My Clinical Experience is Boring!

[gymnut]

I just recently started my clinicals (every Saturday from 7am-3:30pm) in my CNA program at one of the best nursing homes in my area. Everyone who works there is extremely nice and helpful but, the problem is it's a really REALLY boring floor.

The floor is mostly LTC but, they are starting to change it over to rehab so some of those people are slowly coming in. Most of the residents have some form of dementia but other than that nothing interesting. No tube feeds, ostomies, catheters or IVs so we can't practice working around or cleaning any of that. The most someone has is a nasal cannula for oxygen.

Our day pretty much consists of changing briefs, toileting and giving complete or partial bed baths depending on how feisty that particular resident is and assisting with breakfast and lunch. Other than that 80% of the time the residents are just hanging out in their wheelchairs near the nurses station or cruising around the halls. I usually go into every room and ask if they need fresh water (they usually do) and do odds and ends like water their plants or adjust their blinds but they really never need anything.

I'm not the only one that thinks this either and my instructor was also surprised at how quiet the floor was. She believes it's because it's on a Saturday and since management isn't around it's more lax. Some of us asked her if we could switch but unfortunately she said we're stuck.

Now I know some of you are probably reading this and wish you could work on such a relaxed floor and think I should be thankful but I just feel that I'm being gypped in a sense. Clinicals are the time and place to try out everything you're learning and I don't feel I'm getting that. Has anyone here ever had a clinical experience like this? Any advice to make it more interesting?

[CoffeemateCNA]

What you just described is a very typical day in LTC. If you are expecting adrenaline-pumping action, you'll be sorely disappointed. It isn't like Grey's Anatomy or ER (or any other medical TV show). We don't (usually) have big huge code blues, tons of patients with exotic diseases, or lots of fancy medical equipment to handle. For the most part, we bathe, change briefs, dress, and feed. Then repeat. Bathe, change briefs, dress, and feed. If the residents need much more than that, they are usually sent to the hospital. Weekends usually are a bit more relaxed, but the overall routine is mostly the same, no matter what day of the week it is or if management is there or not. If you're looking for hardcore excitement, you'll probably have to live a double life as a secret agent.

In theory, clinicals is a time where you can practice your skills and get 100% proficient so that you'll excel in the "real world." That's just theory, though. There's a lot that you may not get to see, and you may not feel completely comfortable with every skill. There's just not enough to go around for everyone. You may get to see more of the catheters and such with the rehab patients, though.

[gymnut]

Oh no I wasn't expecting it to be all kinds of drama or 'Life in the ER' excitement I think I was just expecting it to be a little more...well..busy.

It's just that for a few months now I've been reading a lot of posts on All Nurses about how stressful the job is, how no one has time to take breaks because of the heavy workload they have, the time management issues and just running around like a chicken with its head cut off. Even all of my friends who are CNAs have said that LTC is a severely stressful environment and the PCA I was shadowing while I was volunteering said that she has no idea how CNAs in nursing homes do it and that the hospital is so much more laid back.

So I think with having all that drilled into my mind for months on end possibly made me over hype situation. I just thought it was going to be non stop work helping to care for all the patients. For the first 2 hours it is pretty busy getting everyone up and dressed and ready for breakfast but then after that it's 3 hours of wandering around looking for stuff to do until lunch comes, then we toilet and change briefs and then we wander around looking for stuff to do again.

Also if you remember I started a thread about making a great impression during clinicals and I just feel that I'm not going to be able to show them what a hard worker I am if it's not busy. And yes, I ask the RNs, LPNs and other aides if they need help and I'm always told there's really nothing to do until a call light comes on.

Ah sorry for this rant. I just hate this fish out of water feeling!

[Kyla.ann]

I know how you feel. Mine was the same way (and I was only there for 4-6 hours at a time). I went in expecting to be ran ragged with things to do but in reality, there wasn't much at all other than feeding the patients. By the end of our time there, my instructor ended up grabbing a bunch of us students, finding an empty room, and we practiced skills on each other. We didn't get to do catheter care and things like that obviously, but we got to practice quite a few skills that way. (ROM, changing occupied beds, transfers, we practiced bed baths with clothes on, etc) Maybe see if your instructor is willing to do that with you when things get slow?

[fuzzywuzzy, CNA]

So... people get toileted/changed as they get dressed in the morning, and again after lunch? That's it? We toilet everyone at least 3 times before lunch, then once or twice after...

What about ambulation programs? Nail care? Passing out supplement drinks? Vital signs? Repositioning? I can't imagine having 3 hours of free time at work. Not in long term care, at least. We have a rehab too and it IS slow over there most of the time, and the staffing is way higher, which makes it even more boring . But on the LTC side we have no downtime. One of the biggest black holes in the schedule is having to get everyone up for breakfast and then put half of them back down again after, only to get them all back up for lunch. Most people are total care and the ones that aren't are super demanding, constantly on the bell, and always pulling shenanigans to waste more of your time. Are the people at your clinical place all independent or low maintenance or something?

[northernguy]

How busy it is depends on how many people you are taking care of. Taking care of say 3 people is a lot different than taking care of 8. As stated this sounds like a pretty typical LTC setting, maybe a little easier than most. You will probably have wonderful short stretches like this as a CNA, and other stretches where you have residents that require a lot more extensive care, including some who are actively dying.

Hopefully before you're done you will get to care for some that are total care for dressing feeding and bathing, require mechanical lifts and will be combative and resist care, better to experience it for the first time in clinicals for sure. Catheters arent a big deal. If they have a catheter that means you dont have to worry about constantly changing briefs.

As for waiting for a call light to come on so you can do something, you sure wouldnt have to wait long where I work.

[gymnut]

So... people get toileted/changed as they get dressed in the morning, and again after lunch? That's it? We toilet everyone at least 3 times before lunch, then once or twice after...

What about ambulation programs? Nail care? Passing out supplement drinks? Vital signs? Repositioning? I can't imagine having 3 hours of free time at work. Not in long term care, at least. We have a rehab too and it IS slow over there most of the time, and the staffing is way higher, which makes it even more boring . But on the LTC side we have no downtime. One of the biggest black holes in the schedule is having to get everyone up for breakfast and then put half of them back down again after, only to get them all back up for lunch. Most people are total care and the ones that aren't are super demanding, constantly on the bell, and always pulling shenanigans to waste more of your time. Are the people at your clinical place all independent or low maintenance or something?

It's hard to say what it really is exactly but, then again I have only been there twice so who knows I could go in this Saturday and be driven nuts. I think a lot has to do with the staffing being pretty decent. Each CNA only has 8 residents on 1st shift. Then you add 8 of us in the mix and that can definitely make a difference.

The residents seem pretty low maintenance too. As I said they pretty much either hang around the nurses station in their wheelchairs, watch old westerns or read books in their rooms. The only one that tends to make everyone nutty is a woman who has stitches going up her thigh, has advanced dementia and is a fall risk. She keeps getting up every 15 minutes or so and setting off all her alarms. It's frustrating because you can't explain anything to her because she immediately forgets. She is really sweet though.

Vitals are only done once a week and I can't remember why but, as students we can't do blood pressures on the elderly. Maybe because of the damage we can do with the cuff? I'll have to ask why we haven't done respirations and radial pulse though. The RNs pass the supplement drinks out and we help but it's short lived because almost none of the residents drink the stuff. I haven't been able to do nail care on a resident yet because I have a hard enough time getting them to take a wet rag to their arm pits and don't want to push too much lest I get stabbed with an orangewood stick.

I'll see how it goes this weekend though. Maybe I can really convince someone they need a tub bath!