Windows and Doors???

  1. Hi lovely ladies and gents.,

    Yesterday I interviewed for a CNA training course / permenant position that is offered through a local facility. I was interviewed by a CNA shift super. and the Director of Nursing. Thanks to you all, I had some pretty good questions and hope that it shows them I have been doing my research.

    I asked about the patients to CNA/LPN/RN ratios. They told me that evening shift (3-11) CNA's are paired up with one another and as dynamic duo they are responsible for 15 patients. Since it's evening shift it would consist of getting residents ready for dinner, bathing, bed, etc.

    They also said that they use a "Windows and Doors" approach to assisting the residents.

    Could some explain to me what this term means? I understand that you would have two CNA's assisting each other with the resident but is there more to it?

    Also, do you feel that this is a good way to handle the patient's as opposed to other approaches?

    Thanks for you help,
  2. Visit colleen10 profile page

    About colleen10

    Joined: Jan '01; Posts: 1,761; Likes: 46
    pre-nursing student, secretary - non-medical


  3. by   AngelicNurse2B
    Hi there! I am in the midst of the CNA course at my college (it is a prereq for the RN program) and I have never heard of an approach called "Windows and Doors"...I will be interested to find out what it is.
    I do think that the team of 2 CNA's per 15 residents is a good way of doing things. So many things that you will do as a CNA require the help of another CNA...and if you aren't already "partenered up" then depending on who else is working that shift, you might run into some trouble securing the help you need But with this teams of 2 approach should eliminate that problem!
    Just curious, from you post it seems like they only do the "dynamic duo" approach on PM shift? AM shift is just as busy, if not busier, with 2 meals and all the baths! Once I finish this class and get certified I'm looking forward to a job on PM shift because it seems less hectic....but maybe I am missing something?
    Anyway, good luck starting your feels so good to take a giant step toward your dream, doesn't it? I know the first day I put on those scrubs I felt so darn proud, happy, and excited!
    And I hope someone clues us in as to what is meant by "Windows and Doors"!

  4. by   alwaysthere
    Been a CNA bout four years now and have not heard of windows and doors.....also what happens if your parteners a no show??
    is there an lpn/rn supervising you two? also what other tasks will you be expected to perform? how many pt's on the floor total? (you will be surprised how many times you are the only one that showed) where do you work? assisted living .LTC, subacute/rehab, hospital (float). ???
  5. by   colleen10
    Hi Angela and Always There,

    So far my understanding of staffing is that During the Day and Evening shift you work as a two person CNA group. I'm not sure about the 11PM -7AM shift. Once I complete training I would be hired for the 3-11 shift.

    During the day the ratio is 2 CNA's per 10 residents. Evening it is 2 CNA's to 15 Residents. Each floor has 60 residents (but they are not usually filled to capacity) so ideally that would be 12 CNA's in the day and 8 in the evening. I know that in the evenings there are 1 or 2 LPN's and 1 RN per floor. I get the feeling though that at this facility it is very difficult to get RN's so I think most of the time the floor is staffed with LPN's and not RN's.

    It is an LTC which is affiliated and sponsored by our County. It is not Private.

    When I spoke with the DON she said that, like Angela said, they team the CNA's up because there are many tasks that need to be done that should be accomplished by 2 people, ie. lifts, showers, etc.

    The DON also said that they are "mandated" and that if they are understaffed they have a rotation schedule of who must stay for an extra shift or be called in. She asked if I minded over time, which, and I will probably regret saying this, I don't right now. I asked honestly though if there are many times one would be requred to stay for an extra 8 hour shift and she that it truly does not happen that often. However, I don't know how many people they have to be "down by" to mandate so that is a very good question that I will ask her.

    I will also ask her many of the other questions that Alwaysthere mentioned too.

    I asked what the duties of the CNA are and she said that for evening shift it is mostly assisting the residents with meals or transporting them to the dining hall, getting them ready for bed, showering, etc. If anyone knows what CNA's can do in PA regarding procedures or meds. etc. please let me know.

    I am very excited to be starting this journey. But, I want to make sure that I end up at a place where I will be properly trained and treated as an employee. Also, they will be training me through a state certified CNA program and will pay for my examination, certification, etc. but I have to give them one year. So, because I will be locked in for a year I also want to make sure that I am making a good decision.

    Thank you very much for your responses. As always I have learned a lot just by tuning into the board today.

  6. by   AngelicNurse2B
    It sounds like you got a lot of good info from them, but I understand about wanting to be totally sure it's someplace you want to be considering you'll be locked in for a year. That's why I decided to take my CNA at the college I'll be attending for my RN, too--so that I'm not locked in to working for a facility. The LTC facility that we are doing our clinicals at right now has their own training program that sounds similar to the one you interviewed for--but I was not willing to be locked in over there. Plus, I just heard that out of the 9 CNA's they had during this last training period, they all just took the state test and of the 9 only 3 passed! You need to make sure that they are really going to train you on what you need to pass the test. At this place they seem understaffed and basically they trained them quick to be able to handle as many residents as possible and used them for the cheap labor during the months they were supposed to be training them the proper way to do everything for the test. It doesn't take a genius to figure out that if the "trainee" has only been on the job a month there's no way they should be taking care of 7+ residents ALONE if they are supposed to be doing everything "by the book". But this is what happened at this facility.

    As far as procedures and meds go, I'm in CA so I don't know what the differences are but we can't give meds at all...the other day the RN brought the little paper cup of meds to my resident and left it there. I asked him to go ahead and take them so I could get his bath started and he said that he wanted to wait and take them after he was dressed and in the chair because he has trouble swallowing them in bed. I said ok and put it on the bedside table...and wouldn't you know it once he was in his wheelchair he scooted out of that room so fast and I had totally forgotten about the meds. My teacher came in while I was making the bed and saw the meds and said, "What's this?" Of course I was like, "Oh, $%%^$@!" I said I'd take them to him but she said I was not allowed to do that, I had to go tell the RN and she would take it from there. Yikes! Good thing she wasn't mad though, she (the RN) said he does it all the time!
    Procedures...we can apply topical ointments as long as they are not prescription, we can do certain enemas and suppositories, we can do bandages and nonsterile dressings, vital signs, we collect specimens, we do shaving. That's all I can think of right now...I have clinicals again tomorrow and Saturday and I still get nervous even though I'm halfway done...tomorrow I will have 3 residents for the first time and I'm scared!
  7. by   darby1

    If anyone knows what CNA's can do in PA regarding procedures or meds. etc. please let me know.

    Col [/B]
    First, if you had been taken a full semester of CNA training like I and other real CNA's, you know that you NEVER give ANY medication to the residents. I am not even supposed to hand the pills to them! Don't let someone talk you into to doing things that are not in your scope of practice. You could be held liable for your actions, if something went wrong. I had started a message to you yesterday, and decided that it may sound kind of harsh, so I decided not to post it. During my training as a CNA, we were taught that we were not supposed to give any"meds" to a resident, not even an aspirin! That's the whole problem with these facilities training their own staff. You will not receive the proper training from most of these places, and it will be basically the blind leading the blind. While I was a student CNA, I observed several of the so called "CNA's" who had been trained at the facility doing things that we were taught NEVER to do! If you aren't certified by your state, through their testing procedure, you can only work at the facility where you are "trained". Please forgive me, but their training is pretty much a joke! You will not receive the proper training that you need to further your career as a nurse. You will be trained by another "CNA" and very seldom does the nurse in charge have time to check in on you guys. The RN's are also overworked and their time is spread very thin. I don't know what it's going to take to get these facilities to hire the adequate amount of people to do these jobs correctly. I was so disgusted by this crap at skilled care facilities, that I never went back after my CNA certification. I am now enrolled in the ADN program, and I hope to be a nurse in a few years. If I'm ever employed at one of these facilities, there WILL be some changes. The public is getting ripped off, and their folks are not getting the care that they are paying for. Don't spend much time at that "CNA" job, your ideas about true nursing may be tainted by improper training. Sorry to be so harsh, but I'm just being honest. Thanks for your time. Darby Williams
    Last edit by darby1 on Jul 18, '02
  8. by   AngelicNurse2B
    Originally posted by darby1

    That's the whole problem with these facilities training their own staff. You will not receive the proper training from most of these places, and it will be basically the blind leading the blind. While I was a student CNA, I observed several of the so called "CNA's" who had been trained at the facility doing things that we were taught NEVER to do! If you aren't certified by your state, through their testing procedure, you can only work at the facility where you are "trained". Please forgive me, but their training is pretty much a joke!
    Hi Darby, that's what I was referring to in my post above to Colleen. I am seeing the same kind of thing in my CNA clinicals now. Like I said, this facility does have its own in-house CNA training program and it is supposedly state certified program and they do have to take the same state test I will have to take to become certified, but again of the 9 in that in-house program only 3 passed the test. Less than half! And the reason why is like you said, that their training is a joke. The training I am receiving through my college is sooo much better and more thorough. One of the staff CNA's at this LTC told me that on their FIRST DAY they were responsible for FIVE RESIDENTS! That right there says a bunch about the quality of the training they, it's non-existent! All they want is to get warm bodies in there to get the work done. My class is halfway over at the end of this week and tomorrow will be the first day that I am responsible for 3 residents...last 2 weeks I had 2, and the first week I only had one! And the most we will ever be responsible for during the entire duration of the course is 4.
    Maybe the facility you are looking at Colleen is not like the ones Darby and I have experienced. I hope not, for your sake!!!
  9. by   darby1
    Thanks for backing me up on this one AngelicNurse2B. I think in my state (N.C.), that a person can challenge the CNA test without taking the CNA college course. I'm personally glad that I took the college course, because I learned a lot of medical terminology that helped me pick apart some words and terms in my A&P classes. I also learned aseptic procedures that have stuck with me, and will be helpful as I start nursing school. We had a small class the semester that I took my CNA training, so we got to do a lot more than a larger class would have. I didn't want to discourage Colleen, but I did want to warn her. She will find out soon enough how unfair they treat the CNA's at these facilities. Hopefully she will have the drive to get away from that job as soon as possible. I love helping people myself, but I want to have the proper amount of time to do so. My nursing instructor told us that we as CNA's would be like scum to the other nurses and staff, and that we were the bottom rung. Basically scraping the bottom of the barrell. She was just giving us her observations about what she had seen as an RN. She also encouraged us not to stop at this level, but rather to go on and get our nursing degree. I couldn't agree more. My teacher was right! Thanks for your time. Darby Williams
  10. by   AngelicNurse2B
    Wow, my teacher doesn't tell us that we will be treated that way! But she knows that we are only in the class because at my school the CNA course is a prereq for the RN she doesn't have to encourage us to go on to RN....that's already the reason we're all in the class to begin with! :chuckle
    I will probably work as a CNA during while in nursing school though, so I can have some spending $$$. However, I don't think I'll be applying at the facility I'm at now!