For all current or past CNAs please answer my ?'s

[lvnsandiego]

Hi! I am an instructor (theory and clinical) for a CNA program. I wondered if any former or current CNAs could help me become a better instructor by answering some questions for me?

1. What were you not taught in your CNA training that you needed to know "in the real world"?

2. What information do you absolutely need about a patient/resident in order to provide good care for them during your shift? For example: transfer ability, diet, mental status, etc.

3. What advice would you give a CNA student that you wish someone gave you when you were a CNA student?

Thank you for helping me in my quest to provide the best education for my students!

[borntobanurse3]

One thing that has really stood out to me in the real world of being a CNA is transfers. It is very important to the safety of the resident and staff. I did not learn enough about transfering a resident and had to learn most of it in my LTC job. Also dealing with death. I was never prepared that death will eventually happen and I must face the facts of life. I know nothing can prepare someone for their first death but a lecture on death and dying would do good.

[Kunzieo]

1. I was not taught any time management. For example, in my current job I have ~36 patients that I need to do vitals, weights, and I&Os on. They need to be toileted and their call lights need to be answered and many of them need to be set up for breakfast. I also have 7-8 nurses asking me to do various chores all night long. I am also responsible for stocking the unit and some light housekeeping.

I was in NO way prepared for that kind of schedule. I would have liked some tips on time management, and also how to diplomatically tell nurses when I am really busy, and no, I really don't have time to run over to the next unit and fetch their patient a sandwich.

I drove myself crazy for a while, and went home every morning feeling like a failure because I didn't have time to help every nurse with every request. I eventually learned to accept that I couldn't do it all, and that sometimes the nurses would have to do part of "my" job for me because I couldn't get to it all.

2. I need this information about my patient: Name, sex, DOB, diet order.

I would like to have: transfer ability, mental status, admitting diagnosis, how they use the bathroom (BSC, urinal, Foley, etc.), if they have a Tab alarm, their turn schedule, their accu-check schedule, and anything unusual about the patient (artificial leg, russian-only speaking, deaf, etc.)

I can find most of my "wants" in the chart, but it can take a while to get all the patients' info, so I like it when I get a mini-report from the charge nurse at the beginning of shift.

3. Nursing is teamwork. Do your part, help others when you can. Respect is earned, not given. Do your best, and others will respect you.

[nghtfltguy, BSN, RN]

:yeahthat:

[RNDreamer]

What Kunzieo said. In addition, I would also tell your students that being a CNA is not all glitz and glammer. Wiping pretend poop off a manequin and wiping real poop off a person are not the same.

[lvnsandiego]

Thank you all so much for your valuable comments! Keep them coming!

[casi, ASN, RN]

1. Transfers. There are 101 ways to move a person and we were only taught one. Transfer belt chair to chair.

2. prefered name, transfer ability, level of cares they need, diet, diagnosises that I may come into play when giving care (ie diabetes, CHF, dementia), any abnormal vital sign baselines (ie if I get a BP of 90/50 and am getting ready to panic, it would be nice to know that their previous BP was 84/47)

3. There's the right way to do something which is the book way that will get you to pass your test, there's the wrong way to do something, and there are 101 other right ways to do something.

[dorselm]

As everyone else said, transfers are a definite plus as well as time management. Currently there is a new class of students at my job in an LTC facility and some are really having a hard time with time management. For me, on the 7-3 shift, I have between 8 (good day) and 15 (bad day) to get up fed, toileted, bathed, dressed, groomed, mouthcare, room clean, turned if needed all by 12 pm. Your newbies are going to have a hard time going into someone's room to wake them but you should teach them that they are helping that person and that it's needed to get things done. Teach them that they should be polite when waking someone, and that if they don't want to get up, go on to the next person and come back to them. I also usually tend to care for the patients who are incontinent and can't communicate first because the continent people will let you know when they have to go to the bathroom or be changed.

Also teach them that when they are pulling someone up in bed to raise the feet of the bed and lower the head. That way they will be using gravity when pulling the pt to the head of the bed. Let them know that people who have tube feedings, trachs should have HOB elevated at all times.

Last but not least always remind them to do to others what they would want done to them or their loved ones.

[hikernurse]

Having worked as a CNA and with CNAs as a nurse, the most important thing I can think to impress on your students is the importance of good communication. They are the eyes and ears of the nurse a lot of times and if they let the nurse know immediately of problems they see, that is more than helpful.

I know when I was a CNA, I knew the parameters, but I didn't know the rationale and sometimes worried that I was bugging the nurses giving them excess information--not that the nurses acted annoyed. As a nurse, I never minded getting information r/t my patients, even if it wasn't necessarily important in that particular case.

Also let them know how important their jobs are as members of the healthcare team. I had no idea as a CNA how much my job mattered--a good CNA is worth their weight in gold :).

Let your students know it's OK to ask questions. Sometimes the nurse may be too busy to answer right at that minute, but I loved explaining things and I think most nurses do, too.

I hope this helps.

[Bumashes, MSN, APRN, NP]

1. Time management skills. Transferring. Scope of practice. Some basic normal values for B/P, HR, RR, T, BG, and other values normally taken by the CNA. That way they know when to alert the nurse. Oh, and good body mechanics.

2. Definitely want to know the pts name, illness, diet, total/semi/independent care. Mostly, it helps if the CNA can make time to sit in on the report with the nurses. All of this is usually covered during the report and you learn other things about your pts.

3. Never never never be afraid to ask questions. Even if the only available nurse to ask is the one that doesn't like you. Realize that you are there to be a pt caregiver, not to be liked.

[locolorenzo22, BSN, RN]

1. That you never learn EVERYTHING, and if you stop trying to learn, you cease to be effective....that being said...transfers, and appropriate parameters for VS. Also, that death occurs in every facility, and how to provide appropriate post mortem care. Time management skills, prioritizing care among residents with different needs...

2. I work in acute so vs. LTC it may be different...but I like to know if they are able to go to the bathroom by themselves, if they use a walker/cane/etc, if they have a Foley, if they are incontinent, Do they have IV fluids running or a lock, are they getting ice to an extremity, are we collecting anything for labs, are they NPO, do they need blood sugars checked?, those are the main basics for myself....

3. Never be afraid to ask if you don't understand why something is being done, know that YOU are the front line for each patient, and treat every patient and patient's FAMILY member how you would want to be treated in their place...

also, you can't do everything. But do what you can.

As a current NS, with 4 years in the world expierence, and a career goal of becoming a instructor to CNAs/LPNs/RNs please feel free to message me with anything you'd like to get a student's perspective on.

[NurseCherlove]

Just a few thoughts here...

Teach them to take initiative within their scope of practice - For example, I worked with this one tech (I told her every chance I got how awesome I thought she was) who would take a BP manually if she got an abnormal BP and then she would tell me the results from both.

This same tech also took initiative and used a lot of common sense in other instances --> Ex. turning the pt. with limited mobility every 2 hours (even though some AMs, it was so busy that I never got time to give her a good report).

Or another ex...going into a patient's room and seeing a tube feeding infusing, but the patient was brought back from x ray laying flat --> raise the HOB of course and tell the nurse so there can be appropriate reprimands.

To echo another poster...communicating info to/with the nurse is paramount, even if it may seem trivial compared to all the stuff the nurse is dealing with. We would rather have more info than not enough.

One other VERY important thing....PLEASE teach them that oral care needs to be considered an essential part of daily hygiene, as important or more than a bath.