blessedinscrubs

We have CNA students that come to my facility (nursing home) for clinicals, and they crack me up. They all wear, like, stethoscopes around their necks and carry blood pressure monitors and take 45 minutes to toilet an ambulatory person. Gotta love 'em.

Once I gave up my dream of working night shift (10 to 6), and agreed to work any shift available, it took me about 20 minutes to secure a job, lol.

Does the person have some balance in their upper body? Do y'all have a sit to stand lift? To me, the sit to stands are so much quicker and less scary to the residents. I :redbeathe using the sit to stand - the added bonus is that for some reason, where the hoyer is a 2 person assist at all times (no using the hoyer by yourself), we are allowed to use the sit to stand with just one CNA.... I would imagine the rules on that probably vary from place to place.... There are certain residents that other aides lift as a 2 person transfer without a lift, but I won't do it. If they ask for my help, I tell them only if we get a lift. Mostly because, if they are totally deadweight, and particularly if they are heavy, gait belts don't help that much. You know how gait belts tend to shift and become unaffective once you get the person standing? That always ends in a *arm under the armpit, grab the pants transfer* to keep from dropping the resident. One of my biggest fears is popping someone's shoulder out of socket in a transfer - the physical therapists tell us it's very easy to do, unfortunately.

In the last two years that I've worked there, my facility has gone through several different sets of DON's, ADON's, supervisors, etc.... Seems to me like when we have level headed, reasonable people in those positions, it makes all the difference. You can be tough and yell at the CNAs and tell them that YES THEY WILL do their nine showers a piece (when a couple people have called in sick) and that there are NO EXCUSES, and then write up the CNAs that don't get them done. That still doesn't help Miss Smith and Mr. Murray, though, that didn't get their showers. What might help is for the supervisor/DON/etc to take ten minutes of their precious time to take out the list of PRN aides, call them, and get more help into the building so that there is a mathematical possibility of everyone getting their shower. Just sayin.'

Make absolutely sure that you knock on the resident's door - loudly enough that a person with not-so-good hearing would hear you - everytime you enter the room. Knock and say "Good morning/afternoon/etc Miss/Mr. Smith/Jones/etc! I'm Yajaira, a CNA, and I'm here to help you with a shower/take your blood pressure/whatever it is you're going to do." Always, always, always remember the privacy thing. Pull the curtain/close the door. I had range of motion exercise on my skills exam, and instead of using a resident, the examiner had me perform it on another student. Because it was not a resident, I didn't bother closing the door. The examiner criticized me for that. Peri care - be super duper careful about only wiping from the FRONT to the BACK. One single wipe in the wrong direction could make you fail that skill. Make a big point of washing your hands before and after the skill. Even if you aren't touching a resident - even if it's just making an unoccupied bed or changing a pillowcase or whatever! Wash your hands first and after anyway. An examiner will never disqualify you for washing your hands too often, but they can fail you on the skill if you don't wash your hands!

Cleaning vomit off wheelchairs is rough for me. I don't mind wiping it off a face, chest, changing vomit covered clothes, etc, but trying to get the bits (ewwww) out of the nooks & crannies of a wheelchair is just :barf01: BM hardly ever bothers me... The only times I can honestly say it has bothered me much involved dealing with ostomy bags. I don't know... For some reason, to me, the odor from an ostomy bag is like a million times worse than the worst (milk of mag induced) dirty brief that I've changed.

I can relate to this. I was the same way during my clinicals. Never in my life had I felt that I was somewhere I really, truly belonged, as I did when I walked through the doors of that nursing home. When I took my test, the state examiner said to me, "Which nursing home have you worked at?", and I said, "I haven't. Just this one for my clinicals." She said to me, "Are you sure?" with a strange look. And I said, "Yes." And then she said, "Oh...well....You have a very nice way with the residents." I have never doubted since I began that geriatric nursing is my calling in life. In the very beginning, the whole experience was extremely emotionally charged for me. I'm not saying it isn't emotional now. It is. But the beginning was like an epic surge of this nurturing/maternal/caregiving emotion. The thing is, the practical side of this work does not allow me to behave in perfect harmony with these emotions. Think of your favorite resident whom you felt most attached to. Imagine they are dying today. The nurse tells you that it won't be long now. Three, four hours maybe. Emotionally, what you would naturally do is sit by their bed, hold their hand, stroke their head, maybe sing to them, etc, right? Well imagine that you have 16 other people to take care of. One of them is about to fall, climbing out of bed. Another is screaming at the top of their lungs because a confused resident wandered into their room. Your supervisor comes up to you and lets you know that you'll need to do an extra two showers on your shift, and as if you didn't already know, reminds you that Ms. Smith and Mr. Johnson's call lights are on again, and that your paralyzed stroke victim needs to be clean, dressed, up and ready to leave for an appointment in fifteen minutes. Then that wierd pain in your knee/ankle/neck/back/wrist reminds you that you really do need to try to stop for at least ten minutes for some sort of break before you run out of time to take any break at all.......

You know, I think alot of it depends on the facility and it's routines. 1st shift seems like it's pretty maddening everywhere.... You've got two meals to get people to and from. Squeezing in showers and other things makes the pace pretty frantic. I really enjoyed 2nd shift, but it can be impractical hours - especially for people who have kids. Third shift at my facility is no piece of cake. They go from 12 CNA's during the day down to just four. I can't imagine having a round of, like, over 30 people. Also, alot of odds and ends tasks get put on third shift - cleaning wheelchairs/shower rooms, etc... I don't know how they get it all done. On the other hand, I don't know how I get everything done on first shift either. After all that rambling, I will suggest 2nd shift.

I spent a week running around trying to find 3rd shift but no facilities were hiring for third shift. Finally I gave up on trying to find 3rd shift, and opened my availability all the way. The first facility I went back to, to tell them my availability had changed and I could now work ANY shift - hired me on the spot for 2nd shift and had me in orientation the next day at 9 AM sharp. lol.

Urine is acidic = causes skin breakdown = bedsores. I really believe this issue is one of the reasons people get sores, not to mention rashes/skin irritation, etc. When you do peri care, you can't necessarily *see* the mess that urine leaves on the body, but it's definately there, and it eats away at the skin if it isn't cleaned. I'm sorry, but if a CNA makes no attempt to clean the peri area after urination - that CNA just plain old does not care, and does not need to be working in healthcare. Let's just tell it like it is!

I would really worry about losing my certification in a situation like that. I'm with the others. Run for the hills. And keep the family in your prayers.

You see CNA's of all different ages. What I would ask, and I would ask this of people at any age - is do you have a strong back and good knees?

My typical day.... 5:45 AM: clock in, get assignment for the day 5:50ish AM: walking rounds with previous shift (checking on the residents on my assignment with the previous shift's CNA), fill clean laundry cart with linens, towels, incontinence pads, etc 6:00 AM: Start getting residents out of bed/dressed for breakfast/peri care and toileting/squeeze in a shower if possible 7:30 AM - bring people to dining room/make beds 7:45 - 9:00 AM - breakfast.pass out trays. feed people. etc. 9:00 - 9:10 AM - ten minute break if possible 9:10: More showers, peri care, toileting, put people back in bed that need to nap between breakfast/lunch 10:30 to 11ish: take lunch break if possible. (often I take a ten minute break or even just 5 minutes if that's all I can salvage) 11 to noon: One last shower if one remains to be done, peri care, toileting, get people back up for lunch 12 noon to about 1:15 PM: Lunch. pass out trays. feed people. etc. Start getting tired and longing for a nap. 1:15 - "Last round": putting people back in bed, peri care, toileting 2 PM: Walking rounds with relief CNA, documentation (charting) 2:15 PM (often closer to 2:30) clock out and go home additional things: pass out ice whenever possible. pass out snacks. help all 8 thousand CNAs and 3 thousand nurses who ask for my help. Run back and forth to laundry a million times to get more towels, pillows, Ms. So & So's favorite yellow sweater, etc. It sounds like a heck of alot of peri care & toileting, but usually at least some of the people are either clean & dry and don't need to be changed, or decline using the restroom because they just used it the last time you took them. It depends on the particular group of people you are taking care of. You have people who constantly dribble urine & BM all day long, and those who go 5 hours between eliminating, and everyone else in between.

Getting attached has it's good parts and bad. Some of the residents I am super attached to are the ones that make my day bright. The cute, sweet or funny things they say, when they call you sweetheart and ask for a hug, etc.... But when something happens to a resident who is so special to you, it can be very, very tough. I remember one that I was extremely attached to who was taken away to the ER several hours before my shift, and when the nurse told me, I was so panicked that I stumbled back and one of my coworkers who (luckily) was behind me grabbed onto me and gave me a hug. I had to walk outside for a couple minutes and then come back in to work.

This fascinates me. You actually find time to brush your teeth? If I find the time to eat at all, I am usually cramming the food into my body so fast I am trying not to gag on it, and my mouth is still stuffed while I am nearly running back to my assignment. I have had to pee at work and been forced to hold it for 3 or 4 hours because I literally could not risk taking five minutes to use the restroom.