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Negative experience on first day

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by justarookie justarookie (New) New

hello everybody,

i've been reading the cna section of this website and have found your posts and advice so helpful. you're all discussing alot of questions i've had but didn't know who to ask!

there is a situation i have run into and would like any suggestions or advice if anyone has any for me.

i just got my cna certification last month and just got a job at a ltc facility. it took 3 weeks before my 2 interviews, tb tests, physical, and orientation were all completed. needless to say, i was more than ready to start this job.

i've had no previous experience in the medical or professional caregiving field, with the exception of taking care of my home bound mother for 2 years, and our clinicals in a very nice ltc- and of course, taking care of my own kids if that counts.

i took my class at a very well-respected training facility in my city. they were so specific on procedures and did everything by the book, with no exceptions given. everything had to be perfect. the instructors taught us to be professional during procedures and to treat other workers and residents with the utmost respect.

yesterday was my first day of work, and my last. i started my shift with an open mind, fully prepared for anything to happen, with the exception of everything i learned in class to be thrown out the window. we were taught (in class) how to do things the "state way", but it was explained that each facility may have "shortcuts" to save time. for example, we were told that different places may use a sheet or blanket to "drape" a resident while dressing or giving a bed bath, instead of going through the draping procedure. i'm sure you all know about the "shortcuts" i'm referring to. just nothing that would harm or humiliate a resident. anyway...

for an entire shift i was "taught" by my trainer at this facility to do things the total opposite of what i had learned. one pair of gloves was used for a bed bath. no front to back wiping for peri care and the same cloth was used for the entire bathing procedure (peri care was scrubbing back and forth). after the bed bath, the same gloves were still on while dressing the resident and while moving the wheelchair around and handling objects in the room. and this was not just done with one resident. dirty wet bed pads and linens were tossed onto the floor instead of in a plastic bag. when i asked about this, i was told that it was not allowed, but if it "accidentally" fell off the bed, it was okay as long as the state wasn't in there to see it. there were no draping procedures being done at all, and never once was a curtain closed. the doors were shut but nothing else was. there wasn't any privacy ever.

in the break room, my "trainer" told me that our hall was designated specifically for the "pains" (she used obscenities), and she named off certain residents and referred to them as obscene words.

after i got home, i felt like i had no business working in a place like that. the residents were treated like they were on an assembly line and weren't spoken to in a friendly manner, with no conversation. it was like they were dolls with no feelings.

this morning i called into work and told them that i would not be returning, and told them why. they apologized to me and said the only thing they were aware of was that dirty items were being put on the floor and it was supposed to have ended a while ago.

am i overreacting since this was my first real job in caregiving and ltc? the facility we did clinicals in was not like this at all. while i am applying for a new job, how do i know i'm not applying or accepting a job in another place like this?

i just feel like i worked too hard to learn all the procedures to just go somewhere and spread pathogens (which is what happened yesterday), and give up residents' privacy (i'm talking about no covering while dressing them).

sorry this is so long, but i have nobody else to talk to about this. thank you in advance for your help. :o

Well...

You will likely have people like that at every facility. Just because one person did it does not mean everyone does it that way, and it certaintly does not mean that you have to do it that way! Take pride in yourself knowing that you are doing things the right way.

I can honstly say that everyone takes some kind of short cuts but YOU make sure that YOU do not take shortcuts that may harm the resident or humilate them. Sometimes managment needs to be told about these situations, and I am glad you said something. The managment may or may not be of the type to follow up on an action, but at least you do not feel like it is on you for not telling!

THe best advice I can give you is that you should work on your skills and learn what you can but also remember the right way to do things and never sacrifice patient care or safety in your job. You can't control others but you are responsible for your own actions.

fuzzywuzzy, CNA

Specializes in LTC. Has 3 years experience.

You're never going to be able to work anywhere if you expect everybody to do everything by the book. I would suggest staying at your next job and doing the best you can. Nobody is saying YOU have to drop linens on the floor or leave people uncovered.

enchantmentdis, BSN, RN

Specializes in Hospice, ONC, Tele, Med Surg, Endo/Output.

Yes, you are over-reacting. You could stand to be more flexible. In this economy you are worried that everything be done perfectly? Come on, get a grip and get back to work. You are a CNA for God's sake. Go back to school before you want to change the world. In this economy you can't afford to have it all the way you want. Good luck finding another job and just do your job next time.

nursel56

Specializes in Peds/outpatient FP,derm,allergy/private duty. Has 45 years experience.

Most CNAs have horrendous workloads and many places lack access to proper supplies. I don't see anything in your list above that a few more days on the job would not have made clearer. A couple of them were actually close to standard procedure not long ago such as using one washcloth for a bedbath with a clean to dirty sequence, throwing dirty linens on the floor and picking all up at once, for example. It hasn't been all that long that gloves weren't worn for anything other than being elbow deep in a real messy incontinent situation. Many people will make a flip remark about the character of a particular resident out of that person's earshot.

I would be the last person to excuse abuse or poor care, but I think you judged too quickly to really tell what the nature of the facility is. If you had stayed and worked to improve things and set an example without appearing as though you came riding in on a white horse to rescue them, you could have made those resident's lives better in your own way. Just a few thoughts.

Queen33FutureLPN, CNA

Has 11 years experience.

When you work in a nursing home sometimes it is hard to go exactly by the book and you are constantly busy.I think you would have made a great Cna for that facility maybe they needed a more caring person like you to work there.I am sure the residents would have loved you.Just because that Cna worked that way it doesn't mean that you had to work that way.I work at a facility where some of the cna's seem like they don't care about the residents.But when I am at work I try to talk to them and give them all the attention I possibly can.Good Luck on your next job.

azcna

Specializes in LTC, Rehab, CCU, Alzheimers, Med-Surg. Has 3 years experience.

Yes, you definitely overreacted in this situation. Many, many people have been through the exact same situation that you have just described. We take our CNA class, we have one resident that we spend 6 hours on, and everything is gravy. Then we come to our first day of work where we are basically trying to keep up with a busy CNA who is trying to take care of 8-16 residents (often with little or no help from other aides, nurses). Nursing homes are busy and chaotic as a rule.

ALL nursing homes are busy, and have a little bit of an inhumane feel to them, but some are worse than others. The only way to know which one you are in is by sticking with the job for a minimum of one month. Most people say at least three, but one month at the bare minimum.

In my opinion, one of the best, and maybe THE best, part of being a CNA in LTC is being able to be a patient advocate. If you continue on in your nursing career you will hear many wonderful nurses talking about how critical it is to be a patient advocate. In LTC you have a set of residents all to yourself, and YOU get to decide how to deal with them. You can be the CNA that they love to have, that they tell their families about, you can be be the best thing that has happened to them in awhile.

Even if you're rushed, you can still smile, talk to them about their day, and make them feel special and respected. Just remember that a lot of the people you are dealing with have been in a nursing home for some time and they are (unfortunately) used to being treated less than perfectly. SOMEBODY has to take care of them. Either you can do it, knowing that they will receive the best possible care you can give them, or you can leave it up to someone else who might not be so caring.

As far as touching everywhere with your gloved hands that you just used for toileting/bathing, I think that is disgusting. It only takes two seconds to throw your gloves off and get some hand sanitizer.

sourapril

Specializes in public health. Has 5 years experience.

Maybe you can try to apply to a hospital. It's nicer environment and you don't have to deal with the safety crap in a hospital. Yes, some people will try to do shortcuts, but you don't have to be one of them. After working in a nursing home for 2 weeks, I realized that it's not for me. I don't mind taking care of people, but I can't risk to lose my license in an over-load, unsafe environment, where I would constantly smell urine and poop (some CNAs do not clean up immediately).

I do not think you over-reacted. You are a bit like me and have a tendency to be idealistic. You know how things should be and you get very quickly discouraged when you see that they aren't done that way, especially since you invested your time and effort into learning a new career. I am a new CNA working in a very well-respected LTC facility in a small town. Because of the workload that every CNA is assigned to handle, it's very difficult or sometimes impossible to really give people the personalized care that I want to give. This fact is very discouraging to me, not to mention the fact that I make less money at this job than I've made in over 25 years in other jobs, including temporary work. I'm going to use this job to get clinical experience that will help me get a job in a different type of facility, hopefully a hospital or working for a hospice organization. I've found I really love terminal care and would like to go in that direction. Perhaps you could use your current job to help you move on to something you'd like to do better

Working as a CNA you are going to see things done totally opposite of the way you were taught in class. You need to have a backbone if you are going to survive in this field. I dont mean any disrespect just telling you how it is. If you quit every job because someone threw linens on the floor or closed the door instead of pulling the curtain (closing the door is considered providing privacy), then you will have trouble keeping a job, and finding any place to hire you. There are people out there who are busting their butts to find jobs and would be grateful to just have a job regardless of the situation. Maybe this is not the career for you as I am sure it will get a lot tougher and harder. Sorry to be so blunt, but this is how I feel.

Jen{NAR}

Specializes in Long term care.

Yeah, I think you overreacted. You really need to stay longer than a day. I freaked out for like two weeks before I learned to love my job. When it came to the procedures it is hard to break the habit of doing things strictly by the book, but you have to break through that cold medical covering and open up to the reality of it all. These are people you are working with and yes we need to be professional and give privacy but if a patient wants me to do something that is not by the book ((such as using the sink bowl instead of the basin I'll do it because it's their life and they have a choice--unless it's a double room, that would be mildly gross :D)) or telling them that you love them--this is a biggy that I found shocking--technically we are not supposed to tell them that "we love them" but in the end how can you not after caring for them for almost 2 years ((and if they tell you that they love you, how can you not say it back? Good golly if someone didn't tell me that they loved me back after I said it I would become sad and sullen)).

Also if you are completely serious all the time it's not good...these people are not always as serious as you may think. I have a lady who I swear is 20 years old, but she isn't :D

You have to be able to have fun and let these people know they are at home and not in a medical institution.

Edited by Jen{NAR}

NA student here. Her role was to train you, so let her "train you" and then do things your way once training is over. If you see/hear abuse or unsafe practices then contact the ombudsman. That is what they are there for. In my view there is no point approaching a DON or administrator about this sort of thing. Real change NEVER occurs as a result of an epiphany moment had by internal staff. Real change comes about as a result of lawsuits, monetary, and/or legal penalty. And just personally, I think the whole "don't let the dirty linen touch the floor" is kind of silly. Would I throw it there on purpose? No, but if it fell there I wouldn't freak out. The sheets will be washed in hot water with plenty of detergent so I'm pretty sure it will be okay when next they get put onto a bed. I completely agree with you about the screening/privacy. That is a matter of respect for the resident and should always be observed. I understand that staff are busy, but it doesn't take two seconds to pull a curtain and give privacy. Good luck to you at your next position!

I just started as a new CNA last week and, to a degree, I feel the same way! Every CNA I have trained with does things completely different from the next one and nobody does anything like I was taught in the CNA course.

But I'm realizing that no matter what way you choose to provide care and as long as you do it in way that is safe, dignified, and efficient, you will eventually find a way that works for you and your residents.

You may have gone in with an open mind and rose-colored glasses, but it definitely changed after things didn't go the way you expected them. I'm sure other jobs (unrelated to health care) you have worked at, told you how things were going to be done when you were in orientation. Then, once you started working there you found things being done slightly or even drastically different, but the business still functioned sufficiently. This is the same situation with every place you will work at...even LTC facilities. Just because the work environment and coworkers around you may seem different or negative doesn't mean that YOU give up on caring for the residents that desperately need you.

Like another post said, watch and learn how your trainers do their job (but don't judge them), ask as many questions as you need, and once your on your own make adjustments that suit you and benefit the residents in your care. You seem more concerned and upset about the things your coworkers are doing rather than how you will do your job when the training period ends. Just know that you are not in any position to judge them nor are you the on-call Mother Theresa! They may not be very respectful or show smiles with lots of love, but if you do then show it! I have found the more I let my positive personality show... the more positive reactions and comments come out of other people.

Your main concerns on your job should be: Is everybody, clean and comfortable? Am I communicating to the residents in a positive way? The least of your concerns are where dirty linens are going. The resident could care less where you're putting their dirty linens! And in my opinion, if I ever got busted for doing something menial like throwing dirty linens on the floor, my response would be " I did what I needed to do in order to provide this resident with the best possible care." (Of course I would definitely not let little things like that happen when state's around!) However, little things can be prevented by being prepared. For example, remedy the dirty linen predicament by simply keeping a couple trash bags folded up in your pocket (as well as gloves). When it comes to trash like dirty/wet briefs.. pull the trash can close to the bed or wherever your working before you start any care. Thinking ahead and being completely prepared wayyy before you start your rounds will not only save you time, it will help you feel more confident about what your doing since you won't have to scramble around looking for things while leaving your resident in an "odd position".

Things that really help me before I start my rounds are going from room to room laying out ALL of my supplies I will need and taking inventory of supplies that need to be ordered and stocked. And don't just stock for you...stock up for the next shifts as much as you can so as not to **** your coworkers off...lol..I hate when I start my shift and even the basics are nowhere to be found in the room. Always make sure you have plenty of trash bags in the trashcan at all times...as "duh" as this sounds, I have left myself in a situation where I had to stop everything I was doing to get a darn trash bag!

As far as using gloves go, I usually only use them when I'm messing with poop, pee, vomit, and blood. I don't wear the gloves any longer than I have to for transmission reasons. After I finish cleaning up any feces or fluids i get all soiled linen/trash/supplies into bags, pull of my gloves and put in the open trash bag, then I tie up all the bags...get a handful of hand sanitizer real quick, and then carry on with dressing, transporting, etc. then wash hands when all is said and done. Not wearing gloves for every single thing won't kill you and of course you should regularly wash your hands.

When you go to look for another CNA job, you could go to websites that give consumer reviews on facilities, but even then its hard to tell what you're getting in to. For me, I went for the nicest most expensive places to live first (which is where I ended up getting a job thankfully) because I feel that they would have the most updated facility and a larger budget to provide better care (more CNAs per residents, more supplies, and they usually have a more extensive hiring process in order to accept the best of the best which often leads to them paying more than other facilities). I'm sure what I'm saying about these expensive places is not necessarily true across the board and many people will disagree with me, but that's my opinion and its true for the place I work at.

And before I write a novel...I just want to say don't waste the money you paid for that CNA course and uniforms, try again with a different outlook, you seem to have great intention. Good luck too! (I'm brand new too, so I'm still learning and the things I have told you are only from my opinion and experience thus far...Listen to the more experienced before you listen to me :) SORRY FOR WRITING SO MUCH!

systoly

Specializes in LTC, Memory loss, PDN. Has 23 years experience.

You said you started your shift with an open mind...when did it close? ;) Just kiddin'. What you experienced is called reality shock. It sounds like you had excellent training and an exquisite facility for clinicals. Not every CNA is so fortunate and some had their training way back when... I've been fortunate enough to have worked with caring and efficient CNAs who demonstrate every day that it is not necessarry to compromise quality of care to get the job done.

Practice what you learned, keep an open mind and you could quickly become a leader.

I am a new CNA, I've been working in my facility since October. The facility I work in is actually IMHO a much better working environment than the one I did my clinicals in, and that shows. But I learned quickly that sometimes you have to take shortcuts. Try to keep an open mind, and avoid taking shortcuts that are unsafe or will cause the resident discomfort, but when you are on your own and have so many residents to care for in just eight hours, not everything will go by the book. There is just never enough time or staff for it to work.

There will always be the people that take the kind of shortcuts that make you cringe, but you don't have to do things their way! You will find your own way in time (believe me, every day is a learning experience), and you may even find that you can save time simply by getting to know your residents' routines (For example, by knowing that if one of my residents is not toileted before lunch, she will have an accident, I make five minutes to get her on and off the toilet. This saves me fifteen minutes of cleaning up and changing her clothes later. We are both happier for it in the end, and she doesn't have to go through the embarrassment of having an accident). Give it a good chance, and never tolerate abuse.

Being new, you're likely going to be very slow at first, and you will start to see why some things are improvised on from time to time. If you do something the wrong way, you'll get in trouble. If you don't get your work done, you'll get in trouble. If you browse around here you will see that this double standard is a constant point of contention for CNA's.

Give it some time! When you're on your own with eight or twelve residents, you'll see!

You are overreacting. With the workload that CNA's are given, you just cannot do everything by the book.

Putting the linens on the floor? That seems petty to me... what if you are changing someone in bed and they are rolled over on their side and you need to pull the dirty pad out from under them to place a clean one... what are you going to do.. walk away and place the pad in a bag?? No.. you toss it on the floor while you finish........

When I first started being a CNA in a Rehab/Nursing home, everything that was done shocked me. I was lost in what I was supposed to do because it wasn't what I was taught. I did what I learned in class but after a while of having coworkers not wanting to work with me, complaining of me being really slow and not getting people up on time, I realized I needed to pick up the pace. Nobody taught me the short cuts. I had to learn it the hard way. I would tell you how it was done in our facility but I'm sure you'd be appalled.

I always tell students who come in for clinicals that when you start to work in a facility, things are done differently from what we are taught and that being a CNA we can't always go by the book. I tell them that because it's the truth.

kelsey.kristine, CNA

Has 5 years experience.

I would say you're overreacting, yes.

You'll find people like that everywhere. I don't know why people get into this field if that's how they feel about people, or maybe they just burn out, I don't know.

I work overnight, and the morning crew is like that, minus one new girl. They're very short with the patients, and while they do their job, they're attitude will easily bring anyone down.

I haven't seen a lot of shortcuts. I guess the hospital where I work is just good at keeping an eye on it. We have A LOT of competencies to do, very often, maybe that helps?

I would actually suggest doing what I'm getting ready to do myself; speak to your supervisor. While my issue's rather different(they get in at 7 and don't answer a single call light till I'm walking out....I often leave late which I know the hospital doesn't like, but when I'm trying to do report, AND someone else's job as well as my own, it's time consuming. Plus the fact that I bust my ass and have some bad mouthing about me going on...long story haha)

Your supervisor should be available to you. Short of going to HR, I'd say do that with any problems. Ask to remain anonymous, but just let them know that you have some concerns about resident care.

What helps me get through the annoying stuff(and the corner cutters!) is knowing that at the end of the day, I'M doing my job and that's what counts. I can't follow everyone else around, but I know my stuff, I know what I'm doing, and I'm doing it the right way. And I know that a patient who has been taken care of less than they should have been, or talked to rudely will appreciate my warm smile and proper care. It's a challenge to me, but I do all that I can to make up for those who don't seem to care anymore.

Bottom line...I recommend talking to your supervisor in the future and settling things that way. It's more professional, it saves you the pain of losing a job and looking for another(and Lord knows how hard that is right now!!), and it's just the mature, responsible thing to do.

Good luck! :nurse: