much as you. Sometimes you have so much to do, you don't get everything done to your original standards (like using conditioner in place of soap). Both of these leading to less than glowing moments in healthcare.

I've read over the thread, and I'm failing to see the presumed dishonest answers that you've gotten in reply to your original post. I also don't see where posters pounced on you, but sometimes tone is hard to interpret through written word.

Ditto. To address your concern that this is really what it's like? My regular assignment now is specifically as a shower aide. I have used conditioner on residents as soap and I've used body wash as shampoo, too. Neither one harmed the resident. Quite frankly, I did not have the luxury of time to stop what I was doing and get the soap I needed. To leave my resident unattended would have been neglect and I would have been fired. I've used conditioner on myself in a pinch when I had no shave gel. I have used it on residents as a shave gel, too, and to be honest, it did a better job than the shave cream the facility often supplies. I am a firm believer that if an ADL makes a resident that uncomfortable, you either find a way to get it done quickly or you get to the root of the problem later. I have plenty of residents who hate taking a shower. I compromise with them and put them in the whirlpool and they are much happier. If this is the worst thing you encounter, then you will be doing much better than the rest of us who work LTC.

I noticed a lot of cut corners when I did my CNA clinicals, I couldn't judge however, there are 14-18 patients per CNA. I find that to be an overwhelming number for a single person. The few things that I did notice that bothered me were the lack of proper cleaning after a bowel movement, not turning bed bound patients and some chose to not feed the patients that were on hospice, they instead opened the food to make it appear as though they had. Those 3 things got to me the most.

Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

It's not about judging other cnas. It's about judging the system.

And as long as people make excuse for "the system" it won't change.

Specializes in Transitional Nursing.

Sadly and ever so unfortunately, yes that is what, for most people, it is really like. Compassion is forgotten, tasks turn into just get it done. The 30 seconds it would have taken to find the soap could have turned into 5 or more minutes if someone had to leave the room and they were flagged down by someone else needing help. Some ways to avoid situations like this is to make sure you have absolutely everything you are going to need before you start. Some people think the solution is not to work in LTC. I think the solution is to work in LTC and be the exception to the rule. I used to sing to my patients in the shower or whatever they needed to get them through it. If they needed to cry and scream, that was OK too. If they liked Christmas carols in July, ok that works.

You have to make a point to remember you are taking care of people, not things. It is emotionally and physically exhausting and for some health care workers, the same thing day in and day out with the same residents makes them forget why they are there. The comment that she was being lazy is what bothers me the most out of this whole post.

All you can do is vow to try to be better.

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