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The Failure of Modern Healthcare due to Administration

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Specializes in CNA. Has 3 years experience.

I recently quit my job working at a Nursing Home as a CNA.

Out of the 8 patients I had my first and only full day of work plus the 1 additional I took on because he was abandoned by his CNA who wouldn't change his diaper because she didn't like the way he talked to her.

Out of those 9, I was only able to fully properly take care of 3 of those patients, 3 were mostly independent, and the other 3 were taken care of by 5 other staff members.

My eyes were opened to realize how much this modern Health Care system is managed to not actually work to fully and properly take care of most people as most people are in buildings like this and treated more like numbers than actual people.

They give 9 patients to a CNA MINIMUM there but it can climb as high as 20 legally in California for 1 CNA. 12-15 is normal in Hospitals I am learning.

I have heard from the patients themselves that they are not properly taken care of. For example you may have patients who wear diapers but they pooped in them and haven't been changed all morning.

The system keeps most of them alive barely, but they suffer so much and can be traumatized by their treatment.

A person needs not just their physical needs cared for, but they need to be treated as a person to and the system doesn't allow you to have enough time to do that for every person. Even then not all of their physical needs are met either.

I can't work with this system and I realize neither can anyone else.

Alot of people who work in this system do their best, but it's not good enough and it's the patients that suffer the most.

But the staff suffer to because most people like me go into the Medical field because we actually care about people and we want to help them in any way we can so when we are given the work load it would take in reality 4 or 5 of us to do and you want 1 of us to do it it breaks our heart because we have 9 people who desperately want help but we simply can't meet all of their needs no matter how much time we are given and we know we have failed them and they deserve better than that.

That's why I am not going to work in The Medical Field in direct patient care as a CNA until I pay back my parents what I owe them and save up $5,000 then they will give me a car and I can go back into Home Health Care.

I worked in Home Health Care in Hawaii for 2 years as a Home Health Aide without required to have a CNA license, but in California you need at least a CNA license to do that (which I just got in mail after a month a half of school and passing the state tests).

It is the complete opposite of most of the modern Health Care System in other places in many ways.

You get hired by an agency, they pay you and depending on the agency they pay for your gasoline to fuel your car to.

You need your own car because you have to drive yourself to your patient's home.

You call your agency and they tell you who they have that needs help.

You can ask as many questions as you want and you the right to refuse to care for anyone before you ever meet them.

And if you work with the patient and they and you don't get along you can leave their home and tell your agency you can't work with them anymore.

I had one patient one time who said Mary the mother of Jesus was not a virgin and Jesus and The Apostles were like hippies sleeping around with many people and I politely asked him not to talk about that stuff when I was working with him. He got very angry his face turned red and he said he refused to have anyone tell him what he can and can not do. So I went back home and the next day my Employers call me and wanted to suspend me because he told them lies that I said he was "The Devil".

I prayed asking God to help me in my head as they talked to me. I told them to look at my record in my reputation with my clients I have had with them and believe me not this lying angry patient I had.

They believed me and did not suspend me, but told me to avoid him.

In Home Health Care you can choose who you will meet as your possible patient and if you get along then you work it out between you and the patient when the best days and times that work for the both of you to work together. So you set your own schedule then you sumbit it to your agency Supervisor aka Manager so they can know and keep track of you.

You document what you do every day, go over it with the patient, and have your's and the patient's signature on it then you email it in to your agency and they log it in as your pay times and you get paid every 2 weeks.

You do whatever you are able to, trained for, licensed for, and can legally do for that 1 single patient for as long as you both agree to according to the schedule you both set up and agree upon together with your agency manager being notified about it.

I wasn't a CNA back then, but I did all the things I still do now as a CNA and more than that.

I cooked, I cleaned, I bought groceries (they give you their card and info and list to buy for them), I changed diapers (for only 1 patient), I showered people (only men), 

I taught old men how to use modern technology like cellphones or tvs even set up their phones to work easier for them,

I made phone calls on their behalf because they didn't have the patience or sometimes the ability to actually hear people they didn't know that well fully on the phone (mostly for Problems with their tv or phone or some thing else, tech support),

I also made phone calls to set up their medical appointments and calls to their Health Insurance services to set up transportation for their medical appointments as they could not drive on their own,

I acted as a go-between them and their health care providers and facilities,

I went with them to their Medical appointments and made sure they understood everything and were properly taken care of,

I called 911 for the ambulance when they needed it,

I even brought them their mail while they were in The Hospital so they could pay their bills and not lose their homes and services while they were recovering in The Hospital (which by the way I was not payed for as the agency won't pay you as long as your patient is in the hospital but they had no one to help them so someone had to do that).

Sometimes the patient just wants to be there to talk to them or listen to them or to watch a movie with them.

They often don't have any family or friends who can stay with them and do all the things you do for them.

They often live in government discounted apartments for the the poor and elderly or in their children's house sometimes or their own house alone.

They often can not walk or drive their own cars or even own a car or vehicle.

They often have no job or income and are retired and live on SSI and their health care is paid for by their insurance which can be Veteran's Affairs, HMSA, etc. and their insurance with a Doctor's recommendation note hire your Home Health Care Agency whom then pays you.

I like this as they often don't have to pay my services out of pocket. Their insurance will even send transportation for their medical appointments to and from their house or apartment with you to ride along with them.

I did this work for 2 years.

I am a man of my Word that's why I don't make promises or commitments very easily or quickly.

Every patient I care for I commit myself fully to in any way I can.

When people have to be in a facility, it is great in many ways as they can be cared in ways that are not always possible by yourself with your level of skill and training and equipment, but they are often given top priority for emergency care then they are increasingly pushed to side as they get better in health.

This is because modern Health Care is no longer properly managed and too many patients are given to every 1 CNA, RN, and even Doctor's which honestly  have it the worst.

Doctors are expected to see every patient no longer than around 11 minutes each when in the past they could take as long as they needed even hours for every patient.

I just hope and pray that I can bring more awareness and be a part of a change of this mismanaged system which honestly is from the enemy not from God.

We need lower Staff to Patient ratios, while it is true that there are often more patients than there are medical professionals we can't use that as an excuse to dump 9+ patients on 1 CNA and that's a low number from what I've read online the experiences of other CNAs who've had 15-30 or more patients they were responsible for all by themselves.

Sure the other staff step in to help when they can, but in reality my Job Title and description is a joke. My job 90% of the time has NOTHING to do with "assisting" The Nurse as a "Certified Nurse Aide". In reality my job is to DO THE JOB of The Nurse for MOST of THEIR patients to as much as I can do within my training and legal limits leaving them (in my limited perspective) with THE EASY stuff like taking vitals, giving meds, doing wound care, etc.

Nurses complain that 5 patients is "too" much for them to handle, they are completely out of touch with the reality of how us CNAs are treated by management and how we are drowning in patients while they complain about a mere 5 patients that they usually don't bathe, feed, reposition, change diapers for, get out of bed, get into bed, dress, etc. which doesn't need to be done "once" or even 3 times a day, some of these things happen all day long at various times! CNAs are like adult baby sitters which includes changing diapers at day care centers that are severely understaffed.

Now multiply by that by 2 or 3 and you got a "normal" amount of patients for 1 CNA. Meanwhile not all of the patient's needs get taken care of.

This needs to change.

There will always be more sick people then there are people to take care of them.

But the way we take care of people has to be the right way and if we take as much time as we need for each patient by giving each staff member only the number of patients they can handle then there will be less sick people as you can not possibly give the needed care to all patients for them to make a full recovery to independent stable health when you have too many patients and care gets split up and decreased over all the patients you have.

In case you were wondering, this isn't a new concept.

Dr. Victoria Sweet in her book God's Hotel tells her semi-biography of her work at a San Francisco Laguna Honda Hospital nicknamed "God's Hotel" of how things were run there before "Modern Healthcare Administration" took over to bring it up to "modern efficiency standards" by cutting the time with patients and the number of staff per patient declining the quality of the care for profits sake.

In her TED Talk on Youtube in her own words, "In seeking to put patients first, they put patients last."

Another Doctor along these lines is The Slow Medicine Doctor®
Dr. Michael Finkelstein, MD.

The concept isn't complex or difficult to understand, it is very simple: slow down and take care of each patient for as long and as much as they need physically and in any other way they need. Assign staff accordingly.

evastone, BSN, RN

Specializes in CEN. Has 4 years experience.

On 9/30/2021 at 9:52 PM, FlameHeart said:

My job 90% of the time has NOTHING to do with "assisting" The Nurse as a "Certified Nurse Aide". In reality my job is to DO THE JOB of The Nurse for MOST of THEIR patients to as much as I can do within my training and legal limits leaving them (in my limited perspective) with THE EASY stuff like taking vitals, giving meds, doing wound care, etc.

Limited perspective indeed. You think our  jobs are easier?! You've obviously never seen what nursing care entails. Wound care is no picnic. On skin that is severely broken down, that can take a good hour alone to treat.

Meds can be time consuming depending on the route of administration. I have had patients that take forever and are super difficult to give meds to. Giving meds via peg tube are the bane of my existence. Sometimes, we have to use clinical judgment to determine if certain meds could even be given based on various parameters, like those vital signs you complain about.

We also do full body assessments, speak with patients and family about care (in their native language), foley care, deep suctioning, central line dressings, blood work, communicate with various healthcare personnel...  The list goes on and on. Much of nursing is based on hard work, judgment, and critical reasoning. 

Oh, and when you are not looking, we clean the patients too.

DO NOT blame nurses for the immense workload you have been given. Nurses are just as bogged down (if not more). We do alot of work that you are unable to understand at this time due to your current scope of practice. We (as in all Healthcare workers regardless of their roles) are all working hard here to accomplish the same goals and keep patients alive despite our limited resources.

JBMmom, MSN, NP

Specializes in Long term care; med-surg; critical care. Has 9 years experience.

You are absolutely right that the workloads are unreasonable for almost anyone in healthcare these days.

Unfortunately, your approach (which I do find a little odd on a nursing forum), is also part of the problem. For some reason, many people in the field want to point out how much harder they are working than everyone else. I don't know of anyone in the healthcare field that has a job where they are sitting with their feet up enjoying BON bons and relaxing. And if they do? Good for them for finding that job. Why do people spend so much time and effort pointing out how much harder they are working than someone else? 

Throughout my nursing career, I have valued my CNAs/PCTs/CCTs beyond measure. My shift is a partnership with them for US to provide the best patient care that we can. Every single one that I have ever worked with knows that I am always willing to help out if they're doing something and they need another hand. We often work very closely together, especially in critical care where most of the patient require two people for care activities. And I know that many of my nurse colleagues have a similar approach, and a respect for our techs. I'm sure there are some nurses that don't assist as much as they should or could, and that's unfortunate. If you're giving meds or doing wound care then someone has steered you in the wrong direction as to what's in your scope of practice. That's something that would require a conversation between yourself and your nurse, or even a supervisor if necessary.

If people could get over the nursing hierarchy idea, and the "I'm working harder than everyone else" martyrdom, maybe we would have a lot more collaboration and everyone's life would be a little bit better. 

On 9/30/2021 at 9:52 PM, ChristopherGllardoJr. said:

In reality my job is to DO THE JOB of The Nurse for MOST of THEIR patients to as much as I can do within my training and legal limits leaving them (in my limited perspective) with THE EASY stuff like taking vitals, giving meds, doing wound care, etc.

Nurses complain that 5 patients is "too" much for them to handle, they are completely out of touch with the reality of how us CNAs are treated by management and how we are drowning in patients

Neither one of these paragraphs are true. You actually do not do the part of the job that is specific to nursing and requires a nursing license at all. You perform some assigned tasks that are otherwise part of the nurse's general duty. The tasks you perform are very important tasks (cannot be overemphasized!!) -- but they are not the tasks that require a nursing license to perform.

Most of us are definitely not out of touch with the impossibilities of the amount of tasks you are asked to perform. Many of us have been in your position ourselves, and even if we haven't we certainly understand how impossible it is to help with or perform all ADLs for a group of people as a single person. You do work very hard and provide an invaluable benefit to the patients and are basically in the same boat we are, which is wanting to do more but actually not having the resources necessary to do so.

I've heard a number of nursing assistants make the charges you're making about our relationship and it's an incorrect and unfortunate way to view things. It isn't about what is easy and what is hard. It boils right down to the fact that 1) part of the nursing role involves performing duties that require a nursing license 2) part of the nursing role involves performing duties that do not require a nursing license 3) we don't really have enough resources to properly perform the part of the nursing role that does require a nursing license 4) everything you are asked to do is based on the idea that I need to do things that you cannot (legally) do, while you are doing the things that you can legally do. If I do the things that you can legally do, there is no one to do the things that you cannot legally do. It's that simple.

Emergent, RN

Specializes in ER. Has 28 years experience.

The opening post was way too long for me to read with my short attention span. I would never work as a CNA in a nursing home. It's a depressing place, and it is unrealistic that you can adequately care for people in this setting. The pay is atrocious. I can't believe how little CNAs make for the work that they have to do.

I just got a job in a farm store that carries feed, hardware, garden stuff and cowboy boots and clothing. I'll be starting at $15 an hour, after a month it goes up to $16 an hour. I will get an employee discount. If I were you I would get a job at a farm store. And this one doesn't require masks, that is paramount for me. I ended up with PTSD from working as a nurse during covid, and I just cannot handle the masks anymore.

People in third world countries are much more civilized in the way that they take care of their elders. They don't stick them in nursing homes but the family cares for them in the home. I think that's too much trouble for first world people who don't want to be around their relatives.

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN

Specializes in Med/Surg, LTACH, LTC, Home Health. Has 35 years experience.

I value the work of CNAs, without a doubt! When I arrive at a facility and am told that there are no CNAs today/tonight, I know that this will be my first and last shift at that location.

With that being said, what you don’t realize is that while you’re in room one and the patient in room two has a code brown, guess who is called to go handle it? THE NURSE!! So you get to scratch room two off your list for a while. 

But when the nurse is in room two and the patient in room three wants pain meds, guess who has to do that? THE NURSE!! Let’s not forget the admission that always arrive at inopportune times, doctors wanting to talk to us, routine meds waiting, etc., etc., etc., and ETC...nothing for a CNA to worry about though because the et ceteras require a nursing LICENSE, not a nursing assistant CERTIFICATE. We get to scratch NOTHING off of our lists, even temporarily. 

Finally, when the CNA doesn’t even come to work, guess who’s blessed with doing it ALL? THE NURSE!!

So, try not to bash us too hard until you’ve had the luxury of walking, no RUNNING in our shoes for even just the first two hours of our shifts.😉😜

Jedrnurse, BSN, RN

Specializes in school nurse. Has 29 years experience.

On 10/1/2021 at 9:19 AM, Emergent said:

People in third world countries are much more civilized in the way that they take care of their elders. They don't stick them in nursing homes but the family cares for them in the home. I think that's too much trouble for first world people who don't want to be around their relatives.

Ah, but the elderly in less developed countries don't have unbelievable amounts of medical resources thrown their way to extend their lives WAY past what nature actually intends...

morelostthanfound, BSN

Specializes in CVOR/General Surgery. Has 29 years experience.

51 minutes ago, Jedrnurse said:

Ah, but the elderly in less developed countries don't have unbelievable amounts of medical resources thrown their way to extend their lives WAY past what nature actually intends...

     True!  As an example, the Japanese have an average life expectancy of over 84 years (almost 8 years longer than the US) and have a statutory health insurance system (universal healthcare) in place.  The US's corporate healthcare model is an abysmal failure by every measurable metric; significantly higher per capita healthcare spending with much worse overall health.  It's way past time to abandon this failed system but it's unlikely that very wealthy and powerful corporate interests are ever going to let this happen-it's only going to get worse folks:(

Edited by morelostthanfound

Jedrnurse, BSN, RN

Specializes in school nurse. Has 29 years experience.

57 minutes ago, morelostthanfound said:

     True!  As an example, the Japanese have an average life expectancy of over 84 years (almost 8 years longer than the US) and have a statutory health insurance system (universal healthcare) in place.  The US's corporate healthcare model is an abysmal failure by every measurable metric; significantly higher per capita healthcare spending with much worse overall health.  It's way past time to abandon this failed system but it's unlikely that very wealthy and powerful corporate interests are ever going to let this happen-it's only going to get worse folks:(

At the risk of pushing this thread into new territory, I think you perhaps misunderstood the gist of my post. I am a firm believer in rationing healthcare in certain situations, a lot of them involving geriatric medicine.

Emergent, RN

Specializes in ER. Has 28 years experience.

The Japanese way of life is much healthier than that of Americans. I'm pretty certain they are much more physically active and I know for certain that they eat a far healthier diet. They also have a stronger culture, one that is shared amongst all the people in the nation, it being the least genetically diverse place in the world.

JBMmom, MSN, NP

Specializes in Long term care; med-surg; critical care. Has 9 years experience.

2 hours ago, Emergent said:

The Japanese way of life is much healthier than that of Americans.

In addition to the reasons you mention for a healthier lifestyle, families tend to live together and take care of one another. No one ends up in a nursing home being visited on Sundays (if then). They are a valued part of every day throughout their life and I think that makes such a big difference. We just don't have the same connections throughout our lives and as our parents and grandparents age, isolation and a lack of connection also have devastating impacts on overall health. 

I worked in a nursing home, I completely understand that not everyone can take care of parents and grandparents as they age and deal with health issues. I don't mean to add guilt to anyone dealing with these situations, but I think it's a reality that without the love and support of family, the care of strangers just doesn't mean the same. 

sleepwalker, MSN, NP

Specializes in Occupational Health. Has 17 years experience.

On 9/30/2021 at 9:52 PM, ChristopherGllardoJr. said:

That's why I am not going to work in The Medical Field in direct patient care as a CNA until I pay back my parents what I owe them and save up $5,000 then they will give me a car and I can go back into Home Health Care.

I stopped reading this diatribe due to the tone and this statement...pretty much sums up the maturity level of the OP