We have seen high turnover for years in Long Term Care; not just CNA’s, but nurses, Administration, housekeepers. The work is brutal and there are few benefits to sticking it out. CNA’s in particular have a very high rate of turnover. It’s not uncommon to hear of aides leaving a facility to go work down the road at another nursing home for a dime more per hour. This is leads into this topic of this article: Giving proper notice.

In most lines of work, across all the various industries, people give 2 week notices. They do this in order to give the employer a chance to replace them. In Long term care facilities, there are often several openings for aides to begin with. When another aide leaves, it just compounds staffing issues even more. If an aide is scheduled to work many shifts but suddenly quits, it leaves ALL those shifts open and often unfilled. Who suffers? The residents, patients, clients fist and foremost. Then the aides left behind to do the extra work. Management has to fill the position and do all the human resource things associated with this: Background checks, abuse registry check, hiring, orientation, mentor-ship if there is any, and on the job training.

I understand the reasons for wage shopping in jobs in this field. Money is tight and people need to make a living. Some people would laugh at a dime an hour increase in pay but when you’re living paycheck to paycheck every dime counts. Still, it is so important to leave on good terms. When an aide or anyone else quits without a notice, they almost always end up on the “No-re-hire” list- which is important if one wants to get a decent reference. Trust me- a bad reference is not a good thing in this work. And very often, the DON of one nursing home is friends with many DON’s of many local nursing homes- they usually have a network. They warn one another about staff who quit without notice as well as staff who are placed on LOA pending an abuse investigation.

Some other reasons for two week notices:

  • In the future at another agency, you might end up working with some of the nurses and aides  of the facility you left. One of those nurses could be a DON of a nursing home you want to work at, or hospital.
  • You may want to come back to this facility in the future. Now you think I’m truly crazy. You’d never want to work for this horrible nursing home again! Well, remember that whole turnover thing? 5 years down the road, the new management of the nursing home may very well increase pay rates and offer better benefits. You would love to go back now. But you can’t because there’s that “No Re-hire” comment attached to your SS number.
  • There are financial benefits to giving notice. If you have any vacation time accrued you may lose it if there is a policy about giving two week notices. Also, consider any health insurance facts as well. You will lose coverage.

As well there are some valid reasons to NOT give any notice:

  • An employee has been physically abusive.
  • A supervisor has sexually harassed you.
  • Your mental health is being seriously endangered by job stress.
  • You have not been paid the agreed-upon wage or wages have been withheld for an unreasonable length of time.
  • You have been asked to do something which is clearly unethical or illegal.
  • Personal or family circumstances are such that you need to leave the job.
  • A crisis has happened in your life, and there is no way you can continue on the job.

Remember it WILL be the residents who suffer the most when you leave. If you have relationships with them, cutting out without notice will be especially painful for them. It will feel like a death in their family. Only you can decide but it seems to me there are better reasons to give the 2 week notice than there are to just walk off the job.

 

 


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The work we CNA’s do is HARD; some say brutal. The stress we put upon ourselves while performing our duties takes a high toll on our bodies. We have to take care of ourselves. And I mean that- especially at work.

Some of the things I do to make sure I’m ready and physically able to do my job are pretty mainstream, or so I thought. Lately I’ve noticed newer aides not bothering to do simple things that can make such a difference.

1) The usual items we hear about are par for the course: Eat right, exercise and get plenty of sleep! Easier said than done in today’s busy world. Family, friends, commitments, kids’ games and activities all keep us, at times, TOO busy to care for ourselves.

2) We use our legs, arms and backs for the vast majority of the tasks we perform. It makes sense to stretch these muscles before we use them. Before I go to work, each shift, I do some simple little stretch exercises that really have helped me stay limber, and I believe they help me perform the lifts and other harsh aspects of this work without pain, and without injury. Please seek your doctor’s opinion before attempting these. The links take you to a site that illustrates how to do the stretches.

3) One thing I always have on my person is my own GAIT BELT. I don’t use the ones work provides; I prefer my own since I take care of it. Actually I have three belts- and it’s important to wash them between shifts. Think of all the germs that come into contact with these things! I have a small can of Lysol spray in my locker and every so often I use it on the belt…to kill the germs.

4) When I am working, I ALWAYS CARRY a small bottle of hand sanitizer. The stuff comes in sprays and pen form now too. I use it A LOT. I work with an aide who will rub it all over her face every so often- and she never gets sick! I use it every time I touch a door knob, or answer the phone. Some of my peers think I’m a little crazy about this- but I rarely get sick. I use it liberally and purchase several trial size bottles at Wal Mart.

5) Staying hydrated. A big one for me. Where I work it’s dry and the air is filtered, so little fresh, outdoor air comes in. I used to not bother drinking water because I didn’t think I had time. I always felt thirsty and my throat hurt due to the dryness. I don’t care for straight water; but I do like Vitamin Water- which comes in many flavors, is very low in calories and tastes good. I get them at Wal-Mart for less a dollar each and only buy them for work; I bring two or three bottles with me.

6) Eating at work can be challenging. We all know that our breaks are often interrupted, or short to begin with. It’s important to bring your own meal with you unless the facility provides them. Even then, I would opt to pack my own lunch. I know a lot of aides who skip meals altogether. That isn’t healthy. I pack a small lunch: A sandwich or pita wrap; some fruit, a granola type bar…keep it simple. Yogurt with nuts is good; a medium size salad can fill me up as well. I try to incorporate the major food groups: Meat, veggie, fruit…protein and the like. Premade pasta salads are very good as well.

7) Vitamins. A lot of people take them. Many or a few or even one. We each have our own needs and desires with this stuff. I take a multi vitamin AND lots of extra Vitamin C: We are exposed to a lot of germs and viruses every day. It’s important to stay well-nourished and the food we eat should provide us with all the daily requirements…however, there are some vitamins that don’t absorb well due to medications or lifestyle habits. It’s important to seek medical advice before embarking on any vitamin regime.

 

Finally, I always have on my person, a bunch of things that might be needed (and from experience, have indeed BEEN needed!)…A small bottle of Tylenol/Advil/Bufferin or whatever pain reliever works; some TUMS, a little bottle of IMODIUM; band aids…all travel size bottles or packages- that fit neatly in my bag or in the glove compartment. One never knows when the headache from you-know-where will come along; it’s good to have some relief on hand.

 


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In our article TIPS & TIMESAVERS, we advise new aides to keep a small notebook on their person. To write down answers to questions; to write down phone numbers and other info needed for the job.

Seasoned aides can also make use of a small notebook. They’re cheap, can be bought almost anywhere and come in so handy for CNA’s. A great resource, the little notebook.

I have one…pocket size that fits nicely in my scrub pockets. What do I do with it? A lot. When the nurse asks for VS on a resident/patient, I have paper to record the results. When a weight is needed; when a height is needed; when intake and output need to be recorded- these little pads come in real handy.

  • At the top of the page I write the date…day, month, year and shift I am working.
  • I record the times I clock in and out– so if there is a discrepancy in my pay I can go back and check.
  • I record what unit I’m working on, and the initials of the staff working with me. Even the nurses. And I note who is and agency staff as well.
  • I record my assignment– resident’s names. No need for more info; names are enough.
  • Any falls or other incidents are recorded in my notebook as well…the vital stats are documented. Who. What. When. Where. Witnesses.
  • Any family visits and any issues/concerns arising from visit.

Some aides will go to the effort to write in certain info about their residents: BM’s, voids, showers, turning and the like.

Many aides use their assignment sheets to record all this info…and that’s fine. But I like to keep a personal record of these things. It can help you keep a clear record of your daily work and one never knows when this information can become necessary to defend one’s actions. Some aides prefer to write notes about their workday at home, away from prying eyes and nosy bosses. No matter where you do this, it’s pretty important to DO IT.

The legal environment in today’s nursing homes demand we keep clear records of the care we give. Most nursing home management can be trusted to not alter records, but not all. Aides can and have gotten into seriously hot water over issues and incidents that were not properly documented; flow sheets have been “corrected” to suit the best looking picture. Since aides are the lowest people in the chain of command, its way too easy to blame us for problems, issues, accidents and the like.

Who hasn’t been called at home, by the DON, demanding to know details about some incident that occurred last week? And who among us has a truly clear recollection of the events? If we had written down all the details, it would certainly help us during this call.

A little notebook can keep a lot of vital information. I wouldn’t go around telling everyone I have one though…management often doesn’t take well to such things. And we have to be extremely careful to respect HIPAA rules, but it is within our right to keep notes about our workday. I strongly advise all aides to do this.

 


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Our appearance is important in how we are perceived. When we dress appropriately, people respect us more.
Lately I’ve seen some aides come to work looking like they’ve been run over by a truck.

Wrinkled and stained scrubs might be OK to wear around the house, but please don’t wear them to work. Thread born, tattered and ripped uniforms are another pet peeve…they present an image of laziness. Really old and faded scrubs also come across as tacky. One can purchase a couple sets of scrubs at Walmart for under 30.00.  When funds are tight as they often are for CNA’s- buy one set one pay period and a second set the next pay period.

Scrubs can last for years with proper care and handling. Some of the newer materials are really easy to care for- wash, dry and wear…There’s no need to iron uniforms but ALL scrubs need to be FOLDED after being dried. Folding them while they are still warm keeps the wrinkles away. It’s always a very good idea to have an extra set of scrubs with you…I keep a set in my car; one never knows when an accidental spill or other event will happen, that requires a change of clothes. Better to be safe than sorry.

Old sneakers are another image buster. And do consider that these shoes probably have an odor as well, that others can smell. When you have newer shoes, spraying them daily with Febreze or a similar product works wonders to keep these odors from ever forming.  Lysol even works well. They also have Odor Eater powers and sprays made for shoes. Clean your shoes, sneakers too- with a damp cloth to remove stains.

Keep your hair neat. Wild hairdos just look unprofessional in our work. Make sure your hair is clean! Greasy slick hair is nasty to look at. It smells. And very few patients/residents want your hair in their face or over any other part of their body as you do personal care. I have witnessed  aides’ beautiful hair fall into a brief full of feces. The hair wasn’t pulled up. It was GROSS. Strips of hair that has been dyed look awesome on folks of all ages-even older aides are dong this- and is very popular right now. Just be aware that the dye can run off– into your scrubs, and face/neck if  you’re working in a humid environment (as most nursing home bathrooms are).

Scents? Nope. Don’t wear perfume to work. Many patients/residents have super sensitive smell and these odors can nauseate them. Same with cigarette odors.

And one final thing: Keep the makeup off as much as possible. It runs. It makes you look like a clown. Even the mascaras that promise 12 hours of wear…smudge under your eyes and make you look more tired than you probably already are. The work we do involves a lot of running around, bathing, showering activities that make us sweat…perfect situations for make up to melt off our faces.

 


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Lifts & Transfers

Keeping your back healthy is very important. We all know this. And yet, at every long term care facility I have worked at, I have seen aides cheat the systems and policies and rules when it comes to LIFTING. Aides will lift heavy residents by themselves; they will also refuse to use mechanical lifts designed to save our backs.


Mechanical Lift Cheating

Most aides will cite time as a major factor when it comes to using the mechanical lifts (ML). Time involved with seeking assistance, as most facilities require two people attend a ML transfer; and time involved with setting the resident up for the transfer. The placement of the lift pad, attaching it to the machine, operating the machine…the positioning of the resident into the wheelchair or bed; removal of pad…the process takes about 4 to 5 minutes. Whereas a two person lift takes about a minute at most.

I’ve asked aides how they manage to perform these lifts, on really heavy or otherwise unsafe residents. They tell me they feel confident with their strength and ability to do the lifts. They are sneaky about it too: Many an aide will go to the trouble of getting the ML and bringing it to the room. But it just sits there, unused. The only time they will use the machine is for the extremely overweight resident, or for a resident who is with it and KNOWS they are not to be lifted/transfered by staff. Even with this, the resident sometimes insists upon being lifted as it is faster. And some residents will badger the unsure aides into lifting them.

Staff Assisted Lifts/Transfers
As for two person “human lifts”, aides will not bother getting help. They do the transfers alone, placing themselves and their residents at risk. Again, the aides have a level of confidence in themselves to do this. The aides don’t consider that these movements might hurt the resident, might be rough or terrifying. And they don’t seem to understand that a few months of doing this will result in soreness and back, shoulder and knee pain. I know aides who’ve been doing this work for years who have bad backs, who are forever complaining about being in pain…who gimp and limp around all shift…who speak of being on different pain meds all the time…it’s no wonder!

Once a facility has enough aides who prefer to transfer residents the wrong ways, it’s very difficult for newer aides to turn this around. The newer aides feel compelled to work on their own. They have asked for help but have gotten nasty looks, rolled eyes and heavy “sighs”, along with comments such as “I do this by myself!” To the defense of the old timers, they probably got stuck one time too many waiting for someone to come help them. In the nursing home environment, time is everything. Once you get behind, you cannot catch up unless you cheat. And that means cheating residents out of the care they deserve.

Fixing the Problem
How to fix this? Should management be concerned? Is management even aware of these practices occurring? Good questions and only each facility can answer. Of course the leadership should be concerned. After all, the worker comp costs are in direct line with staff compliance on lifting policies.

Should punitive steps be taken towards non compliant staff? Speaking as an aide, I say YES. Because the non compliant aide is a virus- and viruses spread. In my experience, aides who are non compliant in this area are non compliant in many areas.

Having said that, I also believe facilities should have a hard look at their policies and promotion of teamwork vs. being task and time driven. If more value is placed upon the timing, then facilities are just asking for the aides to do whatever they can to survive- up to and including cheating. If value is placed upon teamwork and healthy body mechanics, the aides relax a little and are much more apt to be compliant.

If you’re an aide who does cheat, remember you only have one back. Remember too, your shoulders and knees will only put up with so much of these bad lifting habits. It will catch up with you. If it’s in the residents’ care plans that they are to be transfered via a ML or with two staff, you are breaking rules and could lose your certification over this. Especially if you document the transfers were performed as care planned: You’re participating in fraud if you sign it off as done. And if you get hurt, how will you explain it? Worker comp claims are often denied when they find out (and they do investigate) you did an illegal lift.

Is it worth being out of work with an injury, with no pay coming in? Consider your reputation as well…you will probably be fired for not following policy and this will follow you in your future employment opportunities. And remember this: You’re teaching the next generation of CNA’s some pretty poor work ethics- and worse, you’re planting the seeds of a painful future for another person (the new aide)…and keeping this cycle alive and well.

New aides can set the standard, as can aides with more experience who decide to change their attitudes on these things. Do it right! Save your body. And think of the resident’s safety! Use the proper lifting guild lines for each resident…if a ML is called for, USE IT. Get your resident all ready for the transfer BEFORE getting help- remember your co workers time is valuable. Don’t waste it. Work efficiently and with purpose. Make teamwork as simple as possible.


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