So, you’re brand new and a little nervous? That’s okay and natural. Being a CNA is a rewarding career, but there are LOTS to learn and lots of cover in those first few days at work! Don’t be surprised if you feel a bit overwhelmed and anxious. Someday–soon- you will be an “old pro” at this stuff. The first part of this is for the new CNA…
I remember my first few weeks as a CNA- it was hard to get to know all the residents as well as staff as well as the facility policies and procedures. I was very overwhelmed and looking back now- there were certain things I should have done that would have made my life much easier then! Live and learn….
First, it is a good idea to bring a little notebook to work with you. In here you can write down info you need about everything from phone numbers to resident issues. Jotting down info is a way to remember it! At periodic times during the day check the little book to see if there are things you still need info about. When you think of questions and no one is around to answer them- write them down. Later you can refer back to the book.
OK, now onto more things every new CNA should be aware of. It’s always a good idea to know the facility policies and rules before we start a new job. Sometimes this isn’t possible. You should make it a point to find out where to go to get this info if it isn’t provided to you. Again, looking back there were things that I wasn’t clear about and I had to re-learn basic policy stuff. If I had asked in the first place:
1) Holidays/weekend pay differentials? Are there any?
2) Overtime pay: After 40 hours or after 80 hours?
3) Attendance/Tardiness: What are the exact limits/percentages?
4) Pay increases: Based on merit? Or length of service?
5) Performance reviews: When, how often, are raises included with them?
6) Uniform policy: Assistance with purchasing?
7) In service Hours requirements: Does facility offer enough hours to meet mandated 12 hours?
8) Phone numbers to call: For when you need to be out. Time limits?
9) Benefits: What is offered? When do they go into effect? What will cause termination of benefits?
10) Staff meetings: Times? Are the mandatory?
These are basic policy things every employee should know, and know well. Once you have this info, you can make choices about what you need to do- and when. Knowing this stuff will make your life a lot easier and will prevent surprises down the road.
For those ever important first few days, there are several things I recommend you get done, if possible. First off, find out which residents you will be working with on a regular basis. Why? You want to read their care plans as a tool to help you get to know them. Knowing what you are expected to do as far as nursing care is the reason you are there! Knowing what is in the plan will help you care for these residents in a safe and appropriate manner. You may not understand some of the things in the plan, if this happens then ask the nurse in charge of the unit. Nurses write the care plans, and they depend upon us to carry out the objectives to meet the goals in the plans. The nurse is an excellent resource for CNA’s.
In your little book you may want to write down things about your residents- from the care plans. It will be awhile before you can actually place a plan with a resident! This takes time- getting to know them and what rooms they are in, never mind their care needs. Hopefully someone will be mentoring you; while being trained it is a good idea to relate what you are being shown to how it is worded in the care plan. Ask questions and learn. Your mentor has experience and can teach you much.
Watch how your mentor works- directly and indirectly with residents and staff. You should learn much just from observing. The next thing I recommend is that you check with the nurse at the beginning of the shift about what is expected of you:
Do any of your residents need VS, baths/showers, weights, or other care? When are VS needed by? Also ask about special snack/drink requirements. It is so much better to know this stuff ahead of time rather than ten minutes after they were due. Communication is vital in nursing homes- with nurses, peers, residents. Also make sure you find out where you are supposed to document your care? Ask about paperwork and where it is. It is very important that you get the paperwork done every day.
After a few weeks, you will know which residents work well together; you will figure out how to prioritize your care to meet everyone’s needs. It takes practice and hard work. One thing that is very helpful is taking a few minutes at the beginning of the shift to plan your assignment– who gets done first, who gets showers and weights and what not. Gathering all your supplies you need before entering a room is a great time management skill all CNA’s have. Carry around a pocketful of gloves too. Check with the nurses, in most facilities you can bring in your own thermometers as long as you don’t bring them home for use. Having your own tools saves time- I have my own B/P kit too.
The next sections are what this page is really all about: Timesavers and tips CNA’s everywhere use to get their work done. Some things are pretty elementary and others are really cool. Try them.
Being Prepared:
Always be ready with a basic work kit: A waist pouch is a good thing to have- with a pen, tape measure, extra gloves, permanent marker, if possible your own B/P kit, watch and extra elastic hair things.
Keep a mental checklist of what you need before entering a room- linens, clothing, etc. Be ready.
When changing bed linens, roll all dirty linen into a ball within bottom sheet; this is easier to remove than several pieces of linen.
Type a copy of abbreviations to a little card, then get card laminated. Keep in waist pouch.
Plan your work day- check with nurse about nursing priorities and go from there.
Personal Care Tips:
A cool idea for shiny, soft hair: Get a little spray bottle; fill with one part conditioner to nine parts water. Spray in after shampoo and leave; this detangles as well.
Another use for little spray bottles: Fill with water and add a few drops of bath oil; after shower/bath spray a little onto resident’s skin. Make sure you mark these bottles with what is in them!
Bath oil can also be used in showers- small amount rubbed into your hands & onto resident’s skin. Also, add a drop or two into a wash basin during rounds….just be careful when disposing the oily water. Don’t drain in the tub/shower area- someone might slip at the next shower.Find residents slipping out of their chairs? A piece of rubber-type shelving liner works well to keep them upright.
For SUPER stubborn, glued on caked on BM, get several wipes or washcloths wet with hot water and lots of soap…add in a little shave cream –this works wonders with cleaning. Use sparingly as the cream can be drying. Apply a little lotion after.
Meal Tips:
For residents who have thickened drinks- and who don’t like the taste of the thickener, adding flavor drops helps. Thickened water taste terrible. Some say that adding a few drops of lemon juice takes away the bad taste.
It may sound elementary, but do add salt & pepper to foods if it ok; also butter & margarine. Many elderly are used to these condiments being in their food.
If food gets cold, the wise CNA will take plate to a microwave oven to re-heat it.
Residents may eat better if they start with a clean mouth: Provide oral care right before meals.
Remember that meals are supposed to be a fun time; don’t force feed your residents; allow them time to enjoy their meal! Same with drinks- don’t force them down. Allow the resident to determine when they are ready.
Residents who feed themselves may have trouble keeping their plates on the table. Use the rubber shelf liner under the plates.
You can build up a utensil by wrapping a washcloth around the handle and securing it with a rubber band. After each meal remove the cloth for washing.
When feeding a helpless resident- remember to tell them what you are doing, what you are feeding them- before each bite. If they constantly spit the food out, think that maybe they don’t like the certain food and offer an alternative. Or maybe it’s too hot or cold. Ask the resident. Look for cues. During this feeding time, talk with the resident about current events or something like it. Don’t just sit there and stay quiet. Engage with the resident, make this as social a time as possible.
Foods you know the resident likes should be made known to whoever is in charge of meal planning. This is a way for you to advocate.
Documenting meal consumption is a part of every CNA’s job. Be realistic when figuring amounts eaten. Look at serving sizes and look at what wasn’t taken in- look at what was lost via drooling, spitting out…Check the clothing protector/bib!
Also, some residents like to hide their food…know this and keep an eye on it.
Remember that residents don’t always appreciate being made to wear a bib; ask them if they would like to. Don’t force it upon them.
Mentoring a New CNA:
First, recall your first few days and weeks as a CNA. Have some empathy. And remember, the new CNA will watch everything you do and say. Be a role model.
Don’t expect the new CNA to know everything; yes- they have been certified but this doesn’t mean that they have hands on experience. Your job is to teach them this!
Be respectful of the new CNA’s questions. Answer them all as best you can with a smile; if you don’t know an answer either find out or direct the CNA to someone who does know.
Allow the new CNA to observe you for a day or two. Let them see how you work; how you handle your residents. This is called role modeling. Don’t assume that it is ok to have them make your beds and get your supplies. One of the things you should be striving for is to teach them how to be prepared and how to work best to get it all done.
Plan your work and your day with the new CNA. Show them how you prioritize things. If you have questions for the nurse, bring the new CNA with you so she can see how you interact.
While you are working, explain every little thing you are doing. You want to be certain the new CNA understands why you are doing certain things in a certain order….or to please certain residents. Allow the new CNA time for care plan reading. This is vital.
Allow the new CNA break times. They might need more than you think!
If your facility doesn’t provide one, make a checklist of things you want to teach. This way you will cover everything.
No matter what, NO SHORTCUTS should ever be shown to a new CNA! They might think these cuts are ok on a daily basis, which they are not. Show them the right way!
Remember that you are a person who the new CNA looks up too; you are IT. So act it. Be professional, but friendly. Be there for those moments of self-doubt and fear. Be a person who is positive and encouraging. NEVER rebuff a new CNA’s ideas or observations: After all, they see things from a view point you haven’t seen for a long time.
The way you interact with the residents is very important during the mentoring period. Go over Resident Rights, and when the time is right use what you are doing as an example of honoring rights.
Peer Relations Tips:
Treat others how you would like to be treated.
Using manners can leave a positive impression to just about everyone.
If you get your work done early, offer help to others who aren’t done.
Don’t backstab and find fault with your peers. Instead find the good – and offer praise.
When working short, it may be a good idea to “buddy up” with a partner. Doing things together is easier when we are stressed.
Always let your partner and nurse know where you are- even if you are only going to the rest room. This is true when you are doing care- if you know you will be awhile with a resident- say so ahead of time.
Be considerate of your peers: Don’t abuse your break times or meal breaks. Be prompt and on time.
Tell your family & friends that unless it is an emergency- not to call and text you at work.
Dealing with Residents who have Dementia/Alzheimer’s:
Keeping a sense of humor helps a lot.
Being positive is another trait that should be touted. Don’t assume something bad is always going to happen.
Once a struggle has begun, try to remain as professional as possible; don’t get into words and accusations. Don’t be the perpetrator of a power struggle. It’s not worth it. Make sure you report all behaviors to the nurse.
If a resident has become combative, your goal should be to protect the resident, other residents and of course – you. Try to act as a shield between the other residents, but don’t put yourself in a line of fire.
Sometimes it is better to walk away while a resident is having a hard time.
If you feel you might do or say something you could regret— LEAVE the room. Get someone else to take over; recognize your limits and respect them.
If you notice an increase in behaviors, ask the nurse about a special meeting to address your concerns. A team approach is always best. Now your good documenting will come in handy.
Documenting
When writing notes, be clear, concise and to the point. Be objective. Don’t write what you think happened or what you think caused an incident. Only write what you know.
Timely documentation is vital. If you take a set of VS and see that a resident has a fever, let the nurse know right away. Don’t wait until the end of the shift, or even wait until you’re done with this resident.
If your facility uses flow sheets, make sure you’re initials can be easily read.
Getting to know the particular types of paperwork you are required to do can take a little time; it is always better to ask before you sign your name to anything.
Never sign off anything you didn’t do. Never sign off something someone else has asked you to sign. Only document care YOU have given.
Being a witness to something and being asked to sign that you witnessed- this is another story. Just make sure you write that you witnessed….
Use pens with facility approved colors. Don’t use pencils or markers. (KEEP IN MIND: Colored inks do NOT show up on copies- only B/W does)…
When using EHR systems, never share your login info/password with another staff. For any reason. Ever.
Taking Care of Yourself
Don’t go to work sick. Ever. On the other hand, don’t call out over a simple hangnail either. Be respectful of giving enough notice when you call in. Also, never call to say you’ll be late and then call back to say you’re not coming in at all!!
Do some stretching before work! Really- it helps loosen up all those muscles we use and this helps prevent back injuries.
Eat right- right is different for all of us. Make sure you are getting enough calories in daily to do your job as well as your home life.
Drink a lot of water. CNA’s don’t always think of themselves when it comes to fluid intake! Eight 8 oz. glasses a day is the least we should be bringing in; more is cool. If permitted, carry with you a covered water bottle at work. Drinking enough water may very be one of the best things we can do for ourselves! The other end of this is using the bathroom when nature calls. Don’t wait and hold it in. Go when you need to go. Find the two minutes it takes.
Lift people and objects properly. Use good body mechanics: Lift with your leg muscles, not your back muscles. Keep your balance and always work in conjunction with a partner during lifts.Get enough sleep. Again, this is a personal thing, each individual has different needs. Whatever your need are, tend to them.
If you find that you are always getting upset about work, if you feel outraged at things- you need a break. Take a vacation. If this is not possible, then take a mental health day. I don’t condone taking time off that isn’t vacation – but there are those times that we all need a break. Especially right now when the nursing community is changing so rapidly.