Video 3 and 4 here, from the series.

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 then 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 stretches and 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.

SHOULDER STRETCHES

UPPER BACK STRETCH

LOWER BACK STRETCH

SPINE ROTATION

HIP FLEXORS

I do three sets of 10- if you haven’t stretched in a long time, do less.

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 cause 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. Pre made 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.

8) 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.

What things do you do to stay healthy, as part of your lifestyle or specific things for work only?

Question:
At work today I got into trouble because one of my residents’ fell. This man is independent and never needs our help. He can do his own care- showers, dressing, walking, meals, toileting…the works. As far as I know he has never fallen before. I was busy with one of my other residents who requires total cares. I was in the middle of bathing her when the nurse came in to tell me the man fell and why wasn’t I with him? After I finished up with my lady’s care, I was told to fill out a report which wanted to know what I COULD HAVE DONE to prevent the fall; THE LAST TIME RESIDENT WAS TOILETED; THE LAST MEAL consumed- all things that had nothing to do with this fall!!

Later, I was written up for the fall. I told the DON that everyone is responsible for ALL the residents on the hall I was working. Yes, he was assigned to me, but when I am busy with other residents, my co workers should step up and cover for me. What do you think of this?

Answer:
You should not have been written up, in my opinion.

Every resident must be assigned to a CNA. It’s law. No way out of that. Every aide accepts their assignment and therefore responsibility for the residents on it. Each CNA is responsible for her assigned residents and the unit, as a whole, cannot do this.

It’s tough when bad things happen to good aides, though.

Did you read the man’s care plan? Are you absolutely sure he is independent in his cares? If so, did you check in with him to see if he needed any help, with anything? I think sometimes we assume these residents who are able to do their own care never need ANY help- and this isn’t always the case. When doing this check in, it’s always a good to ask when they’re planning to get up; what they’re bathing plans are and the like. This way, you can have some awareness that Mr. Smith is going to be up and about around 9am, and might need someone to just peek at him.

Of course this is where team work comes into the picture. Every time an aide is going to be tied up for awhile with residents, its always a GOOD thing to let as many peers know where you’re at. And include the nurse with this info as well. If you’re so inclined (and I would be) I would ask peers to keep an eye and ear out for your other residents…especially if I was going to be tied up for a longer period than usual with the other resident. A good charge nurse would make sure your other residents are covered as well. It’s a balancing act though: Asking every aide to cover the others’ residents every time personal care is being performed is just not practical.

As for the report: It’s called an Incident Report. The questions asked do indeed have everything to do with the assessment of a fall. By asking you what you could have done to prevent this fall, the answers you provide are supposed to be helpful to prevent a repeat in the future.

Did you know most residents fall because they are trying to get to the bathroom? If they’re hungry they might be trying to rush out to a meal. Usually there are other questions too on these reports- about all sorts of things. Often we don’t know the prior condition of any resident when they have fallen without a witness.

It’s very important for CNA’s to answer these things honestly…however….when we’re written up it takes away the desire for CNA’s to have any respect for these reports. These things should never be used as a means for punishment. When independent residents fall, it is NOT the direct fault of the aides. It was caused by something else. It IS up to management to figure out why the fall occurred- but by placing blame on the aides they are short changing this process. This is another example of autocratic management style- which isn’t helpful. And, I have to wonder if nursing homes with high fall rates have these kinds of managers.

I’m sorry you got written up. Of all the things CNA’s don’t have control over, the FALL tops the list. The work loads alone should tell all that it’s impossible to be everywhere at the same time- or even once an hour. A good fall prevention program begins with a trusting environment where no one is disciplined for falls unseen. Once that is in place, true prevention strategies can be developed AND the CNA’s are the most valuable asset to this process.

I found these videos at YouTube and thought it would be a good resource. I’m including them here in two posts…

Transfer Techniques p.1 of 4

Video Two from the series.

Transfer Techniques p.2 of 4

I have seen a disturbing trend of late. Quietly, medical and nursing facilities have been laying off staff in higher numbers. Not just housekeepers and janitors either; but nurses and CNA’s. In my state, a couple weeks ago a highly rated hospital closed down a unit and laid off 23 nurses and aides. Another facility was going to trim down a nursing unit by 15 beds, and would have laid off about 20 LNA’s and several nurses; the facility changed it’s mind on this, for now.

What’s going on? Did we ever think CNA jobs would be targeted for lay offs? Times are getting tough.

Cape Cod Hospital has notified an employees’ union it intends to eliminate about 17 full-time positions, including jobs held by cleaning staff, shuttle bus drivers, nursing assistants and food service workers.

The hospital is looking to save $800,000 through a combination of layoffs and not filling currently vacant positions, said David Reilly, spokesman for Cape Cod Healthcare Inc., the parent company of Cape Cod and Falmouth hospitals.

The job loss affects only Cape Cod Hospital, which is feeling the brunt of a multimillion-dollar revenue decline.

The 16.9 positions are “full-time equivalents,” meaning each is the equivalent of a 40-hour-a-week job. But the job loss could actually affect more than 17 individuals, since several of the jobs are shared by part-timers.

Revenue is the income a facility receives to pay for it’s operating costs. Much of this money comes from the federal government and state government, as well as from insurance payments. But, because these sources are not increasing their rates of reimbursement to the facilities, we have a shortfall.

Don’t assume belonging to a union will save CNA jobs:

‘The entire health system is feeling the pressure,” said Jerry Fishbein, vice president of 1199 SEIU, United Healthcare Workers East, whose union represents the workers whose jobs will be eliminated.

As required by collective bargaining stipulations, the hospital gave the SEIU a “30-day notice” of its intent to lay off the employees.

The next step is for the union to meet with hospital officials to see if they can whittle down the list, said Fishbein, whose union has 1,200 members at Cape Cod Hospital. “At the end of the day, there will undoubtedly be some layoffs. We certainly think the numbers should come down. It’s process of negotiation.”

This process might save one job, or position. It’s not comforting to know this process, negotiation, is all the unions can offer us when we face a job loss.

Last month, Cape Cod Healthcare CEO Steve Abbott announced that the organization had suffered a $17.6 million revenue loss in seven months.

The company responded by laying off 11 employees, mainly in mid-management and clerical positions, requiring a dozen senior executives to take a 10 percent pay cut and asking employees to consider early retirement.

The cut backs weren’t enough. So now they take it to the next level.

“Cutting back on the nursing assistants is a big problem for us,” said Stephanie Francis of the Massachusetts Nurses Association.

The two nursing assistant jobs scheduled to be eliminated could require nurses to pick up the slack and spread themselves thinner among patients, she said. Such a move would be in direct opposition to the Patient Safety Act being proposed on Beacon Hill, which requires a certain ratio of nurses to patients, Francis said.

Well usually the nurses whine when it’s THEIR job on the line; they complain when they are replaced with the less skilled, lower educated unlicensed assistive personnel (as we’re known as); they cite patient care problems when there are more of US then them. Since UAP don’t fall under Nurse s scope of practice rules, this claim is disingenuous at best. BUT, at least she’s sticking up for the aides in this case.

Abbott, who is retiring this summer, has blamed some of the hospital’s financial woes on the rise of off-site, privately run surgical centers and on an independent physician association, Physicians of Cape Cod, that he says is making fewer referrals to Cape Cod and Falmouth hospitals and their affiliated laboratories and services.

By sending patients to private organizations for procedures that receive lucrative reimbursements, the physicians in the I.P.A. are forcing the nonprofit hospitals to absorb more and more of the cost of serving the community, Abbott said.

More disingenuous stuff here. First off, remember this is Cape Cod. Kennedy country. John Kerry country. Where the rich live and house up for the summers. These people will not utilize the services of a public hospital no matter what. Cape Cod is full of private facilities that offer services at far cheaper rates than the public hospitals, believe it or not. Private sector doesn’t always mean more costs. The people who reside in this area do have a right to pick and chose where they will receive their health care, surgeries and the like. I do know these private facilities offer jobs to nurses and CNA’s and pay them better.

Do we take away this choice in the name of saving jobs? I think not.

What is certain is times are changing. More and more medical and nursing facilities are going to be forced to make cutbacks; this will result in patient care being put in jeopardy in many situations. I would expect to read more and more similar articles in the next decade or so, too. The trend is only just beginning. Brace yourselves.

Cell phones are a wonderful addition to our lives. Communicating quickly with family and friends is a good thing most the time.

However, at work, in nursing, they are fast becoming a nuance. I see many nurses and aides who constantly check their cells for messages; or who are texting someone. Right in the middle of patient care! Or a residents’ mealtime!

Message to CNA’s:
Cell phones no longer interfere with most medical equipment. This is no excuse to use them while we are working. Surely any message can wait until a break. Nothing is more aggravating than watching your co-worker drop everything they’re doing to TEXT someone. Or to check a call. Not only is this aggravating, it’s very unprofessional.

Message to management:
What is YOUR policy on this? Where I work we are not allowed to carry our cells with us on the units. Equipment problems are not the stated reason either. Rather, common courtesy and professionalism are cited. Cell phones take time and attention away from resident care; residents and co workers perceive the use of cell phones during care as rude (IT IS!). Staff are allowed to use their cells on their breaks only, and in the break room only- not in patient care areas.

Question:
At my facility we’re not allowed to call out! Lately there’s been a lot of call outs and even more aides quitting. So we work short all the time. A couple aides have hurt their backs too cause we’re short all the time. Anyway I got the “bug” last week and had a fever, vomiting, and diarrhea. I felt horrible. I couldn’t eat anything; I couldn’t keep anything down. I called work to let them know I would be out for my shift and they put me through to the DON. who told me to come in for work, to report to her prior to clocking in so she could assess whether I was too sick to work. If I didn’t follow this directive, I would be terminated. SO I went to work and the DON took my temp (101.2)- she gave me Tylenol and a couple spoonfuls of Pepto Bismol; she told me report for duty. If I didn’t feel any better in an hour to come back and see her.

Is this legal???

Answer:
Your email tells me your employer is having a hard time with staffing. It appears that the place is going through a downward spiral of problems and management is part of that. When an aide shows up for work, sick with fever and infection, she exposes not only the residents, but her co workers as well.

It’s very likely more than a few will catch the illness. So, it spreads like a fire. As each aide comes down with the bug and misses work, management feels it has to do something to curb what it perceives to be an abuse of attendance policy. Management should be prepared for a staffing crunch knowing a virus is going around. But, this facility’s management is punishing the very people who are out in the battlefields where the germs are located. It’s old fashioned and autocratic.

Instead of being proactive, the DON is being REACTIVE and in a very negative manner. Her actions are telling her staff that she doesn’t trust their judgment on their own bodies health. She is also telling them she has no respect for them. A warm body on the schedule is all that matters, even if that body’s temp is 101.

The Legality of this:
If this is a policy, it must be written as such.

I called a lawyer friend and relayed this scenario and she gave me the following advice: Is the DON a doctor or a Nurse Practitioner?? If not, she is straying from her nurse practice laws. Nurses cannot diagnose illnesses, diseases, disorders and the like. Perhaps she is sending staff to a doctor who is legally licensed to perform a medical assessment. She would be smart to do this. She should NEVER give staff ANY medications without a doctors’ order. She is putting her license on the line by doing so. She knows this. And is counting that you don’t know this.

Legally this practice is not advised for management. They are risking a discrimination lawsuit if this “policy” doesn’t cover ALL employees of this facility- so, when the dietary aide or the cook or the maintenance man calls out, the DON/Management must apply this same requirement towards them. They too must come in, be assessed, and determined if they’re “healthy” enough to work or not. And this would mean doing so 24 hours a day, 7 days a week. Even on holidays and weekends.

What To Do?
If you find yourself too ill to perform the duties of your job, you can and should call out. However, you should also make every attempt to get better or try to reduce your symptoms so you can work. In other words, do take Tylenol/Advil to get the fever down. Immodium will end just about every episode of diarrhea. After this, if you still feel too sick, call out. Make sure you follow the policy- most facilities require 2 or 4 hours notice.

Have your spouse or a friend make the call for you if you’re concerned with being harassed by the DON. Instruct your spouse/friend to take a message but to be firm: You will not be showing up for work. Make sure your reasons are given: Details- fever, vomiting, ect. and the actions you have taken to try to make it better. Then call your doctor and make an appointment. You’ll need to be assessed and diagnosed properly; and the MD will need to write you a note excusing you from work. Often, this note will include actual dates you are not recommended to work.

A doctors note will not protect your job.
We need to know this and not rely upon it. The note does give credibility to you though: You’re putting the effort into seeing the doctor to find out what is wrong and get better; you’re paying money to do in most cases; you want to show your employer you weren’t goofing off, ect.

You can still be terminated unless you’re a member of a union which has rules on this.

I would not wish to continue employment at a facility where this practice occurs. I would leave on my own free will and seek employment at another place with more enlightened management.

The National Association of Health Care Assistants- NAHCA- used to have a magazine for CNA’s called “CNA TODAY”- it ceased publication a couple years ago. NOW, they introduce a new magazine for ALL direct care workers in the nursing field, titled, “MY CAREGIVER”.

From the MY CAREGIVER web site:

My Caregiver is a quarterly magazine published by the Academy of Certified Health Professionals (ACHP) for and about health care assistants and their role in long term care. It is a special magazine, a publication virtually every person in the long term care industry will want to read.

With a circulation of 10,000, we reach nursing assistants, Directors of Nursing, facility Administrators, nursing home residents, and their families, product manufacturers, policy makers, and other health care associations.

The first issue of My Caregiver debuted March 2008. It evolved from the original CNA Today magazine to focus on health care assistants from diverse settings in long term care. The original magazine, CNA Today, launched June 2001 and was unveiled at the NAGNA National Convention.

Now My Caregiver will prove to be a remarkable resource for information on long term care for all who perform the role or duties of a nursing assistant, regardless of title.

The magazine is published quarterly and costs $15.00/year for non NAHCA members; $10.00/year for members.

NAHCA’s main web site is HERE.

A nursing home in New York City cut off health benefits to it’s staff over last summer, and they have been on strike since February.

After three wearying months of walking the picket line, 220 nursing home workers at the Kingsbridge Heights Rehabilitation and Care Center in the west Bronx have had plenty of time to sharpen their message.

“Health care workers like us should have health care coverage,” said Jacqueline Simono, who has worked for 10 years at the six-story, 400-bed nursing home.

In August, the nursing home stopped paying the workers’ health insurance premiums, and as a result, their coverage was cut off. That, the workers say, was the main reason they went on strike on Feb. 20.

The workers, members of 1199 S.E.I.U. United Healthcare Workers East, say they are expecting the National Labor Relations Board to give them some good news soon to help end the strike.

Sadly, those on strike are not earning any income and I cannot imagine how they are making ends meet right now. The costs of health care benefits is skyrocketing for everyone- not just health care workers. We’re seeing more and more businesses from every sector dropping coverages or increasing premiums.

Reading the rest of this article, it isn’t clear what’s really going on here. One thing: If these staff belong to a union, it is the unions’ job to make sure benefits are part of any bargaining plan. Somehow, somewhere, someone let the ball drop here.

I did a little digging into this situation and found a couple articles worth mention.

From a May 7th article:

NEW YORK–About 5,000 members of 1199SEIU from across the Northeast rallied May 3 to support 220 strikers at the Kingsbridge Heights Nursing Home, whose owner, Helen Sieger, has refused for six years to sign a contract with SEIU or pay into the 1199 health benefits fund.

The overwhelmingly immigrant strikers entered the rally at Fort Independence Park in a boisterous show of force, calling on a broad spectrum of militant national labor traditions.
[...]
Bartosz and Tomas, two strikers from Poland, described Helen Sieger’s anti-labor practices: “We have no sick days. We have no health benefits. We are required to arrive at 10:30, but are only paid from 11:00 on. Though we should finish at 7:00, we often have to work later, also without pay.”
[...]
A number of federal, state and city politicians and union officials spoke at the rally, including SEIU President Andy Stern and Sen. Charles Schumer. Barack Obama spoke through a recorded message. SEIU members from Albany and Rochester, N.Y., turned out, along with others from Massachusetts, New Jersey and the Washington-Baltimore area.

The rally highlighted the role that immigrants play in organized labor. A win for the Kingsbridge workers will be a victory for both the immigrant rights and labor movements.

There were not 5000 people at any rally for this. That is a gross exaggeration. Using militant strike methods wins few friends in these causes; however, asking politicians to speak on the behalf of those on strike is admirable.

The fact that many of those on strike are immigrants leads me to ask the tough question: Are they legally entitled to work in the US? Are these people just doing another job Americans won’t do? I wonder how many American CNA’s worked for this facility?

Finally, I ask this: If there is a strong union here, HOW do we explain such bad working “conditions” that include no sick days, not being paid for actual times worked, and so on? In many places of employment, meal breaks are not paid time. So, employees are expected to be on premises for 8 1/2 hours- eight of which are paid and the other that is not. And exactly how much longer were they made to stay over 7:00? A few minutes or hours? If minutes, then this issue is moot. If hours, then there is a serious problem. The devil is in the details, and we’re not getting those.

I also found the latest survey information for this facility. As usual, it doesn’t provide a clear picture of the facility, but all in all it isn’t THAT BAD. I have no doubt this place is a dungeon to work in; I also have little reason to believe the management gives one hoot about the workers. But my instincts tell me we’re not being given ALL the facts.

I ask people to be skeptical on these articles because the lack of detail can make a huge difference. A unionized nursing home should NOT have these issues. A union that has failed it’s members, however, might encourage a strike just to blow smoke in the air around it’s own failings and obscure the truth.

Much of the work we do is aimed at keeping our residents clean, dry, fed, toileted and hydrated. We focus on these things because it is OUR job. There are other things though, that often get lost in the daily shuffle. I work for an agency as a part time job (as well as a full time job at a rehab facility) and through my experiences here, I’ve seen a lot of rushed care and the results of it.

When working short, there’s a saying among aides: Face, Hands and Butts. FHB. This means that our time should be spent washing faces, hands and butts and the rest can go unattended. This isn’t ideal but it is the reality when we’re pressed for time.

Even when our units are well staffed I have seen some pretty poor quality cares that leave me wondering if some of us cannot put ourselves in our residents’ shoes…

No matter how short staffed, we must always consider resident dignity.

Complete bed baths, whirlpools and showers can be postponed.

Washing faces doesn’t mean simply wetting a wash cloth and wiping it over a face. It means using gentle soaps/cleansers. It means using another wash cloth dampened with water, to rinse off the soap. It means paying close attention to the eye areas, removing the residue and drainage we often see. It means making sure noses are clean and the area around mouths is clean as well. Shave the men.

Oral care MUST always happen- how would YOU feel if your teeth weren’t brushed???

Care must be given to underarms. They need to be washed, rinsed, dried. If needed, a light coat of deodorant is called for. Body odor is a major dignity issue for our residents.

Hands have to be washed. Period. Several times each shift. Nail care can wait, unless they are long and ragged or dirty.

Incontinent care has to happen. Buts and other areas MUST be cleaned. Period. No skimping here.

I can’t count the times I have witnessed residents being brought out with messy hair, or worse, with hair dos that are not becoming to them. Ladies like to look presentable. Imagine how you would feel with greasy, slicked back hair…it’s up to US to make hair look nice. Hair should be combed/brushed no matter what; if ladies’ hair is permed, a little spritz with some water often works wonders to bring back some curl.

Clothing choices? It usually doesn’t matter when it comes to staffing issues. Residents have clothes and we assist them with dressing. BUT what does matter is matching colors at best and avoiding clashes at worst: Striped shirts do not go with plaid pants! Just like an elegant fluffy blouse doesn’t go with sweatpants. Some of our male residents prefer to wear t shirts under their tops; and MOST of our ladies like to wear bras. Don’t skimp on this.

A quick note about briefs: For the residents who use them, we have to ensure they are correctly applied. The right size is paramount. Too big a brief is not only wasteful but a major cause of discomfort. Small briefs often lead to nasty red marks in the groin areas. Make sure the brief is centered, and the front portions are pulled up enough to allow for movement. Don’t let the brief bunch up anywhere.

Residents who use wheelchairs need special attention for comfort AND skin issues. This is a no brainer but I have seen countless times, bunched up shirts in the back and sides. Pants that are wedged up in front. We need to make sure these things don’t happen. Take the time to pull down tops once a resident is positioned in their W/C; fix the wedgies and pull down the lower parts of pants. Make sure the resident is seated properly and is comfortable.

As much as most of us don’t like providing less than ideal care, we can do so on shifts where we just don’t have time. Assignments are often increased with two or three residents when there’s been a call out. Always check with the charge nurse about your priorities when staffing is an issue. Better yet, ask the nurse for a meeting with all the aides on the shift, to plan ahead for those times.

Always consider safety, comfort and dignity. Some will say not always in that order, either.