CULTURE:

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.

 

Documenting

When writing notes, be clear, concise and to the point. Be objective. Don’t write what you think happened or what you think caused an incident. Only write what you know.

Timely documentation is vital. If you take a set of VS and see that a resident has a fever, let the nurse know right away. Don’t wait until the end of the shift, or even wait until you’re done with this resident.

If your facility uses flow sheets, make sure you’re initials can be easily read.

Getting to know the particular types of paperwork you are required to do can take a little time; it is always better to ask before you sign your name to anything.

Never sign off anything you didn’t do. Never sign off something someone else has asked you to sign. Only document care YOU have given.

Being a witness to something and being asked to sign that you witnessed- this is another story. Just make sure you write that you witnessed….

Use pens with facility approved colors. Don’t use pencils or markers. (KEEP IN MIND: Colored inks do NOT show up on copies- only B/W does)…

When using EHR systems, never share your login info/password with another staff. For any reason. Ever.

 

Taking Care of Yourself

Don’t go to work sick. Ever. On the other hand, don’t call out over a simple hangnail either. Be respectful of giving enough notice when you call in. Also, never call to say you’ll be late and then call back to say you’re not coming in at all!!

Do some stretching before work! Really- it helps loosen up all those muscles we use and this helps prevent back injuries.

Eat right- right is different for all of us. Make sure you are getting enough calories in daily to do your job as well as your home life.

Drink a lot of water. CNA’s don’t always think of themselves when it comes to fluid intake! Eight 8 oz. glasses a day is the least we should be bringing in; more is cool. If permitted, carry with you a covered water bottle at work. Drinking enough water may very be one of the best things we can do for ourselves! The other end of this is using the bathroom when nature calls. Don’t wait and hold it in. Go when you need to go. Find the two minutes it takes.

Lift people and objects properly. Use good body mechanics: Lift with your leg muscles, not your back muscles. Keep your balance and always work in conjunction with a partner during lifts.Get enough sleep. Again, this is a personal thing, each individual has different needs. Whatever your need are, tend to them.

If you find that you are always getting upset about work, if you feel outraged at things- you need a break. Take a vacation. If this is not possible, then take a mental health day. I don’t condone taking time off that isn’t vacation – but there are those times that we all need a break. Especially right now when the nursing community is changing so rapidly.


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When we accept a job, anywhere, we are expected to act in a professional manner. In health care it is vital to be a good worker, to respect our resident’s rights and dignity and to respect ourselves. After years of seeing certain things and traits of people, I have come up with a few things specific to us, Nursing Assistants.

Appearance
Number one, no matter what ANYONE says, is how we look. Nursing staff are supposed to be clean and neat- in order to prevent infection. All too often we see CNA’s wearing clothing, uniforms- that are wrinkled and dirty looking. Stains and holes are just plain tacky looking.

If we want to project an image of being professional, we must be willing to dress the part. I have heard many a CNA state- “I don’t make enough money for decent uniforms” …This is true for many of us. No one is saying one needs tons of uniforms, just that the uniforms we do have be kept in good shape.

Wear clean clothes to work that are ironed or at least wrinkle free. Wear underclothing that is decent and not too colorful. We all like to wear perfumes and colognes. However, many residents and patients have sensitivities to our scents. Sometimes we drown ourselves in cologne- and it is plain disgusting. Don’t wear it to work.

Next, think about make-up and nails. Have you ever seen women who paint their faces with lots of colors and wear their hair “BIG”? They remind us of clowns. Well, when we go to work wearing lots of makeup, we too look like clowns!

It isn’t good to have too much eye color, blush and mascara on while we are going about our daily duties. Often, the makeup runs and we look awful. We work hard and move around a lot- we get hot and sweaty. Nothing looks tackier than nursing staff with mascara running down the cheeks!

Nails should NOT be long. They also should be real. Many Government and Nursing Professional Groups have positions about artificial nails on nursing staff: Bacteria find a wonderful medium for growth under these nails. Many a patient has been scratched and infected with long unclean nails. It isn’t a matter of looks anymore so much as a matter of safety.

Work Ethics: Attendance, Tardiness
This is an issue of discontent for so many of us. We seem to always be working short. Daily we see others calling out. Some more than others, but it is a constant in our line of work. I would like to spend a few moments talking about this.

Missing a lot of time from work is bad for you. It can really ruin your reputation. If you need to be out for a legit reason, then so be it. People have different ideas of what “legit” means- this is a very individual thing.

Missing a lot of time really affects your co-workers ability to respect you too. No matter what they tell you to your face- they are not pleased that you call out a lot! After all, they have to pull harder loads, do YOUR work for you. If you tend to miss A LOT of time, you might notice that your peers really don’t talk to you much and they don’t ask you how you’re feeling! Don’t be mad at them- try to realize what burden you are placing upon them.

Perhaps some “standards” should be set and I am going to put them here. I personally never call out unless I am ill. “Ill” means- fever over 100, vomiting, diarrhea. I don’t call out for headaches- I take Advil or Tylenol which calm most aches and pains. If I’ve had a single episode of vomiting or other stomach upsets I generally won’t call out. I’ll take Pepto Bismol or Imodium to help.

I TRY to make myself better so I don’t call out. Too often I see CNA’s call out because they had a fever from something other than an infection; when asked if they took anything to make it better- they always say NO. I don’t understand this- why would anyone want to be sick??

In this day and age there are many options for medical care: In almost every town and small city there are walk in clinics that charge 35.00 for a quick exam for simple concerns such as sore throats, earaches, UTI symptoms as well as sprains, fractures and other minor medical needs. These places are open 15 hours a day 7 days a week.

Many of us have children- young ones who do get really sick. They can be the main reason so many of us need to be out so often. My thoughts about this are twofold: On the one hand I see a need for women, Mothers, to be home with their young kids when they are ill. On the other hand, I see many Mothers USE their kids’ illness’s as an excuse to be out. Working Mom’s should have pre-set arrangements made in cases of illness of children. Many private sitters WILL take a child who isn’t dreadfully sick, but not well enough to attend their school/daycare. That, or find another field of work because healthcare does not have funding capacities to employ lots and lots of back up staff to cover call outs. In the end it is often your coworkers who have to pick up slack and take on your assignment when you are out. They work short staffed.

The same talk is true for tardiness, to a lesser degree. In our work, the bulk of what we do on day shift occurs in the am hours. Especially in that hour or so right before breakfast. We call it hustle time! If someone is late, this becomes all the more energy draining for those who show up on time.

I know there are times that everyone is late. It happens. But there are things you can do to keep it to an absolute minute amount. First: Make sure you set the alarm on your cell!

If you work for an agency or employer that employs more than 50 people you might be eligible for FMLA. Ask your HR department about this. FMLA is wonderful for people who truly need it and who don’t abuse it. Sadly, many people do abuse it and miss lots of work without any true accountability. Originally FMLA was set up to help people take of themselves during serious illnesses such as cancer, heart disease and the like. Now, people can claim they have anxiety or headaches and be approved to call out up to 12 weeks each year.

No matter why one is out, and no matter if it is FMLA approved or not: It is unprofessional to miss so much time at work you’re not an effective member of a team. You have to be at work to be effective.

Next-go to bed at a decent hour. Don’t stay up all night partying when you know you have to work the next day. This is just plain dumb.

Listen to the weather channel or local weather reports if you live in areas known for their winters. If you hear snow is coming, set that alarm clock for even earlier than usual. I know this might sound very inconvenient, but it is YOUR responsibility to get to work on time.

I work with a girl who has pulled this: She calls 10 minutes before the shift begins to say she will be a little late. Then half hour later she calls to say she isn’t coming in after all. This is very bad and really rotten. When we asked her why she does this- she said she sleeps through the alarm and wakes late. Hmm. We told her to turn the alarm UP loader and move it far away so she HAS to get up (we even advised her to remove her remote device so she cannot turn it off)These things worked for her, maybe they can help you if this sounds like you.

If you really are sick or cannot make it to work for whatever reason, call in way ahead of time. Not within an hour! Most places require at least two hours, some four.

If you find yourself being out a lot due to these slight ills, perhaps you should think about what the real reasons might be that you’re sick. Maybe you don’t like where you’re working; maybe you’re unhappy with your coworkers and team. Whatever the reason, take responsibility for yourself. If this means finding employment somewhere else, then so be it. If it means getting out of nursing, then do so. Your residents depend upon you being professional. Missing too much time is not helping them.

Work Ethics: Honesty, Integrity
I can tell you without any hesitation that lying is the single biggest thing anyone can do to ruin their professional life. Telling tales is just not acceptable in any situation, in any circumstance and especially has no place in health care. A lie will always come back to bite you. It might take years, but it will catch up with you.

More importantly, in our work, being honest about what we have done is vital to patient safety. We are responsible for providing hands on care and often times we are rushed, short of staff and we forget. Sometimes we just cannot get it all done. It is much wiser to tell the truth, to admit a mistake, than to try to cover up.

An example might be- you forgot to get a weight and you just write in last month’s weight. Seems simple at first but what if the resident lost weight? No one would know and no interventions could occur to help the resident. Another aide checks the weight next month, and two things can happen: The other aide could forget to get that weight and do what you did; or the weight is truly gotten and the loss is noted- if it is BIG loss- they will question why it wasn’t noticed last month. The first thing they will think about- DID YOU REALLY CHECK that weight??? Your integrity will be questioned.

Some people try to justify telling those little white lies. I guess this is a very personal issue that only you can decide upon. With your friends/family, this might be ok once in a while if NO harm can ever come of it. But I would not tell even a white lie because it will come back to me.

When we speak about honesty, integrity always pops up as well. Integrity is when others know we mean what we say and say what we mean. It means we are always a well-valued person who has no agenda that is questionable. It means we are a person who can be counted on to tell the truth. Wouldn’t you like to have some integrity? It’s a good trait and one we should be proud of.

Attitude
I always hear about so and so’s bad attitude. This is another issue that is defined by each of us in our way. To some, a bad attitude is when we see/hear others complaining all the time. For others, it might mean constant bitching about management.

For me, it means something very different. I think a certain amount of complaining, done in the right places with the right people, can be a healthy thing. It can be a stress reliever and a way to think of solutions.

A bad attitude is defined by me as one of being disrespectful towards peers and supervisors, towards residents/patients, of being short and curt with others. A bad attitude can always seeing the negatives and not looking for the good. Spreading rumors- especially about leaders is not a good thing and shows me a rotten attitude. Giving everyone or just a few a hard time- not helping with lifts, not answering call bells, are all things I roll into a group I call ATTITUDE.

Having a good attitude will make others LIKE working with you. They will seek you out and seek your thoughts and opinions. They will respect you and they will talk good about you. Isn’t this better than being spoken poorly about??

Work Ethics— Using Employer Resources
When I talk about using your employer’s resources- I really mean ABUSING these resources. I am talking about the phone, the fax machine, the computers and maybe the supplies on hand for the residents.

I know many CNA’s who are always using their cell phones while working. When doing this, you are in effect stealing time from your employer. You’re being paid to work; to provide personal care and comfort to residents; to engage with them; not to be on your phone playing Candy Crush or texting your 14 year old daughter who doesn’t know what to eat for a snack. Many agencies and organizations do not allow cell phones on the premises; other do allow and CNA’s should never take advantage of this. It’s becoming a huge problem for residents- who need care but who come second to staff’s phone time. Ideally we would leave our cells in lockers or ask the charge nurse to hold onto the phones in the med room. Staff can grab them at break time.

The same applies to fax machine and computer use.

As to using resident supplies- this is not only unprofessional and unethical it is also illegal. It is called fraud and a CNA can go to jail for this. Don’t do it. Ever.

If you find yourself being out a lot due to these slight ills, perhaps you should think about what the real reasons might be that you’re sick.


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Shift Wars

In my years as a CNA I have seen many good aides leave a job because of issues between shifts. I have also seen aides become bitter and negative because of bad feelings between other shifts. This is so silly and unnecessary. There are ways to manage the transition between shifts. It all starts with an attitude change. It also helps to have Charge Nurses and Nursing Management on board with this modern and positive attitude and mindset.

Attitude change? Why, one might ask? Think about it for a moment. If you come to work “ready” for a bad day, you’re going to get what you ask for. If you come to work in a bad mood, chances are pretty good the day will get worse.

If you assume the folks on another shift are lazy, then in your eyes nothing they do is good enough or right. No amount of “excuses” will convince you that they had reasons for not getting everything done. You won’t believe the aide coming off shift when she says a resident was up all night sick and required 10 changes and a shower and that’s why she didn’t get 3 residents up for you; you won’t care if there were 2 call outs on the previous shift. Stuff didn’t get done, and your day is more difficult because of it.

Of course YOUR excuses are paramount and real when you can’t get YOUR work done, so you have a right to expect other shifts to understand your issues, right? You’re different and everyone knows it.

STOP right here. Let’s look at this mindset.

Stuff happens. To everyone, on every shift, every day. Residents get sick; they have major accidents, they die. They also have rights that they are exercising more and more. Staff work short, new admissions show up at inopportune times, room changes happen during every shift. Equipment breaks down, water turns off or gets too cold for baths. Toilets clog up, power goes out, families complain.

Each shift has its own set of unique problems, staffing patterns, nursing issues, demands, and expectations. Residents also have their own demands and needs that are different for each shift. One of the first things to keep in mind is this. If you have worked another shift don’t think you know it all. LTC is notorious for changes happening all the time- what used to be common may not be anymore.

Managing the transition from one shift to another is a process and it involves nurses and aides from both shifts coming together for a common cause. Communication is SO important- as well as having empathy and understanding. A process should be in place to make sure each shift’s staff has clear expectations. Leaving a unit in good shape for the next shift is the goal, and here are some ways to get to the goal:

1) Identify problem areas. Are they true problems? Or situations that result from people being human? First and paramount should be the resident’s safety, comfort and well being (not staff’s comfort and convenience). For example, review the following typical things that cause dissension between shifts:

  • Smith is always soaked. Her bed linens have brown rings! Her clothing is wet all the way up to her neck!
  • Jones was not bathed today!
  • Doris didn’t get weighed.
  • How come the linen cart isn’t stocked?

2) Once problems are identified seek out to understand why tasks and care were not completed. Stop assuming the worst in others. Let’s look back at the problems and list up reasons:

  • Smith was changed at 2pm; she is a heavy wetter would indicate she has a need for toileting program geared more to her individual needs. Also, look at the products being used to manage her incontinence- maybe she needs better briefs and hourly changes.
  • Jones HATES morning bathes and prefers them at night so he refused;
  • Doris was getting therapy today and she was exhausted; she asked that we weigh her tomorrow.
  • Laundry only had one dryer working today so there’s linen wasn’t stocked.

All of this changes things. We go from assuming the other shift has lazy good-for-nothing staff working to a group of people working with residents who are exercising their rights, and other issues out of their control. So while solutions are not always forthcoming, reasons for so called **problems** are human in nature and can’t be fixed.

3) Make a form called “UNIT ROUNDS”- here list everything that should be in place for the next shift. List every area of concern; place a check box or two next to each subject.

4) Implement a UNIT ROUNDS procedure. Staff from each shift assigned to do this duty- together they make rounds and check the areas. If Mrs. Smith is found wet, staff from outgoing shift need to change her, or staff from oncoming shift except Mrs. Smith’s condition and change her themselves. This procedure will take time at first- allow at least 15minutes at the beginning stages of this. Staff who makes rounds should “sign off” they have done rounds.

Another area I frequently hear about is specific to 3rd shift and 1st shift and expectations that a certain number of residents be up by 7am. This is more than just an issue for staff- this effects the residents, the way your day can turn out, and families. Priority MUST be given to resident rights and family concerns. Never should such an issue be talked about without input from the RESIDENT, Resident Council, families, the DON and Administrator.

The reasons for early get ups should be resident based and care planned and not based upon making 1st shift’s job easier or less hectic. DON’s should really look into the feasibility of these types of practices and decide if morally they are right. Residents who get up too early will not thrive, they are apt to be tired, grouchy, and unable to eat well, drink well and behavior problems can result. Getting residents up before 5am should not be allowed.

Also, think about safety. 3rd shift has way less staff than days, and having several residents up can create a safety issue. Who is keeping an eye on the residents who are up and about?

When residents do get up early, when are they toileted? A resident who gets up at 5:30am should be toileted at 7:30 am- does the staffing pattern allow for this? Is someone from day shift available to do this, or are they all getting other residents up? Quality of life must be taken into consideration.

The culture of shift wars and charge nurses responsibility

Do the charge nurses inadvertently create more of an issue with these shift wars? When the CNA’s complain, charge nurses may not respond to the issues, or think they are petty. This creates a HUGE morale problem for the units. Nurses need to find time to listen to the CNA’s complaints and help them identify what is important and what isn’t. Help them sort out assumptions and balance the needs of each shift. A charge nurse should never take th **side** of any shift as this in of itself adds to the highly charged environment between shifts.

Nurses and CNA’s may need to learn skills of communication with each other and members of other shifts. Implementing the Unit Rounds procedure will help but not eliminate shift wars. The nurses must set an example by getting along with the next shift.

 


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Hard Truths

In our work as CNA’s, we see many contradictions. A lot of DO AS I SAY but little of DO WHAT I DO. We have well written care plans that, in the perfect long term care setting, would be ideal for each resident. We have leaders who brag about the “excellent” care facilities provide.

But the CNA knows the truth.

Sometimes these truths are uncomfortable.

And the truth can hurt. It hurts our residents. It hurts US. It hurts humanity when it becomes the norm. Sadly, this is how it is in most nursing homes. Staffing ratios that change from one shift to the next. But the care plan goals and objectives do not. Why is this?

I read all the wonderful programs and processes at the various nursing home trade web sites we link to. The ideas, and the thoughts behind them are based upon good nursing care practices. Much emphasis is placed upon involving the CNA’s in the programs such as eliminating wheel chair use. CNA’s aren’t stupid. We know how these things are harmful.

Much effort is put into making sure staff “understand the importance”; many hours are logged into convincing staff (namely CNA’s) that these ideas are best for our residents. Care plans are written with great detail as to exactly when and how far a resident needs to ambulate (or whatever the program demands).

CNA’s aren’t stupid.

Yet, all this “education” and “staff buy in” baloney only goes so far.

The baloney shows its true colors when there aren’t enough staff to follow through with the programs. A CNA can assist several residents with walking to the dining room, for sure. But to expect the CNA to ambulate 10, 12 or more to meals is a bit much- when we add in the meal set up, assisting with eating, cleaning up and the myriad of other tasks we’re charged with.

The baloney shows its true colors when 3 aides are assigned a unit on evening shift that is staffed with 5 aides on days. It has always baffled me why evening shift has less aides…the claim that the shift isn’t as task-orientated is crap!

Some more uncomfortable truths:

Evening shift aides could keep all their residents out of wheelchairs IF they had enough support in the form of adequate staffing. But NO. Management cannot justify the ratios based upon the low standards of care they like to pretend are excellent.

Evening shift aides could make sure their residents are brought to the bathrooms more often and therefore decrease incontinence; which could lead to less brief use and…wow…less need to purchase all the products designed to “manage” incontinence. And a nice side effect would be less odors.

I am quite sure more than a few residents would appreciate a shower more than once a week- evening shift staff could do these. Clean residents are happier residents. They smell good, look good, feel better and often want to participate in their lives more.

Residents would not have to go to bed right after dinner, or even at 7:30pm, if there were enough aides. What adult retires THAT early in the evening? When residents are in bed, they are at risk of bedsores, contractures and all the problems associated with immobility. In the end, these problems cost far more money and time to correct than a couple extra CNA’s would cost.

I am quite sure nursing homes save money when they don’t have to keep Activity Staff on the clock past 4 or 5pm each day. Most residents would like to stay up later at night, and socialize and enjoy some activities and outings and other similar things. Having things to do is what keeps life interesting and entertaining. Looking forward to nothing is depressing and demoralizing.

I am quite sure nursing homes save money when they purchase chair and bed alarms vs. having a couple more aides scheduled. The alarms don’t require an hourly rate of and the other costs of employing an aide.

I am quite sure nursing home management can do little to change these truths. They can, however, try very hard to provide the right ratios and activity staff and other supports needed to enable carry through of these excellent (and medically sound) programs. Either that, or down grade the expectations to what can reasonably be done. In other words, care plans and programs should be, and must be, formulated and written with staffing ratios in mind.

Ideally, the resident’s needs should justify the ratios. The CNAs know the truth though.


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I have been reading here and there about shift report.

How some nursing homes don’t seem to think the CNA needs to hear report. I think this is not only wrong, its bad business and a law suit waiting to happen.

CNA’s are the hands on care giver.

They are the eyes, ears, noses and hands of the health care team charged with providing care to residents. When a resident’s condition changes, does it not make sense that the first, and more often than not ONLY people who will have any direct contact with the resident KNOWS of the change?

Nursing home management, that decides CNA’s don’t need to get shift report are setting the residents AND AIDES up for potential injury, harm and distress. Physical and emotional. Nurses, going down the hall, barking out orders to the aides, AFTER the nurse has heard report is not acceptable. By then we have often done our first set of residents and it’s too late for some orders to be carried out. Or, the resident must be placed back in bed or otherwise inconvenienced. And it wastes time that which CNA’s don’t have a lot of.

Consider this. A resident fell on evening shift. At the time no known issues resulted from the fall, but the resident needed to be observed and assessed periodically until the doctor could see them the next morning. The doctor tells the evening nurse the resident is not to do any weight bearing activities until he sees the resident. Day shift staff arrive and are given their assignments and are told to go about their job. The aide assigned to the resident who fell has no way to know that a fall occurred… The CNA doesn’t get this info and transfers the resident via a stand pivot. SNAP. A hip is broken.

Consider this. A resident’s urine is noted to be dark and foul smelling. The resident cannot speak for herself but is continent. The day shift aide assists resident to the toilet, where she voids a medium amount of dark smelly urine…the residents usual habits indicate she won’t be voiding again until sometime after lunch. A sample was needed from the morning void but that info was never passed on to the aide in time. Now the resident must endure many more hours of discomfort and pain from the UTI she has, all because of a lack of communication.

A resident was up most the night. For whatever reasons, he could not get to sleep. He is known to have behaviors, and a trigger to this is being tired…the aides don’t get report. They find him in a deep sleep and think, “Oh well, he has to get up to eat!” and wake him up…and the aide gets punched in the face. A nice black eye and broken nose are the result. And time spent at a doctor’s office, ex rays, pain and suffering…all on worker comp billing. Because it was never passed on in report to allow the resident to sleep this morning.

Shift report is vital to CNA’s.

We NEED the information…even when it is repetitive and mundane, it is important. CNA’s must have this information BEFORE they asked to provide care. The little details are often so helpful to us. When we know Mr. Jones hasn’t slept all night, we will allow him to sleep in, to be the last resident we get out of bed. When we know Mrs. Smith might have a UTI, we will collect a sample – many times without being asked. When we hear that Ms. Brown fall last night, we will ASK if she is able to do any weight bearing.

Report doesn’t have to be this long boring ordeal.

Many facilities only pass on information that is out of the ordinary; the typical, usual and common information doesn’t always need to be shared. Normal vital signs, BMs, percentages of meals consumed and cc amounts of fluid intake are not overly important, especially if this information is logged in a book somewhere. On the other hand, elevated temps and B/P’s DO need to be passed on; a lack of a BM in 5 days NEEDS to be passed on; consumption of NO fluids has to shared.

Part of what every CNA needs is information
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We use our training and experience to make everyone’s jobs a little easier; to make our residents comfortable. We depend upon good communication from previous shifts and nurses to provide care that is safe and appropriate. Nursing home management should always insist CNA’s take part in shift report. It should be a mandatory expectation; and, taking this one step further, if an aide shows up late for work, he or she should NOT be allowed to take an assignment until they hear report


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