We’ve all been assigned to cranky, demanding rude residents/patients. You know them: Mean, belittling people who have elevated themselves above all others in level of need. Not just pillow fluffers, these residents demand strict attention to minute details not because the attention is necessary but because the resident believes they are entitled to it. Resident families can be just as hard to work with. I’m not sure who is worse: The demanding resident or the demanding family member. Regardless, here are 7 tips on working effectively with the Mrs. Cranky’s of the world:

Check on the demanding resident 1st thing: Once you know you’re assigned to Mrs. Cranky, go to her room and check with her right away. Let her know you’re her aide.

Ask her if she has any special requests for today: Perhaps she wants her bath later in the morning; or she isn’t feeling well and would like to skip breakfast. Or maybe she has guests coming and would like to wear the hard-to-don red dress. By asking her what her plans are for the day, you are giving her a real say in how her day will go. Based upon her feedback, schedule your workflow to accommodate Mrs. Cranky’s needs. This does not mean you neglect your other residents.

It is perfectly acceptable to let Mrs. Cranky know that your other assigned residents have the same needs as she does. Make it clear that you are responsible to others and that you cannot cut back on time they need. You can say all this in a polite, professional and caring manner. Even further, I would let Mrs. Cranky know the order in which you will tend to her care. Give APPROXIMATE time frames. By doing this, you are alerting her that you hold your other residents’ needs just as high as hers.

Unless she is your first resident, check in with Mrs. Cranky every so often. Anticipate her needs. Use your knowledge of her demands as a tool: If you know she usually rings the bell at 10am for bathroom use, be one step ahead of her and show up in her room at 9:55am to see if she needs the toilet…

5) TALK!
When performing actual cares for Mrs. Cranky, listen to her if she speaks. If she is rude or insulting you, let her know that this offends you! Tell her that her words hurt your feelings. By doing this, you put her on notice that you won’t stand for rude remarks and the like. Try to find some common interests to talk about- this shows her that you do have a genuine interest in her. Ask her about pictures she has; ask her where she has traveled in her life; ask her questions about HER LIFE in an effort to show your curiosity. If she answers your questions positively, GOOD! Keep aiming for this positive energy. If she continues to gripe and complain, remain quiet. Don’t ignore her, but ignore the negativity and by doing so you are not giving her audience.

If Mrs. Cranky seems upset or angry, while doing her care, ask her if something is bothering or upsetting her. Sometimes people are uptight or nervous about things and take it out on the nearest person. If she expresses sadness let her know she can speak with you about those things and offer to pass on her concerns to others as needed. Let her know she can trust you. If she is angry at her family, offer to speak with the nurse to see about a family meeting. If she is mad at other staff, listen but don’t give any feedback. Give her attention for her positive words and say little about her negative words.

During the shift, after her care is completed, check in with Mrs. Cranky. Again, ANTICIPATE her needs! When you take a break, let her know. By doing this you are letting her know you care about her. At the end of the day, if appropriate, check in with Mrs. Cranky one last time. Ask her if she needs anything. Ask her how she thinks her day went- and what could be done to make it better. When we ask people to help us with planning schedules and work flows, it’s amazing how much feedback we get! It’s always appropriate to say goodbye and other polite remarks.


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1 Compassionate: A compassionate CNA is valuable. She respects what her residents/patients are experiencing; she has a knack for knowing what to say, just when to say it too! She advocates for her patients/residents- she gives detailed reports and updates to the nurses on changes in condition.

2 Patient: This CNA does not allow her job demands to get in the way of resident care. She does not **do** the tasks for the residents in order to get it done quicker; she encourages her residents to take their time with tasks. This CNA does not rush her residents thru meals and toileting.

3 Work-oriented: The CNA who loves his job is evident to all. This aide rarely uses her cell phone while working; when this aide arrives at work, she is ready to work; she focuses on her assignment and residents; she has little time for small talk.

4 Enthusiastic: The CNA who is upbeat and positive is rare. He will have a “Let’s get this done” attitude with a smile. He will not let others’ emotions and negativity affect his day.

5 Reliable: A reliable aide is one who shows up for work, on time. She gets her assignments completed in a timely manner and importantly, residents have become comfortable knowing this aide will take good care of them.

6 Punctual: On time, every time. Whether its arrival time for work, or getting residents to activities and meals, the punctual aide is an asset.

7 Hard-working: The hard work CNA’s do is what we are (in) famous for. A well respected CNA isn’t afraid of this work- she doesn’t mind all the lifting, pulling, tugging and moving. She won’t complain when she misses a break occasionally. She will offer to work an extra shift to cover a call out. She doesn’t blink when confronted with confused and scared residents with Alzheimer’s disease.

8 Flexible: One of the truly most important traits of a good aide is whether he/she is flexible…flexible to float to other units, to swap out shifts to cover openings, to swap assignments when needed…to help a coworker who is running behind.

9 Self-disciplined: It’s getting harder and harder to find nurses and aides who are more in tune with their residents then themselves. Self-discipline relates to one’s ability to maintain control of their emotions and feelings. It also relates to staying totally professional when at work. Not too many aides can do this these days. The skills needed however, can be taught and modeled.

10 Focused: Are you totally, 100% focused on your residents and their needs? Do you plan your assignment to fulfill resident desires and ensure you schedule enough time for each resident? Do you carry your cell phone with you? Do you get caught up day dreaming?  Do you tend to get involved with other aides’ problems and gossip? The answers should be YES, YES, NO, NO and NO.

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Definition: The predominating attitudes and behavior that characterize the functioning of a group or organization.

Maybe you have heard a lot about workplace culture lately. It has been a buzzword for the past few years and much of it is geared towards the corporate world rather than the nursing home setting. However, every place of employment DOES have its own culture and within the LTC setting a bad culture is devastating to staff and residents.

Signs of a “BAD” Culture include:

  • High turnover and absenteeism
  • High amount of agency staff use
  • Uptight unsmiling staff
  • Grouchy residents
  • Backstabbing, gossipy groups
  • No teamwork
  • Hostilities between shifts
  • Too many cliques

Causes of a bad culture include the actions, or lack of action from management, charge nurses and YOU the CNA. You have a huge impact on the culture of the unit you work on. Your attitudes and ability to be positive all have a large role in whether the place you work is seen as a good employer.

Everyone has a set of personal values they go by; also, everyone has morals. Knowing these can be a first step towards changing your attitude and therefore becoming more upbeat.

Many of the reasons/causes of an unhealthy culture are not the fault of the CNA, and these areas must be addressed by the Administrator and DON. Some tips for them would include:

  • Hold regular staff meetings with ALL staff
  • At these meetings seek input and advice from staff, and ACT on items that can be acted upon. Explain why others cannot be followed through.
  • Break up negative cliques and do not allow little gossip groupings
  • Examine reasons for shift wars and implement methods to stop them
  • Have a mission and SHARE it with all staff better yet have all staff help with developing the mission statement
  • Maintain a positive attitude and make all decisions based up the mission statement.
  • Catch staff doing things the right way and give them credit for doing so (Gone with the mindset that “They should be doing it this way in the first place”)
  • Hold staff accountable for policies and procedures breaches (attendance)

Many things are within the control of you the CNA, when it comes to creating a positive culture. You have to look at things differently though, and this can be hard work for old timers not used to change. Having the mindset that people are lazy and will take advantage of others, for example, will get you nowhere. You will always been seen as a negative force.

Your attitude might be why you are so unhappy at work. No one likes to be around someone who always finds fault with others with their work, their uniforms, and their lifestyle.

Negative people drain energy from others. It is hard work to remain negative it amazes me to see how some CNA’s can be so miserable for so many years. It does seem that these miserable aides end up having more health problems as they get older, they LOOK so much older than they are, and they are just as unhappy at home as they are at work. The old saying “Misery likes company” may have some truth, but what I think really occurs is “Misery infests others”.

Things You Can DO, Right Now:

  • Try not to get involved with gossip; stay away from groups of staff who tend to share stories about others. If you are approached with a statement like “Did you hear” say NO and say “I DON’T WANT TO KNOW”. Walk away.
  • Don’t be a part of the “Call in Queen Club”. Show up for work, on time. And have a smile on your face.
  • Have a personal mission statement/vision if management cannot pen their own. A simple motto will work something to the effect “I will give the best care I can and I will be a good coworker to my peers.” Live by this. You will quickly become known as someone everyone likes to be around.
  • Don’t keep old baggage on your back. Forgive others for past mistakes and issues. Move on. Talk with them; tell them they have another chance with you. Stand up taller, take the higher road. You will feel so much better, like a burden has been lifted.
  • Use your manners. Saying PLEASE, THANK YOU, EXCUSE ME and I’M SORRY go so much further in the culture you create, then saying things like Nope, I can’t, or doing things like rolling your eyes, sighing heavily, murmuring under your breath.
  • Instead of having that “Us vs. Them” mindset, why not have “Its US”? All of “us” shifts, including housekeepers, cooks, nurses, residents, etc. We are working together, not against one another.
  • When you are training new staff, be kind and gentle to them. Just because they are CNA’s doesn’t mean they should be treated poorly. And don’t expect them to know everything no one knows the little tricks with residents until they get the training you can give. Model decent behaviors and talk about being positive. This will make a lasting impression.
  • When agency staff are utilized, don’t be rude to them. It’s not their fault they are there. More than likely it’s partly the facilities’ and YOUR fault! It all rolls back to culture if a place is full of negative people who refuse to help one another, who call out frequently and where there is management that condones these practices. Folks are not going to work there. People will quit or call out. Face it– a vicious cycle can occur here.

When you treat agency staff poorly, they talk. They tell their bosses and they tell other aides in other facilities we have all heard about HELL HOLE nursing home its hell because of the staff usually. I have heard some stories about agency staff being treated so badly by aides at certain nursing homes I would NEVER consider working at. And that is bad for you: Aides who might consider getting a job where YOU work, so you are not working short all the time won’t even give your employer a chance. And you might wonder WHY you don’t have enough staff.

The same cycle occurs when we mistreat new staff who quickly quit on us. They find employment somewhere else, and talk to others about their experience at your facility. The facility has reputation that has bad culture and is terrible to work at.

Help the culture at your work. Do your part: Smile, stay positive, help coworkers, train new staff well and ask Management to help create a workplace culture that helps with retention, and then in turn, recruitment.

Hopefully management can assist with this because it will take some enforcement on their part to make this work.

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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.



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.

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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…

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Filling In The Blanks

I’ve read at various online forums tales of how CNA’s literally fill in he blanks of vital sign records- without actually getting them.

What if we we all did this? Blew off getting the T, P, R and B/P? What if the resident has developed high B/P and because we couldn’t be bothered to be honest, it went unchecked? What if a real temp wasn’t measured for a couple days, while the resident is coming down with a infection? What if the resident is on a new medication that has a side effect of changing their respirations, but this isn’t seen because no one took the time to count them??

This is very bad. And illegal. And unethical. And most importantly, dangerous. What’s a new CNA to do? Or an experienced CNA? You stand up and advocate for the resident. You MUST not allow this to happen, when you see it, witness it, hear about it or otherwise KNOW of it.

How do you go about advocating in situations like this?

It seems pretty simple to me. Here’s what I would do (and have done many times):

1) Tell the CNA involved that she is committing fraud and that she needs to get the VS in question, right now. While you watch.

2) Report the incident to the charge nurse immediately; explain what happened and leave your personal thoughts out of this.

3) Seek the DON and report the incident to he/she as well. In writing. ASAP…Make a copy of your report to keep for your own records. Even if the charge nurse says she will make the DON aware, go to the DON yourself. You’re covering yourself by doing so. Otherwise, it could come back to haunt you in the misconception that you were aware of the incident but didn’t report it…and so on.

The CNA who fraudulently documents care is opening themselves up to numerous problems. They could lose their job; their certification/license; their chances to work in health care as a career will most likely be ruined for good. If actual harm came to the patient/resident because we slacked off, patients and their family can pursue legal remedy. The facility and the state body in charge of regulating CNA practice can turn the “case” over to the Attorney General and hence start the criminal justice process. You get the idea.

Trust is big in health care.
Do we really think we can trust the aide who doesn’t measure vital signs but who writes in fictional numbers?

It’s not just vital signs. When an aide fills in the blanks in this one area, I question their honesty and integrity in all areas. The box is checked for the bed bath, but did the resident really get one? There are numbers in the intake and output record, but are they truthful?

Patients trust their health care providers to be skilled and honest. Our employers, the nursing homes and hospitals and assisted living centers trust that we’re using our skills and being honest as well. Our charge nurses depend upon our skill and honesty to assist with providing timely and needed treatments and medication administration. Our co workers trust that their peers are doing the right thing for their beloved residents.

The right things mean filling in the blanks with real, honesty measured/provided numbers/care. The right thing means when something isn’t done, it’s documented as not being done. We all know there are days when we can’t get IT all done and that’s the way of this work.

Experienced aides can prioritize their work- they KNOW what care or task needs to be completed vs what can wait. New aides should feel confident to ask for direction and HELP when they need it (which might be often the first couple weeks they are on the job!)

Charge nurses should always provide guidance to help sort through these issues. When it comes to actual skills- some newer aides really have trouble measuring blood pressure. The new aide should seek the help of her mentor, or the charge nurse to really learn this skill.

Paperwork overload is no excuse.
There is WAY too much paperwork in our work. Everyone knows this. Yet, facilities don’t get paid and pass inspections if the paperwork isn’t done. In the medical chart, if it isn’t documented it wasn’t done. Sadly these are facts.

The burden of documenting has become overwhelming. The original purpose of charting was to provide a clear record of a patients’ medical condition, where members of the health care team could go to see updates and alter their interventions and treatments as needed.

The chart is rarely used for this anymore. Now, it’s a place where endless pieces of paper are stored- and kept, in the event of a lawsuit. Nurses and others document on the defensive now. This is the world many have created and our little part in it has tremendous consequences. Those vital sign numbers better correlate with the sudden medical condition discovered on the next shift. When it doesn’t, red flags are spotted and questions are asked.

Maintaining Integrity Isn’t Easy in This Work
The CNA must always be honest in the care and tasks they provide. We are the front line. The first to see and know. We are extremely valuable because of our place. If we don’t feel skilled enough in providing tasks/care, we need to speak up to this and ask for help. Those of us who hear the cry for help need to be willing and able to teach. We need to recognize when a peer is having a bad time, a bad day, and offer assistance. We do this not for the aide but for the patients/residents she is assigned to.

Why is this happening more and more?
In the past few years I have seen an increase in aides who graduate from these small medical-skills schools who don’t have (or are not taught) the same foundations of honesty and integrity. I’m not sure honesty and integrity can be taught either…we either have these ethics or we don’t. Better screening might be one solution.

The quick turnover rates of graduating “classes” of aides amazes me- and the fact they can pass the state tests tells me they know the basics. The basics aren’t good enough anymore.

It gets lost when these fast food CNA’s get on the units and are totally overwhelmed with their assignment. They feel pressured to get everything done and this is where I often see the cheating occur. I have to wonder if these schools are not doing an adequate job teaching the students everything they really need to know. I wonder if the new aides thought the job would be much easier.

When we see cheating happen we have to speak up. Loudly at times. We might even need to make a stink once in a while. Life and death decisions are sometimes made based upon our honesty. As I said, we’re the front line. Our words have HUGE impact upon everyone’s word, all of whom are above us. If we’re not honest, then neither are they. Yet we know it, and they don’t. Remember that.


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