Finished Clinical; Have Questions

[WVlpn2b]

Hi --

I'm a pre-LPN student and just finished my clinical for my CNA training, as required by the LPN program at my college. My class has been great and the clinical was incredibly rewarding. I have such an appreciation for good nurses' aides and believe that all nurses should have this experience. I'd appreciate your input on a couple of things, if you wouldn't mind.

Our clinical was at a nursing home. I fell in love with several of the residents there. Keeping in mind that I have ZERO experience, I saw a couple of things that felt very wrong to me, and I wonder about what you think might be the cause: supplies were very lacking, from gloves to washcloths -- all were hard to come by. I started stuffing washcloths in the pockets of my scrubs just so I'd be sure to have some when I needed them. The linens were all so badly stained that I wouldn't have known a sheet was clean unless I had made the bed myself. One lady had a small decubitus ulcer on her behind that I believe was from lying in her urine for extended periods. Additionally, when I gave her a thorough bath on my second day, she was quite dirty -- I'd be amazed if that was just 24 hours worth of accumulation.

I also felt the nursing staff was sub-par -- I could go on and on but I won't. We all discussed how we saw many examples of what "not" to do during our debriefing -- but how is this avoided? What causes the care to be so lacking? Am I just naive? For instance, I realize I am very green, but it took me an hour to get a patient good and clean, dressed and in her chair, and get her bed changed. If I were an aide with 8 more patients, how on earth could I do my job and feel like I didn't neglect anyone?

I appreciate your thoughts. I feel genuinely changed by this experience and can't get it out of my mind.

[TheCommuter, BSN, RN]

One word = understaffing.

I am an LVN who has spent my entire short career in the nursing home setting. Some of my workplaces are so critically understaffed with CNAs, that each CNA must sometimes care for up to 28 residents by himself or herself during the very busy day shift. It is easy to be judgmental about nursing homes when you are the outsider who's looking in. Keep in mind that things are not always as they appear at the surface.

As for the nursing staff being subpar, I have had to take care of up to 71 patients by myself as an LVN during night shift, with only 2 CNAs to help me out. To be perfectly blunt, I did not have the time to provide "quality" care with this type of ratio. I simply had to do what I could. Even if my nursing care appeared to be subpar or uncaring, at least the residents were alive at the end of my shift.

[WVlpn2b]

Oh, I completely agree, that as an outsider looking in, I can't know all the ins and outs of what goes on. And I know that an aide with a full patient load, or one who is even having to cover for other aides who call off, cannot possibly be all things to all patients. But why is it so understaffed? I know what it costs a month to live there, and their price is high compared to other places that I do actually know something about where the care is/seems better.

As for commenting that the nursing seemed to be sub-par, I know that with a big patient load, you have to do what you have to do and let other things go. But to shout "G--D-----! I am so sick of this ----!" all the way down the hall, away from the man who has had his call light on for 15 minutes because his colostomy bag has burst -- and in fact, he spent another hour like that -- is that OK? And that was only one incident. There were several similar ones. I know understaffing must be a soul-sucking morale-killer. But that behavior is just not acceptable to me.

[Up2nogood RN, RN]

Unfortunately I've seen a lot of LTC facilities to be like that. I worked for 8 years as a CNA in LTC and 7 yrs in the hospital before going on to nursing school. My clinical sites were terrible-no linens,filthy,rude employees,etc.The facilities where I worked were never like that and that's the reason I stayed. They would hire CNA's like that every once in awhile and they would end up quitting b/c we would hold them accountable for their BS and substandard care. I've worked short many times with 50 residents (swing shift) between 2 CNA's and we had great teamwork, would kick butt and still give top notch care. Would I have stayed in a place that consistantly ran their workers into the ground? Of course not. Most of these companies are making millions off of their facilities and not treating their employees or their residents with any respect that they so much deserve. From what I've heard nursing homes are much better than they used to be. Would I put my family member in one? Heck no! I'd quit my job and take care of them at home before something like that happened. Kudos to all of the CNA's and nurses who can work in LTC and not .

[APC53]

LTC facilities can be very frustrating. I work at an MR LTC facility, so I think that's a little more stressful. In general though, nursing work, especially CNA work is a thankless job...for the most part. There are ups....but there are a lot more downs sometimes.

[NurseExorcist, BSN, RN]

It always comes down to money. There wouldn't be a CNA shortage, and the care would be better, if the pay was at least adequate. I am finishing up my clinicals now, and I've been approached by the LTC staff to apply for a position when I graduate. All I can say is "HA!" For $11/hr??? That's NUTS!

If I can't get a job in a hospital, I'll just continue on my path to earn an RN while working as a massage therapist.

And by the way... I'll be turning 45 this year. I may be 50 by the time I get the degree, but at least I'll make a decent living until I'm taken to an LTC as a resident... God forbid.