Struggling (very long)

eveningsky339, LPN · Apr 28, 2010

Did I develop a split personality named Penny? Seriously. You sound exactly like me a few months ago. I went through that same hell of dreading and hating work before, during, and after shifts.

Here's the big picture. The workload is incredibly high because even if a facility meets federal standards for CNA to resident ratio, it's not enough. The other CNA's are nasty because they hate their jobs. The mean alzheimer's patients are just... alzheimer's patients. And here you are, stuck in the middle.

Now, here's how you can improve your situation.

First, about the workload. It will never get lighter, but you will get much faster with time. You need to start taking some major shortcuts. For example, when I work the Dreaded Day Shift, we start getting people up at 6 am. Breakfast starts at 8. Now, according to the DON (who I'm sure you will find has little understanding of reality), we are to give all 8 residents on our assignment a complete bed bath, dress them, and get them out of bed. But if we did that, no one would ever make it to breakfast. We stop giving bed baths at 7 and save them for after breakfast, and it's a huge help.

Speaking of bed baths-- are you trying to wash every square centimeter of the resident? Or are you nailing the "dirty spots" such as under the arms, under the breasts, face, peri area, etc? I learned very quickly that you can realistically only wash the dirty spots. A weekly whirlpool takes care of the rest. Also, a word on PM care-- face, hands, peri area. Day shift handles the complete bed baths.

Now about the nasty CNA's. You need to ignore the yelling. They are not bad people, they are just tired-- mentally, emotionally, physically. It takes some getting used to. If you get really, really, really yelled at, or if ignoring doesn't work, politely ask the nasty CNA why they are yelling. Many times they don't even know that they are.

As for the mean patients, don't be afraid to be firm with them. Just because they are mentally ill doesn't mean you deserve to be treated like crap. When you are called a name or the resident resists care, kindly inform them what you are doing and how it will help them. If the bad behavior continues, inform them that it is absolutely not appropriate to call you names, and that you will not tolerate it. They may stop, but they may get worse. If this happens, leave and come back in 15 minutes.

I've been called horrible names, been told to go "get someone who knows what they're doing", been kicked in the face, slapped, bitten, had fingernails dug into me, the whole nine yards. Be kind and gentle yet firm and unmoving. It's a tough balancing act sometimes, but it's the best way to go.

Many very well-respected CNAs at my SNF have told me that when they first started, they wanted to quit right away due all the things you mentioned. I was the same way. I felt awful because I thought that I had spent all that time and money on a certificate that only brought me misery. There were several times when I, having not eaten or had a drink or sat down for six hours, was about to just walk up the nurse's station, say "I quit", and leave forever.

Stick with that SNF as long as you can. But if you find that just can't take it, which is nothing to be ashamed of, remember that you do not necessarily have to "use" your CNA certification. I'll tell you right now that if I had the choice of flipping patties or working at a nursing home, I'd probably flip the patties. But I've chosen to stick with being a CNA because it will one day make me a better RN.

CoffeemateCNA · Apr 28, 2010

Well said!

What got me through the first few months:

1) A very good, though sometimes dry, sense of humor

2) A large hip flask

3) The knowledge that even though working at Wal-Mart or QuikTrip would be easier and less stressful, those jobs don't offer the same opportunity to make a difference in people's lives

Those first few months were terrible for me, as they are for everyone else who is just starting out. I was beyond stressed and hated everything about the job. I could never get my work done on time, other employees were rude as can be, and my back ached like an elephant had decided to take a nap on top of me. I was using language I had NEVER used before, doing things I would have NEVER done before. But, I managed to make it through okay.

Stick with it. It gets easier.

Experience will come, and believe me, it is well worth it in the end. :)

steelcityrn, RN · Apr 28, 2010

Its a bad place to be in. When your new, it seems you have not yet earned the right to speak up about problems. When you have been there a while, it seems that you are treated better, now that they know you. About the work load, that probably won't get much better. It will always be hurry up and run. Get your experience, if you can, and move to a better floor, if there is one?

NM nurse to be · Apr 28, 2010

I think you just rewrote my first ever post here :) I went home crying every day for a few weeks. But I stuck it out and now almost two years later, I am a good aide. It was definitely worth doing. I'm also in a nursing program (finished my first term today actually) and I can tell you, it was such an advantage to do this job! If I had to learn basic patient care AND nursing skills together, it would have been much harder. I hope you get through this while ok. Ask for more orientation, there's nothing wrong with that at all! If you need an ear, I'm only a PM away :)

Ev1987 · Apr 28, 2010

I am also a new cna, and still dealing with some of the same issues that you are. I mostly ignore the nasty co-workers, but I keep in mind that we are a team and I ask and assist with help when the time is needed. Continue to remain respectful. I have learned to accept the fact that residents can be a pain to deal with. Everyday, I tell myself to go to work and do my job the best way I can. Time management takes practice, you will get faster and adjust to the system soon enough. My best advice is not to quit. Try to gain enough experience and move onto a more professional work environment.

fuzzywuzzy, CNA · Apr 28, 2010

I've been in that boat too. The other CNAs are probably yelling because they're stressed and irritated working with a new, slow person. Some of them have been there so long they kinda forgot what it's like to be new. Usually it's not even personal. Most of the time I would just let it go but there's been a few times that I've asked, basically, what the hell their problem is, and after that they were a lot nicer. If you feel intimidated by your coworkers, you are NOT going to enjoy the job and it's going to take you a lot longer to adjust to the routine, which just makes the cattiness even worse. If there's anyone at all at your job that you feel relatively comfortable with, ask them about the mean people. If she says, "Oh god she acts like that to everyone just ignore her" then you know you can roll your eyes and move on. If there are others who are playing games, assert yourself and say something. It's really hard to do (for me at least, because I'm passive), but in the long run it's a huge relief.

2 days of training on each hall, on different shifts, doesn't sound like enough to me. Do you even know what the routine is? I remember when I first started I was pretty lost. I was on second shift. No one would help me and at the end of the night when I finished putting all my people to bed (the last one done, of course), the other CNAs complained to the nurse about me, in front of me, because I hadn't done my vitals. First of all I didn't even know when we were supposed to do vitals. During my training someone else always did them, and they would do the whole sheet. Whoever did them that night did all of them EXCEPT mine. Then ******* that mine weren't done. This is the kind of petty crap I'm sure you're all too familiar with. After that day I learned to do the vitals before supper. We'd get there, pass linens, get everyone toileted and in their chairs for supper, and make our ambulatory residents walk as we were getting them up. Then I'd do vitals, pass water, take down beds and lay out supplies (a big help), start my check-off charting, then pass supper trays and after those were all picked up you'd haul ass to get everybody in bed. Wash em on the toilet, put a gown on, do their teeth, and put them in bed. After they're all in bed it's much easier to go around and do your rounds by yourself the rest of the night. I used to try to get my baths done early too. On first shift, I try to get as many people done as I can before breakfast- washed, dressed, OOB, bed made, vitals, etc. Some people prefer to leave the beds unmade and go back to do them later. After breakfast there are toileting/repo rounds, snacks, waters, etc so there's really not as much time as you think to get the rest of your AM care done. Before you know it, you're supposed to be toileting everyone a 3rd time and you've got to go to lunch break. So if you really fly through your care in the morning you'll have an easier time later.

The speed and time management come as you get to know the residents. There are tons of little things you can do with each resident to make things easier but you won't figure them out right away. If things are taking you too long to do, it's simple- just do them faster. I've said in another post that when you're getting someone ready for the day (or ready for bed), pretend that it's you and you have 10 minutes to get out of the house, and go that fast. And multi-task... a lot.

One thing that definitely doesn't win any brownie points with other CNAs is when you ask them for help with a transfer and nothing is ready. Then they have to help you get the person dressed or take the bed down or whatever. Make sure they literally have nothing to do but assist with the transfer before you ask. If they take their sweet time coming to help you (everybody gets caught up sometimes but there are other people who take a long time to respond out of passive-aggression), then find something else to do instead of standing around. Just stay in the vicinity or tell them, "I need help with So-and-So. I'll be next door in the meantime."

Don't try to do everything perfectly. There's no time. If your residents faces, hands, and butts are clean, and they have their basic needs met and are as safe as you can reasonably get them (ie alarms turned on, floor mats down, side rails or seat belts correct), then it's fine. This is nothing like you learned in class. Just focus on speed because that's what gets your coworkers to treat you better. After you've got the basics down you can start adding "frills" to your routine.

fuzzywuzzy, CNA · Apr 28, 2010

Oh and I just ignore the name-calling and abuse from the residents. It doesn't even bother me at this point. Trying to talk them out of it just confuses and/or enrages them even more. Usually acting unaffected helps. Or saying the same thing over and over in a flat voice can help too. Like we have this lady who screams for help when you do care. If you keep saying, "I am helping you" she calms right down. Then 2 seconds later she forgets and screams again.

klhmc729 · Apr 28, 2010

Oh, I understand where you are. I came home my first night of clinicals and the second I walked in the door I started sobbing to my husband about how bad it was. I couldn't really even say anything I was so upset. I stumbled through the rest of clinicals (and my nurse said I had done a good job, even though I felt incompetent every step of the way). Last week, I went to a workshop about working with patients with dementia that was PHENOMENAL! :yeah: It was super helpful to know WHY the residents were acting the way that they were (for example, the part of the brain that controls normal words is damaged by Alzheimer's way before the part of the brain that holds the swear words, so really, they just can't access "go to the bathroom" anymore, so they say "I have to ****"). She also had some great tips for caregivers on how to respond to people and have activities that are meaningful for your residents at whatever stage of dementia they are at. I strongly suggest you Google Teepa Snow and look through her website. There's some stuff for sale on her actual website, but there's a lot of free/open source info of hers on the internet that could probably help you out. I say the best thing you can do is be armed with knowledge when you walk in that door - when the patients respond better to you, it will make you faster, and when you are faster, your coworkers will probably be nicer. Keep in mind, in a job that has such high turnover (and it's a really tough job, so of course it has high turnover/burnout rates), your coworkers probably have to mentor a new person pretty regularly, only to see them walk out the door to a different job within a few months. They will probably be a lot nicer when they realize that you are in this for the long haul. Hang in there!:hug:

eveningsky339, LPN · Apr 28, 2010

It's hard to find any CNA who didn't want to quit on the spot, or think that the first few weeks on the job were hell, or feel like they picked the wrong career. Let's face it, assisting with ADLs in a nursing home is pretty near the bottom of the barrel, and in class you learn everything as though you have two patients on your entire assignment. Once you hit the floor, speed and efficiency are key, and your co-workers act like they hate everyone.

I remember two years ago, when I was volunteering at a hospital. I didn't even know what a CNA was, and when I saw what they did, I thought it must have been the hardest job in the world. Now, after several months in a nursing home, I'm starting part time on the Med/Surg floor of a hospital, and it's a breeze. Everything is easier after you work in a nursing home.

There's nothing wrong with doing part time or per diem work in a SNF, and having a second job somewhere like Wal*Mart. That way, you keep your skills up-to-date and you don't die of exhaustion during a typical work week. I considered doing the same until the hospital offered a position.

Poi Dog · Apr 28, 2010

I went into this business thinking that I could change the world of nursing home with my enthusiasm and good nature. That thought lasted oh about 1/2 a second once I was thrown into the hustle and bustle. The best I can tell you is not to let your coworkers unprofessionalism rub off on you. Glue a smile on your face while silently thinking to yourself, "You don't write my check and therefore you mean nothing to me." I used to do that in order to just get through my shift. I had heard from several people that it seems to be the nature of healthcare to "haze" new workers. How true that is, I don't know. I just chalk it up to the person who is being mean as just being a mean S O B. (no, I don't mean shortness of breath) :rolleyes: :lol2:

My first days as a new CNA were horrible. I would go home and be so frustrated that I could not sleep. The would've, should've, could've kept me up at night. I would think about how my coworkers were mean to me and how I wished I could punch them in the nose... :eek: :nuke: It.was.that.bad. I even picked up smoking to "alleviate" the stress but have since quit. I am now PRN and my stress levels are normal .

It's a rough environment and it seems to set some people up for failure, sadly. Do the best you can. Don't let others walk over you. The guy I oriented with yelled at me and I looked at him and told him that I could not think while he was yelling. He mocked me but I just turned my back on him. I had said my piece and he was determined to be a butt. I can't change people like that and why even try?

When a resident would scream at me, I would calmly say, "There is no need to scream at me." Many of them would back down and apologize :cool: . Just think that you get to go home when your day is done. These residents, unfortunately, are home and cannot leave. This probably adds to their frustration and has nothing to do with you or the care that you are giving.

Get the experience that you need while searching for another job or pursuing other avenues, if that's where your heart is. Come here to vent because trust me, WE know exactly what you are going through. The posters here are awesome and have each others backs! Be strong!

:redbeathe

CoffeemateCNA · Apr 28, 2010

The posters here are awesome and have each others backs!

:) :) :)

I went into this business thinking that I could change the world of nursing home with my enthusiasm and good nature. That thought lasted oh about 1/2 a second once I was thrown into the hustle and bustle.

I was the same way. One of my coworkers even got in my face and scoffed at me. Here's the gist: "Give it a week. Your big happy smile will disappear and you will begin to hate the job AND the residents just like the rest of us."

Part of it became true. I did get worn down very, very quickly. But I never truly hated any of the residents (Coworkers, though? Well, that's another story ).