Performing Peri Care While Residents Hang from the Easy Stand

[ldoone]

I just landed my first CNA job while waiting to start my nursing clinicals. Nursing homes seem to be the only facility that will hire a new CNA. At the start of our shift, it seems like I am the only one who washes my hands before starting my job. Is this suppose to be standard practice, especially when you just came in from outside? Anyway, after going through a 12 week CNA class, I am being orientated to the unit where I work. (The same stuff I just learned)

Many of the residents can't walk and must use a Hoyer lift or an Easy Stand. I know 2 people are suppose to use these pieces of equipement at all times. The ladies at this facility are so used to using this equipment by themselves that when they come to help me, they just stand and watch and then end up leaving before the resident has made it to their wheel chair or to the toilet. I am so afraid that a resident is going to fall. Let alone, the standard practice is to have these residents hanging by their arms, while they hold on, quick wash them up(do peri care), and then quick move them to their bed for the night. Does this sound right or should I just shut-up and do my job?

[Daytonite, BSN, RN]

you are going to find in all nursing jobs, whether as a cna, lpn, or rn that there are many people who are more than willing to take short cuts and bypass rules. believe me, that's not the way it's suppose to be done. once you develop the habit of doing a procedure the way it is supposed to be done, it becomes that--a habit. i've written just recently about nurses who continually refused to lock the med cart while i habitually locked it even when i only walked 5 steps away from it and several incidents involving medications taken from the carts by patients occurred. what's happened is these other aides you work with took the route of laziness, never developed the right work habit and now they don't even want to be bothered with learning. that isn't a cue for you to do the same and i'll give you two very good reasons why.

1. worst case scenario: if a resident falls, gets injured because a staff member didn't use a required piece of equipment and sues or reports negligence to the state department of health that licenses the facility your cna status, future nursing license and ability to keep the money you earn could be in serious jeopardy. i wouldn't put that to chance! rules are made to be followed for the protection of everyone in the facility. people often don't realize the importance of a rule until something goes wrong.
   
2. best case scenario: you are following facility policy and being a role model. as licensed nurses we often end up role modeling the correct behavior. we know the rationale behind why we are doing these things. subordinate workers don't always understand the rationales. as much as you might hear many negative comments, keep in mind that people notice what they see more than what they hear. talk is cheap. people understand, "do as i do, not what i say" and that is a powerful adage.

it seems like i am the only one who washes my hands before starting my job. is this suppose to be standard practice, especially when you just came in from outside?

my first job was as a nursing assistant in a nursing home one year after starting my

rn

classes and i found the same thing. yes, washing your hands before starting your job is standard practice when you come in from the outside. good for you that you learned and remembered to do this! other aides laughed at me that i bothered to do this. my hands after a while got a terrible dermatitis from all the handwashing i did between patient contacts as well (we weren't allowed to use rubber gloves back in those days). you get satisfaction and peace of mind from knowing that you are doing the right thing. and when you come in to work and learn that resident x was suspected of getting some bacterial disease from an outside source due to contact contamination, you won't be feeling guilty because you'll be able to truthfully say that you

always

make it a

habit

to wash your hands when you come in from the outside and others will confirm this.

at this point in your career and job position you have no rank or authority to do anything about what others are doing. you should report their behavior up the chain of command (the charge nurse), but do it once because to continually hound the charge nurse about the same people makes you look like a tattletale and makes your work situation difficult, especially as the new guy on the block. this is one very good reason why you will want to move on with your education so you can get into positions where you can be involved in supervision and management of the subordinate staff and have an impact on this kind of behavior.

take mental notes. when i got my

rn

and had more experience in supervision and management i went back into ltc where i worked hard to make a difference. to make a difference though, you have to follow the rules yourself and be a role model. here's the hard part: many ltcs are a sea of negativity and many are not going to pat you on the back for your positive strokes and behavior. you have to be mentally strong and that comes from being sure of yourself and not needing constant positive stroking to flame your fire. but i can commend and encourage you because i came from that background and i know what you are facing. your job is also a wonderful opportunity for you to practice and learn. focusing on what you have been taught is the right way to do things, ignore the negative attitudes of others, let the charge nurses know that the other aides just stand around instead of assisting you with the assistive equipment like they are supposed to, and eventually other aides are going to come forward and use the equipment like they are supposed to when you are around them (they will be the ones you'll end up loving to work with).

as i said, you are going to find some of this lackadaisical behavior in lpns and rns as well and it will break your heart. you start by being responsible and staying true to your own actions and good nursing procedure. then you move on to get legitimate power to be able to do something about it. now, however, is a time for you to watch and learn no matter how much anguish you feel. can you do that?

good luck with your new job!