Traits of A Successful CNA (PDF file)

The five most important foundational skills that a successful nursing assistant needs are:
Reading for information
Locating and using information
Observation skills
Applied mathematics
Writing

I agree. We do have a problem here, though. A lot of CNA’s cannot read and comprehend English very well, therefore they cannot report (verbally and in writing) the things they observe. I think more education is needed in order to carry out observations- I see problems every day with this. Math is a no brainer, but it goes with the language problem.

The characteristics of successful CNA’s:

cooperation, goodwill, optimism, order, savvy, and determination/striving

Good start. We have some articles that go into detail on these issues:

Observation Skills for CNA’s

Legal Issues for CNA’s

Professional Boundaries

Being Professional

CNA’s & Respect

Why Being Negative Can Really Hurt You

7 Habits of Highly Effective CNA’s

7 Habits of Highly INeffective CNA’s

State of the art technology is changing the way nursing homes operate.

Inside one Louisiana Alzheimer’s facility, each room is equipped with a fall prevention system.

“We have a ‘smart’ system, which is a computer system that will learn, actually learn patient movement and activity,” said Neal Rider, Guardian House CEO.

Each resident has an individual profile that determines their risk for potential falls. If they are categorized as a “fall risk,” the computer and motion sensor devices will monitor their every move in bed and alert the staff if anything is abnormal.

“The unauthorized bed exit is coming in and you can see an individual getting out of the bed. It identifies where the person is in the building and where other individuals and staff members are located throughout the building,” said Rider.

Does anyone have experience with these types of systems?

The article she linked to implores management to take action to become more employee-friendly. There are some issues that management might not be able to change. Health insurance for staff is a BIG issue. Affordable and practical insurance is needed.

SEIU’s Andy Stern is calling on US to help him advocate for this important need. He will be testifying before Congress and will be sharing worker stories about health insurance, the lack of or inability to afford.

When I think about what’s wrong with health care, I think of Jacqueline.

It’s one thing to talk about our broken health care system, but Jacqueline lives it every day. For 19 years, she’s worked as a nursing home CNA in Wisconsin. Short staffing in her unit means skipped treatments and longer waits for her patients. And a lack of equipment and supplies puts the strain on the entire facility when things get busy.

Unbelievably, while Jacqueline spends her life providing care for her patients, she can’t afford it for herself or her family. The coverage her employer offers costs too much on her salary.

This has to stop. Congress needs to hear how this crisis is affecting real people. Share your story: http://action.seiu.org/page/s/memberstories

Next week, I’m going to Capitol Hill for a Senate roundtable on fixing health care. It’s one of three roundtables that Senator Max Baucus is holding to hammer out the final details of a health reform bill.

If you’ve got a story to tell, now is the time to do it. Do you have health insurance? If not, why not? Does your employer offer it? Is it too expensive for you to afford? Have you held back on seeing a doctor or other health care needs due to costs? Let Andy know.

The LTC industry is getting excited about this as well, but for a more sinister reason.
From McKnights LTC News:

A major development is afoot in the labor movement, and it could have interesting implications for long-term care.

I’m talking about American unions’ recent plans to unify. In case you haven’t heard, the leaders of the two major federations and the nation’s 12 largest unions have formed the National Labor Coordinating Committee. The interim body will help form the federation.

Naturally, the thought of one massive union, 16 million members strong, is enough to send shivers down a long-term care employer’s spine. But let’s think about this a minute.

Clearly, a single union could have an impact on unionization. This is the year of the card check, and if the Employee Free Choice Act passes, nursing homes could be facing a serious increase in union activity.

Sounds good huh? Never trust the LTC industry to do the right thing for YOU.

But there also may be at least one area in which nursing homes can benefit from a unified labor front. That is immigration reform. The AFL-CIO and Change to Win federations recently said they are joining forces to support the effort. That includes a path to citizenship for undocumented workers.

Why worry about immigration reform, in the broader picture here?

Read on:

The American Health Care Association, the largest association of nursing homes, if you will remember, was in favor of a guest worker program that would provide a temporary workforce of skilled and unskilled workers for employers in the future. Given the industry’s reliance on low-wage help, that is not surprising.

Read that last sentence. LOW WAGE HELP. The thinking here is simple: Bring in as many immigrants as possible, allow them to fill our shoes, at lower rates of pay…supported by the Unions of course…And read between the lines: Unskilled workers = low wages is NOT GOOD FOR US. These efforts will drive down our rates of pay. Why would any facility hire an American CNA who will expect a living wage- when hiring an immigrant who will work for cheap hourly rate is a viable option? We need to seriously think this out and speak up on it.

What is your opinion on this?

WASHINGTON (AP) – American workers – whose taxes pay for massive government health programs – are getting squeezed like no other group by private health insurance premiums that are rising much faster than their wages.

While just about all retirees are covered, and nearly 90 percent of children have health insurance, workers now are at significantly higher risk of being uninsured than in the 1990s, the last time lawmakers attempted a health care overhaul, according to a study to be released Tuesday.
[...]
The problem is cost. Total premiums for employer plans have risen six to eight times faster than wages, depending on whether individual or family coverage is picked, the study found.
[...]
For the Ramer family of Denver, Iowa, it’s already too late. Husband Jim, a truck driver for a road-building company, died of a heart attack in 2005 at the age of 59. He was uninsured and trying to cope with diabetes, a chronic disease that requires prescription drugs and follow-up medical care to keep under control.

His wife, Cindy, 58, works full time caring for mentally disabled people as a certified nursing assistant. But the nursing home that employs her canceled its medical coverage several years ago because it had become too expensive. Ramer is now uninsured and hasn’t had a regular checkup in about three years. Instead, she goes to health fairs for bone-density measurements and other screening tests.

“I don’t think it’s fair that I’m caring for people and helping them with their health care, and I don’t have adequate, affordable health care of my own,” said Ramer. “I’m not asking for a handout. I’m just asking for something I can afford, and won’t have all these restrictions that they’ll cover this and won’t cover that.” Ramer says she can afford to pay about $100 to $150 a month.

It’s sad. She wants to take care of herself so she can do her part to keep health care bills lower, but because she has no insurance she cannot afford preventative care. As mentioned in the article, her taxes pay the costs of health care for others. We need to fix this problem.

First off, look up to your right. You’ll see a sidebar topic titled: POPULAR CONTENT. The list of articles speak for themselves.

We have a new SITE MAP now. Check it out when you have time.

We have many articles full of advice for CNA’s:

Getting Paid. For every minute you work.

Tips & Timesavers for CNA’s

What Not To Wear to Work

Lifts & Transfers: Doing It Right

7 Habits of Highly Effective CNA’s

7 Habits of Highly INeffective CNA’s

And there’s many more HERE.

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We also have an extensive archive of educational articles, that can be used for in services and other trainings. CNA’s are, of course, welcome to read these articles for their own benefit.

The Nursing Process and The CNA

Observation Skills for CNA’s

Legal Issues for CNA’s

CNA’s & Respect

LTC Survey Scope & Severity Scales

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Would you like to connect with other CNA’s? Join the NursingAssistant Yahoo Group- it’s free and you can read the emails or messages on the web.

More than a year after she began advocating for the residents of Manor Care and seeking to organize the facility’s workers, Trisha Miechur has won a crucial battle.

Last month, a National Labor Relations Board judge ruled that the Palmer Township nursing home violated the law when supervisors disciplined then threatened to fire Miechur for her efforts.

“We felt like we were being harassed and a lot of people were afraid to fight for what they believe in. I’m happy that we won,” said Miechur, a certified nursing assistant.

“I was afraid to work at my job. I was watching my Ps and Qs because at any given time I could be fired. Now that that’s all done with, I feel relieved.”

Miechur knows Manor Care may appeal the decision, but is hopeful that won’t happen.

What are the P’s and Q’s? Probably any little thing- stupid meaningless thing- management can find to discipline employees.

Miechur says she went to work for Manor Care in 2005 and slowly watched the facility deteriorate, with understaffing posing the biggest threat to quality care.

The Lower Nazareth Township resident shared her concerns with supervisors then sought help from the SEIU when she didn’t see significant improvements.

That was September 2007. In the months that followed, Miechur was cited for disloyalty and other alleged behavior referenced in the NLRB decision.

Note the dates. When we work for a nursing home (or ANY health care facility) WHO are we loyal to? The facility– or our residents/patients/clients?

When Carlyle Group acquired Manor Care in December 2007, Miechur was hopeful the private equity firm would get the nursing home back on track. By then, SEIU was already involved in a national campaign aimed at pushing Carlyle Group to do just that.

Miechur joined the effort and in January 2008 confronted firm co-founder David Rubenstein at a Philadelphia business conference. The encounter grabbed headlines in the New York Times and the Philadelphia Inquirer.

Matt Richards, an SEIU spokesman, said the decision is gratifying, but the punishment falls short.

“She’s been walking into that nursing home every day for the last year fearing for her job,” he said.

“This is what’s fundamentally wrong with our labor law. When the employer violates the law, their penalties are virtually nothing in the long run.”

Miechur, who once said “she wouldn’t stop until something’s improved at Manor Care” has remained steadfast in that promise. To that end, she is now advocating for the Employee Free Choice Act.

Good for Miechur. We need more of this- people to stand up to poor care and lack of resources, AND lack of doing the right thing for the people we serve. The nursing home industry deserves to be unionized- every facility- as far as I’m concerned. NOW- this is a change for me as I used to be extremely anti union. Like Patti, I saw no use. However, seeing firsthand how CNA’s and others are taken advantage of- I hold a very different opinion.

However in her most recent post, she writes about the potential rationing of health care for people who receive federal assistance- based upon the probable “comparative effectiveness research” on medical procedures, pharmaceuticals and devices. What this is about is the Obama administration’s plans to form a board that will decide which procedures will be cost effective…the plan doesn’t come right out and declare that procedures and treatments will be denied payment- but one can assume this will be the case.
Ms. Gross supports the plan and explains why.

We need to remember that a very tiny amount of people are covered by Medicare. Less than 2% of our elderly population receive federal assistance. Even as the baby boomers come to age, these numbers will increase a lot but not enough to make a huge dent, overall, of the elderly population. The fact is, most old people will fend for themselves when they get old: Either they are rich, or have prepared and saved enough money, or their families will provide care.

Ms. Gross:

The goal of comparative effectiveness research isn’t to kill people who otherwise have good and long lives ahead of them. The goal is to make rational decisions about what works and what doesn’t, what makes sense and what doesn’t, in a universe of limited resources — and to stop indulging the fantasy that it is possible, or even desirable, to live forever if we just take one more pill or have one more surgical procedure.

I have a question. Senator Kennedy has brain cancer, tumors and he’s ailing. He is not considered to THAT old- in terms of the discussion Ms. Gross takes on in her post. Kennedy’s cancer is terminal. It is going to kill him. Because of his personal wealth and endless resources, he has been able to get every treatment, every new and untested medication, for his condition. Some of the drugs are only known to extend life by a few weeks if not a month. It’s all very expensive care. He’s rich and can afford it.

What about the lady I once took care of at the local nursing home? She was 75; had mid-stage Alzheimer’s Disease. She relied upon Medicare to pay for her nursing home care. She was able to do her own care still, and recognized her children; she could still manage her ADL’s and she was expected to live another three to five yrs. One day we found a lump on her breast. They sent her out for testing and sure enough, it was cancerous. It was large- but still contained within a sack. It had not metastasized. Her family, her daughter to be exact, declined any treatment, knowing that it would not increase her Mother’s longevity. She figured the “dementia” will kill her Mom before the cancer did her in.

The lady experienced horrendous pain and disfigurement over the next TWO years. That lump grew, it came out of her breast, it weeped blood, pus and other nasty stuff. It smelled terrible. It caused the woman so much pain she would pass out. She never screamed- she would just curl up in a ball and cry softly for hours on end. This is with morphine for pain control. Nothing we did comforted her. The woman lived for two years with this horrible cancer, spreading throughout her frail body- into her liver, then her lungs, her brain, her spine. She lost her sight. She ended up on O2 most the time; she died of breast cancer. Not her dementia.

How do we protect people like this woman, in an age where we are willing to discuss rationing health care for old people? Did this woman deserve to die, in such a horrible manner, simply because her daughter didn’t think her quality of life would suffer? In terms of government funding, would it be acceptable to deny care, based upon some research recommendations?

Ms. Gross points out that many old people (women) are “subjected” to needless tests such as pap smears and annual mammograms…in all my years of experience at nursing homes, never once did I see old ladies being sent out for these tests. I did see families insisting upon exrays when a fall occurred; I did see hip surgeries performed. I’ve seen dental work being performed as well.

K Tree, CNA has noted a few times at her blog, how a DNR order seems to mean- DO NOT TREAT...which is totally wrong. When an old person, confined to a nursing facility, shows symptoms of a UTI or bronchitis or strep throat, I believe they MUST be treated. DNR orders don’t tell us to DENY TREATMENT of these things.

I fear that the world Ms. Gross would like to live in will deny this, and much more. I get a sense of strong resentment from Ms. Gross, towards old people…the sense that somehow these people are a drain on resources and therefore not worthy of receiving a newly defined set of rules for what is adequate and appropriate. We have to be careful when we go down this road. It is, a very slippery slope.

You see them everywhere — nurses, doctors and medical technicians in scrubs or lab coats. They shop in them, take buses and trains in them, go to restaurants in them, and wear them home. What you can’t see on these garments are the bacteria that could kill you.

Dirty scrubs spread bacteria to patients in the hospital and allow hospital superbugs to escape into public places such as restaurants. Some hospitals now prohibit wearing scrubs outside the building, partly in response to the rapid increase in an infection called “C. diff.” A national hospital survey released last November warns that Clostridium difficile (C. diff) infections are sickening nearly half a million people a year in the U.S., more than six times previous estimates.

Ewww. I wear my scrubs to work, ONLY. I go directly home after my shifts, and remove them, shower, and re-dress.

The problem is that some medical personnel wear the same unlaundered uniforms to work day after day. They start their shift already carrying germs such as C.diff, drug-resistant enterococcus or staphylococcus.

Really? I don’t know anyone who wears dirty uniforms to work…at least I don’t THINK I know anyone.

Do unclean uniforms endanger patients? Absolutely. Health-care workers habitually touch their own uniforms. Studies confirm that the more bacteria found on surfaces touched often by doctors and nurses, the higher the risk that these bacteria will be carried to the patient and cause infection.

That’s a no brainer.

So what to do??

Until about 20 years ago, nearly all hospitals laundered scrubs for their staff. A few hospitals are returning to that policy. St. Mary’s Health Center in St. Louis, Mo., reduced infections after cesarean births by more than 50% by giving all caregivers hospital-laundered scrubs, as well as requiring them to wear two layers of gloves. Monroe Hospital in Bloomington, Ind., which has a near-zero rate of hospital-acquired infections, provides laundered scrubs for all staff and prohibits them from wearing scrubs outside the building. Stamford Hospital in Connecticut recently banned wearing scrubs outside the hospital.

When I first began working in healthcare, I remember the hospital DID indeed wash the SCRUBS- but not the required white UNIFORMS- which we all purchased and maintained on our own. This was 18 years ago.

Across the pond, a British study found that one-third of medical personnel did not launder their uniforms before coming to work. One British surgeon who specializes in hip and knee replacements reduced postoperative infections by two-thirds at her hospital by protecting patients from contaminated uniforms. Before approaching any patient’s bed, nurses put on disposable, clear plastic aprons that were pulled off rolls like dry cleaning bags. Each one costs a nickel.

A nickel is certainly a small price to pay to prevent an infection.

And that old standby- washing our hands- would most likely curb the spread of infection 95% of the time- if we complied 100% of the time.

Does your employer launder your scrubs? Or offer gowns to wear at each patient-care session?