fairdinkum

Thank you for your responses - I found the APS information for my state. I'm actually a CNA, there aren't any nurses involved. I wanted to make sure my motives aren't influenced by my being angry at the family but I can see from your responses there is a legitimate concern. And thank you for pointing out that anonymity might be a bad idea, but (un)fortunately there have been HIPAA violations in the form of all the texts my boss uses to communicate with me, that nevertheless prove she knows what's going on.

I've had a couple of alcoholic patients who I finally realized were refusing it because they thought it was a secret breathalyzer (they had told us they no longer drank, of course). The long tube made it look like the police equipment to them, so I had to quickly explain that they suck in, not blow out, and then they were more than willing to use it. It does look a little complicated to the uninitiated, and I think some nice lettering on the outside would help. But patients like the competitive aspect of having numbers to show them how well they're doing.

In addition to my hospital job I work a couple of nights a week of home care, which I'm pretty sure is not a licensed agency - one of my coworkers at the hospital runs it with her sister and it's all cash. My concern is with the family of one of my clients. She's 99 with an MD son and two MD granddaughters (so they know better). There is never any food in the house - the family is very cheap and won't ever go grocery shopping, so often there is nothing there and my boss has to go buy something. Once she spent part of my pay because she didn't have extra and has forgotten to pay me back. I had to ask for a month to get soap for my client's showers. I always check the charting for the last week or so when I come in, and I noticed that 2 or 3 times she's become unresponsive at night. The aid on duty called my boss, who comes over because the son forbids them from calling an ambulance because of the cost. If it happens with me, I'm certainly calling 911 which I fear may get me fired. My question is this - I want to quit working for this client because I think it's only a matter of time before something goes very wrong and I'll be blamed (I take a lot of heat from my boss when the client's family is irresponsible). I'm wondering if, since I'm a mandatory reporter, I should make a neglect report? I don't have a lot of specifics to report, but I'm quitting because I'm pretty sure this situation will end badly which I feel means I shouldn't just walk away from it. Should I make some kind of neglect report, and to whom? Is there something to report when nothing major has happened but I feel it will? I don't know exactly what details I would actually report to justify a neglect report. Since the agency isn't licensed, who do I make the report to?

As a CNA I'm a little annoyed by this post, since you as RN are totally responsible for your patient's care - that's why you have a license. We're here to help, not do whatever you've decided is beneath you because you had the money for more school. What kind of NP will you be, if you think you should move on before you get experience because you don't like changing diapers? But realistically, you're lucky you have a job at all. Here in Hawai'i, the hospitals don't hire new grads, period, and they're all working as CNAs -- for CNA pay. Many new grad RNs cannot find jobs anywhere. Consider yourself lucky and quit griping that you have to provide patient care. That's what nursing is.

"Mar 8 by JoseQuinones, ADN, RN Whoa! Calm down! Did you ever stop to wonder what she went through to be there? It sounds to me like she acted professionally. That her words offended you is your decision, not hers." Next time one of your stressed out, overworked CNAs talks back to you, you'll remember this comment you made here, right?

I loved your post! I wish the hospital staff knew the position we're always in with call lights and demands. I'm really surprised the PT was like this - they have always been the one department that supports me. And helping patients do physical activity is part of their job. I've have had the PTA volunteer to give my patient a bath since it would help them get the patient's ROM in and help me be somewhere else. Don't you get those kind of comments and a daily, if not hourly, basis from the RNs and patients? I do. If one of them bothers you a lot, this is going to be a hard job. I agree with other posters that trying to explain will never help. I would just ignore the behavior and pretend it didn't happen. You could try setting precedent but at this point I've come to terms with fact that as a CNA no one will ever think you're doing your job right, and you just have to get over it. And yes, imagine flushing her down the toilet :)

I agree with most of the comments except - NO! patients do NOT sleep at night! They go insane. They elope, get sundowners, feel pain more acutely, and are often more violent at night. Night shift is a great way to learn CPR, since many codes happen at night. To Starletta - yes, there is day and night, 0700-1900 and 1900-0700 typically. So you have to be able to stay awake and alert all night, especially if you're sitting. Do not take a night shift in acute care thinking you'll be sitting on the hospital floor chatting with the other nurse aides. Hospitals have admissions, transfers, surgeries, imaging and emergencies at all hours of the night. There are nights I never sit, and nights I do end up relaxing a little. I only work 12-hour nights now, mostly because day shift is too hard on my body and, like many have commented, the nurse managers are so annoying it's just a relief to spend the night without them. You can focus more on patient care and not HCAHPS crap. You absolutely must find a way to take care of your body if you work nights - to get sleep, not feed your body and soul on the endless supply of junk food that is always plentiful in nurse lounges, and work out a way to still have daylight hours available. I just make sure I get plenty of sleep on the days I don't work, and then do without on the nights I do. The extra money is for the havoc that night shifts wreak on your life and health. And as others commented, CNAs make so little money that for me, the night/weekend diff is absolutely essential. I cannot work days, the money isn't enough. All this being said, I wouldn't be able to work at the level of competence that I do if I hadn't started out on the day shift, but I would never go back.

Hi salvati08, I strongly recommend travel nursing or agency. In general, mainlanders don't get hired easily in Hawai'i, although Queen's has magnet status and as a result hires a wide variety of nurses from around the country and world. Travel nursing and agencies offer you a guaranteed contract (travel) or flexibility (agency), and you'd have a foot in the door, so to speak. Nursefinders is good, Altres is bad. Hospitals are unionized and nurses are some of the very few in Hawai'i who can actually earn a living. Bear in mind that they're well-paid because they put up with a lot. For example, if you don't want to specialize in substance abuse, Hawai'i is not for you. I would estimate that on an average shift, around 75% of my patients are users, no matter what type of unit I'm on. InklingBooks is not exaggerating the cost of living. Why do you want to buy a home? You should find out whether you even like Hawai'i, and what part of it you'd be comfortable living in. It's not the US, and you will not be welcome in parts of Oahu, especially if you are caucasian. I've met so many mainlanders who came and bought, and now they're stuck. Spend some time exploring Hawai'i to find what you love about it before you dive in and buy property. On the other hand, if you have 18-40 million there are many mansions available on Kahala Avenue right now :) I really hope things go well for you! With any luck, we'll meet on the floor of your new unit :)

I feel bad telling you, but I really dislike being a CNA and desperately wish I could move on. It's got to be one of the worst jobs in the hospital. But reading over some of the other responses you got, it seems that CNAs in home health and hospice are happy. I'm strictly acute care and float to pretty much every type of unit, and some are definitely better than others. In acute care, CNAs are treated like crap by so many people, that being a hospital CNA can be a very demoralizing job. I even had an EMT comment once that she didn't think she could ever do my job because of the way she sees us getting treated. I enjoy patients and care a lot about the quality of my work, but try to imagine what it's like to go to work every single day and have no one feel you do anything right, and leave every day having been treated like an incompetent moron. The problem is that you have huge responsibility and no decision-making power. You're also the last person everyone can dump on when they get overwhelmed, and when you get overwhelmed everyone who did the dumping is upset because their work didn't get done. At this point, I do the job the best I can for my patients, hide from the mean RNs and hope I'll someday have the means to move on. Also, please listen to the other posters who are telling you how hard this job is on your body. I've hurt my back, hips, shoulders, etc. having to lift and change 400-lb patients alone, because it's so hard to get someone to help (they're all too busy too). I work 12-hour night shifts, sometimes 3 nights in a row, and have to be able to stay awake and alert. I've been punched, kicked, hit, shoved, and even had a commode thrown at me! You cannot get angry and you can't get tired or you won't be able to keep up the pace, which is extremely fast in an acute care scene, even in the middle of the night. All this being said, I can't regret the range of humanity I've experienced, and what I've learned about people - how to talk to them, how to handle emergencies, how to calm people in their worst moments, etc. I don't know if there's another job outside of the nursing field where you experience so much of what people are, just keep in mind that a lot of it isn't good. If you aren't willing put your whole heart into resuscitating a rapist or providing care to a drug dealer, this isn't for you. If you are interested in acute care anyway: great floors: oncology, ICU and post-partum are where I have my best experiences watch-out floors: med-surg, especially post-op/GI and units with shared rooms hit-and-miss: ortho (it can be horrible or excellent, totally depends on the staff)

Aloha snehengl. I do not work as a NICU nurse, but I would recommend you check out which hospitals actually have a NICU, because many of them don't and that might limit your opportunities. Kapi'olani, for certain, and maybe Tripler, but Queen's doesn't. Also, some hospitals do have a NICU but it means neuro ICU, so look carefully (like Queen's). The hospitals are unionized. If you haven't lived/worked in Hawai'i before, I strongly recommend you come as a travel nurse and not try to move here and then get a job (or vice versa). That is a great gig, especially for specialized RNs, and you'll be able to see if you really want to live and work here. Some of the travel nursing agencies pay very well and set you up with an apartment (a HUGE blessing), so make sure you understand the reality of financing a Honolulu life if you decide to stay and work directly through the hospital. I am a CNA, not an RN, but I can tell you that RNs have one of the very few jobs here with a salary commensurate to the cost of living, which is no small potatoes. You could also work through an agency like Nursefinders, which has national offices and does well placing specialized RNs in Honolulu.

Can anyone tell me what they think a good CNA/patient ratio would be on the 1900-0700 shift on a post-op floor? I'm worried that I suck, because I just had one of the worst shifts I've ever had as the only CNA with 23 patients (nurse/patient ratio was 1:4 or 1:5). I actually left the hospital in tears because the nurses were so impatient and the day shift got angry I didn't finish weights, but there was no way to be everywhere at once and on this unit the RN's will not touch anything that's CNA work (vitals, answering call lights, etc.). This unit's policy is that there is only 1 CNA unless the census passes 24. I'm agency, so I realize I'm never going to be exceptional because I'm always new, but how can you handle 23 patients and keep the nurses happy? I know most of the CNAs cut corners on vitals (fake the respirs, etc.) or just don't talk to the patients, but I'd love to hear real advice from CNAs who manage to handle this kind of unit without the RNs looking at you like you're crap. I know they have a stressful job and they're busy, but how do you keep them happy when 5 of them call at once while you're supposed to be taking vitals on 23 people? I don't mean this post as a complaint, I really need some ideas as to how to leave the hospital each morning not so completely burnt out on this job - it's going to be awhile before I can find another.

I'm not completely sure why someone who does not live here thinks the posters are offering untrue and naive advice, but I definitely support all that the other Hawaii posters have said. Please listen, as they/we have the experience you don't and are really only posting for your benefit: You absolutely will not get a job here. You will not get a CNA job, you will not get an RN job, you will probably not get any job. Your best bet is to apply as a CNA through an agency, work your 500 hours and then try to get hired at the hospital (as a CNA). After a year or so (after the year you put in as agency) you may get hired. But you will only get hired by an agency if you have at least 1 yr of hospital work experience as a CNA (not an RN degree). I agree that you might be able to find something in long-term care, but believe me when I say that those places are truly heartless in Hawaii and I think you'll become very disheartened. Don't watch TV thinking you know Hawaii and then discount the advice of the people who live here. I'd do anything in the world to get out of here, but unfortunately I'm probably stuck here forever because the pay is so low and the jobs so few, it'll be something like 40 years before I even save enough for a cab to the airport.

The market is not turning around for new grads, especially if you are not from Hawaii and did not go to school here. If you are not from HI, I strongly recommend getting several years of experience elsewhere, and then if you insist upon working in Hawaii, come as a travel nurse. I work in HR and can tell you the market is highly over-saturated and hospitals don't care at all about who is a better nurse since the vast majority of hiring is done by staffing agencies who know nothing about healthcare. mcubed45's comments are right on - as a CNA you will wait 1-2 years for an RN position, if you're even able to get hired as a CNA, which if you're a mainlander is unlikely to happen unless you go through a medical staffing agency. CNAs with experience can make up to $17/hr base pay, but those jobs are very very hard to get, and no, you will not be able to afford the Hawaii cost of living on that salary. Your plan to stay in CA is probably best. This is not a stimulating environment in which you'll learn from great nurses how to become one yourself. You'll get frustrated, lose your life savings and if you're lucky know someone with the money to fly you back to the mainland.

I'll look into them, Mahalo!

Uh. . .can you explain to me the purpose of nursing education, if it's not to affect the level of care given to patients? The whole point is the level of care!! I guarantee, if this person ends up at your bedside, a naive belief in a misappropriated spiritual element is not going to help you when he/she screws up.