Newbie CNA shocked "care" given by CNA co-workers!

Nursing Students CNA/MA

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I passed the state exam and received my CNA certification about the same time I started working at my first CNA position at a LTCF - I'm only working weekends; I work during the weekdays at a very good paying job.

I'm changing career with the goal of becoming an ER nurse. I'm working the weekends as a CNA because I'll be entering an ADN or LPN program August 2015 - ADN first choice, but if I get wait-listed, it makes sene to me to go ahead with the LPN program which has no wait list, then do LPN to RN. I'm a 44 year old male and don't think I should wait any longer.

I've been working at the LTCF for 4 weekends (CNA experience - 4 weekends) and I am just appalled at the care, treatment, and/or verbal abuse given by some CNAs to the residents. My wife (yes I am a male CNA), who was a CNA a while ago and is now an MA, said I should tell the DON.

Nothing is more important to a person than his/her health. We as CNAs are entrusted to help maintain their health - that's a huge responsibility, one that I take seriously. Making up numbers on charts is crazy; a non-compliant resident wouldn't allow me to take her temperature, so I asked a seasoned CNA (33 years) to help me - she looked at the previous day's vitals and just copied it. CNAs who didn't feed an assigned resident (they feed others assigned and not assigned) when charting say "well they usually eat and drink this much", and "they usually have this many BMs" - charting what they usually do will not catch changes which may prevent something; c'mon, their health is at stake.

Providing as much comfort and dignity is the next most important thing (of course safety trumps all). Needing help near the beginning of the shift with a resident whose large BM leaked out his briefs all up his back down his leg and all over and through the sheets, the experienced CNA I asked for help said he can wait, we being the only 2 CNAs (short that night) have to distribute johnnys/bibs/pads to the wing before dinner - yeah we were short, but with 2 of us and 1 experienced it wouldn't have taken but 10 minutes to change him and the sheets, instead of him waiting in his **** for an hour - c'mon that's disgusting.

And I can't even number the verbal abuse I witnessed or that they jokingly tell me about.

Maybe because I'm a brand new, wide-eyed, idealistic, fresh, untainted CNA, I expected caring and compassionate healthcare professionals. As was taught in CNA class and re-emphasized during new employee orientation the residents at LTCF have lost all their possessions - all they have now fits in half a room; their home now resembles a hospital floor; they are dependent on others to wipe their butts, or feed them, which in their minds may be humiliating and degrading; they lost a lot of independence; so yeah, some may have a hard time with that and may be a little grumpy. Again, maybe because I'm new, but some of the residents who have "rude" behavior and language doesn't bother me.

I took my wife's advise and told the DON - I'm not trying to be a snitch or get anybody in trouble, but as I said, I take seriously my job of providing safety, care, comfort, dignity; CNAs are also advocates, standing up for them against those who bully them - that's how I see it, as much as we hear about bullies in school, these CNAs are bullying those weaker than themselves. I don't know what actions may be taken, and I am a little worried that I will be found out as the "snitch" - I do have to work with them, and hopefully will get help when asked. I keep thinking of the last 10 months of my dad's life - he was reasonably healthy and lived on his own in an apartment; but, when his body started to shut down, it was a runaway train going down a cliff. He had no major health problems for 77 years, then his health just ran away from him - he spent the last 10 months in a nursing home, and I can't help but to ask, "is this how they treated my dad?".

Treat others the way you want to be treated, and the way you would want your loved ones treated - every time I go in to work, I think of how I would have wanted my dad treated.

I don't want to be the bad guy; but when I think about it, I'm not.

If I ever win the Powerball, on my bucket list is to create a nursing home the way a nursing home should be run.

Nursing homes should not be where we dump people off to languish until they die. That is torture of the most lonely of kinds.

Life is so hard, and in the twilight of our few short years on this planet, our reward should be a comfortable and pleasant end; in the hands of those whose mission it is to ensure this is so.

You know there is child protective services and adult protective services. The APS is for the elderly for a reason. People even CNAs or what have you disrespect them like children. It is very unfortunate. I think you did the right thing. Thank you for caring. At least the residents have you on the weekends.

Specializes in LTC.
I worked in LTC for six years before I became burned out and entered a different specialty. What I'm about to mention might be viewed as controversial or terribly offensive to some parties, but here it is.

Due to welfare-to-workfare regulations that have existed in all states since welfare reform laws were enacted in 1996, many caseworkers are under immense pressure to get people off the public assistance rolls and help them transition into paid employment.

Job training is a major aspect in this transition into the working world. Healthcare training programs such as CNA, HHA, medical assisting, phlebotomy technician, and dental assistant are popular offerings because they're cost-effective and can get a person trained for a new job in a few short months.

Here is the problem. While many of these women love their new jobs and the sense of self-efficacy they receive, there are many more who are part of a forced workforce. Essentially, a number of the aides with whom we work do not really want to be there, and are simply going with the flow to avoid sanctions.

When someone really does not want to be there, they have the tendency to objectify the residents and do less than the minimum to survive on the job.

I actually agree with you to an extent. I think the issue is less with someone not wanting to work, and more with someone not wanting to work in the healthcare field. They go from welfare to back breaking labor. I know that many quickly see that their lives have not improved much monetarily, and now they are working long underpaid hours in an overburdened, underfunded system. It's kind of a really sad way to staff LTC imho. It's perfectly appropriate to get people who want to work in healthcare in on welfare to work, but not people who don't want to be there. Train them in something they would actually like. In my former career I came across a lot of these people. I worked as a pit supervisor in a casino. Dealer schools love the welfare to work funds! I got a lot of people who didn't want to work in a smoke filed environment where you got screamed at a lot and verbally abused. A lot of them also didn't know how to function in a job, so in addition to "breaking them in", I also had to teach them to have jobs.

I'm sorry if I sound jaded, but for profit nursing homes will cut every corner they can get away with. I have a friend who is an LPN a nursing home. She regular has a patient load of 45+. How is that safe? She has very little time to provide individualized care. One med pass blends with the next one. CNAs typically earn minimum wage for a mostly thankless job. Until recently, they did not even qualify for overtime. Many more people are concerned about the value of life at conception/ birth than they are about the value/ quality of life at its end. Perhaps its cultural, but that's how it is. That any state would allow 1 LPN to oversee more than 40 patients (most of them with multiple health problems) is beyond me. For-profit facilities are squeezing out every dime they can, and the end result, I fear, too often is the sort of treatment/ conditions described by the OP. Not that he necessarily works for a for-profit institution, or that this kind of treatment is exclusive to them...just arguing it's more likely to occur when profit, and not care, is the underlying mission statement.

Specializes in Psychiatric Nursing.

The Commuter gave me the answer to one of the most baffling, puzzling questions I have ever pondered. While working in LTC, I used to ask myself, "Where in the world do they find some of these CNAs?" I did not realize that there were welfare-to-work programs that actually sent people to CNA classes, but it certainly does make sense. I noticed that there seemed to be two types of CNAs: The nursing students that were earnestly seeking experience or "getting a foot in the door," and the tired, overburdened single mothers or grandmothers who would rather not be there.

I worked in LTC for six years before I became burned out and entered a different specialty. What I'm about to mention might be viewed as controversial or terribly offensive to some parties, but here it is.

Due to welfare-to-workfare regulations that have existed in all states since welfare reform laws were enacted in 1996, many caseworkers are under immense pressure to get people off the public assistance rolls and help them transition into paid employment.

Job training is a major aspect in this transition into the working world. Healthcare training programs such as CNA, HHA, medical assisting, phlebotomy technician, and dental assistant are popular offerings because they're cost-effective and can get a person trained for a new job in a few short months.

Here is the problem. While many of these women love their new jobs and the sense of self-efficacy they receive, there are many more who are part of a forced workforce. Essentially, a number of the aides with whom we work do not really want to be there, and are simply going with the flow to avoid sanctions.

When someone really does not want to be there, they have the tendency to objectify the residents and do less than the minimum to survive on the job.

Agree!

Some of these people I worked with reminds me of inmates

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I think the issue is less with someone not wanting to work, and more with someone not wanting to work in the healthcare field. They go from welfare to back breaking labor.

In many instances, the women in the welfare-to-workfare program have already completed one or more job training programs that had been unrelated to healthcare, but couldn't find paid employment.

Programs such as manicurist/nail technician, computerized office clerk, legal secretary, court reporter, culinary arts/chef, and florist training immediately come to mind as popular offerings that do not always lead to paid jobs at the end of the pipeline.

What will happen if the welfare-to-workfare participant cannot secure paid employment within a specified period of time after having completed a job training program?

They must choose between an unattractive unpaid work placement or completing yet another job training program that will be more likely to result in gainful employment. Since the CNA training program traditionally has had a high job placement rate, caseworkers steer women in this direction.

The participants will face severe sanctions if they do not make a choice quickly, so many end up enrolling in nurses' aide training programs to avoid austere punishment such as revocation of three months worth of food stamp/EBT benefits. Hence, many nursing homes in America are staffed with front line workers who are part of a forced workforce.

Specializes in nursing education.
In many instances, the women in the welfare-to-workfare program have already completed one or more job training programs that had been unrelated to healthcare, but couldn't find paid employment.

Programs such as manicurist/nail technician, computerized office clerk, legal secretary, court reporter, culinary arts/chef, and florist training immediately come to mind as popular offerings that do not always lead to paid jobs at the end of the pipeline.

What will happen if the welfare-to-workfare participant cannot secure paid employment within a specified period of time after having completed a job training program?

They must choose between an unattractive unpaid work placement or completing yet another job training program that will be more likely to result in gainful employment. Since the CNA training program traditionally has had a high job placement rate, caseworkers steer women in this direction.

The participants will face severe sanctions if they do not make a choice quickly, so many end up enrolling in nurses' aide training programs to avoid austere punishment such as revocation of three months worth of food stamp/EBT benefits. Hence, many nursing homes in America are staffed with front line workers who are part of a forced workforce.

The Commuter, you have such a wonderful way of explaining this. What do you think is the solution,if any?

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
The Commuter, you have such a wonderful way of explaining this. What do you think is the solution,if any?

As always, complex problems cannot be resolved with easy solutions. This is certainly a complex problem that has plagued us for generations.

The solution will have to be at a societal, upstream level because the core of the issue is inequality. The inequality exists on several fronts. For instance, the frail elderly are socially devalued while children and younger adults are highly valued.

Also, some people are born into a disadvantaged economic rung and, due to a myriad of social reasons, never climb the ladder into middle class security. It's ironic that the devalued elderly are receiving basic care from employees, a large number of whom might be considered socially devalued due to stigma, educational level, economic status, and other issues.

My best friend worked for several years as a state caseworker who placed participants in welfare-to-workfare programs. In addition, my cousin was a participant in the welfare-to-workfare program, although she was difficult to place into job training programs due to having only an 8th grade education when many of the more attractive offerings required a HS diploma or GED.

Unfortunately, there will always be a degree of inequality in society. Due to my education, salable job skills and basic knowledge about the system, I can navigate life without bureaucrats such as caseworkers controlling my behavior, telling me what to do, and sending me to placements against my will.

However, the underprivileged woman from across town with limited education and skills and a lack of sophistry about the system will be pushed around, suffer 1000+ humiliations and get lumped into a forced workforce of caregivers for the devalued elderly.

The solution is equality, but I do not see that happening during my lifetime.

Let me give you some advice. Find employment elsewhere and enroll in LPN or ADN or go to EMT school even... ASAP. If you turn a blind eye to abuse or let it go unreported a single time you become part of the problem.

As a paramedic who worked in the tampa/st.pete area I would guess 80% of my calls were for geriatric patients. half of those were at assisted living, nursing or LTC facilities.

They are the most horrible place on earth. I worked as a correctional officer in 2 states before EMS. We take much better care of our inmates.

I have seen an LPN doing CPR on a consious patient.

I have seen multiple patients with aspiration pneumonia from being force/rapidly fed orally or through feeding tubes.

I have been called for difficulty breathing only to find the patient laying flat on their back, with no oxygen, and no nurse or CNA present.

I have seen 80% of LTC patients with toe nails yellowed and an inch long, severe bed sores, infections and rashes from laying in feces and urine.

I have smelled the overpowering smell of urine and feces in 80% of LTC i have been in.

I have run on a patient with a UTI so far gone they became septic, had a core temp of 104, a blown pupil, screaming, babbling, crying, seizure like activity, hypotension and mild hypoglycemia. SA02 @ 88%. Laying in days worth of feces and urine. basically left to die. When the screaming became unbearable the LTC called 911.

I have had nursing homes request that I begin CPR and transport a deceased patient with obvious rigor, and dependant lividity.

I have seen first hand a LTC facility make up fake 911 compalints for patients on an entire wing to have them removed so they could deep clean for a state inspection.

I have called the department of health and human services because of filthy conditions. returned a week later and found the same dirty used band-aid on the floor where it was a week earlier.

I have transported "Difficult patients" that "accidentally" fall or get dropped by staff.

I have had patients from an infamous LTC close to st.pete general hospital tell me stories of patients having to trade sexual favors just to get their food and medications. Staff allowing violent psychiatric patients to prey on the old and infirm.

In many cases ( certainly not all ) CNA's are uneducated, overworked, underpaid, understaffed. LCT facilities are in the buisness of warehousing people. They make a profit when medicare or medicaid pays. All that is required is that the residents are kept alive. The very poor or lower middle class without supplemental income or insurance are doomed to neglect if they are very lucky. Downright abuse and maltreatment very often.

The few CNA's or LPN's at nursing homes that are waiting with the patient, have a full medical history, list of meds, allergies and a good history of recent changes, signs and symptoms... I literally have hugged them and praised them for doing an amazing job. I have given my number and email out and assisted many of them into finding an affordable EMT or LPN Program.

Patient Advocacy: Speak for those that cant speak for themselves. Defend those that nobody else cares about. Always Err on the side of caution when a human life is involved.

File a complaint every single time you see a violation of patient safety, dignity, human rights, care or comfort. Meet with a patients family, encourage them to visit often and to participate in patient care.

This is the ugly side of healthcare that nobody wants to talk about.

Specializes in hospice.

Commuter is right about the elderly being devalued, but even children's caretakers are often hanging at the bottom rung of the wage ladder. We don't value caretaking jobs in our society.

While I agree that our treatment of the elderly is reprehensible in a lot of ways in this country, you have to realize too, that we don't know the whole story of these people. I can give an example from my own life.

Last I knew about a year ago, my mother was living in a long term transitional shelter run by the Salvation Army, a state and a half away (nine hour drive). I won't write you a tome describing all the years and issues, but I will tell you that both my brother and I offered help multiple times, over the course of several years. We funded groceries, car insurance, and prescriptions trying to keep her on her feet. And she spit on all of it and cut off communication because I won't hand her cash. When she ends up in a care facility somewhere, I'm sure the people who work there will think poorly of me and my brother. They won't know she pushed us away and refused the help we were willing to give.

Yes, I think some older folks are victims of selfishness. But some are victims of their own choices. None of them deserve abusive or neglectful treatment, but sometimes they end up paying a high price for alienating the people who should've cared for them.

Yes, I think some older folks are victims of selfishness. But some are victims of their own choices. None of them deserve abusive or neglectful treatment, but sometimes they end up paying a high price for alienating the people who should've cared for them.

Also a sad fact. Many of the residents at our most notorious nursing facility were in fact frequent flyers long before that. In the few years I worked the area I saw at least 3 of our 3 time a week drug and alcohol realted patients end up there. Some had homes and families. The worst ones are where you end up when nobody is willing to fight for you anymore.

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