I have a question for all nursing home nurses.

Tim-GNP · Jan 20, 2001

This question has been the topic of much debate in the LTC industry. First of all, I want to state that I used to be a CNA [before the 'c' was even needed!]-I state this for any argumentative individuals who would read this post and reply with stuff like 'why don't you try doing a CNA's job for a day...' so, I figured I would let you know right off the bat.. been there, done that, got the T-shirt. Secondly, I want to emphasize the importance of the CNA role. Without all of us in nursing, RN,LPN,CNA, none of us could do our job.

Now that I have used the standard disclaimers, I will answer the question posted with my rationale: Yes, CNA's should have more education. Now, I don't mean sending them off for a 4 year degree, what I mean, is the length of their CNA training program. I used to teach the CNA program at a local nursing home, and here in PA, CNA's are only required to take 75 hours of instruction before they sit for their 'competency exam.' When we stop and consider that nursing homes, today, are like hospitals of the 1980's [in terms of acuity of patients], it stands to reason that the knowledge base of the CNA should be bigger. By the time I left teaching, our curriculum was up to 128 hours, and I was preparing an additional expansion.

Logically, at this point, it should be noted, bigger knowledge base requirements should yield larger salaries. CNA's aren't paid a half of what they are worth, and a truly professional CNA isn't paid a tenth of what they are worth! But, since no nurse is paid what (s)he is worth, this is not surprising.

Until more $$$ is dumped into healthcare [and I don't mean into Administrator's pockets] for training and retention, I doubt people will ever be paid what they are worth. I hope this answers your question.

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Tis with our judgements as our watches, none go just alike, yet, each believes his own.

-Alexander Pope

chili2641 · Jan 21, 2001

Tim,

I would first like to thank you for responding to my question. I agree with what you have said. I feel that nurse aids are very important members of the health care team. It is in the patients and the nurses best interest that some nurse aids remain nurse aids. By that I mean that we do not want every one to pursue a nursing degree. In my opinion nurse aids are looked down on by some of the professional nurses. I have heard several of them say that we are not smart enough to cut nursing school. I'm not sure that is always the case. I know several nurse aids who would make wonderful nurses. I want the nurses to remember that true professionals bring people up with them. When I worked as an aid I helped several of them finish their GED's and I encouraged them to go to college. One aid who had a minor learning dissibility wants to be a special education teacher and she is well on her way!! So nurses you be nice to your aids because there is a world of opportunities out there for us,and we may just leave the field if one of us can inspire all of the others.

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Nursing assistant

nursejanedough · Jan 21, 2001

Tim, you are right that CNA's are grossly underpaid. I worked as an RN in LTC. It would infuriate me when the CNA's would call in sick or just not show up. But after a few days of doing their job, I thought, I would call in sick, too! This is exhausting! My feet and back were killing me! (Now, I'm talkin about these short staffed places where there are 42 residents for one nurse and 3 to 4 CNA's.) My next thought, was I wouldn't do this for 7 to 9 dollars an hour. I would rather work at Wal Mart or sack groceries, etc. Unless you are a missionary or have a heart of gold, or really don't need the money, I don't get it. Not only is it hard work, it can be very unrewarding. Most of these residents are confused, combative, and in the South some can be racist. All I can say is, I have tremendous admiration for good CNA's. Most days I felt like I should give some of my paycheck to those hard working CNA's, they deserved it. (But I had to pay my bill for my student loan.)

mustangsheba · Jan 23, 2001

As I was leaving work last night, I was thinking "what would I have done tonight if I hadn't had a CNA to help?" They are gold to me. They are part of my team. Each of us has our own part in the job of taking care our patients. We all need each other to do that job well. I depend on the CNAs that work with me to be my eyes and ears when I have to put out administrative fires or deal with bureaucratic nonsense. I trust that they will let me know when there is something going on with a patient that takes priority. Last but not least, CNAs bring the best food to work. Bless all their little hearts.

Tim-GNP · Jan 23, 2001

Chili2641:

I can relate to what you said: "In my opinion nurse aids are looked down on by some of the professional nurses. " There are a great number of people out there, today who have poor self-esteems. The only way they can make themselves feel 'bigger' is to make others feel smaller. The important thing is that you recognize that all nurses are not that way.

huddlero · Jan 24, 2001

I have been a RN for only 3mo and I am quite aware of the value of the nsg Assts.I use them to do just what I cant do because I am stuck doing paper work to cover the hospitals but as well as mine They are like my ears and eyes. Esp. with the confused pt who keeps trying to get out of be 11p 7a shift. I do have a frustrating tale to tell though The institution I work in has decided not to allow nsg asst to do vital signs(one nsg asst made a mistake or so the MD says) So now the RN/LPN has to do the assessments and vital signs on rounds.This is outrageous!!Rounds now takes 2x the time. and if a pt has a temp and it has to be rechecked??What a pain in the butt.I think my nsg asst can do v/s accuratly and I would hope the hospital would think so as well but the MD has quite a bark and I guess he won . What an insult to the Assts.I am too new to moan but I am wondering how much longer the hospital will pay for OT for the nurses who are too busy doing V/S. Anyway I believe nsg asst are my right hand and can really help me help my pts(our pts)

leslie :-D · Feb 4, 2001

Yes Chili, Yes,Yes,Yes!

CNA's (the diligent ones) are the backbones of the facility. Every week the staff developer goes over what entails good pt.care and what is not being done... I'm telling you that more money equals the recognition that cna's deserve. I'm fortunate enough to work with cna's that treat the whole pt.; recognize changes in mental status; impaired skin integrity; pedal edema; change in appetite...you name it. I would be lost without these people. Again however, I'm talking about cna's that take pride in what they do and who they are. The same attitude holds for any person with any title.

reylem · Feb 24, 2001

Nurse aides plays a vital role in the nursing home. Care of the elderly is hard work and I do admire our nurse aides that are dedicated to this service.

It is when I see CNAs that are not sensitive to the needs of the residents, that spends time running their mouth and taking long break hours, ignoring residents calls,

that I stop and say "No, this should not happen to our elderly." I give credit where credit is due but when I see neglect, attitude in a staff member, I act on it and work for improvement.

JillR · Feb 25, 2001

A CNA can increase their education, responsibilies and respect by becoming a LPN. A LPN can increase their education, resposibilities and respect by becoming a RN. The ADN can increase their education, possibly responsibilies and respect by getting their BSN, same goes for BSN to MSN and MSN to PhD.

So see, it all makes sense now, and this not impossible to do. It is very easy in this country to get student loans and grants for continuing education.

Should we increase the amount of education and responsibilies of the CNA? No I don't think so. Why? Because we are always going to need people at that level to do the very basics of nursing care at a reasonable cost, especially in long term care facilites.

I have no disrespect for CNA's, I was one and they do a very important, maybe even the most important part, of nursing care.

I do not look down on the CNA's and I do really appreciate having them around, when I get that lucky. However, I do think that some CNA's think I am being disrespectful if I delagate a task to them. Would you empty that foley bag? to me is not disrepectful, but just delegating. Yes, I can do whatever the CNA's do, but they do have to realize that they can only do a fraction of what I am responsable for during a shift.

I understand that at times, it apprears that the nurses are at the nurses station more than on the floor and gabbing all the time, but now that I am on the other end of it, I realize that all the gabbing at the nurses station is usually one RN consulting with another and/or an MD.

My point is that you have no idea what it is like to walk in anothers shoes unless you do so.

One thing I do believe is that all LPN's and RN's should be required to work as CNA's for at least one year, before being allowed to sit for NCLEX. I think this would help solve many misunderstanding reagarding the respect issue.

[This message has been edited by JillR (edited February 26, 2001).]

nursejanedough · Feb 25, 2001

Jill, maybe you are right. Maybe all nurses and MD's should do the nursing assistant job (CNA) in LTC, especially, for at least 3 months. OK, maybe MD's for a week. It is very hard work. CNA's, nursing assistants in Long Term Care/Nursing Homes need more pay! The geriatric population is growing rapidly. CNA's do a great service (they are the real "hands on" nurses). I have worked with wonderful CNA's. They have a heart of gold. They understood their position and my position as an RN. If I said, "Hey, Mr. So and So took his pants off again" They knew what to do. If my ADON said, "Hey, I need you to chart that Mr. So and So took his pants off and you had to give him Ativan." I knew what to do. I understood my position and my ADON's position, and DON's position and administrator's position, etc.

iamme457 · Feb 26, 2001

Advancing education for nurses assistants depends on each individual. I think that they can be offered different levels if they choose in hospitals right now but in nursing homes where most of them are employed it is difficult. Most long term care facilities are limited in the number of beds and the type of residents they take. Usually one 20 to 40 bed long term care unit and one 20 to 40 bed alzheimers unit. In the near future LTC nursing will be where the majority of patients are in the health care field, starting to educate the staff now for behavioral, sub-acute, different stages of alzheimers, and rehab is where we should be aimed. Training Ostomy aids, phlebotomy aids, behavioral aids, respiratory aids....lets think about this for the future.