Terrible first clinical experience (CNA)

[bustthewave]

I'm taking my nursing assisting class, a pre-nursing requisite. I started clinicals yesterday, and I'm dreading going in again tomorrow. Not because I'm doing a bad job, I'm doing a good job, and the CNAs I'm shadowing love me. The patients who I got to know love me too, and the charge nurse loves me for volunteering to come in this weekend to play piano. It was terrible because I hated the way these patients got treated... and because no sanitation is used!

It's an assisted living facility, I worked on a unit for those who needed daily care, who were dealing with dementia. The day started okay, I helped with breakfast, I helped with feeding and cleaning and all that. It started when I had to assist in helping with a bed bath. This woman was completely bed bound, unable to speak. My guess is it was alzheimer's at a very late stage.

The CNAs I was working with decided to let me and another student take over for this, which was fine because I needed the experience. They sat in chairs. But then they turn on MTV, and banter back and forth about this woman's family, and how horrible her sister is. This was after they removed her clothes and left he laying there completely naked on the bed, no bath blanket or anything. I asked for a bath blanket and they said "oh we don't really do that... I guess you can check the linen closet." They threw towels on the floor... one of the CNAs didn't even wash her hands or wear gloves.

This type of insensitivity went on throughout the day. After lunch is "down time" because everyone takes a nap, so the CNAs literally do nothing. They sit in the work station. I wander the halls looking for things to do, I see a call light on (I haven't gotten used to checking for those yet... but the woman claimed it was on for 30 minutes, and I believe her). She was sitting in her wheelchair, and said she needed so many things and I wouldn't be able to help her. but she said she was cold, and wanted to be in her bed. I told her that her needs were very important to me, and that I would go find a CNA and we would help her. I finally find the CNAs in the work station, they tell me, "oh she's always confused after lunch. She'll give you hard time if you let her..." "Is it really a problem to move her to a bed when everyone else is in a bed?" "She doesn't know what she wants, just turn her call light off."

My unit wasn't nearly as bad as a unit down where some other students were (leaving patients on standing lifts for 15-20 minutes, who can't hold themselves up because it's 'easier to clean them that way.' Not cleaning their bottoms, or under skin folds, or even their legs... where they constantly smell like poo and urine).

I go in again tomorrow, and I don't know what to do. I know that for my standards I need to provide the kind of care that gives dignity, but I can't dictate to a CNA, when I am just the student who will be here for a few weeks. What can I do? Is this kind of thing normal? I work as a vet tech... and I treat dogs better than this...

This experience in all honesty has made me want to die in a car accident tomorrow, before ever getting old and being in that situation. I would rather lose the rest of my life now, than to end up being in that situation later.

[xluescluesx]

I don't think you're overreacting at all either. Just because this happens often does not make it ok, and hopefully these same "caregivers" will receive the same "care" when they are in a nursing home! Good for you for being such a caring person. Keep up the good work.

[ckh23, BSN, RN]

This experience in all honesty has made me want to die in a car accident tomorrow, before ever getting old and being in that situation. I would rather lose the rest of my life now, than to end up being in that situation later.

A little dramatic don't you think?

[CareteamRN70]

I don't think th OP is being dramatic. There are many nights I think about my patients and the old "there but by the grace of God go I" rings in my ears.

I had a TIA several years ago and it terrifies me that I may end up trapped in my own body unable to care for myself, dependent on the care of some who may not quite share the same view as patient dignity as me.

To the OP, all I can give you is this, and it can burden you and add a lot of weight to your load...but I go home after shift and I do not regret...

I go home and know "I" made a difference (even if no one else but the pt knows"

I go home and my own problems diminish a little after seeing what others have to live with.

I go home and hug my wife and kids daily and call my mother once a week because I know other's don't have that opportunity.

When I see bad care provided, I try to lead by example what I think good care can be.

Continue in your schooling, because for every "good" healthcare worker that joins the ranks, you improve the situation, you become less a wage slave and more an advocate for dignity...and I find I can live with that despite some of the ugliness I see at work.

Big J

Semper Fi

[lillymom]

Unfortunately this is how it is in many, many LTC facilities. The pay for CNA's is horrible and so is the work load. Facilities end up hiring people who don't care because most people who do care won't work in this type of environment for long, usually. When I worked at one I did the best I could for any of the pt's but it will eventally wear on you.

I ended up staying for 3 months and went to home health. Stick it out until you are done with clinicals and do the best you can for those pt's while you are there. It's great to see that you actually care about the pt's just be careful to not become jaded because it is easily done.

[Up2nogood RN, RN]

It is very sad that respect isn't given to our patients who are in need. I started cna training at the very green age of 18. I had an amazing instructor who taught us how to respect and provide dignity just by imagining our patients were a member of our family. It has stuck with me to this day and got me through some very long shifts with difficult pts and family members.

I would speak with your instructor with these valid concerns. You will encounter this again and again sadly in your career. You will find a way to cope and do the most that you can but know you have no control over how others act. But you can make your voice be heard and your actions to guide others.

[bustthewave]

Well, clinicals again today. It was MUCH better! The CNA who worked this time actually cared about her patients, and managed to get things done on a timely manner. She didn't turn on MTV, she spent time with me showing me how to care for them, she talked to them like they were human beings. It was a breath of fresh air.

Thanks everyone for the advice, I'm obviously sticking it out I just don't understand how it's so easy for people to become so callaced to other human being's needs. I mean sure, being a CNA sucks... and is terrible pay, but it's the job you chose so do it right.

But fortunately I found my instructor today, and got her help to do total care on this bed bound patient (who REALLY needed it, she was one of the ones who's family was bad mouthed in front of her by aids, and where the aids decided to watch MTV while providing care... she was bed bound, unable to speak, and pretty unable to move).

We did a complete, and thorough bed bath (where, unlike last time with the CNAs, we used blankets and bath blankets to keep her warm, instead of just laying there completely exposed) which took about 45 minutes (extra time because I'm new at this), we changed her bed, we combed her hair, and gave her a back rub, and even did range of motion on her entire body, and I swore she was smiling at the end. Then for good measure we turned her to her side, which probably never happens (it wasn't done monday anyway). But she was so stiff, the range of motion didn't have much range, though I could physically feel her muscles loosening as we did it.

Anyway, it was a much better day.

I mean if you have, as previous posters say, like 1 cna to 60 or more patients, care in any manner would be impossible. But then what's the point of keeping these people alive when they get to that place with that level of care?

But I think as a nurse, I can have some say over what at least my aides do. I mean, we are technically above them on the totem pole right? I guess it would be facility specific, but if I'm a nurse on a floor, I'm going to make sure the aides are providing good care to the patients (in a respectful way of course, I'm just saying I'm not dealing with the attitudes of the CNAs that I'm seeing at this facility).

[bustthewave]

A little dramatic don't you think?

and nope, not at all. It's my opinion. I would rather die now than to grow old where life ends in complete loneliness and isolation, with no dignity. It kinda makes the rest of the stuff you did before then meaningless. I actually think people are being in general under-dramatic. How easy it is to not care about the people in these situations, and how little those people can do to change it. You will be old too, and with our healthcare and culture there is a good chance you will make it to an age where you will need that kind of care. It will be too late then for you to have a problem with it.

Obviously I'm not saying I'm going to kill myself (that would be over dramatic actually), because there is a ton of things I can do between now and then to add some value back in the world, and a ton of things I can do to prepare for old age.

[Cul2]

Good thread. I can see a young nurse just starting being hesitant to stand up to those doing the training when poor care is observed. I'm not necessarily excusing it, but I do understand it. On the other hand, what disturbs me is to hear more experienced nurses pretty much implying that the best one can do is just do one's job and act as an example. The news has been full of nursing home problems lately. At what point does "poor care' turn into abuse. At what point does "poor care" become a safety issue. I would suggest this can be a fine line and it's best to deal with the issue officially before it gets to this line and crosses it.

[bustthewave]

Good thread. I can see a young nurse just starting being hesitant to stand up to those doing the training when poor care is observed. I'm not necessarily excusing it, but I do understand it. On the other hand, what disturbs me is to hear more experienced nurses pretty much implying that the best one can do is just do one's job and act as an example. The news has been full of nursing home problems lately. At what point does "poor care' turn into abuse. At what point does "poor care" become a safety issue. I would suggest this can be a fine line and it's best to deal with the issue officially before it gets to this line and crosses it.

Thanks :). And don't nurses take an oath to never willingly or knowingly cause harm? Isn't that the pivitol corner stone of being a nurse?

I strongly (I cannot emphasize how strongly I believe this), believe that turning a blind eye to harm is the same as causing it. You CAN effect what other people do, and you SHOULD. You can't change people's beliefs, but you can work the system to your advantage. If your the nurse, you are in charge of the CNA period. If you are a CNA, you can go to the nurse. If you are the nurse, and the CNAs do nothing, you can take it to the charge nurse. If the charge nurse does nothing, you can take it above her. If this does not work, you can always try finding another job and taking it to the media.

But bottom line is, you don't work in a vacuum and allowing other people to provide bad care while doing nothing to prevent it, is the same thing as providing bad care yourself.

[netglow, ASN, RN]

You are tracking right OP, but, if you read, read, read posts here on allnurses, you will find that going to management often is like going nowhere. Going to the media, sure, reporting to the state is better, but remember one thing nursing home owners have is lawyers. So one must be careful as it is not difficult to find some reason to discredit the whistleblower.

MANY nursing homes are warehouses for aging/dying bodies. Often the people who own them are focused on just this. Your complaints to the "higher ups" are to people who just don't care. This type of place skates on the edge with the fewest staff possible to garner the most profit. Unfortunately, there are many more places like this than not, and often family cannot afford the better run places.

[Up2nogood RN, RN]

You are tracking right OP, but, if you read, read, read posts here on allnurses, you will find that going to management often is like going nowhere. Going to the media, sure, reporting to the state is better, but remember one thing nursing home owners have is lawyers. So one must be careful as it is not difficult to find some reason to discredit the whistleblower.

MANY nursing homes are warehouses for aging/dying bodies. Often the people who own them are focused on just this. Your complaints to the "higher ups" are to people who just don't care. This type of place skates on the edge with the fewest staff possible to garner the most profit. Unfortunately, there are many more places like this than not, and often family cannot afford the better run places.

THIS...is the truth. It's not about turning a blind eye it's about you won't be able to keep track of your cnas because you will have a hard time keeping up with the workload. The ABC's: airway, breathing, circulation will always take precedence over tracking a lazy cna. It's very difficult to get a bad employee fired. As a cna I had reported a few cnas over the years fo negligence to the charge nurses and DNS and nothing ever came about it one single time. You complain too much and you will be blackballed. It can be a small world in the healthcare indusyry and word can travel.

This is the reason I would never choose to work LTC. In my hospital it's mainly primary care nursing where I have more control over pt care and I know it's being done the right way.

[General E. Speaking, RN, RN]

Oh so many years ago when I was a young nursing student I recall book learning how to do a bed bath (privacy, warmth maintained)

Fast forward to shadowing a CNA at a nursing home for my very first clinical: soaping up the resident quickly, quick dry and move on to the next.

I stood there with my mouth hanging open... it was awful.