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.

Specializes in Med-Surg, Geriatrics, Wound Care.
10 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.

It is what you choose to believe. I really do not want someone talking to me about their personal relationship with imaginary creatures (gods, fairy tales, mermaids) while I am sick in a hospital bed. It find it very uncomfortable, especially as a captive audience. If you want to believe in stuff like that, so be it, but don't push it on others. You are at work, not home. People don't need to know about your life, relationships and beliefs. They need to be cared for professionally. I am sure you would not appreciate people discussing their Satanism, Paganism or worship of various other gods/demons at work, and probably would not wish to hear about my atheism.

10 hours ago, FlameHeart said:

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

You may look into "group homes".  They are smaller areas with fewer patients.

Specializes in Community Health, Med/Surg, ICU Stepdown.
1 hour ago, CalicoKitty said:

People don't need to know about your life, relationships and beliefs

Very true. When someone is sick or dying the focus needs to be on them and what they request. I am a lapsed Catholic (can't really go anymore since I'm gay) but I still hold the good parts of Catholicism close, like generosity and virtue (without all the political nonsense). I never mention religion but if patients bring it up and want me to participate I will. Faith is so important for some people, and can be a huge comfort in sickness and death. I've called Catholic priests for the last rights and prayed with patients per their request, and I would never bring up my issues with the Catholic Church.

I've participated in Hindi blessings, prayed in Spanish, listened to a beautiful Baptist choir at my patient's bedside, overheard super religious narcotics anonymous meetings, and so much more. It's great to have your own faith, but it should never be pushed on patients, and if you can participate in their faith when they request it without feeling uncomfortable, some people really appreciate it. 

Specializes in Medsurg.

I stopped reading after awhile. It's too long it gave me anxiety LOL. Anyways I do appreciate your feelings. It's hard for every level of the nursing field unfortunately. Can only pray it gets better. 

 

I do appreciate everything you do. So do our patients.

Specializes in Home Health Care.

I recently applied to 3 Positions at Loma Linda University Medical Center:

 

1. Patient Care Assistant - (21000240)
U9100 Neuro ICU (Full-time, Day Shift)

Neuro Progressive Care Unit, not ICU

 

2. Patient Care Assistant - (21006423)
9A Cardiac/Cardiothoracic ICU (Full-time, Day Shift)

 

3. Patient Care Assistant - (20006430)
8A Medical ICU (Full-time, Day Shift)

 

I've been doing alot of research recently and scrambling to get another job, but I just can't seem to want to do anything other than Patient Care as a CNA.

 

So I've learned that the more Acute Patients are the more care they need and this lowers the staff per patient ratio.

ICU tends to have 1-3 Patients per Nurse and the Nurses do far more in ICU than other Units like Med-Surg, so I thought not only would I get to have less patients overall to focus more on a few, but I would get the opportunity to work more closely alongside The Nurse as an actual assistant and learn far more than I would in areas of less Acuity.

 

I used to think I was slow and would never get any faster.

 

But I look back on my Dishwashing Days, and while at first I was slow and overwhelmed by the speed of multiple activities going on I did over time get faster as I memorized where all the dishes went and I learned how to do my job properly.

 

Even though I quit my Nursing Home job I still moved far faster than I had ever done before in Patient Care (going from 1 Patient to 3 effectively means I tripled my speed in 1 Day, but of course I could not adapt to 9 Patients in 1 Day).

 

So if I have around 3-5 Patients in the ICU and since The Nurse would have to be around most of the time I would get to work alongside them so I wouldn't do most things on my own, I think I just might make it in ICU.

 

I even applied to Neuro Progressive Unit, which seems to be a form of Step Down which is slightly less Acute than ICU, but more Acute than Med-Surg.

 

What do you all think?

Specializes in Periop.

.....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.

 

Did I really just read that?

 

Specializes in "Wound care - geriatric care.
13 minutes ago, prayingmantis said:

.....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.

That's good! Like a poem to me.

Specializes in school nurse.
55 minutes ago, Leonardo Del Toro said:

That's good! Like a poem to me.

Meh. Poets (generally) know how to write better than that...

Specializes in Peds/outpatient FP,derm,allergy/private duty.
On 10/5/2021 at 10:01 PM, FlameHeart said:

I recently applied to 3 Positions at Loma Linda University Medical Center:

 

1. Patient Care Assistant - (21000240)
U9100 Neuro ICU (Full-time, Day Shift)

Neuro Progressive Care Unit, not ICU

 

2. Patient Care Assistant - (21006423)
9A Cardiac/Cardiothoracic ICU (Full-time, Day Shift)

 

3. Patient Care Assistant - (20006430)
8A Medical ICU (Full-time, Day Shift)

 

I've been doing alot of research recently and scrambling to get another job, but I just can't seem to want to do anything other than Patient Care as a CNA.

 

So I've learned that the more Acute Patients are the more care they need and this lowers the staff per patient ratio.

ICU tends to have 1-3 Patients per Nurse and the Nurses do far more in ICU than other Units like Med-Surg, so I thought not only would I get to have less patients overall to focus more on a few, but I would get the opportunity to work more closely alongside The Nurse as an actual assistant and learn far more than I would in areas of less Acuity.

 

I used to think I was slow and would never get any faster.

 

But I look back on my Dishwashing Days, and while at first I was slow and overwhelmed by the speed of multiple activities going on I did over time get faster as I memorized where all the dishes went and I learned how to do my job properly.

 

Even though I quit my Nursing Home job I still moved far faster than I had ever done before in Patient Care (going from 1 Patient to 3 effectively means I tripled my speed in 1 Day, but of course I could not adapt to 9 Patients in 1 Day).

 

So if I have around 3-5 Patients in the ICU and since The Nurse would have to be around most of the time I would get to work alongside them so I wouldn't do most things on my own, I think I just might make it in ICU.

 

I even applied to Neuro Progressive Unit, which seems to be a form of Step Down which is slightly less Acute than ICU, but more Acute than Med-Surg.

 

What do you all think?

I think you should definitely interview for every job you can, Flameheart.  After many years of varied experiences, I have a rock solid belief that personalities, nursing jobs, and facility particulars are a driving force in anyone's journey in this career.

For example, I've never worked as a nurse in a Long Term Care center because I can't imagine myself being responsible to pass meds to 30 patients.  I admire those who can, but I don't think I could handle it.

When I worked in the hospital, I was much happier caring for 3 higher acuity patients than 6 less acute diagnosis patients.  

I wish you the best in your job search.

Specializes in Hospice, LPN.

I came up as  CNA in LTC and agree that the system sucks. As a nurse I fully understood how toxic the healthcare industry can be because I'm responsible for the actual delivery of healthcare. That said,

Nine patients is a pretty decent ratio.

Sometimes patients get really backed up and have hard stool and painful BMs. There are medical reasons for that. As a CNA you may not be aware of them. If your patient is in distress, comfort them. Or tell the nurse. CNAs are the eyes and ears of the floor.

It sounds like a lot of your frustration revolves around the amount of work you do, and you're looking for lower patient ratios because you think it will mean less work. That may not be what you mean, although you seem pretty emphatic about this. Maybe it would be helpful to take a step back to focus on organizing your thoughts and the way you talk about things.

You shouldn't be talking about yourself to your patients.

You shouldn't be posting on a public forum with your own name and identfying where you live and the specifics of your applications.I know you changed your screen name but your real name is still attached to your posts.

Specializes in Home Health Care.
22 hours ago, PoodleBreath said:

I came up as  CNA in LTC and agree that the system sucks. As a nurse I fully understood how toxic the healthcare industry can be because I'm responsible for the actual delivery of healthcare. That said,

Nine patients is a pretty decent ratio.

Sometimes patients get really backed up and have hard stool and painful BMs. There are medical reasons for that. As a CNA you may not be aware of them. If your patient is in distress, comfort them. Or tell the nurse. CNAs are the eyes and ears of the floor.

It sounds like a lot of your frustration revolves around the amount of work you do, and you're looking for lower patient ratios because you think it will mean less work. That may not be what you mean, although you seem pretty emphatic about this. Maybe it would be helpful to take a step back to focus on organizing your thoughts and the way you talk about things.

You shouldn't be talking about yourself to your patients.

You shouldn't be posting on a public forum with your own name and identfying where you live and the specifics of your applications.I know you changed your screen name but your real name is still attached to your posts.

First paragraph and next sentence: yup.

2nd paragraph: I did inform the LVN she was very empathetic and willing to listen. I think he's in good hands with her.

3rd paragraph: Nope. I was clear that the patients needed more care than I could give to all 9 of them in 8 hours and I do think even the care they do get from other CNAs on the other shifts is not enough as the patients themselves told me this and the ones I was able to help really liked me.

As for your last sentence and paragraph:  I disagree.

If you aren't willing to get personal with your patients you can't take care of their emotional needs as a person that gets almost no visitors and just wants someone to acknowledge their existence and to talk to them as a person and not as a job.

As for my choice of revealing my identity, I'm not scared and I consider anonymity dishonest.

That being said I did hide my last name to keep in line with the rules of this forum.

Also the hospital I applied to has probably 100's of people working there and hospitals especially ICU units don't have alot of long term patients.

Specializes in Home Health Care.
On 10/8/2021 at 5:42 PM, nursel56 said:

I think you should definitely interview for every job you can, Flameheart.  After many years of varied experiences, I have a rock solid belief that personalities, nursing jobs, and facility particulars are a driving force in anyone's journey in this career.

For example, I've never worked as a nurse in a Long Term Care center because I can't imagine myself being responsible to pass meds to 30 patients.  I admire those who can, but I don't think I could handle it.

When I worked in the hospital, I was much happier caring for 3 higher acuity patients than 6 less acute diagnosis patients.  

I wish you the best in your job search.

Thanks, another person who gets it!

I got alot of characteristics that make me think ICU may be a good fit for me.

I'm willing to try it out.

Specializes in Home Health Care.

From my understanding the ICU is place with very few patients compared to other areas of Hospitals, probably because they simply don't have enough people to staff large ICUs in many cases since Nurses are assigned to patients usually 1 or 2 Patients per Nurse.

 

This is because the kind of care required by each patient requires application of years of schooling and training in Medical knowledge. This is also why some ICUs don't have ANY CNAs at all, because they simply aren't trained enough to handle a majority of the required care.

 

Even simple things such as turning or bathing or changing a diaper are important for the Nurse assigned to that Patient to participate in or observe because everything is connected and related to keeping this Patient stable and alive and must be documented.

 

In the cases where CNAs may be hired to work in ICUs they will either do things that don't require supervision such as taking phone calls, restocking supplies including fresh linen, taking out the trash, cleaning rooms, or they will work closely alongside to help the Nurse as truly more in their title of "assistant" more so in this area more so than any other area of healthcare (sadly) this includes bathing or turning or changing the diaper or emptying the colostomy bag of the patient, taking vitals, and probably also includes admitting and discharging patients.

 

The pace and atmosphere most of the time will be quiet, organized, detailed, calm, careful, and intentional.

There may be times more so than any other unit of the Hospital, except the ER, where the patient starts to worsen in condition suddenly getting much closer to death. This is called "Coding" as each situation has a different assigned Code to it that requires specific instructions be followed quickly to save this patient's life such as CPR.

Sometimes the patient may not be able to be saved from death in these situations and other times they will be saved.

Although patients are more likely to die in the ICU than other parts of Hospital, except in the ER, death here is not guaranteed, unlike Hospice which is always comfort care given to Patients who are going to die. Other than the ER, this is really the place where lives can be saved more so than any other area of the Hospital.

 

This sounds like exactly the place where I want to be as a CNA. Other than Home Health Care.

 

Don't get met wrong, I love all areas of HealthCare as I truly have a heart that loves to serve people. I give every patient my full attention, time, devotion, love, and care, and treat them as a person. The problem though is because of idiotic greedy Medical Administration patients are only given care to barely keep them alive by intentionally giving more patients to every staff member from CNA to Doctor than can be realistically given the best amount of care possible. This sacrifices quality of care for quantity. It's good for profits, but these aren't objects being traded, these are people.

 

This could be solved by increasing funding to hire more staff, decreasing staff to patient ratio to a realistic safe number (staff have been complaining about Patient Ratio for years, listen to them before they quit, which many do), and not accepting any more patients when they don't have the staff to actually care for them effectively.

 

It's sad that the patient has to be near death for them to get the time and consideration they need regardless of their physical condition. Emotional condition is almost never considered or properly treated in most HealthCare settings unless you're mentally unstable and even then you may be neglected (I've seen this first hand where a Hospital long term care unit will have Mentally Unstable Patients who belong in a Mental Hospital but they won't get proper treatment or restraints for them because of some stupid Law that takes away Medicaid or Medicare funding if your facility uses restraints effectively endangering the patient and other patients and staff because the patient has violent tendencies). I've also seen all call lights taken away from patients, because they have a tendency to be too needy.

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