Which way forward now???

CoffeemateCNA · Mar 26, 2010

I would really love to work in a hospital. how hard is it to get myself into a hospital as an NAR as soon as I get registered??

It really just depends on the area you are in. Some hospitals require previous experience, and those positions are very tough to come by. Other hospitals hire brand new CNAs straight out of class.

If I do get to work in an LTC, am I going to be immediately assigned like 10 patients to care for on the first day I start working and be expected to know how to organize my clock around them?

Usually you will have have an orientation period for a few days. You will shadow another CNA on the unit and learn the overall routine and how each resident likes to be cared for. Some facilities do it in 3 days, others do it for a week or two. And, not to scare you, but you will probably have more than 10 people to care for (depending on where you work). :)

Should I totally ignore taking up jobs in assisted living facilities and concentrate more on getting jobs on acute care LTCs just so that I can get myself into a hospital setting and hope it will come in handy when I do get to become a nurse?

Although the work at a LTC facility is much more difficult physically, the experience you gain will be more handy when you are a nurse.

fuzzywuzzy, CNA · Mar 27, 2010

It seems like you think it's better to skip LTC since it's so awful for newbies. But I don't think you'd fare any better starting off in a hospital. CNA work is hard no matter where you work, and especially at first because of the time management stuff. You will have to learn how to be fast and competent at both places, and that learning process isn't easy. You happen to be on a forum where most of us work in LTC and the vast majority of the ones that work in other places started off in LTC, so I think it just seems like LTC sucks so bad compared to other places.

If it does come down to you working in a nursing home, do your research. Some of them are waaaay worse than others.

shix · Mar 27, 2010

Thanks CoffeemateCNA & fuzzywuzzy for the input. Its greatly appreciated. I didn't mean to come off like I have anything against LTCs - quite the contrary, I know nothing about LTCs other than what I read and hear from people. I had a friend once who told me never to work in an LTC because I'd end up having back problems. you know..then you read all this forums about new CNAs and their bad first days at work and things like that. is it possible for some of you who've already been there a while now like give me an example of how you'd organize your time if it were you getting to do this the first time? just some insight and it would go a long way to help me out. At this point I don't even have a clue how many minutes should be spent doing what. If you'd be able to give me a mock example of how a whole shift could be organized in such a way that everything gets done in the right manner at the right time. How long does it normally take to get acquainted with the schedule for new CNAs? How long did it take for either of you to get 'comfortable' enough to know that you were ready to do it? did your charge nurses give you a difficult time? if yes, how did you deal with that? Just curious questions. I think its good to go into it at least being aware of some facts here and there :)

caliotter3 · Mar 27, 2010

You need to take the job that is offered to you or hold out for what you want. Chances are better to get the job that you prefer, though, if you have experience. Another option is to hold off working and go on to nursing school, but I don't think you will want to do that. The whole purpose of getting the nursing assistant certificate was to gain experience. You should just jump in and get your feet wet. Good luck with your class.

josebeltran88 · Mar 27, 2010

It really just depends on the area you are in. Some hospitals require previous experience, and those positions are very tough to come by. Other hospitals hire brand new CNAs straight out of class.
Usually you will have have an orientation period for a few days. You will shadow another CNA on the unit and learn the overall routine and how each resident likes to be cared for. Some facilities do it in 3 days, others do it for a week or two. And, not to scare you, but you will probably have more than 10 people to care for (depending on where you work). :)
Although the work at a LTC facility is much more difficult physically, the experience you gain will be more handy when you are a nurse.

I second that! At the moment I'm working at SNF (locked) where I am assigned 12 residents daily.

CoffeemateCNA · Mar 27, 2010

Thanks CoffeemateCNA & fuzzywuzzy for the input. Its greatly appreciated. I didn't mean to come off like I have anything against LTCs - quite the contrary, I know nothing about LTCs other than what I read and hear from people. I had a friend once who told me never to work in an LTC because I'd end up having back problems. you know..then you read all this forums about new CNAs and their bad first days at work and things like that. is it possible for some of you who've already been there a while now like give me an example of how you'd organize your time if it were you getting to do this the first time? just some insight and it would go a long way to help me out. At this point I don't even have a clue how many minutes should be spent doing what. If you'd be able to give me a mock example of how a whole shift could be organized in such a way that everything gets done in the right manner at the right time. How long does it normally take to get acquainted with the schedule for new CNAs? How long did it take for either of you to get 'comfortable' enough to know that you were ready to do it? did your charge nurses give you a difficult time? if yes, how did you deal with that? Just curious questions. I think its good to go into it at least being aware of some facts here and there :)

As far as back problems go, the best way to lift is to NOT lift. :up: It's hard, but it's entirely possible to work in LTC and be free of back problems. Always get a helper when it's time to transfer difficult residents. If they don't want to help, keep bugging them until they give in or ask a different person. :)

When you are organizing your time, it's really just depends what shift you work on. Day shift has a lot of get-ups in the morning, and a lot of residents are either doing activities or receiving therapy. Evening shift is more centered around getting through dinner time and getting everyone into bed. Night shift changes briefs and keeps them dry as well as "entertains" those residents that won't go to sleep. :lol2: No matter what shift you work, try to combine tasks as much as possible. While they're going to the bathroom, you can be getting the new brief, wipes, and barrier cream ready to put on, or change their clothes. Also, remember that some residents don't need help with everything. If they only need help transferring into bed, you won't need to stand there and supervise them while they are brushing their teeth, etc. You can use that time caring for another resident. The length of time it takes to do a procedure always changes -- there is no set time frame. I've had "simple" toileting of one resident turn into 45 minutes!! Or a difficult resident that you expect to take 30 minutes to care for only ends up taking 10, etc.

It will probably take a few months for you to get acquainted with your new CNA position. They teach you so many things while you are in school, but there are even MORE things that they don't -- you just have to learn them through experience. I have -- and I still do -- learn lessons the hard way. Just learn from your mistakes, and move on. You'll know better next time. :) Your confidence will go up and you will become more comfortable. Before you know it, you'll have newbies coming to you for advice. :cool:

Charge nurses may give you a difficult time, but more often than not it's the other CNAs. There is such a high turnover rate in LTC that new CNAs are trained all the time. It takes a great deal of time and energy getting someone oriented to the shift. Then, when they quit a week later, it makes the CNAs feel as though they've wasted their time. You may get a lot of attitude from other CNAs, but keep your head up!! Working in LTC is never perfect, but it does get better as you gain experience. Whenever some looks down on you or complains that you're being to slow, just work harder next time and try to show them off with the fantastic job that you do. :yeah:

It will vary at every facility, but here's what I do on a typical evening shift:

I arrive at 2:30p and get report from day shift. It takes about 15 minutes, and then I do rounds on my assignment to make sure everyone is clean and dry. Then I go fill up the water pitchers and start passing them out. I get done at about 3:30p. Next comes vitals. It takes around 20 minutes to get them done, unless I have an incredible number to do, or somebody is on q15 min neuro checks, etc. At 4:00p I make rounds again and start getting people up and ready for dinner. Usually I have them all pushed down to the dining room by 5:00p. From 5:00p to 6:00p we pass trays and feed the residents that need assistance. As people are finished, we push them back to their rooms one by one. Once the dining room is clear we start putting everyone to bed, which lasts until about 8:30p. From that time until the rest of the shift we answer call lights and change briefs/toilet everyone q2h. We also have all of that obligatory charting to do. :uhoh3: It takes anywhere from 15-45 minutes to complete. Night shift arrives at about 10:30p, and I give them report. After that, I run like crazy out the door to get home.

I love my job in LTC. No, it's not always pleasant, but I know that I really AM making a difference in my residents' lives.

There. I feel like I've just written my first novel. :thankya:

Good luck to you!!

adorblepuppy · Mar 27, 2010

I think second shift is easier than first shift or that is what i have been told. Not only do you not have the "corporates" hanging over your head. You don't have all the showers that come with first shift. So places have a shower person so it makes that part easier to. Cause you don't have to do all your own.

fuzzywuzzy, CNA · Mar 27, 2010

1st shift:

Start washing and dressing people. The more you can do before breakfast, the better. Some residents are allowed to eat breakfast in bed and others have to be up (aspiration risks), so I try to dress as many of the ones who get up as I can. You partner up with someone and get all the aspiration residents on both of your assignments up. Then I run and change/repo all the people who stay in bed. First rounds are done. Pass trays, feed, collect trays (quickly repositioning people as I go along) and write down intake. This is when it gets hairy. You still have people to wash, dress, & get up, plus it's time for 2nd rounds, you need to pass nutritional shakes out, and the recreation people are coming around taking residents away before you've had a chance to toilet them. Usually I try to toilet (or at least check for incontinence) all the residents who are already up, because if I don't do it right away Rec will take them. Then I wash the ones in bed and have someone help me get them up at once. Or if another CNA happens to be across the hall or washing the roommate, we help each other. Luckily there's more staff on 1st, so the showers are more spread out and I don't always have one. And for some reason the nurses usually do their own vitals on days too. If I have the hardest assignment I let someone else deal with the nutrition shakes. If not, I pass them out with the waters (I don't know why everyone doesn't do this).

At 11 the CNAs have to start taking lunch break. I try to get 3rd rounds done before I go, but I don't usually get a chance to do every single resident because they'll be at bingo or something. When I get back from lunch we transport most of the resident to the dining room and feed. After dining room is done we do last rounds- toileting, walking ambulatory people, laying everyone down for naps. Normally we park someone at the end of the hallway, ambulate them to the bathroom, and then pop them in bed. Gets everything out of the way at once. Then pass more nutrition shakes, do some chores (linens and stuff) and you do your paperwork.

2nd shift is more cut-and-dried. Pass out linens and stuff for the night. Get everyone up, toileted, and walked. Then one person usually does the vitals while another takes down all the beds. Supper gets served- almost everyone eats in their room. Collect trays and chart intakes. This gets done around 6 o'clock, which is when CNAs start doing lunch breaks and the ones left on the floor start HS care. Everyone is washed and put to bed. Usually I do this at breakneck speed either because people demand to be put in bed or I'm just concerned they might be wet (because after supper they usually all are, plus they need a position change because some of them go to all the activities and are up all day). A lot of times I just lay them down, peek down their pants and if they're wet all i do is change them and I do their HS care when I come back. Usually that's all done around 830. I do another round, then I pass those damn nutrition shakes. 10 o'clock it's another round (this is when I have the people who get shakes brush their teeth) and then chores and paperwork. Then you have downtime.