Shocked with my CNA clinicals.

[Dhalia27]

I am shocked with the quality of instruction during my CNA clinicals. One incident is particularly poignant of the lack of heart that residents/patients have to deal with from health care administrators. I am new to nursing and would like to work as an RN for a few years before receiving my NP but am absolutely horrified at the attitude I've encountered from the teachers and even my student partner. Is this how it REALLY is?

My partner and I were instructed to give a shower to Diane (name changed). Diane has alzheimers and is very unhappy. She is obviously severely depressed and apathetic and completely exhausted all of the time. I have never seen her smile. Since it is clinicals the instructor accompanied us to the shower. My partner has been a resident assistant for a couple months so I am doing most of the work (no problem there since I want to because the more experience the better). Our patient, Diane, is very difficult to work with as she is so unhappy that everything makes her even more unhappy and she HATES showers. So we tried to make it as fast possible for her.

After I washed her hair I got a towelette to scrub her body and was handed a bottle of conditioner by my partner. I said "this is conditioner" and my partner said it doesn't matter, we just want to get this done with. I look over at the teacher and she said the same thing, to just "hurry up". Diane was in no danger to herself or us at the time, she was moaning and complaining. I asked if there was soap and they prodded me on to just do the job, and I told them to give me the shampoo since it was still nearby.

I cannot believe that the student and teacher who were working with me in the shower would use conditioner to wash Diane's body. Am I missing something? Perhaps conditioner is useful for cleaning? I'm not being sarcastic. Maybe they thought it's a soap anyways. But my partner is extremely intelligent (the "get the right answer" type of intelligence) so I don't think she thought it could be used as soap as well. I really think they were trying to cut corners to the point where the conditioner was just an excuse to get the "act" of washing done so that we could get the shower skill done. Might as well be slapping on butter to clean skin...

It made me feel uncomfortable, as if we were putting a dirty depend on Diane. I told them that I didnt' want to use conditioner because it would take longer to wash off instead of being upfront and saying, "I'm not going to play along with pretending to shower Diane".

Then today me and my partner were pushing her in her weelchair and asking Diane to raise her feet (no footpads... not the best nursing home I know). I kept having to press behind her knees to get her to elevate them since her feet kept dragging on the ground and getting pushed behind. Diane kept saying her feet were too heavy, which is porbably true, Diane has Alzheimers and her muscles are atrophying. Anyways, I told my partner that "poor Diane doesn't get it" to which my partner replied, "she's just being lazy". I seriously don't think Diane was being lazy, I don't see why she wouldn't raise her legs up to make things easier for herself but that she just doesn't "get it" and that it actually does require strength to raise them. My partner insisted that she was just being lazy.

What concerns me more is the conditioner incident. The wheelchair thing I mentioned because I needed to vent. But the conditioner thing????? What is up with that? Am I possible missing something (please please let it be that).

Thank you.

[Kitsey]

I would say yes, that is how it really is. Sometimes you just have to use what you've got (and I am not saying this is RIGHT, but I am saying this does happen in real life). In my unit we haven't had any male body wash to stock rooms all week, so we have been using baby shampoo or even hand soap, because that is ALL we have. Our facility doesn't even have conditioner, we aides buy it with our own money for the few residents with longer hair. You will see a lot of the 'just get it done' attitude because most of the time we are so rushed and frazzled we simply don't have time to do things the way they should be done. I never thought I could end up this cynical, but 2 years as a CNA in a LTC can totally break you.

[duskyjewel]

This kind of crap, and what I saw in my own clinicals, is why I have sworn an oath that I will never, never, NEVER work LTC. I don't think I could even bring myself to put my mother, whom I don't particularly like or get along with, in one of those places. Even if my family was facing losing our home I don't think I could bring myself to work LTC. IME the hospital sucked too. The staffing ratio was nowhere near that ridiculous, but still too much. I jumped ship and work hospice, and am pretty satisfied with my job. :-)

[vintagemother, BSN, CNA, LVN, RN]

Sometimes, when I hear the phrase, "nurses eat their young", I actually think they mean that the training process weeds out the compassionate.

/just saying/

I say this from the perspective of a person who has had several experiences in LTC/SNF that were so horrible that I decided to take a hospital sitter/CNA job for lower pay, but better conditions.

I am in LVN school now and see things that aren't ethical occur in SNF's each day. I know I will have to suck it up and deal with it in order to work when I graduate.

I loved the Duskyjewels post about her mom! True that!

[TurtleCat]

This kind of attitude was all too prevalent in the LTC I worked at. It seemed speed was valued more than thorough and quality care. You constantly rushed and pressured to get things done as fast as possible lest you be running behind in your work. You basically had to cut corners and work at a breakneck speed just to get anything done, especially if you were working short-staffed. It was depressing and why I'm glad I got out of that environment. I now work in a group home with 3 Alzheimer's residents and LOVE it, it's a much nicer environment and I can actually take my time with the residents and give them the care they need and deserve.

[Bbo.W]

Unfortunately, the sheer volume of residents per CNA causes this issue......that and a lack of organization and planning. When you give someone a shower, you will need soap :-) Resolve to give better care to your residents when you start working!!!!! "A soft word turneth away wrath", even with dementia patients.

[duskyjewel]

You can resolve all you want, but when the staffing ratio makes it impossible, it's impossible. I often wonder if anyone has done the study to correlate the insanely high injury rate for CNA's with the fact that they are routinely expected to provide care for dozens of people, often with little to no help, and because of that are forced to ignore ergonomics and the rules of safe lifting and transferring. Respecting those can't always save you, but it can improve your odds, at least.

[psu_213, BSN, RN]

Then today me and my partner were pushing her in her weelchair and asking Diane to raise her feet (no footpads... not the best nursing home I know).

I really don't have a lot of original information to contribute here. I just wanted to say though--don't judge the facility based on the above. At the LTC facility when I worked as an aide, the vast majority of wheelchairs did not have foot rests on them. This would allow residents to self propel themselves around the facility.

[pebbles049]

Welcome to long term care :). I have been there for 16 years as lpn and a couple of years as cna. All that i can say is it is fun some days not. Our facility likes to cut cut cut.

[fuzzywuzzy, CNA]

Like someone else said, supplies in LTCs suck, even the good facilities, and if you want anything decent for the residents you have to buy it yourself. And if the person can self propel, then putting foot rests on their chair is a restraint.

And shampoo and conditioner are pretty much soap anyway. I've used conditioner on myself a couple times when I've run out of soap, and I still felt clean.

[Paws2people]

I work in a huge hospital. All we have is tiny bottles of liquid soap. We use it as body wash, shampoo, and conditioner. Lol. Sometimes we don't even have that, and we use the soap dispenser by the sink. Welcome to healthcare...

[LightX]

That really is what it's like.

It may not be perfect, but there isn't TIME for "perfect".

If you try to do everything 'textbook' and "the way it REALLY should be done", then some of your residents will sit in a dirty brief or not be repositioned for hours because you spent "too much time" doing things the RIGHT way.

It's sad. It's not fair. but it is what it is and at least you do the best you can so EVERY resident is clean and fed.