This is a spinoff of another thread, since I didn't want to hijack it with my own question.
Where I work, there is a mix of experienced aides that have been around for a while, and some new ones who are very inexperienced, one right out of high school and a couple of career changers. These new ones haven't even worked in LTC, and were hired for our acute care cardiac unit with no experience (but that is another subject).
Some of the issues I have are with the lack of self directed work habits, lack of proactive work habits, and lack of self sufficiency.
For example, last night I was taking care of a dying patient. The CNA who was assigned never came to me for report, never communicated with me about this patient, and I never even saw her until about 10pm (we start at 3). CNAs are supposed to round on the patients at the start of the shift and change the names on the white board and start a new I&O tally. I went into the patient's room at the very beginning of my shift and was in there frequently throughout, and never once saw the aide in there, and the white board never got changed. I repositioned the patient myself, just pulling his shoulders over one way and his legs over the other to straighten him out, pulling the draw sheet over to take pressure off one hip and onto the other, and fluffed and replaced the pillows under his arms and legs. It was easily done with one person. I did oral care. I lotioned his hands, arms, and legs, and washed his face with a cool washcloth. Now, none of this stuff do I mind doing for a dying patient; I enjoy it, actually. But, the aide could have easily done these things as well. I'm just assuming that due to her inexperience, she doesn't know what to do. She finally approached me at ten, while I was in the middle of something else (my new MI admit's 3 hour troponins had been missed by the lab during the journey from the ED to the floor, and I had meds to pass) to ask me to help her turn the dying patient. I told her I was in the middle of something, but would be glad to help her in a little while. When I had a moment inbetween everything else I was doing, I went in to assess the dying patient, and since the aide wasn't around, I repositioned him myself.
I had another patient with pretty good bed mobility who could assist with turning himself, so I was able to do a complete linen change and clean him up without any help. Instead of finding someone to come help me boost, I put the bed in a reverse trendelenburg and had him push with his legs while I pulled on the draw sheet, and we were able to get him back up to the head of the bed, me and the patient working as a team. I have used this approach before with many patients who can push with their legs. Another thing I do is if the patient is able to stand, I just have them stand up and move up to the head of the bed. But for some reason, the aides haven't figured this out and will come to me to get me to help with a boost, even with patients that can boost themselves, or with patients that can stand up and walk to the head of the bed.
I suppose the answer is to take the time to teach the aides these little tricks of the trade that I learned when I was an aide. I had to learn these things out of resourcefulness, in order to complete my tasks with little to no help (I worked LTC and hardly ever had assistance with linen changes, undergarment changes, dressing, repositioning, etc. and learned to judge whether a patient has good bed mobility and can help, and when help is truly needed). The problem is that I am so short of time, it's just more efficient to do things myself, or to just pop in and help with a quick boost or turn, than to take the time to teach the aides.
Perhaps I've answered my own question, but has anyone else encountered this, and what approaches have you found to be the most productive?
Well I don't want to make you mad or anything but why did you not find her prior to 10pm if you guys started at 3. You wouldn't let a knew nurse you were orienting go that long without some guidence. If she only had 5 days orientation then im sure it was not enough for her to know all the little things that can be done to make things easier. I would take the time to show her and even though it does take your time your teaching her and then when she gets to the point she will be teaching someone everyone gets a piece of the good advice. She probably wasn't comfortable enough to move that pt by herself. Had i been in the same situation i also would have waited for help. Sorry don't want to rattle any feathers, but 5 days really isn't enough and then it comes down to the nursing staff to show them the shortcuts. Heck ive been a nurse 10 yrs and left the hospital for ltc and am now learning different short cuts everytime i work
She's been working on my unit for six months, and the expectation is that the CNA will obtain report from the nurse at the beginning of the shift.
when I started as a PCT in a hospital setting (coming from Elder Care) I was totally new to using the Dynamap system since I did everything manually before in LTC...heck even our beds were the ones you had to crank up and down manually its ridiculous...anyway soo in the hospital you have what they call "RN/PCT BOOT CAMP" where you basically have a whole week of orientation classes with the new nurses and the new PCT's on things like applying restraints, drawing blood, using waiver testing and all that good stuff...and then you are also to report to your floor to get oriented there as well...soo we had it pretty good!
I am a PCT (CNA equiv), and was trained by a great nurse for one 8 hour day, who herself started out as a PCT. She knew the questions I would have and integrated her experience into the teaching. All levels of staff checked on me throughout my day for the first few weeks, to make sure I wasn't overwhelmed, and to see if I had any questions. I learned as I went along, building upon the tasks, and asked questions anytime I was unsure. I am blessed to work in a very good environment with good management, and I LOVE my job! (I work for the experience, because goodness knows the wages aren't career-worthy )
I have to wonder if some PCT/CNA's aren't prepared for (or fond of) the level of physical activity required for this job. I am a high-energy person, and frankly enjoy the supplemental exercise - I eat a hearty, guilt-free lunch!
I think much of the issues in this subject come down to the challenge of personal integrity in the worker and consistent leadership in management. Tough things to instill or "train".
She's been working on my unit for six months, and the expectation is that the CNA will obtain report from the nurse at the beginning of the shift.
Sorry for my comment then. She should know that then. If she is not doing what she needs to be doing by getting report from the nurse. i would first talk to her, then talk to the manager if nothing changed. THat length of time is long enough for her to know the basics of her job. Some people are just not cut out for that type of work. How many cna;s are there for the floor. Is she the only one. I have since been working in ltc in a cert alz./dem center and the cna's there are excellent. THey know there job and they do it with very little direction from me. I don't know what the difference is between the ltc and the hospital that the cna;s have such a different style.
be much more explicit even though it is more work for you at the beginning. Provide a written list of tasks to complete, timeline for completion & instructions to report back to you when they are complete.
This seems like a good idea. I'm a CNA in LTC, which is different, but I'm a "big picture" kind of person, and during my orientation period it seemed like there was no rhyme or reason to what we did. Nothing was explained to me. My trainer (and a lot of other people), got short with me if I did something wrong or asked a stupid (to them) question, so I was pretty nervous and uncomfortable. When I first got off orientation I was a mess. I kept stressing out thinking, "Okay NOW what?" It would have been so much easier if they had blocked off the shift into chunks of time and explained what you did and why you were doing it then. Maybe these girls are in the same situation- they might be dragging out tasks or doing something pointless because they're not sure what they really should be doing.
Just thinking about those first few weeks makes me feel depressed!
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Virgo_RN, BSN, RN
3,543 Posts
She's been working on my unit for six months, and the expectation is that the CNA will obtain report from the nurse at the beginning of the shift.