Families: Why the Battle?
Posted by Patti on October 31st, 2006 / 
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One of the issues CNA’s deal with on a daily basis is interactions with resident families. Like it or not, they are the most important part of our residents’ lives. I think an admission to a nursing home is not only a shock to the person, but to their family as well.
Families deal with many feelings when they decide to place their loved one into a nursing home: guilt, helplessness, financial worries. They hear the stories about abuse and neglect. They fear these things will happen to their loved ones. Usually families have little experience with how long term care facilities work- the daily pulse and beat. The nursing home becomes HOME to the resident and the second home to many of their families.
CNA’s on the other hand work in nursing homes for a living. We punch in, do our shift and go home. We love most of our residents and do the very best we can with what we have. Often, we work short of staff and this is heartbreaking for many of us. Few of us remember our first days in this work…the shock and dismay we felt at the lack of time to do really good work. We went home feeling guilty and a little shamed of the care we gave. Soon enough, we each realize this is how it is and we also know it could be much worse than it is. I think we become immune to that SHOCK effect.
Families go through the same thing. Some come to know how nursing homes operate. Some don’t bother to learn and others just don’t care. They expect the world to halt to their demands and they could care less about who ends up being neglected because of their demands. They tend to put the heat on management with complaints and needless accusations; and they have expectations that are really not in tune with the typical model most nursing homes follow.
At the message board for this site, a discussion was initiated about this very subject. We got hot handed, a little, because I believe aides can have a huge impact on the families perceptions of who we are and why we do things the way we do.
This one is for the families of nursing home residents
You know who you are, you are the one who likes to show up a few minutes after your family member was looked after but has had an accident and then claim they had been that way for hours. You think you know our jobs, but never had a hour of medical training. You think I am your servant but I serve only god and country. My boss is the nurse, hunt her down with your bitches.I have a real nice question for you, here it is in little words that I know you can understand:
If you think that you can do a better job then why the f—k don’t you?
Now be honest.
Understand this:
1. I am a CNA, not whipping boy or girl.
2. I am worthy of respect and you will respect me.
3. If you do not do #2 I will talk real bad about you to my co-workers about much of a moron you are.
4. Again, I am a CNA. I take of more patients that just your family member, so if you want extra special care and attention given to Sally or Fred or Ann then you going have to shell out for a private sitter.
5. O if you think I got an attitude, well think no more and now you should know.The familes are the single worse thing about this job. Nursing homes should have stricter visiting hours.
This is an extreme view, held by more than I would care to know of. I could not work with people who hold this opinion and I can see how negative the work environment could get, surrounded by aides who are seething to the brim with these feelings. Yet I understand where Kevin is coming from…I have had days where I just wanted to toss the towel in literally at a spouse of a resident- who was caught up in the middle of this battle. The demands of one family can have a very negative effect on the other residents we are assigned to care for.
This presents a problem for us. Management always applies grease to the squeakiest wheels, and this bandaid approach never truly heals the wound- instead it makes it worse. I do place blame on management for allowing this to happen. It is up to them to deal with the nitty gritty demands and expectations that truly do take away hours of care from other residents. Dealing with these people might mean telling them how things really are. It might mean letting the families know their petty concerns over missing laundry equate to another resident getting their medications late. It might mean holding a meeting and explaining to these families that they are disruptive and detrimental to overall morale of both staff and residents.
What can a CNA do when caught up in the middle of the family/facility battle?
My best tips:
Smile!Apologize. It may not be your fault but it is your responsability as an employee.
NEVER say that you are shorthanded!!!! It maybe true but families and patient don’t want to hear it. (I know I don’t want to here it from the bank teller when I have stood in line for 10min.)
If it is something you can’t mend as a CNA then get the RN involved- use your chain of command. Get the risk manager involved if it comes to that.
That about sums it up, nicely. Try to be upbeat and positive, and at the same time acknowledge the families concerns. If there is ever a time to pass the buck, now would be the time.
Hopefully management can do some things to make this issue better for all:
*Before someone is admitted, a good educational session about the workings of the nursing home should take place. Families should always know and understand the aides are responsible for MANY residents, not just one. Timeframes should be disclosed- it should be well known that 20 to 30 minutes is the normal expected amount of time an aide can spend with each resident.
*The family could be asked to come in and watch part of a shift. To see how things work; to learn about how nursing care and treatments; to see the food and meals and laundry service. This is a good time for families to be introduced to the dept. heads
*Get this book, several copies of it…and lend it out to families:
The Eldercare Handbook: Difficult Choices, Compassionate Solutions
*And this book:
Living Well in a Nursing Home: Everything You and Your Folks Need to Know
It wouldn’t hurt to have everyone read these books to be honest- nurses, aides, laundry staff…
October 31st, 2006 at 6:27 pm
Patti
A well written piece. I totally agree. Now all people have to do is printed out and give it to their DONs.
October 31st, 2006 at 7:55 pm
Well I am going to add more in another post: More things aides can and should do to keep families content as well as balance out the work.
November 2nd, 2006 at 12:57 pm
Although you are discussing CNAs in the facility environment I recently wrote a blog piece about a CNA who is an in-home caregiver and whose work I know makes such a difference—not just for the man whom she cares for, but for his entire family. Truly it is an underappreciated field. I know that there is a great deal of frustration which is inherent in your work, but I just wanted to let you know that some of us are aware of the work that you do for us and our loved ones.
November 9th, 2006 at 9:12 pm
Thank you Lara. This is appreciated more than you know!!
November 12th, 2006 at 2:54 pm
I agree with you compleatly we do deserve respect I am getting really tired of being called a dumb cna by families worse yet staff agreeing with it it just to make the families happy I got into trouble for tell a family that they should look at what they want for there family member and how there money is being spent do they want to see their money spent on enough staff that is trained to take care of their loved one or do they want it spent on flowerbeds and fishpond for the home
November 15th, 2006 at 3:37 pm
[...] The problem for Crystal from Aunt Pickle is how to tell her patients the things she needs to communicate with them, and writes a series of letters to try to help them see their perceptions and expectations from her point of view. This is something I have found useful in the past, writing a letter (but not necessarily sending it) to a patient or difficult colleague is a great way of learning how we can better communicate, not to mention getting some things off our chest about our real feelings! The reactions and expectations of people whose relatives have just moved into a nursing home and how we deal with them are a source concern for Patti Green from Nursing Assistants.net, something which had led to some interesting discussions on the site’s discussion board. [...]
November 16th, 2006 at 11:19 am
Holy cow. You have just taken me back 31 years to my first job as a CNA. When my alert and oriented patient was happily watching TV in her room in her bed jacket at 10:00 am while I cleaned up the other seven incontinent patients who had been laying in urine for hours (hey, no blame here – there were only two aides at night for 50 patients).
The daughter came in that morning and went straight to the Head Nurse to complain that her mother was not yet up and dressed.
I was told that because the alert and oriented patient was a “private paying” patient, I was to tend to her needs first.
I finished my shift, walked into administration and quit. Right there. I could not, in good conscience, place money before the needs of other patients.
I entered nursing school two weeks later and have never set foot in a convalescent home since.
Never mind that the alert and oriented patient didn’t WANT to get out of bed yet – she was enjoying her coffee and watching game shows on her own TV, never mind that there were other patients who were decubiti just waiting to happen. I was ORDERED to care for the private patients first.
Also: God bless the CNAs who taught me the value of good, basic nursing care long before I ever sat foot in a classroom. I wasn’t even a “C”NA, I was just a soon-to-be nursing student off the street, but I learned more in three months than I ever have since. To this day, I use tricks-of-the-trade those tireless aides taught me back in 1976.
I’d rather work with a top notch CNA than some of the RNs I’ve worked with over the years. And the best RNs were CNAs at one point, either before their nursing education or during it!
December 1st, 2006 at 6:36 am
I like you, Kim. Wish more nurses were like you.
February 28th, 2007 at 5:53 pm
all i can say is wow! this is my first visit to this website.. thank god someone came up with a place where we can say what we want….. i’ve been doing this for 13 years, and i have seen quite a bit and thought i heard it all.we still get distraght families in there that think noone takes care of thier family member better than they do, if that was the case, they wouldn’t be in the nursing home to begin with!!!!i live in florida and the pay really sucks!!!! where i work, we cap out at a certain amount, no matter how long you’ve been in the business… i say we need more pay for what we do!!!!!
April 27th, 2007 at 12:31 am
oh my GOD this is some really good stuff, everything i have heard is on target, i will print a copy and give to my job
thank you soooooo much