The Truth About Being a CNA
Certified Nursing Assistant---Good Move?
Yes and No.
Before I broke down and filled out my application for CNA training, I had no desire to be a CNA. My mother worked as a CNA for much of my life and I never thought I could ever do it. My major reservation about going into it was seeing the private parts of grown people--not to mention, being in direct contact with their poopie doop.
So why did I do it? Well, i was in school at the time and working as a "helper" in the nursing home where my mom worked, passing out snacks and pushing residents here and there. At this point I had done this for 2 years and I was tired of it. I wanted to quit, but I don't have the personality, connections, or whatever it takes to land a job at Target or Walmart.
I'd love to say that I registered for the CNA training because I have a huge heart and wanted to take care of people, but no. I needed to escape and I wanted to make a little more money. And being that I couldn't get a job in the grocery store, I had to bite the bullet and earn a skill set so that I could work someplace else.
On one hand, I would suggest CNA-ing to someone who needs job security in the moment. The course I took was only 8-10 weeks and places always need CNAs--especially nursing homes because CNAs are always quitting. Another good thing is that if you decide to go to nursing school, you won't have to do the CNA part, which is required with most nursing programs. Also, with certification you are qualified to work in more places. There are a few places I know of that hire PCAs (personal care assistants) without certification, but these people are paid slightly less than CNAs and can't transfer their experience to most other facilities unless they are certified.
Although there are a few good things about this career choice, I would not recommend that anyone go into this without an exit plan. IMO this should not be anyone's last stop. One CNA I worked with had been doing it for 30 years, and I know others who have been doing it for nearly as long. I was in the game for just three years, and I can't imagine sticking around if you can do better in any way.
Now, if you think that this is all you're capable of doing in life, or if you happen to love it (yeah right) then you be the best CNA you can be! (Err...I guess)
It's been 2 years since I've changed a brief (diaper) and if you can't tell already, I still harbor a fair amount of disdain for this type of work. Contempt. Irritation. Much of the rest of this lens will explain why.
If you look at the Certified Nursing Assistant page of any career catalog, you'll likely see some version of this picture--an older person sitting with a CNA who is smiling and happy to be there. Your instructors will try to paint a pretty picture and if you don't know anyone who does this, you'll probably be surprised at how much work is involved. Even in the articles you may have come across, supposed CNAs make it seem like the job is wonderful and that they love it. It always annoyed me that no one tells the truth!!! Honestly there are some moments when it's calm and you have the chance to sit and talk with your residents.....and there are those times when some of them express their appreciation for what you do for them, but those times are far and few between.
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Where to Work
As you read this, keep in mind that all my 3 years of CNA work took place in nursing homes. Out of all the places you could choose to work, I think nursing homes are the most intense. Where I live nursing homes pay a little more (a $1) than hospitals, who prefer experience (they want experience, but pay less...what sense is that?). From what I hear, hospitals tend to be a little easier to work because the patients are of varying ages and it's more likely that they will be able to do for themselves or have a family member to help them dress, bathe, etc... Also, if a patient doesn't want a bath or any personal care it's not so bad because more than likely they'll go home in a couple days.
On an average day (morning shift), I would be assigned to a "track" of 6 rooms, which equals 12 residents. If lucky, 2 or 3 of these residents may need minimal to no help with their personal care. That leaves 9 people that need to be bathed,dressed, and (possibly) put into their wheelchairs or recliners BY LUNCH TIME. Of course if someone calls out sick we would have 8-10 rooms.
When in CNA training, you will be taught the proper way to make a bed, give a bed bath, brush someone's teeth, etc. You'll have it all down when you take the practical part of your CNA test. Unfortunately, much of what you learn will go out the window when you hit the floor.
As awful as it sounds, residents in nursing homes don't get the best care possible. It's not that the CNAs are heartless, careless people, but that if they do every single thing "by the book" they'll get very little done. A bed bath, for example. In training they show you the proper way to wash the entire body from head to toe.
I usually only filled a wash basin (some don't even do that) and washed under their arms and torso and washed their bottoms as i changed their brief. If these people can't speak for themselves or if they don't have family members that will come in later and complain, their teeth won't be brushed. Nail care will not be done. I know that's bad, but there are other people that need to be prepped for the day.
And you know what? The beginner CNAs that try to do a perfect job are the ones that other CNAs start to dislike because they have to pick up the slack when lights are going off and the assigned CNA has been in a room forever. Even if you are busy, a nurse will grab you and ask you to take care of a resident you're not even assigned to even if you have your own work to do! Resident family members resent "slow" CNAs, too, because all they know is that it took 30 minutes for the CNA to make it to come get 'mom' bathed and dressed or they are upset that their parent isn't 'up' yet when they come to visit.
After the resident is clean, next step is to dress them. This part isn't so bad unless the person is contracted, really big, or a "fighter" (will explain later).
After the resident is presentable, the next thing to do is to put them in their wheelchairs. The proper way to transfer a resident is to wrap a gait belt around the ones who can stand or to use some sort of mechanical lift (for the heavier ones). I never got the hang of using a gait belt because I rarely used it! Some residents could stand with help, and I would just kind of physically lift or pull the lighter ones that couldn't move into their chairs.
That's one thing about CNA work I disliked: being dependent on other CNAs to help me sometimes. I always helped my fellow CNAs with a smile, but a lot of CNAs can give attitude when you ask them to assist you in lifting someone or helping you change someone. In nursing homes, you are going to have to work with some big residents that can't do anything for themselves...some can't even roll over without your help. It's just frustrating when you have someone dressed and you can't find anyone to help you (because they are busy or because you don't want to ask a certain CNA for help) to change them or transfer them into their chairs.
Mealtime is usually not so bad because after everyone has their food, you can sit and rest a little bit as you feed the "feeders" (residents who need to be fed, of course).
After meal time, it's usually time to lay the residents back down to be changed. Most likely they will want to stay in bed until the dinnertime.
Nursing homes are different as far as resident makeup and patient care supplies. In the last nursing home I worked, most of the residents needed some degree of care but the resident makeup was not dense with people who needed the max amount of care. Out of the whole facility, at any one time, we had about 5 at most who really, really, really required the hoyer lift to be transferred--which is good.. The hoyer lift is useful, but a pain because it takes longer to transfer someone with it than to just underarm them and put them in their chair, but those who need the hoyer lift, really do need it because they are too big. For a minute I worked at another place that had 4 hoyer lift people on one track!!! It seems they accepted any and every body. I hated that place.
As far as supplies go, I worked at two places that made us use towels to clean people. On the one hand, towels are good because we wet them with warm water (as opposed to shocking the resident with a cold adult wipe), but they are unsanitary because if you have to clean up a "mess", the whole towel is going to get nasty and touch the residents' skin again and again. Also, i think the towels are really rough on the skin.
The last place i worked used adult wipes. While they were cold, they were more sanitary (throw away with each wipe or two).
Now, that may not sound so bad....and it wouldn't be if all you had to do were steps 1-3 with everyone and go home. This is a people-oriented job and there are lots of personalities to deal with. Including annoying residents.
While you are trying to get your people up and ready, there will be lit call lights to meet you when you exit a room. Call bells serve their purpose and most of the time the residents really do need assistance, but a CNA is only one person. Imagine coming out of a room just to dispose a soiled brief and throw clothes in a hamper and three of your other rooms are lit up and one of the residents is yelling because their light hasn't been answered soon enough. And you still aren't quite finished in the room you just came out of!
The first group of annoying residents are the "Light Sitters". They are known for "staying on the light" and where I worked you'd have one or two patients that fit this description. You could have just fulfilled their last request and they turn the light back on wanting something else. There was one lady that would put her light on nearly every 20 minutes wanting to be changed. We'd check her and she's not wet or her diaper has just been sprinkled.
And then another lady would always turn on her light wanting to be pulled up higher in the bed. She wasn't light enough for one person to do, so whenever her light came on that means her CNA would have to go out and find someone to come and help.
Then another lady used to put on her light for nothing. She'd turn the light on like every five minutes to ask you to move a cushion or to ask what was for dinner.
The second group is the "Fighters" and/or "Mean People". Just as it sounds, fighters are those who try to hit, kick, slap you when you are doing their care. All the "fighters" I've encountered (except one) were not cognitive enough to understand what was truly happening. Fighters tend to be amusing because usually they aren't strong enough to hurt you but they hit and kick you with all they have.
My most memorable "fighter" was this little tiny lady in my last nursing home. Whenever I'd have to change her or dress her, she would beat me up. It was kind of funny because all you could hear from behind the privacy curtain was "Slap! Pap! Slap!" from her smacking my arms, all while Im just turning her back and forth to clean her and put her brief on.
Mean people are worse than fighters because although they may not have "all" of their mind, they have enough of it to try to call you names and degrade you. I've never had the "N" word dropped on me, personally, but I know of residents who have used that word and said equally derogatory things to CNAs. For the most part, I'm not all that much of a sensitive person,but twice, my feelings have been kinda hurt.
One night i went in to a man's room to change his brief and put on his nightgown before going home, and I was nice as I could be....and while i was trying to get his pants off, the cuff of it hurt his foot and he basically cussed me out. Another time I went to get up this lady i wasn't familiar with and I was just trying to get her changed or clothes on and she was being resistant, saying mean things, along with pinching and deliberately trying to hit no matter how sweet i tried to talk to her.
There aren't all that many mean people, but they are the worst because here you are trying to make sure they are clean and not left in a soaking wet brief or poopie bed and they cuss and call you names.
You know? You couldn't pay most people enough to clean adult dook, but here I am to make sure you're dry, clean, and not in filth...which is where you'd be if you were left alone...
Resident families can sometimes be helpful. Sometimes they'll take their family member out on the porch or off site. Some of them will take their elderly loved ones to the bathroom and believe it or not, some will even take it upon themselves to change their parents' briefs. However, this is not common. Most family members are PAINS.
They will turn the call light on to have CNAs come to take "mama" to the bathroom. Or to change "mama's" brief. Or to put "mama" in the chair. Or to lay her back down (which likely will take more than one person to do....and then you may not be able to find someone available to help). And then, half of them will stay in the room to watch you do patient care, which is uncomfortable. I've had family members stay in the room and watch me feed their parent, which I think is ridiculous. I know it's the CNAs job to feed, but family members will usually take their loved ones tray and help them eat, freeing the CNA to feed someone else.
Nurses and Administration
I know that most of you probably think that cleaning adult poop is the worst part of this job. In my opinion, it's not. After the first week, you really get used to it. I got to the point where I could barely even smell it if I was the one doing the patient care. I'd only really smell it in the hallways when someone came out of a room or if the trash barrel was full.
In my opinion, the worst part of the job is the nurses. The best nurses are the ones that have been CNAs before because they understand how the job is. The older nurses didn't have to go through CNA certification when they went through school so they don't have first-hand knowledge of what it is. I had one nurse who would help bathe and dress a couple patients, but you're too lucky if you end up working with one who would do that.
Most of the nurses are so inconsiderate and think it's not in their job description to do this or that. We used to have staff meetings and in every one, it would be mentioned that the nurses are supposed to answer call lights. But will they? No. They'll just want to run the CNA around like maids. One time I witnessed a nurse ask a CNA to fix someone's bedsheets. C'mon. The nurse just came out of the room and he couldn't simply pull the sheet over the lady's feet? Another time I heard a resident ask a nurse to hand her a remote control.....and do you know this nurse came out of the room and waited on a CNA to exit another room to ask her to see what the resident wanted? This other time, a nurse asked a CNA to go to a room just to put someone's socks on. ABSURD!
I've had my own personal experiences like this. It was nearly afternoon and I was still in the process of getting all 1250 of my residents up and a nurse came out of a room and yelled to me that a patient needed to be put on a bedpan. She had just come out of the room! You mean, she couldn't have taken a minute to put the lady on the bedpan, seeing that Im struggling to get everyone bathed, dressed, and beds made? And another time, this same nurse called me down to a room, not even on my track, to change this lady whose family was present. Considering this wasn't my room and also that this resident was really big, I thought that this nurse would stay and at least hold her to the side so I could change her, but she just left! I was so POd about that.
Nurses really got on my nerves because most of them are such HYPOCRITES! In the meetings, they claim to love the residents so much and that they want to help us the best they can to give these patients the best care. I only came across one nurse who was true to that (the one I mentioned earlier). She would clip fingernails, feed, make beds where she could...(and still manage to have her meds passed) she's the awesome-est nurse!
It's not that I expected nurses to do our job for us, I just wish that they would have some consideration and respect for CNAs. If I'm in a room and my lights are going off, can't you see what they want and help if you can? Would you want your mother to sit in her room waiting 45 minutes to be put to bed or to be handed an item from across the room? .....and you supposedly care about these people so much like they're you're family. All the nurses want to do is hurry and pass out their medicines so they can sit down behind the nurse station. That's really the life goal of most of them.
Administration was terrible too because they had an idea about how the place should run...and there's ideally....then reality. For example, the residents are supposed to be turned to their opposite side every two hours (to prevent bedsores). HA! Every once in a while, they'd put these colored discs under some patients that you were supposed to turn in to the nurse when you found it. . There is no way one CNA can keep up with turning people every two hours with all the work that has to be done.
Another time a male resident on my track was complaining because he wanted a shower. It wasn't his shower day and the reason why no one could get to it is because we couldn't leave him unattended in the shower room and this man took a literal 30-45 minutes in the shower. He went and told the administrator (who isn't a nurse or CNA) and she came to our wing and said that someone had to do it. He was on my track so that meant me. What was supposed to happen to my other residents who needed to be changed and put to bed after lunch? Because the nurses surely weren't going to help out and answer their lights while Im stuck in the shower with this guy.
Blood Pressure Cuffs
As a CNA, you may be required to take vital signs. Your wing may have a set or two of vital sign equipment for the wing you are working on. One thing that I found so useful is an automatic blood pressure cuff. I'm not talking about the ones you pump--I mean the kind that you put on the residents' wrist. It reads blood pressure and pulse. Some peoples' arms are really big and it's hard to get a blood pressure measure with a manual cuff because the velcro will keep popping open. The wrist BP cuff will fit around any wrist (and if not, OMG!) and take about 30 seconds to read. Be careful because some nurses don't like CNAs to use them (another way to make your life hard), saying that they aren't accurate. I say, hide one in your pocket and just make sure the nurse doesn't catch you using it.
And you would think that a nurse would do his/her own vital signs to ensure that the values are correct instead of depending on busy CNAs who can barely squeeze in the time to get them done.
The purpose of this lens is not to scare anyone out of being a CNA. I just wanted to shed some light on the reality of the job because, like I said, everywhere you see CNAs described, they make it seem like it's such an enjoyable profession, like you are going to love it. Like you're going to be sitting around laughing and reminiscing with sweet old people all day.
In the midst of all the busyness and BS, there are good times. Some of the older people are sweet and understanding and will try to help you the best they can. It's so sweet when you get that rare one that is so grateful for what you do to help them. Every once in a while, some of the resident family members will bring in gifts or food for the CNAs to show their appreciation, and that's really nice.
Despite the negative aspects, I encourage anyone who gets into CNA work not to get discouraged if you have to do it for a while. Your first days on your own can be very depressing when you're new and you're still programmed to do everything by the book.
With some time, you'll get the hang of it. You may feel like a weakling in the beginning but with time, you'll get much stronger. I wouldn't call it a true workout, but after a couple months at my very first CNA job, my arms and back were kind of built. Don't get discouraged the first couple days on your own....you'll probably be slow (trying to do it the way you were taught) but it just takes some time to get a routine.
Still, I don't think anyone loves this job. I don't care what anyone says. Keep in mind that all I know is nursing homes, so maybe it's easier to function in a hospital or hospice setting. Nursing homes are going to be pretty much the same anywhere you go. I think the only way this job would become desirable is if the CNA to patient ratio were reduced. If the CNA only had just 6 people to concentrate on, I think that all the things required of them (mouthcare, full bed baths, nail care) could be easily managed.
But that won't happen because it's all about money and the corporations don't want to pay to staff the nursing homes with more CNAs.
Agree? Disagree? Change of Heart?