The Failure of Modern Healthcare due to Administration

Nurses General Nursing

Updated:   Published

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.

Humanity is trying to find its way in a new situation. What do you do when large numbers of people grow older, lose their ability to live independently, and don't have family available to care for them?

I look back on my great grandparents. Most of them didn't actually live to grow especially old. The ones that did moved in with one of the children on the farm where the daughter (almost always women did the labor here), took care of the elderly parent, and since farming is working from home, could combine work and family care needs. Medical costs weren't an issue because there were few to no treatments- no antibiotics, no chemotherapy, no feeding tubes, no chronic medications. Back then it was rare for people to live very long once their health collapsed. I come from the rural third world background. 

Now you can live longer, but with expensive chronic conditions to manage. We don't have the social infastructure to handle this well. The farms were sold long ago, the children moved to the cities and the developed world. Many people today do not have much family or children to oversee their care. 

5 Votes
Specializes in "Wound care - geriatric care.

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.

 

Dude...firstly, I feel your pain and I know well how hard your job is. I do appreciate CNA's a whole bunch. I help CNA's anytime as possible as my RN position permits. But if you think our job is any easier come and step on my shoes for a moment.

We keep track of so many things, we are overworked in all levels. Let's look at the easy task of passing meds for a moment:  

We have to pass insane number of meds to an insane number of patients, make sure there are no med errors, we have to purchase the meds, call doctors and beg them to send triplicates for narcotics, we have to decipher Dr's orders I recommend you try that sometime, we have to document hundred's of things about medications given. The little pain pill the patient asked you to tell the nurse, one mistake and your *** is on the line with the state. Certain medications can be given others can't, you have to know all the signs and symptoms these patients are telling you. You must call doctors and ask that some medications must be given, others must be stopped. And the list goes on...oh, and don't forget, we're doing this while there are 5 people asking you questions, answering phone calls, dealing with complicated appointment arrangements, dealing with this patient having a crisis and having to decide if we should send it to the ER and then write a book about it. And that is just a fraction of what we have to deal with...my fingers are getting tired.

4 Votes
Specializes in Critical Care.
On 10/1/2021 at 4:01 PM, Emergent said:

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.

Not entirely, there is a work ethic that leads to young and middle aged people dying from overwork either by suicide or heart attack.  But since they live by the sea they eat more seafood, fish which is healthier than the American diet of red meat, chicken and pork.

https://thetruejapan.com/all-about-karoshi/

1 Votes
Specializes in Critical Care.

To the OP Christopher, it sounds like this was your first time working at a nursing home.  Nine patients is actually very good ratios for the typical nursing home.  It takes time to get used to a new job juggling multiple patients, especially when you are used to only caring for a patient one on one.  It sounds like you didn't even give it a chance.  With time and experience you would have been able to pick up your speed in all your tasks and it sounds like there was good teamwork as well!  It is too bad you quit before you even gave it a real chance.  Also the fact that 3 were independent that left you with only 6 needed total care so it was actually a very reasonable assignment.

But you are mistaken that you are doing the nurses job and the nurses are lazy.  Healthcare corporations are training CNA's and techs to do some of the more mundane tasks from nursing so they can concentrate on things only a nurse can do and, of course, so they can take a larger patient assignment.

It is perfectly fine to choose to work home health care if you prefer, but you are limiting  your options.  If you plan to go into nursing you will find you will need to get experience in a hospital or nursing home or possibly a clinic before you can work as a home care nurse.  Then in nursing school and working as a nurse your eyes would be opened and you would realize all that nurses do and the incredible responsibility they have to keep the patients' safe!

Regarding the offensive man you took care of many people are not Christians and there are many rude, coorifice, angry people in this world.  Consider how many criminals there are and then again all the domestic abusers and rapists that haven't ever been charged and they grow old and will still have the same angry, violent tendencies.  You have to take care of everyone, but if dealing with a violent patient you can call security, even file a police report in some situations.  You can't avoid crude, rude nasty people working in healthcare it just comes with the territory.

I believe you have written some posts that you are a devout Christian so to that end I will mention two Catholic saints known for caring for poor, sometimes crude men, even killers.  Both St Catherine Laboure of the Miraculous Medal in France, who was born shortly after the violent French Revolution, and St Mother Teresa of Calcutta nursed sick and dying people and didn't walk away from them over their bad behavior or words.  They served them and prayed for them and tried to show God's love to them.  Working as a nursing assistant or nurse isn't easy or pleasant and you deal with many difficult people as there are in this world.

But you can't just preach to your patients, even if working for a Christian system you have to respect the patient's own religion.  If you feel the need to preach it is better to do that working as a preacher and not as a nursing professional.

5 Votes
Specializes in Community health.
On 10/1/2021 at 7:58 PM, JBMmom said:

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 know it’s off topic. But I lived and taught elementary school in Japan for several years. I love their culture. But they absolutely hide away those with disabilities or differences, because they’re embarrassed by them. I had a student who was always introduced as an only child. That was the way the parents talked about him and filled out his school paperwork. The boy, who was 5, eventually spilled the beans that he actually had a 7-year-old brother, severely autistic, who lived in a group home. The younger brother had been advised not to talk about him, and, instead, to pretend he didn’t exist.  (And no, that is not an anecdote about a dysfunctional family; that is common.)  So— as I said— I love Japan. I love the Japanese. But to pretend that they have the market cornered on universal respect and valuing all individuals shows a massive lack of awareness about their culture. People absolutely end up “being visited on Sundays,” although it is less often the elderly. 

4 Votes
Specializes in Critical Care.

We are all drowning. Maybe not the most optimistic answer... just my honest perspective. 

Healthcare has become a business and people are more selfish than ever. But theyve also been trained to be that way. It's a vicious circle. 

Im a nurse (ICU mostly). The people I have worked with: Xray Techs, CNAs, Clin Techs, LPNs, RTs have been LIFESAVERS. 

Sometimes its the environment (you get stuck with lazy nurses + other staff: colleagues including fellow CNAs, or nurses, MDs, mid-levels..).. Sometimes it is all on Admin and they have too much power and are too unwilling to deal with long term consequences...(at the end of the day, they're looking out for themselves, and if correctly calculated, they won't have to deal with the long term damage) 

Sometimes you get lucky enough to work with a great team who realizes the problems and stand together and take care of one another and all of their patients. 

It'll be interesting to see how healthcare goes in the near future... 

Specializes in Home Health Care.
On 10/3/2021 at 4:26 PM, brandy1017 said:

To the OP Christopher, it sounds like this was your first time working at a nursing home.  Nine patients is actually very good ratios for the typical nursing home.  It takes time to get used to a new job juggling multiple patients, especially when you are used to only caring for a patient one on one.  It sounds like you didn't even give it a chance.  With time and experience you would have been able to pick up your speed in all your tasks and it sounds like there was good teamwork as well!  It is too bad you quit before you even gave it a real chance.  Also the fact that 3 were independent that left you with only 6 needed total care so it was actually a very reasonable assignment.

But you are mistaken that you are doing the nurses job and the nurses are lazy.  Healthcare corporations are training CNA's and techs to do some of the more mundane tasks from nursing so they can concentrate on things only a nurse can do and, of course, so they can take a larger patient assignment.

It is perfectly fine to choose to work home health care if you prefer, but you are limiting  your options.  If you plan to go into nursing you will find you will need to get experience in a hospital or nursing home or possibly a clinic before you can work as a home care nurse.  Then in nursing school and working as a nurse your eyes would be opened and you would realize all that nurses do and the incredible responsibility they have to keep the patients' safe!

Regarding the offensive man you took care of many people are not Christians and there are many rude, coorifice, angry people in this world.  Consider how many criminals there are and then again all the domestic abusers and rapists that haven't ever been charged and they grow old and will still have the same angry, violent tendencies.  You have to take care of everyone, but if dealing with a violent patient you can call security, even file a police report in some situations.  You can't avoid crude, rude nasty people working in healthcare it just comes with the territory.

I believe you have written some posts that you are a devout Christian so to that end I will mention two Catholic saints known for caring for poor, sometimes crude men, even killers.  Both St Catherine Laboure of the Miraculous Medal in France, who was born shortly after the violent French Revolution, and St Mother Teresa of Calcutta nursed sick and dying people and didn't walk away from them over their bad behavior or words.  They served them and prayed for them and tried to show God's love to them.  Working as a nursing assistant or nurse isn't easy or pleasant and you deal with many difficult people as there are in this world.

But you can't just preach to your patients, even if working for a Christian system you have to respect the patient's own religion.  If you feel the need to preach it is better to do that working as a preacher and not as a nursing professional.

You are assuming I was preaching to people, yes I do that when it is the right moment, but that rarely comes up.

Usually I'm just myself and I make conversation with everyone I can as it flows and it's impossible to talk about myself without talking about God or Jesus eventually especially when someone is dying, I would see it as a sin against God not to speak the truth about him to a dying person, and I'm not ashamed of that and I make no apologies for any of that. This is who I am and the truth, not what I believe.

 

That being said I choose not to work Hospice and with Mental Patients as I don't want to be around that all the time, it takes special people to work those areas very often.

 

If you remember in my post I just said I took care of that patient because his CNA abandoned him, sometimes CNAs are just lazy or too sensitive especially Women and don't understand an old black man screaming as he tries in a diaper on the bed laying down to defecate the hardest most painful BM I have ever seen someone go through and I felt it when I cleaned him up, it was hard.

 

And management had me strike that she abandoned him from the record as technically it was a "walk-away policy" she enacted, and apparently he is able to walk and use the toilet on his own they said. These people are evil liars...most likely. He might be able to do that, but not all the time or from what I've seen anyways.

 

I actually got help from a Nurse and PT on that shift with 2 of my other patients.

 

I know it's hard from both our perspectives of CNA and Nurse, and it's really hard for me to understand the Nurse perspective, but I'll just have to take you all's words for it.

 

This system overburdens everyone in every staff position.

 

I just wish I could work somewhere with 3 patients at same time at the most for this point in my life.

 

But honestly, if we could do our jobs the way we can for Home Health Care, I do think patients would be healthier and staff to.

Specializes in Home Health Care.

Thanks, it feels really good to talk to people who "get it" and understand what I go through in Healthcare as a CNA. Not everyone can. I really appreciate you all.

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
6 hours ago, FlameHeart said:

it's impossible to talk about myself without talking about God or Jesus eventually especially when someone is dying

Try harder.

8 Votes
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
6 hours ago, FlameHeart said:

Usually I'm just myself and I make conversation with everyone I can as it flows and it's impossible to talk about myself without talking about God or Jesus eventually especially when someone is dying, I would see it as a sin against God not to speak the truth about him to a dying person, and I'm not ashamed of that and I make no apologies for any of that. This is who I am and the truth, not what I believe.

No reason to be ashamed in your faith at all. But you do need to realize that this isn’t about you, it’s about the patient and there are many, many patients who absolutely would not want you to talk about god at any point but especially not on their death bed, myself being one of those patients. If the patients brings up god or religion, that’s different although I would still tread carefully to maintain professionalism.

6 Votes
Specializes in Private Duty Pediatrics.
8 hours ago, FlameHeart said:

But honestly, if we could do our jobs the way we can for Home Health Care, I do think patients would be healthier and staff to.

Yep. This is why I've worked private duty home care for most of my life. ?

1 Votes
8 hours ago, FlameHeart said:

You are assuming I was preaching to people, yes I do that when it is the right moment, but that rarely comes up.

Usually I'm just myself and I make conversation with everyone I can as it flows and it's impossible to talk about myself without talking about God or Jesus eventually especially when someone is dying, I would see it as a sin against God not to speak the truth about him to a dying person, and I'm not ashamed of that and I make no apologies for any of that. This is who I am and the truth, not what I believe.

That being said I choose not to work Hospice and with Mental Patients as I don't want to be around that all the time, it takes special people to work those areas very often.

     Uh, I've got a major problem with this.  First of all, it sounds as if you are proselytizing to a captive audience, "Hospice and Mental Patients"-both of who are so chronically ill, they probably can't articulate their objection(s) or get up and walk away.  Second, and most importantly, this is your truth, no one that I know has seen or spoken to God.  If your religion give you comfort and solace, great!  However, stop, just stop, your religious zealotry and accept people (and their beliefs) as they are.  Your job is to provide for their physical needs, not try to convert them to your religion.

 

 

3 Votes
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