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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.

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.